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					                                          SMC Board Paper

Date of SMC Board: 10th November 2008


Author:                             Dr Ranjit Gill
                                    Chair

Date:                               05 November 2008


Subject:                            Quarter 2 Performance against Accountability
                                    Agreement 08-09
                                    To provide the Board with a quarter 2
Purpose:                            performance report against the agreement it
                                    holds with Stockport PCT.

Recommendation:                     To receive, note and comment


SMC Sponsor:                        Ranjit Gill
                                    Chair

Enquiries to:                       Helen Manley
                                    0161 249 4212

Related Business Objective:         All


Resource Implications:


Signed off by (individual/group):


Identified Locality
dimension/impact:


Executive Summary:

The main issue this second quarter has been the increase in overall referrals to
secondary care and the reduction in referrals to Tier 2 /CATS. This only came to light
at the end of the first quarter and a schedule of actions have and continue to be
undertaken. A project manager has been appointed working 2 days per week to lead
on referrals.




                                     Stockport Managed Care


SMC Board Paper                                                                 Page 1 of 13
Date: 10th November 2008
   Performance Report to Stockport PCT under the terms of the Annual
                       Accountability Agreement
1. Report for period April 2008 – September 2008 (Quarter 2)

1.1 This report details SMC’s performance against the 08-09 Accountability Agreement.

1.2 This report details the following:

      -      Delivery to date
      -      Risks and Issues

2. Delivery Plan – Performance to date

2.1 At the beginning of the financial year the Business Plan was drafted and agreed. This plan
    detailed the work programmes that would take place in this financial year to realise the
    initiatives allocated to SMC. A summary of some of the progress to date is included in this
    report.

    To summarise the key SMC business are as follows:
     -    Redesign Primary Care Long Term Conditions
     -    Community Audiology Service
     -    Restructure Medicines Management
     -    Development of Primary Care Facing Diagnostics
     -    Mobilisation and development of Tier 2/CATs/IS CATs
     -    Reduce Outpatient Appointments
     -    St Thomas Diagnostic & Treatment Centre
     -    Termination of Pregnancy Pathway
     -    Assisted Conception Pathway
     -    Reduce Follow Ups
     -    Weight Management Pathway
     -    End of Life Pathways
     -    Stroke Pathway Development
     -    Cancer Pathway Improvement
     -    Early Intervention Service
     -    Maternity Pathway Development

    There are some initiatives which are organisation wide and support the delivery of those noted
    above:
     -     Locality Development
     -     Practice & Members support
     -     Develop & implement Communications Strategy
     -     Establish corporate governance systems
     -     Pathway development and implementation
     -     Referral Management
     -     Commission services and develop pathways in order to deliver year 1 of new Urgent
           Care Strategy
     -     Roll out Health Inequalities Strategy and Locality working
     -     Develop & implement Training & Development Strategy




SMC Board Paper                                                               Page 2 of 13
Date: 10th November 2008
    Board sponsors have been identified to provide leadership and guidance on each of these
    initiatives.

    SMC and PEC operate a joint business case approval panel. Regular reports regarding this
    meeting are presented to the SMC Board.

2.2 Budget Performance to September (month 6)

    SMC indicative Budget performance as at month 6 (September) and the forecast for the year is
    summarised below in Table 1, this shows a £ 244k adverse variance to September but £ 413k
    favourable variance for the year for PBC budgets and no variance from budget for the total PCT
    resource. The annual forecast shows an addition to the resource of £ 2.15m to increase the
    annual resource to £ 414.7m for the year, this is due to a lodgement with the NWSHA for the
    return of £2.15m.

   The cost of Continuing Care continues to increase and is forecast to be significantly over budget
   for this year due to the relaxation of the criteria. The effect of this is an over spend in other
   Health Care Providers by £ 2m to September, £ 6m overspent for the year. These figures show
   a partial off-set by savings in other non NHS providers.

