version control sheet - city and hackney ccg us/tenders procur… · date reviewer change reference...

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Version Control Sheet

Document Ref

Status Draft

Programme Board Primary Care Quality Board

Programme Director Richard Bull

Period 01.04.2016 – 31.03.2017

Author Richard Bull/Laurie Sutton-Teague

Spec Approved by NHS City and Hackney CCG Contracts Committee

Spec Approval Date

Revision History

Version number

Date Reviewer Change Reference & Summary

1.0 13/11/2015 R Bull First draft

2.0 20/01/2016 R Bull

Changes made to Version 1.0 following consultation:

Minor clarifications made to following domains:

3a; 3d; 14; 15

Major change made to Domain 13

Domain 17 (Pan Hackney Audit) – audit agreed at CEC 10th Feb 2016

Distribution History

Version number

Date Distributed to Reason for distribution Action

1.0 20/11/2015 PPI Committee 26/11/2015

Consultation (on summary version)

No action required as approved by PPI

1.0 24/11/2015 LMC

2/12/2015

Consultation (done virtually – comments received 30/11/2015)

No action required as approved by LMC

1.0 26/11/2015 GP Forum 3/12/2015

Consultation Respond to comments

1.0 2/12/2015 CEC

9/12/2015


http://www.cityandhackneyccg.nhs.uk/

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1.0 3/12/2015 PCQ Board

10/12/2016


1.0 30/12/2015 Mike Fitchett Consultation No action required as approved

1.0 31/12/2015 NHS England Approval Approved 15 Feb 2016

2.0 20/01/2016 LMC 27/01/2016

Consultation (done virtually – comments received 29/01/2016)

No action required as approved by LMC

2.0 28/01/2016 GP Forum 4/02/2016

Consultation Approved

2.0 4/02/2016 CEC

10/02/2016

Approval Approved

2.0 3/12/2015 PCQ Board

11/02/2016

Approval Approved


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SERVICE SPECIFICATION

Service Clinical Commissioning and Engagement Contract

Commissioner Lead Richard Bull

Provider City & Hackney GP Practices

Provider Lead Identified GP lead

Period 01.04.2016 – 31.03.2017

Date of Review

1 Population Needs There are 43 GP practices in City and Hackney, delivering primary care services to a patient population of circa 301,786 (31st Dec 2015). The objective of this contract is to improve the quality of primary care and to ensure that effective and high quality services are consistent throughout City and Hackney. This is to be done by giving GP Practices clear standards and quality requirements as well as supporting them through sharing good practice and evidence about what care works best for patients. Practices are required to adopt certain best practice behaviours (e.g. in-house discussions of non-urgent referrals, attending education sessions, recording of duty of candour issues) and carry out a number of pieces of work (e.g. reviews of referral activity, pan C&H audit) all aimed at promoting positive commissioning behaviours, and ultimately improving quality of patient care. These activities are all above and beyond what is expected of GP practices under the GP contract, and this has been confirmed by NHS England.

2 Outcomes

1 Preventing people from dying prematurely -

2 Enhancing quality of life for people with Long term conditions -

3 Helping people recover from episodes of ill health or following injury -

4 Ensuring people have a positive experience of care

5 Treating and caring for people in safe environment and protecting them from avoidable harm

-

The contract will contribute towards the PCQ Board’s commissioning intentions which include aiming to promote positive commissioning behaviours in clinicians in order to continue developing the quality of patient care in City & Hackney.


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Historically, this contract has contributed to lower than London average referral rates to secondary care which means that more investment has been able to be made in primary care/community services – the wider benefit to patients is that this means more services closer to home/out-of hospital.

The contract is made up of 4 overarching areas:

Core elements

Ethnicity

Patient and Public Involvement (PPI)

Medicines Management Prescribing Incentive Scheme

See Appendix 1 for detailed breakdown of requirements for each of these areas.

3 Scope of Service

3.1 Service model

The contract is to be delivered by each City & Hackney GP practice individually. Practices are required to deliver all elements of the contract to receive full payment. Practices will record evidence of how they have met the requirements of the contract in year on a contract tracker document and participate in a mid-year review meeting with their consortium lead and a member of the CCG.

