Transcript Co-commissioning - Ipswich and East Suffolk CCG

Locality Meeting
15 May 2014
Co-commissioning
Prescribing
Urgent care and Health & Independence
Update on RAIDR
CCG feedback
EPaCCs reminder
Co-commissioning
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Simon Stevens (NHS Chief Exec) has announced an option for CCGs to cocommission primary care services
Expressions of interest are required by 20th June 2014 (from interested CCGs)
Largely relates to GP services
Scope
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work with patients, Health and Wellbeing Board
Designing local contracts, eg PMS
Discretionary payments eg premises
Managing resources
Contractual performance
Procurement for new services
Key points
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Geography? Single CCG or joint with neighbouring CCGs?
Benefits?
• Improved integration of health & care services and out of hospital care,
mental health, community services etc
• Improved service quality
• Enhanced patient and public involvement in developing services
• Reducing inequalities
Co-commissioning - continued
• Any submission would require the CCG to identify the areas that it
would wish to cover
• Spectrum of co-commissioning
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An Ipswich and East Suffolk bid or with West Suffolk ?
Greater involvement in decisions made by Area Team
Joint commissioning with Area Teams
Delegated commissioning arrangements – CCG undertakes tasks on
behalf of Area Team
• Expressions of interest would need to indicate the form and
proposed timescales of the co-commissioning, extent of co-location
of Area Team Staff and in particular how the CCG would deal with
potential conflicts of interest.
• More detail is being worked up by the NHS Commissioning
Assembly
Co-commissioning – What next?
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Some proactive approaches from practices expressing interest that those
involved in the delivery of primary care should be shaping primary care
services.
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Before the CCG goes any further with thinking about this we want to ask
you what you think. We will send Senior Partners a letter this week,
requesting your practice’s view on:
– Option 1 - Supportive of a submitting a proposal to pursue these
additional opportunities
– Option 2 – Do not support the option and wish to retain the status quo
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We will also be asking other partner organisations what they think, including
the LMC.
Prescribing Budget update
• Current YTD position (up to and including Feb 14) £1.4m overspent
(3%)
Budget 14-15
• Based on forecast outturn 2013-14
• Same methodology as last year i.e. weighted ASTRO PUs taking
into account deprivation
• Public Health drug spend will be top sliced as per last year
• Net uplift of 0.2% (1.9%* uplift - £1m QIPP saving)
Changes this year
• Spend on DN supply chain dressings will be top sliced
• Spend on drugs commissioned by NHSE will be top sliced
• Nationally allocation of ASTRO PUs has changed. Less weighting
for patients aged ≥65 yrs.
*regionally recommended uplift
QIPP priorities
Project
Description
Target saving
(Total £1m)
BGTS
Implement guidance for type 2 patients, complete and
implement guidance for type 1 patients
£170k
Pain
Implement pain guidelines, work with IHT for joined up
approach to pregabalin, use most cost effective oxycodone and
morphine brands
£50k
Wound care/stoma
/incontinence
appliances
Update formularies and launch new ordering scheme to
Nursing Homes in July to ensure adherence to formulary and
recommended quantities
£55k
Incontinence drugs
Implement UI guidance and switch solifenacin to cost effective
alternatives
£50k
Respiratory
Promote asthma guidance - use of cost effective ICS/LABA
inhalers. Review COPD guidance with IHT to include Relvar
and look at shifting away from tiotropium as 1st line LAMA.
£85k
Dietetics
Revise infant formula guidance, stop prescribing soy and LF
milks. Review gluten free guidance - reduce units for adults
£20k
Joint formulary
Complete full joint formulary by end of 14/15
£160k
Specials
Switch to cost effective alternatives, create list of cost effective
branded specials
£20k
Other switches,
restricted items, red
drugs etc…
Tech to continue wide range of switches, repatriation of Red
drugs, house keeping, Optimise Rx as key enabler. Recruit
new pharmacist to work out in practices reviewing complex/frail
patients.
