city & hackney ccg primary care quality programme board clinical commissioning & engagement...
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City & Hackney CCG Primary Care Quality Programme
Board
Clinical Commissioning & Engagement contract
2015/16
1. Lead GP Contact Appointment
The practice will identify a GP lead for this contract and deputy. The practice will inform the CCG and its consortium lead of the name of the GP practice lead on sign-up.
The practice lead GP or deputy will have a mandate to speak on behalf of the practice at meetings related to this contract and when attending other CCG meetings, such as the Members' Forum.
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2. Routine discussion of all non urgent referrals
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The practice will have a system in place to ensure non-urgent OPD referrals are discussed with another GP prior to being made, to ensure these are in line with agreed pathways, enhance clinical care and use resources most efficiently (all to support the gate-keeper role).
The practice may decide to deliver this element of the service preferably via regular (BUT at least weekly) referral meetings involving clinical staff or via an at least weekly one-to-one buddying arrangement.
Following the discussion, the code ‘XXX’: "possible referral discussed with GP colleague" will be entered into the patient’s notes. It is suggested that either this is done immediately if the discussion is occurring around a computer or a list of those patients discussed is given to an administrator for data entry.
The practice will run a search for "possible referral discussed with GP colleague" twice a year.
The practice’s GP lead for the CCE contract will ensure that the process for referral discussion and the 2 data sets form part of a more general review of referral behaviour (see Domain 14) at a clinical meeting twice during the course of the 2015-16 CCE contract year (and where relevant, fedback to individual clinicians if their undertaking of referral discussions differs significantly from their peers).
A referral Management template will be made available to practices to facilitate data collection.
3. Education sessions attended, pathways adhered to, implemented and communicated
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3a. Engagement with CCE contract accredited education events
The practice GP lead for the CCE contract is responsible for ensuring practice engagement with CCG accredited education sessions.
The practice will send a GP representative to at least 12 sessions (of a planned at least 20 CCE contract accredited education sessions).
Of the 12:
Attendance at CCG accredited Masterclasses can contribute a maximum of 2 of the 12.
Attendance at CCG accredited consortia-based or practice-based education sessions can contribute a maximum of 2 of the 12.
If a practice wishes, attendance at 12 ‘Friday’ Homerton sessions can be used to fulfil the entire requirement.
If attendance in person at a ‘Friday’ Homerton education session is not possible, then the practice (a GP) can view a maximum of 3 sessions over the course of the 2015-16 CCE contract year via the webinar live recording of the session. The GP must be logged onto the webinar for at least 45 minutes and complete the survey (as recorded by the CCG centrally and in line with the under development CCG webinar policy).
Information from each of the 12 sessions must be cascaded (and refreshed) throughout the practice
3b. Adherence to pathways
The practice GP lead for this contract is responsible for ensuring and reviewing adherence by all clinicians within the practice to agreed pathways.
Such pathway adherence activity (where appropriate for good patient care) can include: easy near-patient access to CCG pathways and consultant advice lines; cascades to, and discussions with colleagues at clinical meetings and review of referral management data.
The practice is expected to start to use the new DXS system to support pathway adherence when this becomes available.
The leads for this domain are Teresa McInerney ([email protected]) and Paula Stanley ([email protected]).
3. Education continued
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3c. Acting on any feedback from provider services following referral
The practice GP lead for the CCE contract will be the main point of contact for feedback from Homerton consultants (when data received) on pathway adherence and clinical appropriateness of referral activity.
The practice GP lead for the CCE contract will be expected to act on referral feedback, ensuring the practice behaviours and administrative systems are amended accordingly.
3d. Engagement with CCG accredited 'cancer‘ education events
Engagement with two educational events.
All practices to send a representative of clinical/non-clinical staff to two educational events.
Event 1:
Participation in training/educational on the use of cancer risk assessment tools/Macmillan Electronic Clinical Decision Support Tool or Qcancer within consultations to assess patients in whom there is a possibility of cancer diagnosis.
Event 2:
To be confirmed.
The CCG leads for this work are Siobhan Harper ([email protected]) and Dr Gary Marlowe ([email protected]).
4. Use of Consultant Services
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4a. Using the service
The practice will be expected to use the range of consultant advice services available as an alternative to routine OPD referral.
Following use of a consultant email or telephone contact, the code ‘YYY’: ‘consultant advice service used’ will need to be entered into the patient’s notes.
The practice will run a search for ‘consultant advice service used’ twice a year and discussed at a practice clinical meeting twice in the 2015-16 CCE contract year as part of a more general review of referral behaviour (see Domain 14).