3.2 Care Pathways

Not applicable.

3.3 Structural Support

Each practice will be asked to nominate a practice lead GP and deputy who will be responsible for ensuring that the practice is adhering to the requirements of the contract. Consortia leads are asked to monitor engagement with this contract through interaction with the practices at consortia meetings and their mid-year review, reporting any concerns back to the CCG.

4 Applicable Service Standards

Not applicable.


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5 Key Performance Indicators

Please see appendix 1 for the full list of requirements.

6 Reporting Requirements

Practices are required to attend a mid-year review meeting with their Consortium Lead and a CCG representative, and also submit a fully evidenced tracker at year end to evidence their engagement with the contract.

7 Financial and Procurement Summary

7.1 Budget and Payment

Type £

Core budget 923,213

Ethnicity element 90,000

Public and Patient Involvement element 43,000

Medicines Management element 176,000

Total 1,232,213

The total budget for this contract across all City & Hackney GP practices is £1,232,213. The core budget is divided into two pots – A and B. Core budget Pot A is 40% of the core budget. This is made up of a flat rate element (£2504.27). The remainder will be divided amongst practices in proportion to list size (as at 31st Dec 2015). Pot A will be paid to practices following sign-up to the Contract (practices will be invited to sign up before 31st March 2016 ready to go live 1st Apr 2016) – payment of Pot A will be made April/May 2016. Core budget Pot B is 60% of the core budget and will be divided amongst practices in proportion to list size (as at 31st Dec 2015) and is paid on assessed performance. Ethnicity, PPI and medicines management are non-core elements, and are paid as detailed below.

Payment for core contract

Performance on the core contract will be assessed on the basis of submission at year end of a fully evidenced contract tracker – the evidence for assessment will be a combination of practice’ own narrative explaining how it has delivered each element of the tracker together with documentary evidence to support the narrative, embedded in the tracker and available for inspection. The type of documentary evidence required are minutes of meetings that for example record where patients have been discussed with peers prior to a non-urgent outpatient referral being made; certificates of


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attendance at educational events; audits, etc. Where supporting evidence is in paper form (i.e. it can’t be embedded electronically into the tracker) this data should be referenced in the tracker and kept safe by the practice.

Consortium leads will assess practices within their own consortium. Consortium deputies will assess the consortium lead’s practice. The assessment will be based on the tracker. This assessment will additionally be informed by a mid-year review of engagement. Each review will take place between the consortium lead and constituent practice with the addition of one or more non-clinical members of the CCG Primary Care Quality Board (Programme Director; Project Support Officer; Head of Practice Engagement; Education and Training Coordinator) as an observer (Consortium deputies will assess the consortium lead’s practice). The lead reviewer will submit a written an account of each review to the CCG. Consortium leads (or deputies where indicated) will give a GREEN/AMBER/RED assessment rating.

GREEN: the practice has engaged well with the Contract and has provided a complete and well evidenced tracker

AMBER: the practice has engaged quite well with the Contract and has provided an evidenced tracker but with some weaknesses or gaps

RED: the practice has not really engaged well with the Contract and has submitted only a partially evidenced tracker with notable weaknesses or gaps

Practices rated as GREEN will receive 100% of their share of Pot B

Practices rated as AMBER will receive 50% of their share of Pot B

Practices rated as RED will receive 0% of their share of Pot B

Consortium leads and deputies will receive support from the CCG to enable them to conduct fair and consistent mid-year reviews and end of year assessments in the form of two annual development sessions.

As an additional validation a sub-group of the PCQB (the same people who observed the mid-year reviews - Programme Director; Project Support Officer; Head of Practice Engagement; Education and Training Coordinator) will review a random sample of trackers which will include at least one Green tracker per Consortium and all trackers rated as Amber or Red.

Leads will submit their final RAG rated assessments to the Primary Care Quality Board.