£390k
Urgent Care
Key messages from GPs at December Education Event
• Urgent care services need to be where the patients are
/ go to currently
• Integrated urgent service at the front door of A&E,
including primary care, with senior leadership
• Increase patient awareness and understanding of selfcare options
• Discharge planning on arrival
• Up-skill staff
• Ensure access to other urgent services including
diagnostics
To boldly go…
Vision of the Urgent Care System
Diagram provided by Dr Imran Qureshi
Proposed Overall Urgent Care System Model for Suffolk
Components
Key Services and Functions
NHS 111 and Care
Coordination Centre
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NHS 111 is part of National Mandate – compulsory for local
NHS
Where patients can phone to get urgent care advice, including
111 service, out of hours service, community health
Used by health and social care professionals to access
specialist urgent care advice, arrange dispatch of services (e.g.
to relieve paramedics)
Refer patients into Integrated Neighbourhood Networks or
Urgent Care Services that travel to patients, are based in
community locations away from the two main hospitals, or
referral to Urgent Care facilities co-located with A&E facilities.
Directory of Services
Urgent Care Services in
the community, including
travelling to patients
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Community based locations serving urgent care needs
Step-up beds
Explore access to diagnostics and minor injuries
Urgent Care Services colocated with A&E facilities
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Co-located at Acute Trusts
Sees all unannounced arrivals previously seen by A&E and
referrals from professionals.
Primary Care, commissioned specialty input, diagnostics, minor
injuries and transfer to community-based services
A&E for the ‘genuine emergency’
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Date
Key Milestones
February 2014
Clinical commissioner work on development of strategic
commissioning intentions including consideration of the
reports from stakeholder events
March-April 2014
Design of outline service model
May 2014
Receipt and approval of outline service model by statutory
bodies
June-August 2014
Formal public engagement
Further system work on the detailed service specification
including financial modelling
August-September 2014
Evaluation of responses
September 2014
Formal approval of service specification and agreement to
start procurement by statutory bodies
October 2014-February 2015 Formal procurement and evaluation of bids
March 2015
Statutory bodies approve letting of contract(s)
April-September 2015
Mobilisation of new contract
Update on RAIDR
The RAIDR (Reporting Analysis & Intelligence Delivering
Results) system is being offered to practices as of now.
The first wave of practices have been contacted and are
already starting to receive training on the system. It is
anticipated that all practices will be able to receive the
training and use the tool by the end of June.
RAIDR will be able to support the NHS England
Admissions Avoidance DES, Over 75s work, MDTs.
CCG Feedback raised at April education event
To raise a query, you can email [email protected] The mailbox is monitored twice daily, issues are
then logged and a response should be available within 20 working days.
Issue/Query
Practices are having issues with
contacting the CCC (Care Coordination
Centre), with the service having no
capacity and asking practices to call
back
Practices are having problems getting
hold of the RAAC
Practices have not been given enough
time with the Suffolk Federation to
discuss the Over 75s work
Outcome/Update
This has been raised with the Contracts Team at the CCG, however the team will need
specific examples in order to investigate. If practices continue to experience this, please
email [email protected] with the detail.
This has been raised with the Contracts Team at the CCG, however the team will need
specific examples in order to investigate. If practices continue to experience this, please
email [email protected] with the detail.
At the next event (25th June) at Trinity Park, the Federation will hold a meeting afterwards
at 5:15pm to give practices the opportunity to meet with them.
OA Knee referrals are going to the
Nuffield due to patient choice (C&B) and
T&O consultants are advising this to
patients and encouraging them to go
through C&B
The CCG is aware of this issue and working closely with consultants to ensure this does
not continue. If practices find that this is still happening, please email specific examples to
[email protected]
SERCO contract and query around
workforce numbers – GPs would like to
see a new map of where Serco is now
compared to where they were at the start
of the contract (to include a skill mix)
We are working with the Contracts team to supply this information to practices
Admission Avoidance DES – practices
would like help and support for templates
and coding. It would also be useful to
have templates attached to LES’ and
DES’ when they are issued.
