It has been a strange week.
It was the week we announced a change to the commissioning policy we had been suggesting in our urgent and necessary measures that would require smokers to quit 8 weeks before elective surgery and for those with a BMI of over 35 to lose weight before having their procedure. Or, as reported, "a U-turn", "backtrack" or "reverse".
Having worked on the measures for some time, we felt there was a good rationale that balanced the benefits to the individual to their own health both to do with general anaesthetic and recovery from surgery and in terms of their longer term health with the financial necessity of the position we are facing both this year and next.
But by Thursday, I was explaining on local BBC evening news that we had taken the decision to encourage, rather than require, people to change these behaviours before their operations. I and been on the same programme only a week earlier explaining the rationale for the changes and why we thought they were the right idea, so understandably people wanted to know about the shift.
The reality is that we managed to attract a lot of media attention, more than we had been anticipating, especially at a national level and as a result of significant feedback, felt that progressing with the measures as outlined would not get the results we needed with the level of support from whole system.
It leaves us with the need to identify other savings to achieve our financial plan and as we move in to the last quarter of the financial year, this look incredibly challenging. It also means that we need to get staff working on a different approach. I hope our clinical leaders will be able to work to create another programme to deliver the outturn we need.
Highlights of the Week 1: A new structure for Mondays: lots of meetings, but each with clear purpose
We now have a regular Monday meeting schedule that will carry us through to March which will ensure we attend to both the in-year financial position and planning for next year. Last year we ran a series of bigger meetings that were successful, but did involve a large number of people. This year we have tried to break the sessions down in to smaller groups with a clear purpose during the day. As Chief Operating Officer, I get to attend all of them, so a very well structured day!
We start with Operational Delivery Group 9-11, which is our key Director forum for actions that deliver the in-year financial position and chase down the urgent and necessary measures action plan as well as the delivery of the schemes we set out the start of the year.
The Commissioning Managing Directors' meeting at 11 is a forum to ensure that the MDs are acting consistently and to share information from across the different System Resilience Groups (there are 3 in our CCG) and the two Better Care Funds.
We have a technical planning group at 1pm that will ensure that we hit all the deadlines required for planning - submission of finance information, activity returns, trajectories for key targets and the update of our annual plan - and to make sure that they are consistent. This co-ordinating activity is vital and something we need to improve on from last year where, with external support both helping and confusing, we didn't manage to meet all expectations.
The Contract Negotiation Oversight Group at 2pm allows us to review the consistency of our approach across the negotiation of all our contracts. It ensures that we treat providers in a similar way or understand the uniqueness of circumstances and apply ourselves to community, mental health, children's or acute contracts equally.
We finish the day with the Commissioning Intentions Group where we work on the transformation schemes that will deliver the financial plan. This is critical, but important to maintain energy as we get to the end of a productive, but challenging Monday.
Highlights of the Week 2: Our press office has been really busy, but impressed with how they have responded to the seemingly impossible
We have been inundated with interest in the urgent and necessary measures we have proposed, which have attracted national and local political as well as media interest. This has meant an incredibly busy time for the press office in the CCG dealing with the requests for statements, interviews and appearances.
They have responded really well and it feels like we have been able to give a clear message about what we have been doing.
Towards the end of the week, the message shifted as we took the decision to change our advice on the requirement for people to seek support to lose weight or quit smoking prior to elective surgery, but again, they managed their part of this well and, however difficult, we responded to the further round of interest.
It isn't an easy task, but we have a duty to communicate as clearly as possible and they are a vital team to allow us to do that to the best of our ability.
Highlights of the Week 3: @NEWDevonCCG Western Locality GP Members' Forum-real willingness to work with us on the financial challenges
We spent Tuesday talking to our member practices in the Western Locality of the CCG about the urgent and necessary measures we were taking. We need to be able to carry our members with us as we try to implement changes to the way elective care is offered, so this was an important moment. Clearly all the actions we are proposing have been worked up by clinical leads in the CCG so there is good clinical evidence and advice that supports our proposals, but testing this with the wider group of GPs who need to implement on a daily basis in surgery is vital.