The practice’s GP lead for the CCE contract will ensure that there is a process within the practice for the data to be fedback to individual clinicians if their use of consultant advice services differs significantly from their peers.
A referral Management template will be made available to practices to facilitate data collection.
[Note for discussion: data to record GP by name and speciality advice service used and data searches run to include these measures]
4b. Review of data showing use
The practice will receive biannual information (Homerton derived data) on use of consultant advice services from the CCG. The practice will also run a search of their own coded data twice yearly (see above).
The GP lead for the CCE contract will lead on a discussion of the data twice yearly at a clinical meeting (when reviewing other referral activity – see 4a above and see Domain 14).
4c. Cascading information about how to use the services throughout the practice
The lead GP for this contract will ensure that information on how to use the CCG consultant advice services is made easily available to all clinicians (including juniors and locums) and that there is a process within the practice to share any learning from the advice provided across the full clinical team.
4d. Cascading information about new services throughout the practice
The GP lead for this contract will ensure that information on new advice services is cascaded within the practice and that each clinician has up to date information on advice services available.
The CCG will inform the GP lead for the CCE contract when a new advice service is launched or an existing advice service has been refreshed.
5. Routinely review locums and juniors referrals and activity
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5a. In-house review of junior GP and locum non-urgent referrals
The practice will have a system to ensure all non-urgent OPD referrals being proposed by a locum or a junior clinician are reviewed by another GP to ensure these are in line with agreed pathways and enhance clinical care before a referral is made.
The practice may decide to deliver this element of the service via regular referrals meetings involving clinical staff or via more informal arrangements.
5b. CCE contract induction
The practice will have mentoring support in place for locums and junior clinicians.
This will include ensuring that locums and junior clinicians are introduced to CCE contract, are taken through the tracker with a discussion into clinical commissioning behaviours that will include: referral reviews, use of pathways and the POLCV policy.
6. Adhere to procedures of limited clinical value 15/16 (POLCV)
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The practice will have a system in place to ensure the most recent version of the Procedure of Limited Clinical Value Policy is adhered to and that supporting information is made easily available to all clinicians (including junior clinicians and locums). Referrals to be discussed to ensure compliance with POLCV exclusions (prior to an IFR application/referral being made).
The practice will discuss any new or changed POLCV Policy at a clinical meeting and disseminate the same information via email.
7. Practice Nurses attendance at targeted PN Education Sessions
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The CCG is keen to support various education events and activities aimed at supporting Practice Nurses' professional development.
As part of the CCE contract attendance is not mandatory, but the CCG wishes to encourage practices to allow their nurses to attend.
8. Information Sharing & Governance
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8a. Information Sharing & Governance
Supported by the Duty Doctor contract with the Confederation, the practice will have a robust system in place across admin and clinical teams to ensure when a consultant telephones the practice to discuss a patient with a GP this happens without undue delay.
The practice will ensure it completes all faxbacks from the Homerton (gradually being replaced by the HIE system) and other hospitals in relation to patients attending A&E and returns these within 3 hours of receipt.
The practice will also fax care plans if asked (detail to be provided by the Care Planning and Integrated Care Steering Group - [email protected]).
8b. Data Sharing
The practice will be asked to sign up to data sharing agreements (within primary care or at the primary/secondary care interface) that demonstrate that it is working with other organisations to facilitate integrated health care. The lead for this domain is Dr Niifio Addy ([email protected]).
8c. Information sharing with ELFT’s blood borne-virus team
East London Foundation Trust's Blood borne-virus team is keen to share relevant data with all C&H practices: we would like practices to share relevant blood results between practices and the BBV team for specific patient groups (further detail to be provided by Dr Niifio Addy).
9. Consortium Meetings
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The practice will attend at least 5 of its consortium meetings, to input into discussions and cascade any information to all clinicians in the practice. A GP must be present at least 4 of these meetings - your practice manager can deputise for 1 of these 5. Information from the meetings must be cascaded through the practice to relevant staff (practice meetings, email etc).
10. Clinical Commissioning Forum Meetings (CCF)
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The practice will attend at last 9 of the planned 11 CCF meetings (either the lead GP for this contract, another GP, the practice manager or the practice nurse - the GP lead or another GP must attend at least 5 of the meetings), to input into discussions. Information from the meetings must be cascaded through the practice to relevant staff (practice meetings, email etc).