    The corporate level budget for the 5 main providers is over budget to September by £ 2,472k, £
    4,768k for the year. The areas over budget are in urgent /non elective £ 1,569k to September, £
    2,127k for the year and non-tariff which is £ 946k to September, £ 2,641k for the year. The over
    spend on emergency / non elective is split between emergency and non-elective tariff.

    Practice level budgets are slightly over spent to the end of September but forecast to be under
    spent by £ 294k for the year. Out-patients are £ 961k overspent to September, £ 2,046k for the
    year, this is split between firsts, follow-ups and procedures. This over spend is off-set by under
    spends in elective activity £ 179k to September, £ 890k for the year and prescribing which is
    £725k under spent to September, £ 1,450k for the year.

    Summary Budget Performance – Table 1

                                                                FORECAST                                    Year to Date
                                                                             (Adverse) /                                    (Adverse) /
                                             PBC Resource for    Forecast                      Budget to      Actual to
                                                                             Favourable                                     Favourable
                                                 2008-09          Spend                          Date         Sept -08
                                                                              Variance                                       Variance
                                                      £000's        £000's       £000's            £000's        £000's         £000's
    BUDGET AREAS
    PCT & Collaboratively Managed Services          £59,829        £59,577         £252          £29,519       £29,079            £440

    SMC Corporate Level Budgets
    Healthcare providers excluding 5 main           £73,682        £79,756      -£6,074          £35,864       £38,023         -£2,159
    providers
    5 main providers
       Non-Tariff                                   £42,130        £44,771      -£2,641          £21,621       £22,566           -£946
       Elective                                      £1,015         £1,015           £0            £501          £458              £43
       Urgent / non-elective                        £59,787        £61,914      -£2,127          £29,341       £30,910         -£1,569
    Central Prescribing                                £986           £986           £0             £493           £493             £0
    Reserves & LDP less CRES                        £14,763         £4,054      £10,709            £4,003            £0         £4,003
    Practice Level Budgets
       Elective                                      30,675         29,785        £890             15,152       14,973            £179
       Outpatients                                   22,920         24,966      -£2,046            11,506       12,467           -£961
       GP Prescribing                                49,410         47,960       £1,450            24,705       23,980            £725
    Total PBC Budgets                               355,196        354,783         £413          172,705       172,949           -£244

    Non PBC budgets                                  56,501         56,914        -£413
    SMC Corporate budget                              3,041          3,041           £0 what do I put in here as it's the amount the PCT give us!
    Total PCT Revenue Resource                      414,738        414,738             0




SMC Board Paper                                                                                                           Page 3 of 13
Date: 10th November 2008
     The increase in overall referrals to secondary care and the reduction in referrals to Tier 2
    /CATS is continuing. A project manager has been appointed to investigate this increase in
    outpatients, to formulate and action a plan to address these problems.

    Corporate Budget Performance to September 2008 (month 6).

    SMC Board’s Corporate Budget is shown in Table 2. The budget is £ 181k under spent to
    September, forecast to be £ 593k under spent for the year. The forecast saving equates to the
    innovation fund savings which is forecast to be significantly under spent as we are postponing
    any initiatives not approved in the first round until 2009-10.

    The funding available for 08/09 comprises the PCT Accountability Agreement income, as well
    as income deferred from last year. Grant income has also been received from Schering-Plough
    Ltd to fund the services of Continuum Professional Services to facilitate the development of a
    model of care for patients with cardio-metabolic disease, the cost of this is shown in other
    consultancy. Other small amounts of miscellaneous income have been received.