The Primary Care Quality Board will meet to make its final recommendation on payments for core elements and non-core elements (see below for details of non-core elements) based on the final RAG ratings from the Consortia and the recommendations of the PPI Committee and Medicines Management Board and the CEG end of year activity report. No employees of Practices will be allowed to take part in this final decision making process. See Appendix 2 for a full indicative breakdown by practice of potential earnings (this will be recalculated using end of year ethnicity recording data).


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Practices will receive one year end payment comprising any qualifying payments for Pot B and the three non-core elements.

Payment for non-core elements

Ethnicity

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. This element of the Contract is to recognise the additional work this requires of practices. The full available budget of £90,000 will be paid to practices in proportion to their amount of READ-coded activity as collected and reported by CEG, at year end (activity recorded from 1 Apr 2016 to 31 Mar 2017).

Qualifying READ-coded activity:

• Interpreter present (9NQ0)

• Telephone interpreter (9NQ3)

• Family member interpreter (EMISNQFA8)

• Practice member interpreter (EMISNQPR13)

PPI

See core specification 18a and 18b on page 17 for the requirements (unchanged from last year). Successfully engaging practices will be paid £1000 each, flat rate.

Medicines management prescribing incentive scheme

The CCG’s Medicines Management Board will assess each practice’s engagement with the requirements of this element and advise the Primary Care Quality Board of their overall recommendations for payment. Practices successfully delivering all the requirements of this element will be paid the equivalent of £0.58 per patient. 16a is part of the core CCE Contract specification and does not attract separate funding.

2016/17 Medicines work stream of Clinical Commissioning and Engagement Contract

Evidence to be submitted Payment

Section A: Entry Level for CCEC - Prescribing

1. The practice will meet the prescribing advisor at least four (4) times during the financial year.

a. The 1st meeting – the annual prescribing visit must

be undertaken by 30th June 2016. The primary

purpose of this initial meeting is :

o Action planning for 2016/17 & in particular

to understand the basis of required work

Copy of Post-Visit Letter from Practice Pharmacist including agreed action points

Part of Core CCE Contract


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including audits and QiPP

b. The Practice will in addition to 1a, have three (3)

subsequent meetings with Practice Pharmacist /

Specialist Pharmacist during 2016/17 to include

progress & feedback on:

Prescribing Performance during previous

12 months

Medication Review

QiPP programme

Audits

ScriptSwitch

Any Specialist Review e.g. Respiratory

Practice’s submission of action points agreed at these 3 meetings

Section B: Audit Levels for CCEC - Prescribing

2. Bi-annual submission of Reviews of Prescribing data on ‘Restricted Prescribing List’

Review data on:-

Dressings

Hospital only/ Non-Formulary

Specials

Each Practice must submit data

outcomes forms, no later than

29th July 2016

(review of latest 3 month data)

31st January 2017

(review of latest 3 month data)

Plus

Dressings:-

Q4 2016/17 epact data must

show 95% reduction from

baseline (Jan-Mar 2015) on

costs of FP10 dressings (that

are available via dressings

store)