We run the forum twice on the same day to allow practices to attend either a morning or afternoon session and that way we usually get over 85% of our 52 practices attending at some point.
There were plenty of questions about the measures we have articulated - requiring people to quit smoking for 8 weeks or to lose weight if their BMI is above 35 prior to routine surgery are the most well reported, but there is a longer list - though a general sense of this being a necessary, if not welcomed move. The practices understood the scale of our financial challenge and the need for us to take action that would lead to a real change in referral processes.
We described the Macro Marginal Analysis approach that we have adopted, building on work by Professor Cam Donaldson and Charlotte Williamson. This looks at the treatments that add less value to people, based on best evidence and is how we identify areas like second hearing aids or shoulder surgery as issues we should review.
It felt like we achieved good understanding and left with an optimism that we would be able to implement the changes.
Highlights of the Week 4: The Planning and Programme Office Christmas Meal: first one I've been to in ages...
The small and perfectly formed Planning and Programme Office Team based in Exeter are a key part of supporting the work I lead as Chief Operating Officer. They are the hub and co-ordinating force for a lot of our activity, including planning, assurance, financial recovery and project tracking.
It was the Christmas meal this week and, after several years working on my own, it was great to be back in the office christmas party swing. (I will miss the Locality's party this year for the second year running, due to a diary that places me in the wrong place at the wrong time).
A good way to end the week and to say thank-you to a team that are often unnoticed in the organisation, but bring a real professionalism and dedication to an often thankless task. Clearly, it would breach protocol to divulge any more details, but safe to say that there was an appropriate moment to make my excuses and head home, leaving those with age on their side, to continue their celebrations.
Highlights of the Week 5: It only takes one meeting to remind me why I do this job; lots of exciting opportunities to offer better services more locally
When I use to battle a golf course each week, there was a saying that it isn't the 80+ average shots that would bring you back the next week - the combination of hooked drives, balls landing in bunkers, duffed chips or woeful putts - it was the one fantastic, glorious shot, that would see you loading up the car on a cold Sunday morning at 6.30 to have another go. As the ball left the club and arrowed towards the green with the clean sound of a perfect strike, the feeling was addictive.
So in a week when there were plenty of challenges, there was one meeting that allowed me to explore the opportunities that primary care has to take forward new initiatives and how we can work as a CCG to make that happen. Sat with a GP and members of the CCG and practice team we were able to consider ideas, create new thinking and look at how patients could get better care more efficiently and effectively.
One great shot; I'll be back next week.
When I use to battle a golf course each week, there was a saying that it isn't the 80+ average shots that would bring you back the next week - the combination of hooked drives, balls landing in bunkers, duffed chips or woeful putts - it was the one fantastic, glorious shot, that would see you loading up the car on a cold Sunday morning at 6.30 to have another go. As the ball left the club and arrowed towards the green with the clean sound of a perfect strike, the feeling was addictive.
So in a week when there were plenty of challenges, there was one meeting that allowed me to explore the opportunities that primary care has to take forward new initiatives and how we can work as a CCG to make that happen. Sat with a GP and members of the CCG and practice team we were able to consider ideas, create new thinking and look at how patients could get better care more efficiently and effectively.
One great shot; I'll be back next week.
You can read other blogs related to the work of the Western Locality of NEW Devon CCG
About our workplan: Western Locality Workplan
About our Locality business: Western Locality Business
Jerry Clough is Chief Operating Officer for Northern, Eastern and Western Devon Clinical Commissioning Group. He is also Locality Managing Director for the Western Locality of the CCG covering Plymouth and the surrounding areas of South Hams and West Devon.
Previously Jerry has been a Chief Executive and Finance Director in the NHS before spending several years running his own business driving programmes of change and delivering executive coaching and team and Board development.
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