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Appendix 2 - Commissioning Best Value Programme
Cash releasing schemes

There are two elements to the Falls Programme; a new community falls pathway and NWAS deflections. The primary care falls pathway to pilot in two practices. This has been delayed as one of the practices originally identified has withdrawn from the process. A replacement practice has been identified but is likely that implementation will not commence until September reducing the potential savings from £20k to £12k. NWAS has established a pilot to divert unnecessary non-elective admissions related to falls to the Rapid Response Team within Intermediate Care. It is proving very difficult to obtain any activity data from NWAS since the key point of contact at NWAS has left the organisation. In light of the difficulty in obtaining activity data is not possible to identify the savings that have been achieved to date against the BV savings target of £148k.
A high level report has been published summarising the national research on the Whole System Demonstrator. It identifies a significant reduction in hospital activity as a result of implementing Telehealth,and a 45% reduction in mortality rates. The financial impacts are given as saving £1.2bn per year with a cost of £750k. Assuming £750k is a recurrent cost this indicates average savings of £3m per PCT. Next steps include establishing whether this piece of work will be rolled out by the cluster across GM or whether PCTs/CCGs should look at it individually. This is part of the reablement programme.
The savings identified relate to drugs coming off patent. Cost pressures identified for 2012/13 have been funded. The price reductions for some drugs coming off patent have been less than anticipated. For example Pioglitazone is now available as a category M generic but its price remains high; the drug tariff price has only dropped by 35% not the 75% which was anticipated. However this has been offset by unexpected windfalls in relation to Olanzapine & Valsartan. The price reduction in one has reduced by over 90% (target set based on 75%) and in the second drug the price has dropped much sooner than anticipated. As a result we are still forecasting to achieve the savings target of £1.6m.
The Optimising Pathways Phase Two work is on hold pending the outcome of the Kings fund project being jointly undertaken with SRFT. The commissioning manager has produced a matrix detailing all the initiatives that are currently being undertaken for each of the four age groups that have been defined for Optimising Pathways Phase Two. The urgent care project is not delivering the reductions in attendances that were planned. A meeting is planned with SRFT to ensure service provision is in line the business case. The plan reflects a reduction in activity to bring annual attendances to less than 83,197. Activity figures suggest that the annual attendance figure is likely to be in excess of this target. As a result Salford will not fall within the activity band which it currently contacts and as a result will have to pay an additional £755k to fund the additional activity.
The Optimising Pathways Phase Two work is on hold pending the outcome of the Kings fund project being jointly undertaken with SRFT. The commissioning manager has produced a matrix detailing all the initiatives that are currently being undertaken for each of the four age groups that have been defined for Optimising Pathways Phase Two. Cash releasing schemes
SRFT continue to see Rheumatology patients at regular follow-up appointments despite referral to the patients GP. It is unlikely to generate significant savings as annual follow-ups are to be maintained with SRFT as patients remain under consultant care and additional payments are being made to GPs through the LES. However it will improve the patient experience. A meeting was held with SRFT on 2nd July with the aim of agreeing a way forward. SRFT are taking approximately 400 patients back each year just for blood monitoring purposes and when chal enged on this the only justification was ‘patient choice’. SRFT have now agreed to review all of these patients and move them into primary care if their conditions are stable.
The shared care protocol has now been approved by all the required groups. It will now require approval from the Clinical leads which is being requested in early September.
COMPLETED Please review July IRP paper for detailA demand management referral process was established from 5 March 2012. Activity figures have been received and this is not resulting in the anticipated reduction in referrals. Manchester have comparable dental heath and they are seeing significantly greater reduction in referrals than Salford PCT. Analysis has been carried out on referral rates for GDPs in Salford and those with the highest rates are going to undergo further investigation. Greater Manchester is developing care pathways to establish consistent referral practices but this will take time. Commissioners are to develop a PID for a community based clinic to deal with deflections of minor extractions from the acute service.
Planned Care Commissioning Strategy Group The new pathways have been signed off by NHS Salford CCG and education events are being held to promote the new pathways to GPs. By mid April 27 practices will have attended these events, two further events are to be arranged. Activity figures have yet to be received to establish if the programme has been effective.