Practice support

pharmacist time

provided by the

CCG and incentive

of 2p per

registered patient

for prompt

submission of

Practice’s Data

Outcomes Forms

and Prescribing

achievement for

dressings

3. Repeat Prescribing Training Each Practice must ensure that

their Admin & Clerical Staff (who

support the practice’s repeat

prescription functions) have

participated in a training session

delivered by a Practice Support

Pharmacist by 31.01.2017

Practice support

pharmacist time

provided by the

CCG and incentive

of 2p per

registered patient

for prompt

submission of

Practice’s

Learning & Action

Points

4. Clinical Audit 1 –

Learning Disabilities Audit

Medicines Management Receipt

of Practice Audit & Re-audit by

28.10.2016; 28.2.2017

Practice support

pharmacist time

provided by the

CCG and incentive

of 2p per

registered patient


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Each Practice must submit a

Summary report which outlines

what the Learning from the Audit

has been & the Practice’s Action

Plan, no later than

Audit:- 28 October 2016

Re-Audit:- 28 February 2017

for prompt

submission of

Practice’s

Learning & Action

Points

5. Clinical Audit 2 –

Clinical Audit & Training - reducing

Antimicrobial Resistance

Antibiotics Audit

Patient Education – through

poster/ leaflets

Antimicrobial Training - TARGET

Medicines Management Receipt

of Practice Audit & Re-audit by

30.11.2016; 28.2.2017

Each Practice must submit, a

Summary report which outlines

what the Learning from the Audit

& TARGET training have been &

the Practice’s Action Plan, no

later than

TARGET Training:- by 30

September 2016

Audit:- 30 November 2016

Re-Audit:- 28 February 2017

Display of Antibiotic Poster

Provision of Leaflets – confirmed via PSP

Practice support

pharmacist time

provided by the

CCG and

incentive of 2p per

registered patient

for prompt

submission of

Practice’s

Learning and

Action Points

Practices that submit the Summary of Learning Points and Action Plan, by the due dates for all 4 audits will be incentivised with a payment of 58p per registered patient


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6. The Practice will actively engage in the Medicines QiPP Agenda & reach stipulated thresholds [threshold figures will be made available to practices as soon as these are finalised]

MMT will: provide QiPP dashboard at least quarterly

Practice will review prescribing against QiPP

indicators, demonstrate improvements and reach

thresholds for the 10 indicators below:

a. % Low dose inhaled corticosteroids (ICS) as % of all ICS [↑]

b. Most cost effective choices of low/moderate inhaled corticosteroid-long acting beta-agonists (ICS-LABA) as a % of all ICS-LABA combination inhalers [↑]

c. ADQ per STAR-PU for benzodiazepines

(indicated for use as hypnotics) and z drugs [↓]

d. % of Morphine, as a % of all strong opioids [↑] e. Tramadol – Defined Daily Doses (DDDs) per

1000 patients [↓] f. % of analogue insulins prescribed as % of all long

acting and intermediate insulins [↓]

g. % broad spectrum antibiotics prescribed

(cephalosporins, co-amoxiclav & quinolones) [↓]

h. % of metformin and metformin combinations as a

% of all oral anti-diabetes drugs (BNF 6.1.2) [↑]

i. Pregabalin Spend Cost per ASTRO-PU[↓]

j. Emollients Cost per 1,000 ASTRO-PU [↓]

Dashboard Quarter 4 2016/17

Dashboard with Epact data Q4

2016/17 data will be available in

June 2017

Practices are encouraged to access monthly and then review, their current QiPP status on the secure site of the Prescribing site

Payment

5p per

registered

patient for

achieving

each of the 10

prioritised

indicators on

Action No 6 ,

so max total

50p per

registered

patient for

achieving all

10 indicators

Max 58p per registered patient for all work within the Medicines Workplan submitted to [email protected] by due dates

Summary of deadlines for Medicines work stream of CCE All work must be submitted to: [email protected]


mailto:[email protected]


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Deadline date

Submission of Who submits Tools to support

29.07.2016

Prescribing Advisor Visit Letter Showing:

Visit was undertaken by 30.06.2016 & agreed

Action Points

Practice Support Pharmacist (PSP)

N/A

29.07.2016 Review of prescribing data on

Dressings

(review of latest 3 month

data)

Designated Practice Support

Pharmacist

Web link will be provided to Practice data


Hospital only/ Non-Formulary drugs


data)


Specials (review of latest 3 month

data)

30.09.2016

Summary report outlining

what the Learning from

TARGET training have

been & the Practice’s

Action Plan

Practice submits Summary of

Learning & Action Points

TARGET Antibiotics Toolkit: http://www.rcgp.org.uk/TARGETantibioti

cs

28.10.2016 Learning Disabilities Audit

Practice submits Summary of


Practice Support Pharmacist

submits actual Audit results

Web link will be provided to audit template

30.11.2016 Antibiotics Audit Practice submits Summary of



submits actual Audit results

Web link will be provided to audit template


http://www.rcgp.org.uk/TARGETantibiotics

http://www.rcgp.org.uk/TARGETantibiotics

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Deadline date

Submission of Who submits Tools to support

31.01.2017 Evidence of training: all admin & clerical staff (who

support the practice’s repeat prescription

functions) must have participated in a training session delivered by a


Practice submits a copy of

attendance at training provided

by PSP

PLUS

an indication of the proportion of relevant staff who

have received training

Repeat Prescribing Training Pack (to be made available through PSP)


