Transcript Draft Five Year Strategy and Operational Plan

Dr Nina Pearson
Chair Luton CCG
[email protected]
Agenda
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Health and Social Care Reform – NHS Commissioning 2014
Luton CCG
Cluster Development
Key Priorities
Encouraging Evidenced Based Referrals and Practice
LCCG Intranet
Future GP Leaders
Health and Social Care Reform
Act
www.kingsfund.org.uk/altguidenhs
Cluster Meeting
General practice
1.Terms of Reference
2.Practice Agreements
3.Cluster level Reports
Quality/Performance
4. Cluster level
Indicative Budgets
Structure
Services to align
with Practices in
each Cluster
e.g.
demographics
Patient Engagement
Practice
Cluster
Representation
N
Bramingham
Sundon Park
Northwell
Icknield
12
22
10
Leagrave
6
23
Limbury
Stopsley
Barnfield
16
Lewsey
8
Saints
25 & 29
Challney
14
1
Round Green
20
3
19
2
17
Dallow
Biscot
5
High Town
4 & 28
Wigmore
11
13
30
15
Crawley
27
18
7
31
24
21
Farley
Index of Multiple Deprivation 2010
9
South
26
70
60
50
40
30
20
10
0
1
2
3
4
5 km
0
Contains Ordnance Survey data © Crown copyright and database right [2013]
Luton CCG Clusters
South East Luton
Cluster
7 Practices
list size: 64549
GP Chair: Dr Abbas Zaidi
Cluster Development
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All Chairs appointed
Currently meeting approximately monthly
Remuneration for attendance via PCIS
Key priority areas – workstreams currently
identified at Cluster level
• Communication/distribution – agreed at
Cluster level
Key Priorities
• Better Together - New model of Care for Frail and Elderly:
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Better Care Fund
Risk stratification and Care Plans
MDT Care Coordinators
L&D Directorate of Medicine for the Elderly (DME) consultant
• Demand Management (Referrals)
• Unscheduled care – BI producing data at Cluster/Practice
level
• Improving Access – GP patient survey results
Better Care Fund
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Initiated in 2013, Nationally £3.8b to drive the development of integrated
care.
Not new money, but there are national conditions for its use
For 2015/16 £1b represents a “performance payment”. Part of this is based on
the local achievement of a targeted reduction in total Emergency Admissions
Local areas need to achieve at least 3.5% reduction (excluding maternity and
mental health acute)
In Luton this is likely to be higher than 3.5% as Luton is in the top 10% for
emergency admissions growth since 2009/10
All system partners need to agree to this target
The performance payment is to be used for NHS Commissioned out of hospital
services
The total BCF for Luton is £13m and the performance payment element is
3.4m
Better Care Fund
Risk Stratification and Care Plans
• Practices have undertaken risk stratification for the unplanned
admissions DES (2% adult population) and now further work
on this identified list
• Better Together team (Larkside Cluster) – identifying priority
patients:
Risk Stratification and Care Plans
• Personalised care plans in place for all patients initially added
to the 2% DES register (approx 3,500 patients Luton wide) by end of September 2014.
• Recognise that these care plans likely to be basic due to NHS
England stipulated deadlines and patient volume
• Next step. Larkside Cluster to work up model with allocated
multidisciplinary team and MDT care co-ordinators to ensure
care plans are comprehensive integrated plans.
MDT Care Coordinators
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Aim for. 10 coordinators.
Phased approach – starting with Larkside Cluster
3 Larkside Cluster MDT Co-ordinators recruited
Integrated with CCS team – member of practice team
Allocated to member practices (based on list size/ number of
elderly and complex patients)
• Support practice with: case finding, risk stratification, daily
review of hospital activity, development of care plans,
updating clinical system records, coordinating work of CM's,
DNs, therapists, social workers, mental health team, voluntary
organisations.
• Improve networks and navigation of the health and social care
system.
L&D- DME Consultant(s)
• Alignment of DME consultant to Larkside Cluster GP practices.