    The budget to date has been profiled to more accurately reflect the timescales of expected
    expenditure. Staff costs shown under SLA Staff resource show an under spend of £ 97k to
    September and are expected to save circa £ 207k by the year end. There are additional costs
    for the remainder of the year, these are off-set by the additional £ 150k from the PCT to cover
    the costs of the new director and administrative support. The costs of GP and other consultancy
    are forecast to be overspent by circa £ 153k reducing this saving to circa £ 54k. Both areas of
    consultancy are over spent by £ 26k and £ 14k respectively to the end of September and are
    forecast to be over spent by £ 66k and 86k by the end of the year. The GP consultancy was
    under budgeted and did not take into account the amount of time several of the board members
    are spending in SMC in various clinical areas. Other consultancy includes the services of
    Continuum Professional Services consultancy work that is matched by income of £ 27k as well
    as various ad hoc consultancy commissioned by SMC. The forecast includes two consultants
    that have recently been commissioned to cover urgent care. Professional Fees are above
    budget by £ 22k to September and are forecast to be £ 32k (possibly more) above budget for
    the full year. As part of this legal fees are above budget, this is likely to increase by year end
    due to completion of the annual return and changes to the rules.

    Direct listing expenditure is £ 5.4k to date and forecast to make a saving of £ 170k. The use of
    Direct Listing may increase in the future as it is being publicised.

    Just over half of the innovation fund has been committed to pilots £ 511k within the 4 localities
    of which £416k is currently forecast to be spent in 2008-09. It is expected that the remainder will
    be spent in 2009-10. Several of these bids are aimed at improving health by healthier eating,
    ceasing smoking, alcohol intervention etc and so should improve overall health and reduce
    illness. Details of the innovation fund and how they meet SMC objectives are in Appendix C1-
    C4.

    It has been assumed that the element of the incentive scheme connected to referrals is paid in
    full. The various elements of this scheme have been discussed recently and the details
    developed, however this is based on the existing scheme and includes a retrospective audit by
    the practices. The Board will discuss this further and decide whether to redirect the incentive to
    be more prospective.

    The Venture Fund balance of £ 302k has been earmarked for the SMC contribution of £ 300k
    towards the EIS project.




SMC Board Paper                                                                  Page 4 of 13
Date: 10th November 2008
          SMC Budgets Performance against Budget to September 2008 – Table 2
                                                                    FORECAST                                             YEAR TO DATE
                                                                                      (Adverse)/                                           (Adverse)/
                                                  Annual Budget    Forecast Spend     Favourable         Sep-08             Sep-08         Favourable
                                                     2008/09          2008-09           Variance         Budget             Actual         Variance
                                                      £000's           £000's            £000's           £000's            £000's          £000's
          Income
          Accountability Agreement Income                 3,041             3,041                   0          1,521             1,521                 0
          Resources rolled forward from 07/08               673               716                  43            337               358                21
          Miscellaneous Income                               32                35                   3             32                34                 2
          Total Income                                    3,746             3,792                  46          1,889             1,913                24
          Expenses
           Board Funding                                     60                39                21               30                  20               11
          Clinical Leadership                               140               206               -66               70                  96              -26
          Other Consultancy                                  73               159               -86               36                  50              -14
          Training Costs                                     80                62                18               10                   8                2
          Professional Fees                                  50                82               -32               19                  41              -22
          SLA for Staff resource                          1,444             1,237               207              722                 625               97
          General Operating costs                           155               125                30               77                  64               14
          SLA for Accommodation                              80                70                10               40                  32                8
          Depreciation                                        0                10               -10                0                   5               -5
          Incentive Schemes                                   0                 0                 0                0                   0
          Infrastructure/Practice plan                       54                54                 0               27                  25             2
          Implementation of new care pathways                54                54                 0                0                   0             0
          Minmim Referral Criteria Scheme                   296               296                 0                0                   0             0
          Direct Listing                                    190                20               170               95                   5            90
          GP attendance at Training & Education              70                70                 0                0                   0             0
          Innovation Fund                                 1,000               416               584                0                   0             0
          Venture Fund expenditure                            0               300              -300                0                   0             0
          Total Expenditure                               3,746             3,199               547            1,127                 970           157

          Total                                                0                593                593             762               942           181




2.3       Productivity Outcome Performance Indicators to September 08 (month 6)

          The data presented details SMC’s performance against its key indicators up to September
          2008.