Pilot of a new pathway was established by SRFT from 1 September2011 and is continuing. The report from SRFT detailing outpatient activity was presented at the August Planned Care CSG but it was deemed unacceptable. Commissioners have requested a response has been requested to address specific questions on this service which have yet to be answered by SRFT. COMPLETED. Savings are being released monthlyThis is primarily a quality initiative. A city wide service is anticipated to divert 50% of activity from Urgent care services in to community services. The service is planned to start in the last quarter of the year. There is a risk of not achieving the planned savings if anticipated numbers of referrals are not seen in the community clinic. The procurement process is currently underway and a bidder event is being held on 30th July. Due to delays in the procurement process savings will not now be realised until next financial year. The tender specification will be ready for the 31st August.
COMPLETED. Savings are being released monthly LTC Programme Commissioning Strategy Group Scheme has been implemented and savings are greater than planned.
The new triage service was established from 1 May 2012. 58 patients have been seen in May and it is anticipated that the target of 635 contacts for the year is achievable. A clinician from the new service is going to a practice to review consultant to consultant referrals. Work is being undertaken to establish robust monitoring information. A PID has been drafted. This will be presented to the Planned Care CSG in August. A partner has been identified for the pilot scheme. There is no requirement to tender for a partner as it is a pilot scheme. The delay in the start date of the pilot will make achieving the savings target of £100k extremely challenging. It has now been confirmed that the pilot will start in November.
Cash releasing schemes
External Brokering of High Cost Placements The savings indicated for 201213 are based on savings from schemes which are NHS alone, joint with the LA and reductions achieved through improved incl Jointly funded and new brokered negotiations for new providers. Previously it has been reported that very few providers had been willing to negotiate with us, this situation has recently improved and better results are now anticipated. Only one placement is yet to be renegotiated. Savings are being monitored monthly.
The service spec for the redesigned service has been signed off by NHS Salford CCG. A meeting is to be held to agree the performance management of the new service. There has been a delay in repatriation of Salford patients as a result of objections from patients families. Anticipated savings are being No timeline to manage the lease issues in relation to Pendlebury House has yet been shared, this is being actively pursued. The service currently provided from Pendlebury House is not seen to provide value for money and it is anticipated savings will be released by tendering the service provided from Pendlebury House. However the tender cannot be taken forward until the lease issues are resolved. This is still being reviewed by the Estates Department.
Children and Young People Partnership Board A PID was approved by NHS Salford CCG in September- An update will be provided for the September NHS Salford CCG PMG Other Commissioning Cost Efficiency Schemes A reduction in direct access pathology costs has been negotiated into the 2012/13 contract with SRFT from August 2012.
This is a nationally renegotiated contract. There is little detail provided on the expected level of savings but there was an indication that it would be in the region of 50%. This has been halved for the purpose of the figure used in this schedule, representing the lack of clarity around additional local costs required to deliver the nationally procured service.
This scheme is being monitored within the best value programme as savings are anticipated. However no savings target has been set as the service was established as part of the investment in alcohol services via the Strategic plan. The service works with a cohort of the top thirty most frequently attending patients. Evidence presented from SRFT showed that attendances have not been reduced but admissions have reduced.
It is proposed that the interpretation Service will be piloted at seven practices. The commissioning lead is developing a PID to be taken to the August CSG for approval. Initial indications are that there is potential to save £30k.


07_wils 29.33

A.N.Z.J. Fam. Ther., 2000, Vol. 21, No. 1, pp 29±33Specific Cases, Techniques and ApproachesStories provide one way to say the unspeakable. Drawing on systemic, constructionist and narrative ideas, this paper offersa commentary upon the development of a therapeutic story for a seven year old child and her mother. and Freedman 1990 and 1996; Dwivedi, 1997, Bowen &Robinson, 1999). Stories

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WHAT IS IT? Schizophrenia is a chronic, severe, and disabling brain disease. Approximately 1 percent of the population develops schizophrenia during their lifetime – more than 2 million Americans suffer from the illness in a given year. Although schizophrenia affects men and women with equal frequency, the disorder often appears earlier in men, usually in the late teens or early twenties, than i

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