• Launched GP hotline in September allowing clinicians to
contact the specialist to:
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alert of an impending admission of an acutely unwell patient
discuss further action in light of a patients abnormal test results
discuss the need for urgent consultant. Is admission appropriate?
enable an admission to be abbreviated by earlier inpatient investigation
gain clarification of details following an admission - follow up plan
Demand Management
• Letter of guidance (managing referral demand) to all GPs from
Clinical Directors 04.09.2014.
• The challenge for the team (Cluster Chairs, CD Primary Care,
Primary Care & Planned Care team) is to devise practical
solutions to ensure:
– Peer to Peer referral review at practice/ Cluster level
– Ensure practices understand policies for Procedures of Limited Clinical
Effectiveness (PoLCE), and improving access to information
– Collate real-time referral data and feedback to team to track progress
– All Practice Teams (e.g. Medical secretaries) on board and supporting
practices
– Ensure primary/ community services are used as 1st option (raise
awareness of available services)
Breakout Session:
Trauma and Orthopaedic Data
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What does the data show e.g. usage etc..
Where do you see issues, and why?
What can be done to resolve?
Next steps?
Improving Access
• National GP patient Survey Report – presented to
Clusters
• Discussion and analysis for outlying Cluster/ Practices
• Collating and sharing examples of best practice
models (e.g. telephone systems, receptionist ways of
working)
• Consider receptionist training
• Peer to Peer support/practice buddy system
Unscheduled Care
• Mapping urgent activity by practice e.g:
– In hours - time of day patients arriving at A&E
– WiC and UGPC activity trends by practice
– Frequent attenders being identified
• Collated GP practice opening times including
extended hours. Triangulate this with urgent activity
data to look for trends.
• Looking at best practice models, peer to peer
support and advice
• Paediatric activity – Kingsway
Innovation for Improvement
Urgent Care
GP Centre
opens
Social
Marketing
Promotion of
NHS 111
Acute
Assessment –
new approach
Breakout: Frequent Attenders
What does the summary of top attenders tell you?
Why do you think they are attending?
What would you do as a plan of action?
Next steps?
Analysis of A&E Attendances By
Patient Attendance April to June
2014
Individual
Total
Count
Patients Attendances
60
1
60
13
1
13
12
1
12
11
1
11
10
1
10
9
1
9
8
3
24
7
7
49
6
14
84
5
25
125
4
73
292
3
215
645
2
1294
2588
1
10,984
10,984
Total
12,621
14,906
Cumulative
Patients
1
2
3
4
5
6
9
16
30
55
128
343
1637
12621
%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
1%
3%
13%
100%
Cumulative
Attendances
60
73
85
96
106
115
139
188
272
397
689
1334
3922
14906
%
0%
0%
1%
1%
1%
1%
1%
1%
2%
3%
5%
9%
26%
100%
Please see the data sheet for an analysis of attendances with any patient with a count of 8 of more in the three months to June 2014
Encouraging Evidenced Based
Referrals and Practice
Managing Planned Care Activity
Elective activity – mainly acute – i.e. Luton and Dunstable Hospital
Includes inpatient and outpatient
Closely linked with community services – especially long-term
conditions management
Primary
Care
Referral
handling
Pathway
Re/design
Procedures of limited clinical
achieve the best outcomes
for patients
effectiveness
ensure that all patients receive the best possible quality of care
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• improve the consistency of referrals and clinical pathways for all
patients
• clarify referral criteria based on current evidence
• reduce inappropriate or untimely/premature referrals
• maximize opportunities for management of patients in primary
care
• reduce variability between practices
• aid practices in managing the budget
• provide assurance that NHS funding in being deployed in the
most equitable, effective and efficient manner
Procedures of limited clinical
effectiveness – initial list
Speciality
Procedure
Dermatology/Cosmetic Surgery Surgical excision of Benign Skin Lesions
ENT
Tonsillectomy/ Adenoidectomy
Surgical management of Glue Ear/Grommets
Gynaecology
Maxillofacial
Musculoskeletal/Orthopaedics
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Surgical interventions for Dysfunctional Menstrual bleeding/Hysterectomy
Minor Oral Surgery
Arthroscopy
Podiatric Surgery
Hip Replacement Surgery
Hallux Valgus (Bunion)
Knee Replacement Surgery
Ophthalmology
General Surgery
Surgery for Cataracts
Surgery for Carpal Tunnel, Dupuytrens contracture and Trigger Finger
Circumcision
Surgical management of Ganglions
Surgery for Haemorrhoids
Surgery for Varicose Veins
Surgical repair of Abdominal Hernia
Evidence Based Referral Process
including Procedures of Limited
• GP makes a decision to refer based on the evidence that the patient is
Effectiveness
likelyClinical
to benefit having followed
relevant pathway in primary care
GP
• LCCG complies with Hertfordshire and Bedfordshire Priorities Forum
Guidance
• Referral template is completed to ensure all evidence is provided to the
receiving (Provider) clinician
Referral • Incomplete referral template will not be accepted at LDH
• Procedures will be carried out by Provider on receipt of evidence that the
patient has completed the agreed pathway prior to referral = completed
referral template
Provider • If a PoLCE is done without receipt of the completed template, procedure
will not be paid for by LCCG
• Audit of procedures through contract to highlight good practice
Implementation of Project
GP/Practice
List of procedures
circulated for all
Practice staff incl.