          Graph 1: Outpatients

                              Efficiency Plan - Outpatients in CATS Specialties
                                        Attendances after GP Referral Moving Annual Total
        50000

        45000

        40000

        35000

        30000

        25000

        20000

        15000                 OPs; 1st Attendances in CATS Specialties (GP Referred)

        10000
                              OPs; FU Attendances in CATS Specialties (GP Referred)
         5000

             0
                  2006 03
                  2006 04
                  2006 05
                            2006 06
                            2006 07
                            2006 08
                            2006 09
                            2006 10
                            2006 11
                                                  2006 12
                                                  2007 01
                                                  2007 02
                                                  2007 03
                                                  2007 04
                                                  2007 05
                                                                    2007 06
                                                                    2007 07
                                                                    2007 08
                                                                    2007 09
                                                                    2007 10
                                                                    2007 11
                                                                                          2007 12
                                                                                          2008 01
                                                                                          2008 02
                                                                                          2008 03
                                                                                          2008 04
                                                                                          2008 05
                                                                                                         2008 06
                                                                                                         2008 07
                                                                                                         2008 08
                                                                                                         2008 09
                                                                                                         2008 10
                                                                                                         2008 11
                                                                                                                            2008 12
                                                                                                                            2009 01
                                                                                                                            2009 02
                                                                                                                            2009 03




                                                                        Year Ending:-




      SMC Board Paper                                                                                                Page 5 of 13
      Date: 10th November 2008
    Quarter 2 has shown an overall increase of around 3.5% in GP referrals and a significant shift
    from use of CATS to secondary care, with a resulting 23% increase in referrals to secondary
    care and a corresponding decrease in the volume of referrals to CATS. This has had a
    significant knock on effect on levels of OP First and Follow Up activity in Quarter 2. Although
    referrals back to CATS services has recommenced and is almost back to March 08 levels, it still
    leaves a significant change to take place to redress the situation affecting the year. Significant
    work on referral management and planned expansion of CATS capacity are expected to have
    an impact on these targets later in the year, but it is feared that this will not be enough to
    change the compliance to accountability agreement.

    Graph 2: Admitted Patient Care
                                         Efficiency Plan - Admitted patient Care
                                                           Admissions Moving Annual Total
  5000

  4500

  4000

  3500

  3000

  2500

  2000

  1500

  1000                       LTCs; ACS & PARR Admissions
   500                       EUR Proscribed/limited Admissions
     0
         2006 03
         2006 04
                   2006 05
                   2006 06
                             2006 07
                             2006 08
                                       2006 09
                                       2006 10
                                                 2006 11
                                                 2006 12
                                                           2007 01
                                                           2007 02
                                                                     2007 03
                                                                     2007 04
                                                                               2007 05
                                                                               2007 06
                                                                                         2007 07
                                                                                         2007 08
                                                                                                   2007 09
                                                                                                   2007 10
                                                                                                   2007 11
                                                                                                             2007 12
                                                                                                             2008 01
                                                                                                                       2008 02
                                                                                                                       2008 03
                                                                                                                                 2008 04
                                                                                                                                 2008 05
                                                                                                                                           2008 06
                                                                                                                                           2008 07
                                                                                                                                                     2008 08
                                                                                                                                                     2008 09
                                                                                                                                                               2008 10
                                                                                                                                                               2008 11
                                                                                                                                                                         2008 12
                                                                                                                                                                         2009 01
                                                                                                                                                                                   2009 02
                                                                                                                                                                                   2009 03
                                                                                          Year Ending:-



    The number of emergency spells for ambulatory conditions has shot up from 1% above base at
    the end of quarter 1 to 12% above base at the end of quarter 2 against a target reduction of 5%.
    However the baseline figure provided to SMC to June was incorrect and should have shown an
    11.5% increase.
    There has been considerable delay to EIS, due to developing the model and partnership
    agreements with SNHSFT, this is now finalised and should now commence Feb/Mar09 along
    with other winter initiatives which together should show a significant impact on admission of
    ACS conditions.
    EUR activity on the wider policy definition is still at a historically low level although currently
    slightly above last year’s level.