Dressings


data)

Plus

Q4 2016/17 epact data

must show 95% reduction

from baseline (Jan-Mar

2015) on costs of FP10

dressings (that are

available via dressings

store)

Designated Practice Support

Pharmacist

Web link will be provided to Practice data


Hospital only/ Non-Formulary drugs


data)


Specials (review of latest 3 month

data)

28.02.2017–

Re-audit

Re-Audit of Learning Disabilities Audit


Web link will be provided to audit templates

28.02.2017–

Re-audit

Re-Audit of Antibiotics Audit



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8 Proposed Contractual Terms

The intention is to make this contract available to all City & Hackney GP practices.

Each City and Hackney GP practice will be contracted to deliver the service specification via the NHS Standard Contract. Delivery of the service specification is to commence on 01/04/2016, for a duration of 1 year.

- Type of contract proposed (NHS Standard contract, Grant agreement, Alliance contract) NHS Standard Contract

- Service Commencement date 01/04/2016

- Initial term of service and expiry date 1 year

- Option to extend the initial term? If so, on what basis? No

- Details of proposed sub-contractors None

- Contractual interdependence with other existing services / providers None


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Appendix 1 No. Domain Description

1 Contract lead The practice will identify a GP to act as Contract lead (referred to as Contract

or practice lead throughout the Tracker) and another GP to act as a deputy

Contract lead. The practice will inform the CCG and its consortium lead of

both names on sign-up.

The Contract lead and 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.

2 Routine discussion of all

non-urgent referrals

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.

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 EMISNQPE50 "peer review of

prospective referral carried out" 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 (NB we acknowledge that the discussion may

happen after the referral has been made on Choose and Book/e-referral

system so it won't be ""prospective"" but please use this code anyway).

The CCG and CEG will co-design a template and search to facilitate data

entry and usage.

The practice will run a search on the EMISNQPE50 code twice a year and

use the information as part of the biannual review of referrals (see domain

14).

The Contract lead 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 year (and where relevant,

fed back to individual clinicians if their undertaking of referral discussions

differs significantly from their peers).


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No. Domain Description

3a Engagement with CCE

contract accredited

education events

The Contract lead is responsible for ensuring practice engagement with CCG

accredited education sessions. Increase support through education:

For practices with patient list size >5,500, a 25% increase in the undertaking

of CCG accredited education sessions (from 12 sessions to 15 sessions),

offset by an increase in % that practices can attend via Webinar (and see

below).

Of the 15:

Attendance at CCG accredited Masterclasses can contribute a

maximum of 3 of the 15

Attendance at CCG accredited consortia-based or practice-based

education sessions can contribute a maximum of 3 of the 15

If a practice wishes, attendance at 15 ‘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 6 sessions over the

course of the 2016/17 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 CCG webinar policy).

Information from each of the 15 sessions must be cascaded (and refreshed)

throughout the practice.

For practices with patient list size <5,500 requirement remains at 12 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 2016/17 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 CCG webinar policy).

Information from each of the 12 sessions must be cascaded (and refreshed)

throughout the practice.

The leads for this domain are Paula Stanley ([email protected]) and

Curtis Whyte ([email protected]).



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3b Adherence to pathways The Contract lead 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 use the DXS system (where functioning

appropriately) to support pathway adherence.

3c Acting on any feedback

from provider services

following referral

The Contract lead will be the main point of contact for feedback reports from

Homerton consultants (if/when data is received) on pathway adherence and

clinical appropriateness of referral activity.

The Contract lead 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 cancer related educational events.

All practices to send a representative of clinical/non-clinical staff to two

CCG accredited cancer related educational events.