11. Acting on newsletters
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The practice will have systems in place to ensure that all CCG newsletters are cascaded to all clinicians and other staff within the practice (via email and/or printed versions) and that practice systems are amended to reflect any arrangements which have to be implemented.
Remember, this is a CCG newsletter for staff. It is not designed for distribution to patients.
12. Undertake CQUIN feedback
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During the course of 15/16 the practice might be required to provide information, within reason, to the CCG on adherence by providers (eg the Homerton) to CQUIN targets, where they exist.
The CCG will share further details if and when a practice is approached to undertake this work.
13. Review A&E attendances
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The practice will meet with representatives from the Homerton Hospital’s Frequent Attenders’ Group once in the year and develop their working relationships.
The Frequent Attenders’ Group will bring the names of the practice’s top 5 – 10 A&E attenders along with any management plans they have developed for these patients. Case based discussions will occur allowing the practice and Frequent Attenders’ Group to update their records and care plans for those patients reviewed.
The practice will also once in the year extract its own data from NELIE and review the care plans for up to 15 patients who have had 5 or more attendances at A&E within the past 12 months.
Care planning will include continuing to develop relations with the Tavistock’s service for supporting the management of patients with ‘Medically Unexplained Symptomatology’ (MUS).
Consortia leads will ensure that at least twice in the 2015-16 CCE contract year there is space on an consortia meeting agenda for practices to share learning (either clinical and/or relevant to commissioning of services) with their colleagues. The outcome of these discussions will be minuted and fedback by Teresa McInerney to the CCG’s Urgent Care Programme Board (and/or relevant others in the CCG).
The CCG leads for this work are Mark Scott ([email protected]) and Dr May Cahill ([email protected]).
14. Biannual Review of referrals
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The practice will start to use the new EMIS referral management template to ensure all routine referrals are coded both by speciality and against the name of the referring clinician (or ‘locum’) prior to the referral leaving the practice.
Twice a year the practice will continue to review a biannual dataset received from Moz showing referral activity and hospital derived data showing use of consultant advice services (generally inconsistently recorded by the hospital) in each specialty domain.
The practice lead for the CCE contract will ensure that these data sets are reviewed and areas which have increased significantly or where the practice referral behaviours are either well above or below the average across Hackney are reviewed with colleagues in more detail.
This review will include running a search of the practice’s own coded data for the relevant specialities to include:
> Search results of referrals made by named clinicians.
> Search results of use of ‘consultant advice service used’ (if one exists) by named clinician (see Domain 4).
> Search results for ‘possible referral discussed with GP colleague’ twice a year (see Domain 2).
The practice should undertake detailed analysis of one area of referral activity – the area to be decided on by the practice but will probably be one where referral activity is changing and is significantly higher or lower than the C&H average (either through ranking or standard deviation) and ideally an area where evidence exists that an intervention (e.g. education) could be expected to result in an improvement in the quality of patient care and a concomitant reduction in referral activity.
Remember, the practice derived data will be much more up-to-date than that received from Moz (which will continue to be a few months old). Therefore practices may want to focus on areas where they know referral behaviours are changing before waiting for the Moz data to flag this up.
Analysis of, learning gained and plans of action to address issues exposed by these data sets and the in-depth review of one area will be presented for discussion at a practice clinical meeting and shared twice yearly at Consortium meetings.
The CCG leads for this work are Siobhan Harper ([email protected]) and Dr Gary Marlowe ([email protected]).
15. Participate in a CCG review meeting
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During 2015/16 representatives of the CCG (including your consortium lead or GP deputy lead) will visit your practice (at least once) to discuss this contract. This meeting can be with anyone the practice wishes to be involved but must include the GP lead for the CCE contract and the practice manager (or agreed nominee).
The practice is expected to ensure it is fully engaged in the meeting, in preparation for it and for implementing any agreed actions.
16. Medicines Management and Prescribing Incentive Scheme
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NOTE: 16a IS THE ONLY SECTION YOU HAVE TO MEET THE REQUIREMENTS OF THE CCE CONTRACT. 16b AND 16c ARE VOLUNTARY AND ARE PAID SEPARATELY TO REST OF THE CCE CONTRACT.
16a. Entry Level criteria for the Prescribing Incentive Scheme
By July 2015, for the main annual Prescribing Advisor Visit to discuss:
- Medicines management performance during the previous 12 months.
- Action planning for medicines management.