    Graph 3: Efficiency Plan Indicators

    This graph shows the significant increase in referrals and actions are being taken to explain this
    increase and to get back on target. All indicators except prescribing are above target and
    actions need to be taken.




SMC Board Paper                                                                                                                                                Page 6 of 13
Date: 10th November 2008
                                                         Efficiency Plan Indicators; Cumulative 2008/9 Progress
                                          +30%                                                                                   Emergency Spells ACS & PARR ( Target -5%)
                                                                                                                                 Proscribed Surgical Procedures, New Policy(Tgt -4%)
                                          +25%                                    Well above last year.
  Activity Level vs Base Year (2007/08)




                                                                                                                                 1st OP Activity (Tgt -12%)
                                                                                                                                 Follow-up OP Activity (Tgt -9%)
                                          +20%
                                                                                                                                 Medicines Management (Tgt -£730k, -9% approx)

                                          +15%
                                                                                                                Well above target now.

                                          +10%                                                                  Running too high, improving trend reversed

                                          +5%
                                                                                                                Above target & last year (by this year's definition)
                                          +0%


                                           -5%                         Good performance, but not yet on target. (drug data takes
                                                                       longer to arrive)

                                          -10%


                                          -15%
                                                 April




                                                                                           August
                                                                               July




                                                                                                                                                               January




                                                                                                                                                                          February
                                                                                                    September




                                                                                                                                                   December
                                                                June




                                                                                                                       October
                                                         May




                                                                                                                                        November




                                                                                                                                                                                       March
2.4 Overview of Performance

                                     Reducing OP 1st attendances in 6 key (CATS) Specialties (Graph 1)
                                     (General surgery, Urology, ENT, T&O, Gynaecology and Dermatology)
                                     Senior Responsible Officer: Diane Jones

                                     A project to improve the local service commenced in January 2008 and should be completed by
                                     December 2009.

                                     Early service commencement of the national IS CATS contract is planned for February 2009
                                     with a ramp up to full service delivery over a 6 month period. However the potential impact of
                                     this service is low due to the location of the service, the closest venue to Stockport being in
                                     Denton. Despite all these challenges the PCT and SMC team are fully engaged in mobilising
                                     this service.

                                     The third strand of the CATS strategy is the procurement of additional capacity. Three bids were
                                     received and a robust evaluation was undertaken. The findings were taken to SMC Board, PEC
                                     and PCT Board. A number of clarifications have been sought and a decision will be made as
                                     soon as possible. Service commencement is anticipated by the end of the financial year.

                                     Once all three strands of the strategy have been completed a much larger reduction in first
                                     outpatient attendances is anticipated.

                                     Referral Management Action Plan (Graph 1)
                                     Senior Responsible Officer: Diane Jones

                                     Despite initial work being undertaken to identify the cause and slow the growth, referrals
                                     continue to increase rapidly. A project manager has been appointed and a comprehensive
                                     project plan has been developed. The first phase of the project to evaluate paper based
                                     referrals has been initiated. A project team and structure has been developed and discussions
                                     with the FT to undertake some joint audit work have commenced.


SMC Board Paper                                                                                                                                                Page 7 of 13
Date: 10th November 2008
    Reducing OP Follow-up attendances in 6 key (CATS) Specialties (Graph 1)
    (General Surgery, Urology, ENT, T&O, Gynaecology and Dermatology)
    Senior Responsible Officer: Diane Jones

    Preliminary work has been done comparing follow up rates by speciality, within speciality and
    across providers.

    We have met with the Contract and Performance Unit and agreed that the best way forward is
    for them to negotiate terms for the new contracts that specify a rate for each speciality based on
    the Greater Manchester average and to withhold payments when rates are above these levels.


    Reducing activity in 5 key (EUR) Procedures (Graph 2)
    (Tonsillectomy, D&C, hysterectomy, lower back surgery and myringotomy)
    Senior Responsible Officer: Vicci Owen Smith

    We are currently auditing and validating patients from EUR procedures in the efficiency plan of
    SMC and including procedures for varicose veins, cosmetic breast surgery and pinnaplasty. In
    the New Year we will audit patients through CATS for dermatology and minor surgery.