Event 1: Details to follow

Events 2: Details to follow

Attendance at these education meetings forms 2 of the accredited sessions

(see 3a above) practices must attend (and cascade learning from to

colleagues) over the course of the contract year.

The CCG leads for this work are Siobhan Harper [email protected] and

Dr Gary Marlowe ([email protected]).

4a Using consultant advice

services

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

EMISNQC0234 "consultant advice service used" will need to be entered into

the patient’s notes.

The CCG will provide a template to ease the entry of referral related codes.

The practice will run a search on the EMISNQC0234 code twice a year and

use the information as part of the biannual review of referrals (see domain

14).


entry and usage.

The Contract lead will ensure that there is a process within the practice for

the data to be fed back to individual clinicians if their use of consultant

advice services differs significantly from their peers.

4b Review of data The practice will also receive biannual information (Homerton derived data)

from the data analyst (Moz) at the CCG on use of consultant advice services

from the CCG.

The Contract lead 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).




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4c Cascading information

about how to use existing

and new consultant

advice services

throughout the practice

The GP Contract lead will ensure that information on how to use CCG

consultant advice services is made easily available to all clinicians (including

long term locums) and that there is a process within the practice to share any

learning from the advice provided across the full clinical team.

The Contract lead 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 let practices know when a new advice service is launched or

an existing advice service has been refreshed.

5a In-house review of

locum non-urgent

referrals

The practice will have a system to ensure all non-urgent OPD referrals being

proposed by a locum 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 long term / regular

locums and recently appointed clinicians.

This will include ensuring that long term / regular locums and recently

appointed clinicians are introduced to CCE contract and tracker with a

discussion about clinical commissioning behaviours. This will include:

referral reviews, use of pathways, education activities, audits, review of

hospital activity and the POLCV policy.

6 Adhere to the most up to

date version of the

Procedures of Limited

Clinical Value policy

(POLCV)

The practice will have a system in place to ensure the most recent version of

the Procedure of Limited Clinical Value (POLCV) policy is adhered to and

that supporting information is made easily available to all clinicians

(including long term / regular locums and recently appointed clinicians).

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

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.

8a Information Sharing &

Governance

Supported by the CCG’s Duty Doctor contract with the Confederation, the

practice will have a robust system in place across administrative 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 fax-backs from the Homerton and

other 2ry care providers (gradually being replaced by the HIE system) in

relation to patients acutely attending A&E and return these within 3 hours of

receipt.

The practice will also fax (or send electronically when possible) care plans if

asked (details, when available, to be provided by the Care Planning and

Integrated Care Steering Group - [email protected]).


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8b Data Sharing When necessary, 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 leads for this sub-domain is Dr Niifio Addy [email protected] and

Mark Scott ([email protected]).

8c Sharing information with

Out of Hours provider

Practices will share ‘special patient notes’ with the local Out of Hours

service. Further information to be provided by City and Hackney Urgent

Healthcare Social Enterprise (CHUHSE).

The lead for this area of work is Dr Victoria Holt and Mark Scott

([email protected]).

9 Consortium Meetings The practice will attend at least 80% of its consortium meetings (e.g. 5/6 OR

9/11 depending on how often – and for how long – your consortium

meets/year), to input into discussions and cascade any information to all

relevant staff in the practice (practice meetings, email etc).

A GP must be present at least 4/6 OR 7/11 of these meetings - the practice

manager can otherwise deputise at some meetings.

Information from the meetings must be cascaded through the practice to

relevant staff (practice meetings, email etc).

10 Clinical Commissioning

Forum Meetings (CCF)

The practice will attend at last 9 of the planned 11 CCF meetings to input

into discussions. Attendance can be either by the GP Contract Lead, another

GP, the practice manager or a practice nurse.

The Contract Lead or another GP must attend at least 7 of the meetings.

Information from the meetings must be cascaded through the practice to

relevant staff (practice meetings, email etc).