The practice will have 3 subsequent meetings with a Prescribing Adviser / Specialist Pharmacist during 2015/16 covering feedback on:
• The practice’s audits
• QIPP
• Hospital only drugs and unlicensed specials
• Medication + Adherence reviews
• Scriptswitch
16. Medicines management continued
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16b. Audits Non clinical audit: Interface Prescribinga. Reconciliation of hospital letters with PMR Recordsb. Shared Care Guidelines AuditClinical Auditsa. Diabetes: 3rd line diabetic agents b. Antipsychotics: Antipsychotic monitoring
16c. DashboardPractice Epact data to show Practice achievement Jan16-Mar16:
• Percentage of patients issued >15 salbutamol inhalers / year • Percentage of patients on quinolones & cephalosporins • SMBG for patients not on Insulin • Percentage of metformin & metformin combinations as % of all oral antidiabetics• Percentage of analogue insulins % of all insulin • Percentage of patients on incretins for >6mths who have not achieved NICE targets • Volume of antibiotic prescribing • Percentage of formulary choice overactive bladder (OAB) drugs as % of all OAB drugs• Percentage of high risk NSAID prescribing as percentage of all NSAIDs • Percentage of formulary choice 2kcal/ml ONS products % of all ONS products
17. Pan City & Hackney Audits
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17a. Pan C&H audit #1
Supported by the Cancer Lead and CRUK Primary Care Engagement Facilitator, each practice to undertake RCGP audit of new cancer diagnoses.
Each practice to meet to discuss Significant Event Analysis on any delayed diagnosis.
Participate in an annual meeting of the practice with the CRUK Primary Care Engagement Facilitator or CCG Cancer Lead to discuss and share ideas on:
• practice profiles;• audit results and reflection on patient management;• referral dilemmas;• quality of referrals and improving referral practice;• cancer significant event analysis;• comparative practice referral rates for diagnostics & screening• formulate a practice action plan
Participate in an annual feedback meeting at consortium level to share results of audits and SEAs and examples of good practice.
17b. Pan C&H audit #2
Paediatric referral activity - further info from Children's Board
18. Public and Patient Involvement (PPI)
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18a. Newsletter for patients
The practice will disseminate the CCG newsletter for patients on a regular basis. This could include (but not necessarily be limited to):
• Publicising on the practice website • Availability in the waiting room • Distributing via the practice PPG
18b. Involvement in ‘super-PPGs’
The practice and its patients will make attempts to participate in 2 CCG commissioned super PPGs a year working alongside a voluntary sector organisation.
19. Duty of candour
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19a. Recording of concern
The practice will receive a book from the CCG in which any member of staff can record concerns about care quality (including information from patients reported during consultations, PPG meetings, or more informally - e.g. conversations with receptionists). The GP lead for this contract will ensure that the rest of the practice team, both clinical and non-clinical, know where to record these concerns and that the GP lead for this contract is the person to whom concerns about patient care are shared. The GP lead for this contract will review the book prior to each consortium meeting and bring significant issues to that meeting.
When an issue is reported by a patient it is very important to attempt to seek the patient’s consent for their personal details to be shared with relevant parties at the CCG and provider organisation in order for the case to be investigated thoroughly. The patient of course can decline without prejudicing their on-going care. A record of the decision regarding consent needs to be recorded in the patient’s notes.
Any sharing of patient identifiable data must follow the usual rules for information governance.
The recording of concerns via this duty of candour process does not replace an individual’s responsibility (when appropriate) to report serious concerns directly with the provider Trust (again with patient consent) or report it as an SUI. The CCG is giving practices a form to use when wanting to report concerns to the Homerton about individual patient care.
19b. Reporting of concerns at consortium meetings
Each consortium meeting will include on its agenda a regular standing item where issues of quality of patient care will be discussed. The practice will be asked to report on concerns. Agreed concerns will be minuted.
20. Ethnicity
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Consultations with those who do not communicate easily in English or in another language spoken by the member of the primary health care team providing health care or undertaking a consultation are more likely to be 2-3 times as long as a standard consultation. An upfront sum of money is included in each practice's CCE contract allocation to pay for consultations provided to those patients who have indicated they have difficulty communicating in English. The upfront sum is calculated on previous coding as well as flat sum. This includes consultations:
• Mediated by the Newham Language Shop (telephone interpreting)• Where an advocate or interpreter is present, including an employed interpreter• Where family or friends have interpreted
Practices are asked to either continue or start to READ code:• Interpreter present (9NQ0) • Telephone interpreter (9NQ3) • Family member interpreter (EMISNQFA8) • Practice member interpreter (EMISNQPR13)
There is a ring fenced £90k budget for this one element - practices' shares of the budget will be in proportion to use (i.e. coded activity)