The CCG has received the final specification for this DES from NHS England and are
currently reviewing the content. Further updates and any necessary supportive
documentation will follow.
GMS/PMS contractual changes –
practices would like to work closely with
The CCG will continue to offer support to practices and is happy to work with practices
taking into account the CURRENT commissioning environment
Issue/Query
Outcome/Update
Palliative Care patients – lack
of co-ordination between the
Hospice, IHT and Hospice at
Home. Oncology and the
Hospice also appear to be
‘pushing back’ which is leading
to acute admissions
Inpatient beds are for patients who have specialist palliative care needs (uncontrollable
symptoms, complex psycho social issues etc) and so a hospice bed cannot always be
offered as a choice for patients. However, if a patient is referred they will ensure they
have a package of hospice care, which may be hospice at home, day care etc.
Oncology will also prioritise their beds for oncology patients (especially patients
requiring active treatment) by default their beds get used as palliative care beds but
again capacity is limited. The CCG will take the issue of co-ordination to the next end of
life network where all providers are present to discuss further
The CCG has noted this query however requires more detail in order to be able to
investigate fully. Please email [email protected] with full details so
that we can investigate.
Palliative Care patients –
patients are being admitted to
nursing homes as services are
not available for patients at
home. GPs are not being
funded to look after these
patients.
IHT forms – can these be
standardised with SystmOne
and EMIS?
ALL Spinal and MRI referral
forms
Problems with Neurology not
seeing patients
All referral forms which are issued from IHT (via the CCG) should be made available in
EMIS and SystmOne formats. Many forms can be found on the CCG website in the
Members area. If you are using a form which is not on the website, please email the
form to [email protected] and we will look into it.
REMINDER: the ALL spinal form and MRI referral forms are available and can be
downloaded from the CCG website. The latest version of the ALL spinal form has been
included within the delegate packs.
There are issues with under staffing in Neurology at IHT. The CCG is aware of the issue
and working with IHT to solve the problem. If practices encounter any further issues,
please email [email protected] with the detail.
Hospital Ambulance Liaison Officer (C)
• Collaborative working
• Supported 7 day working
• 65% fewer delays reported
• Positive patient outcomes in handover and response times
• Reduction of financial consequences
Community Escalation Beds and
Discharge Planning Nurses
(AA/C/ESD)
Primary Care Contract
COPD (AA)
• Positive patient outcomes
• Reduced respiratory admissions
• 2,253 patient contacts by Primary Care
• 1,407 prescriptions issued
• 24% reduction in COPD admission than
last year (Jan- March)
• 4% reduction in overall respiratory
admissions than last year (Jan- March)
• Supported 7 day working
• Positive patient outcomes, being treated in
the right place
• Collaborative working
• Reduced patient length of stay in hospital
• Used by 218 patients
• Average length of stay 9 days
Weekend Diagnostic,
Therapies and Pharmacy
(AA/C/ESD)
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4% increase in weekend dispensing
Supported 7 day working
Positive patient outcomes
Collaborative working
12% of patient seen by therapies were
discharged the same day
• 58% of patients seen by therapies were
discharged at the weekend
Top 5 Patient Flow
Winter Schemes
2013-14
Evaluation Based
Additional Consultant hours
in ED, EAU and Capel Ward
(AA/C/ESD)
• Positive patient outcomes
• Supported 7 day working
• Reduced waiting times for patients
• Improved patient flow
• Senior clinical decision making
• 20% additional weekend discharges on
Capel Ward than before consultant
• 95% year end ED performance met
(AA) Admission Avoidance | (C) Capacity | (ESD) Early Supported Discharge
EPaCCS Reminder
• EPaCCS (Electronic Palliative Care Coordination
System) went live on the 6th May
• Practices need to create EPaCCS records for patients
on End of Life registers.
• Supportive documents to help practices do this is
available on the Ipswich & East CCG Palliative Care web
pages
• An FAQ has been included within the delegate packs
• EPaCCS is a national requirement