secretaries
Gelifish to be
updated with
Protocol, Link and
templates
Acute Services
List of procedures
for all specialties
to be circulated
Procedure for
collation of
templates being
confirmed
IT support
Implementation
of Referral
Templates to GP
systems
Updating Intranet
site to facilitate
accessibility
Awareness
(PLT; PMFI; e-mail)
LCCG Intranet
An internal web-based site for Luton CCG staff
and member practices – Launched in April 2013
To replace/incorporate the functions of:
• Starfish –the former Luton PCT internal staff
intranet (STaff ARea For Information SHaring)
• Gateway – centralised practice communication
tool
Each section has nominated authors, moderated
by staff in Luton CCG Communications team
Gelifish
Group Electronic LInk For Information SHaring
Our vision
A 'one stop shop' for
up-to-date, useful
and easy to find
information.
Single site for
both member
practices and staff
to unify LCCG
To promote
openness,
knowledge sharing
and participation.
Develop a valuable
means of two-way
communication
Our public site
https://www.lutonccg.nhs.uk/home/
Gelifish homepage
What will I find on there? (1)
Broad content 'areas':
• Clinical zone – including information on GP referral pathways
and relevant forms
• Our LCCG – Board reports, information relating to each
workstream, finance (e.g. budget reports, prior approval
process)
• Patient safety and quality – to include Safeguarding and
incident reporting
What will I find on there? (2)
• Prescribing - Medicines Optimisation
• Knowledge Hub - Training and development
• Public Health
• Useful links – including signposting to partner organisations
Embedded PDF
documents
First level
Second level
Third level
Features
Other features available:
• Contacts directory
• Calendar of events – including training courses and meeting
dates
• Search function
• Discussion forums to share best practice
• Central document library housing policies
• E-learning tool – including module on diabetes
• Practice areas
• A consistent process for urgent and non-urgent information
and requests
What next?
• Register at https://www.lutonccg.nhs.uk/extranet/
• Practice Managers are local administrators of practice areas
and can also add practice staff
• Feedback to LCCG Comms, clinical leads and /or Kath
• Flexibility and on going development and review
• May eventually be a password-protected area of the LCCG
public facing website
• a comprehensive and consistent process for urgent and nonurgent information and requests.
Future GP Leaders Posts
• 5 sessions a week in a Luton practice
• 2 sessions either LCCG commissioning
• Or University Bedfordshire teaching Health
courses
• Education role does Masters in Medical Education
• Commissioner role international MA
• Aim to advertise in April/May
• 3 year posts
Contact
Dr Nina Pearson
Chair Luton CCG
E mail : [email protected]
Katy Patrick
Corporate Governance and Strategy Manager
Telephone : 01582 532090
E mail : [email protected]
Useful Contacts
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Acute Care Community Nursing Team - 07899813023
Acute Respiratory Assessment - 07535977268
Admission Avoidance, Social Care – 01582 548800
Psychiatry Crisis Team – 01582 556971
Cambridge Community Services, Nursing – 0333 4053000
My Care Co-ordination Team – 0808 180 7788
GP Liaison Service – 01582 497050