Locality Meeting15 May 2014

Co-commissioningPrescribingUrgent care and Health & IndependenceUpdate on RAIDR CCG feedbackEPaCCs  reminder 

Co-commissioning • Simon Stevens (NHS Chief Exec) has announced an option for CCGs to co-

commission primary care services• Expressions of interest are required by 20th June 2014 (from interested CCGs)

• Largely relates to GP services

• Scope– 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• 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

– 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?

• Some proactive approaches from practices expressing interest that those involved in the delivery of primary care should be shaping primary care services.

• 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

 

• 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 CareKey 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 self-care 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

• 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

• Community based locations serving urgent care needs• Step-up beds• Explore access to diagnostics and minor injuries

Urgent Care Services co-located with A&E facilities

• 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’

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 engagementFurther 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

Issue/Query Outcome/UpdatePractices are having issues with contacting the CCC (Care Coordination Centre), with the service having no capacity and asking practices to call back

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 iesccg.gp-contract-queries@nhs.net with the detail.

Practices are having problems getting hold of the RAAC

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 iesccg.gp-contract-queries@nhs.net with the detail.

Practices have not been given enough time with the Suffolk Federation to discuss the Over 75s work

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 iesccg.gp-contract-queries@nhs.net

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 each other and the CCG on this

The CCG will continue to offer support to practices and is happy to work with practices taking into account the CURRENT commissioning environment

To raise a query, you can email iesccg.gp-contract-queries@nhs.net The mailbox is monitored twice daily, issues are then logged and a response should be available within 20 working days.

Issue/Query Outcome/UpdatePalliative 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

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.

The CCG has noted this query however requires more detail in order to be able to investigate fully. Please email iesccg.gp-contract-queries@nhs.net with full details so that we can investigate.

IHT forms – can these be standardised with SystmOne and EMIS?

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 ipswichandeastsuffolk.ccg@nhs.net and we will look into it.

ALL Spinal and MRI referral forms

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.

Problems with Neurology not seeing patients

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 iesccg.gp-contract-queries@nhs.net 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

(AA) Admission Avoidance | (C) Capacity | (ESD) Early Supported Discharge

Top 5 Patient Flow Winter Schemes 2013-14

Evaluation Based

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)

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

Weekend Diagnostic, Therapies and Pharmacy

(AA/C/ESD)•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

Community Escalation Beds and Discharge Planning Nurses

(AA/C/ESD)•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

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