11 Acting on newsletters The practice will have systems in place to ensure that all CCG newsletters

are cascaded to 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

During the course of 16/17 the practice might be required to provide

information (within reason) to the CCG on adherence by providers (e.g. the

Homerton) to CQUIN targets, where they exist.

Although this has not happened during the last three years, some practices

will be asked to undertake the following piece of work:

CQUIN for palliative care.

Up to 5 practices will be asked to look back over the discharge summaries

relating to 5 adult patients who have died (excluding accidents), to see

whether the Homerton had indicated in their discharge summaries that the

patient was expected to be in the last year of life - further details and timings

from the CCG's Palliative Care Board chaired by Meena Krishnamurthy.





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13 Review of high users of

services:

See below

1. frequent attenders at

A/E

Each consortium will have discussions with representatives from the

Homerton Hospital’s Frequent Attenders’ Group at least once in the year to

discuss patients who are high attenders at A/E.

The Frequent Attenders’ Group will provide cases for review and before the

meeting alert individual practice leads of the details of any patient registered

to their practice in order for them to familiarise themselves with their cases.

Case-based discussion can include review of care plans, multidisciplinary

working, communication and general mutual learning. The outputs of the

meeting will be captured in the minutes of the consortia meeting and sent by

consortia leads to Curtis Whyte for distribution to the relevant CCG

Programme Board(s).

Information and learning from the meeting must be cascaded throughout the

practice to relevant staff (practice meetings, email etc).

2. Sharing learning from

quadrant

multidisciplinary

meetings

Each practice will need to cascade information and learning generated from 3

out of the 4 annual quadrant meetings throughout the practice to relevant

staff (practice meetings, email etc).

The CCG leads for this work are Mark Scott [email protected] and Dr

May Cahill ([email protected])




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14 Biannual Review of

referrals

The practice will use the EMIS referral management template to ensure all

routine referrals are coded both by specialty and against the name of the

referring clinician (or ‘locum’) prior to the referral leaving the practice.

Twice a year the practice will review a dataset received from the CCG’s data

analyst - Moz (sent to practices May/Jun 2016 and Nov/Dec 2016) showing

referral activity and hospital derived data of use of consultant advice

services (generally inconsistently recorded by the hospital) in each specialty

domain.

The Contract lead 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 specialties to include:

• Search results of referrals made by named clinicians

• Search results of use of "consultant advice service used" (in areas

where such a service exists) by named clinician (see Domain 4)

• Search results for "peer review of prospective referral carried out"

twice a year (see Domain 2)


entry and usage.

The practice should undertake detailed analysis of one area of referral

activity – the area to be decided upon 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.

Alternatively, a practice could repeat a previous audit where referral activity

has ‘improved’ to better understand and consolidate the factors that led to the

change.

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])




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15 Participate in a CCG

review meeting

During 2016/17 representatives of the CCG (including your consortium lead

or GP deputy consortium 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 Contract Lead 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.

Practices will review and discuss their activity against the Primary Care

Quality Dashboard at a consortium meeting at least once in the contract year.

Practice leads to cascade any learning (via practice meetings emails etc) to

relevant staff following the meeting.

16a Entry Level criteria for

the Prescribing Incentive

Scheme

The practice will meet the prescribing advisor at least four times during the

financial year.

a) The first meeting – the annual prescribing visit must be undertaken by

30th June 2016. The primary purpose of this initial meeting is action

planning for 2016/17 and in particular to understand the basis of required

work including audits and QiPP

b) The Practice will in addition to the above have three subsequent meetings

with Practice Pharmacist / Specialist Pharmacist during 2016/17 to include

progress and feedback on:

Prescribing performance during previous 12 months

Medication Review

QiPP programme

Audits

ScriptSwitch

Any specialist review e.g. of Respiratory/CVD

16b Audit level Bi-annual submission of reviews of prescribing data on ‘Restricted

Prescribing List’

Review data on:

Dressings

Hospital only / Non-formulary and Specials

Repeat prescribing training

Clinical Audit 1: Learning Disabilities audit

Clinical Audit and Training: reducing antimicrobial resistance

Antibiotics audit

Patient education through poster/ leaflets

Antimicrobial training “TARGET”