    The EUR team have written to all GPs enclosing a summary of treatments covered in the policy.
    The policy is also available on the SMC website. We plan a series of visits to outlying practices
    to improve engagement and reduce unnecessary activity.


    Reduce emergency admissions for HRGs most associated with PARR tool LTCs.
    Senior Responsible Officer: Roger Roberts (Graph 2)

    There has been little activity in this area during Q1 & Q2, other than continued work with active
    case management. Work on LTC pathways continues with completion of Diabetes pathway.

    Prescribing Performance
    Senior Responsible Officer: Roger Roberts
    The prescribing forecast as per prescription pricing division Aug 2008 is as follows. This is
    forecasting a higher spend than PCT Finance but the actual out-turn is expected to be better
    than the pricing division forecasts early in the year.

                           Spend                   Budget                Underspend
                           £48,521,808.00          £49,410,597.00           £888,789.00

    Appendix B contains further information regarding Stockport performance on individual
    indicators, a report from STAMP and the budget setting and incentive schemes.


    Public Health
    Senior Responsible Officer: Vicci Owen-Smith

    Planning for the next Stockport Health Survey has begun. The first survey, published in 2006,
    has been invaluable in providing health behaviour intelligence to inform the service
    commissioning process. The next survey will be undertaken in 2009. It is likely that the sample
    will be boosted in areas of deprivation, for men and for younger adults.
    Infant Feeding Research will take place across Stockport. This is a qualitative piece of work
    focusing on first time mothers and attitudes to infant feeding (not merely breast feeding) and



SMC Board Paper                                                                  Page 8 of 13
Date: 10th November 2008
    baby clinics. They will be interviewed at late stage pregnancy and followed up when the baby is
    3-4 months old.

    The Area Deputies in Public Health plan to work more closely with the neighbourhood renewal
    teams and focus on improving health in communities of need within their area.

    The low uptake of breast and cervical screening is an issue in across Stockport. The Locality
    teams have identified several practices with high numbers of unscreened women, and are
    developing a short term action plan to deliver change by April 2009. The teams will work directly
    with GP practices and the SMC public health manager to understand the reasons behind this
    problem and increase uptake. Further work is to be developed, to work with other practices with
    low screening coverage, and this will include immunisation and CVD screening.



3. Development Plan: Performance to September 2008 (month 6)

3.1 Service Reviews

    Updates on service reviews are given regularly in the SMC newsletter. Recently completed is
    Specialist School Nursing, a report to SMC board was presented in October 08.


3.2 Training and Education

    An outline training strategy has now been established under the leadership of Dr A Patel and
    Ms K Long. The strategy has taken a phased approach to accommodate the evolution of SMC
    and to ensure flexibility around meeting key business objectives. Phase one, which ran to July
    08 is focusing on understanding GP members and Practice’s specific requirements around
    PBC. From this analysis and through input from each business unit within SMC a training
    framework has been developed which is updated as and when new sessions are introduced.
    This framework is available on the training and education section of the SMC website for
    Practices to access.

    Educational initiatives around referral management are currently focusing on MR training, the
    Map of Medicine and the Provider Market Place on 20th November. Focus will move towards
    education around new pathways in the New Year as and when pathways get signed off and are
    ready for implementation. We are also developing work around an Orthopaedic Preceptorship
    with GMSC to offer to practices in February which will help increase their confidence around
    Orthopaedic referrals. We have also developed the capacity to work with Cardiology GPwSIs
    from Greater Manchester to support Practices around their cardiology referrals should they
    require this.
    Other projects that are ongoing relate to Practice training around Dermatology; COPD and
    Asthma and Diabetes.

    In relation to the Provider Market Place and referral management an educational event will be
    held on 20th November, this event has been welcomed by our Providers and we now have over
    25 different Providers coming to the event. We have representation from the Acute Sector,
    Independent Sector, CATs/Tier 2 and Community Services as well as some other exhibitors that
    want to market their services to GPs. This will be a fantastic opportunity for Practices to get to
    know the Providers and to build confidence about the services they offer to help them when they
    are having Choice conversations with their patients.
    There will also be 6 educational sessions running alongside the exhibition which will cover the
    referral management topics of COPD; Dermatology; Cancer; Urology; Direct Listing / Pre-Op
    work ups and Orthopaedics. GPs have been informed of this event through several
    communication channels and we are hoping for representation from every practice in Stockport.

SMC Board Paper                                                                  Page 9 of 13
Date: 10th November 2008
    Phase 2 (July – Dec) is focused on developing Practice skills around Practice Based
    Commissioning. This work is being fed via information from the training needs analysis and will
    consist of a modular training course to run throughout 2009 which will be available to all
    Practice Managers and some GPs should they wish to attend (this will be based on the NHS
    Alliance PBC Academy course).

    In addition quarter 2 has seen the beginning of work around developing practice specific training
    plans which will be linked into Practice Account Plans which are currently under development.
    This plan is linked closely to the referral management work stream in order that should any
    training needs be identified during discussions around referral management these can be linked
    in.
    In line with the Communication Strategy the training and education section of the website is now
    up and running with information regarding scheduled courses. Any presentations from previous
    events are also on the site so that people who couldn’t attend can see the information outside of
    the meeting.

    Following the re-election of the current board in September we are also now looking to pick up
    development of a Clinical Leadership Programme for GPs and other board members in line with
    the World Class Commissioning standards.


3.3 Communications

    Following the consultation that took place in March and April 08, the Board were presented with
    the final SMC Communications Strategy in June 2008. The paper presented explained the
    rationale and methodology required to develop a robust communications strategy and
    implementation plan and suggested implementing the findings in a phased approach:

      -      Building an understanding
      -      Building a dialogue
      -      Building for a future

    The paper also detailed 6 overarching principles to govern the strategies development, namely:

      -      Good communication is everyone’s job
      -      Two-way communication
      -      Respect and partnership
      -      Co-ordination with the work of stakeholders
      -      Use effective communications as part of effective change management
      -      Provide staff time and resource to communications

    Corporate Identity

    To take the first part of the strategy forward a full corporate identity has been agreed by the
    Chief Officer and Chair which will be used to help clearly label the work that is being undertaken
    by SMC. This is made up of a colour palette, logo and a full branding document detailing how
    letters, presentations, corporate documents etc should be formatted.

    A core “descriptor” is in a draft stage which seeks to describe the key elements of the
    organisation. This document will be used as a basis for all future documentation to ensure
    consistency in our messages. It will serve as “approved text” which can be utilised should the
    necessary people not be available to sign off any documentation required urgently. From the
    above a variety of documents can be produced. This is currently on hold due to the costs
    involved.


SMC Board Paper                                                                 Page 10 of 13
Date: 10th November 2008
    Communication with practices

    One major theme that resulted from the feedback from the consultation was the amount of
    emails practices receive from staff in SMC and the PCT. Since coming into post, the Business
    & Communications Manager has initiated regular monthly newsletters aimed primarily at
    practices but circulated also to relevant staff in SMC, Stockport PCT and Stockport Health
    Enterprises. The aim of the newsletter is to consolidate the information sent to practices,
    checking it for appropriateness.

    The main content of the newsletter has focused on notifying the recipients of the decisions
    taken at SMC Board, advising of developments in services, highlighting upcoming events and
    providing feedback on those that have taken place as well as informing of any achievements
    and other items of interests. As the newsletter has become a more established method of
    communicating with practices, it is felt that it is now becoming too large.

    A monthly operational email noting actions to be taken has therefore been initiated. It will
    contain links to relevant internet sites meaning that practices will be given the headlines and
    summaries if items of interest but will be able to decide whether they want more information on
    a particular item by delving deeper into the article.

    The monthly newsletter (with its new branding) will continue but will have a much more
    conversational, informal news-style feel to it. The newsletter will therefore become an
    “information giving” tool and will stretch wider than SMC incorporating information from the PCT,
    SHE and the Foundation Trust.

    Website Development

    After a tendering exercise a consultant was appointed to develop the new SMC website. The
    first phase of the website went live at the Annual General Meeting on the 17th September 2008.

    The site has four sections:

    Public - gives a basic understanding of SMC’s purpose, aims and vision. Part of the explanation
    details the close links with SPCT and member practices. As SMC is not a public facing
    organisation this section of the site is fairly minimal.

    Practices & Members - provides a portal for 2-way communication, access to online training
    resources, access to locality and practice performance data and acts as a central hub for all
    PBC and SMC related resources and information.

    Partners - when developed this section will detail information on SMC that is necessary for
    strategic partners to see but not for public consumption.

    Staff - provides an internal communication mechanism to engage and update SMC staff on the
    work taking place in their organisation. It also acts as a portal for 2-way communication, an
    internal information source (for example, a database of staff and GP contact details) and an
    internal training resource.

    Future work is focussed around fully integrating the performance management tool, placing the
    content and ensuring SMC staff have the skills and resource to continue to develop the website
    in house.

3.4 Corporate and Financial Governance




SMC Board Paper                                                                Page 11 of 13
Date: 10th November 2008
    In line with the timescales in the SMC Business Plan the post of Assistant Director of Finance &
    Performance for PBC was successfully recruited to. This agenda is now being taken forward by
    the above with active support from the Business & Communications Manager.

    Board systems and processes have been established and audited by the PCT Internal Auditors.

    An internal audit report detailing recommendations has been received and is being taken
    forward, progress will be reported at the Audit Committee in December.

    The main areas of note are:

    The PCT/SMC Business Case Process has been rewritten but requires further clarification
    regarding governance arrangements and appropriate sign off;

    The SMC Rules need amending to firm up the arrangements relating to declarations of interest,
    Board membership, quoracy and the links with the PCT Accountability Agreement;

    Segregation of Duties/Standing Financial Instructions, Standing Orders and Financial
    Procedures need finalising to fully ensure the governance framework is documented, robust and
    easily understandable to staff.

    In line with the Rules of the organisation a Company Annual General Meeting was held on the
    17th September where the proposed 07-08 Annual Report, Accounts and Board and Auditor
    appointments were agreed.

    The financial statements have been filed with the Financial Services Authority.

3.5 Locality Development

    Locality plans were presented to Board in July 08, practice plans have been received from 51 of
    the 54 practices and these practices are therefore signed up to the incentive schemes.

    Work continues as in the previous quarters report in additional progress to date:

      -       Innovation Fund Panels have met for all localities and have committed a total of £ 511k
              of which £416k is expected to be spent in 2008-09.
      -       Locality meetings have continued with updates on Finance & Performance at some
              meetings.
      -       Future meetings will have more consistent agendas and the December meetings are
              being run for 2 localities at a time and will include updates on Finance & Performance,
              Training, Referrals and EUR performance.
      -       Details of locality progress against SMC objectives covering innovation fund bids and
              plans are shown in Appendix C1-C4.
      -       Due to the resignation of 3 of the locality managers and interim staffing structure has
              been put into place until the new Director can review and implement the structure they
              require, see Appendix D.

4   Risk Issues

    Please see Appendix A for an analysis of SMC’s performance against its Business Plan.

Ranjit Gill
Chair


SMC Board Paper                                                                 Page 12 of 13
Date: 10th November 2008
Appendix A



   App A KPIs.xls



Appendix B



App B Prescribing &
STAMP Update.doc




Appendix C



App C1 SHV Locality App C2 MW Locality   App C3 CB Locality      App C4 H&TV
    Report.doc          Report.doc          Report.doc        Locality Report.doc


Appendix D



App D Structure.doc




SMC Board Paper                                                                     Page 13 of 13
Date: 10th November 2008

				
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