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16c Dashboard level The practice will actively engage in the Medicines QiPP agenda and reach

stipulated thresholds [threshold figures TBC]

MMT will: provide QiPP dashboard at least quarterly

Practice will review prescribing against QiPP indicators, demonstrate

improvements and reach thresholds for the 10 indicators below:

1. % Low dose inhaled corticosteroids (ICS) as % of all ICS [↑]

2. Most cost effective choices of low/moderate inhaled corticosteroid-

long acting beta-agonists (ICS-LABA) as a % of all ICS-LABA

combination inhalers [↑]

3. ADQ per STAR-PU for benzodiazepines (indicated for use as

hypnotics) and z drugs [↓]

4. % of Morphine, as a % of all strong opioids [↑]

5. Tramadol – Defined Daily Doses (DDDs) per 1000 patients [↓]

6. % of analogue insulins prescribed as % of all long acting and

intermediate insulins [↓]

7. % broad spectrum antibiotics prescribed (cephalosporins, co-

amoxiclav & quinolones) [↓]

8. % of metformin and metformin combinations as a % of all oral anti-

diabetes drugs (BNF 6.1.2) [↑]

9. Pregabalin Spend Cost per ASTRO-PU[↓]

10. Emollients Cost per 1,000 ASTRO-PU [↓]

17 Pan C&H audit Ultrasound and endoscopy – details to be agreed by Planned Care

Programme Board

The CCG leads for this work are Siobhan Harper [email protected]

and Dr Gary Marlowe ([email protected])

18a Newsletter for patients The practice will disseminate the CCG's patients' newsletter "Checking the

Pulse" 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 “NHS

Community Voices"

The practice and its patients will make attempts by advertising (which can

include, but is not limited to, any or all of the following: the PPG; text

communications; the practice website; posters at reception etc) to participate

in two of the CCG’s PPI committee’s commissioned meetings for patients

and the public run by NHS Community Voices.

18c Improving patient

feedback

The aspiration in the CCG’s primary care strategy is “in three years all

practices to be above London average for patient satisfaction”. To do this we

need first to understand better patient feedback for current satisfaction

measures: the national GP Patient Survey and the Friends and Family Test.

In the 16/17 CCE contract practices will work with their PPGs to collect

additional patient satisfaction data using recognised metrics (compatible with

the GP Patient Survey and the Friends and Family Test).




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19a Sharing of concerns /

celebrating achievements

The practice has 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 Contract Lead will ensure that the rest

of the practice team, both clinical and non-clinical, know where to record

these concerns and that the Contract Lead is the person to whom concerns

about patient care are shared. The Contract Lead 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 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 a significant event

or SUI. The CCG has given practices a form and email to use when wanting

to report patient identifiable concerns directly to the Homerton.

Practices are encouraged to note, share and reflect on other elements of

patient’s care; especially examples of good care, SEAs and interesting patient

narratives. The same process of practice staff recording then sharing at

consortia meetings will be encouraged (including consortia meetings

providing standing item space on their agendas for this to happen).

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 and share example of good care (see above).

The outputs of the discussions will be captured in the minutes of the

consortia meetings and sent by consortia leads to Curtis Whyte for

distribution to the relevant CCG Programme Board(s). In addition, consortia

leads can escalate concerns directly to colleagues in the CCG and/or report

them at a Clinical Executive meeting.


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20 Ethnicity 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. This element of the Contract is to

recognise the additional work this requires of practices which 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 continue using the following READ codes:

Interpreter present (9NQ0)

Telephone interpreter (9NQ3)

Family member interpreter (EMISNQFA8)

Practice member interpreter (EMISNQPR13)

The full available budget of £90,000 will be paid to practices in proportion to

their amount of READ-coded activity as collected and report by CEG, at year

end (activity recorded between 1st April 2016 to 31st March 2017)

With reference to the Primary Care Strategy – action point 9: all quality

measures in primary care can be analysed by age, sex and ethnicity and the

six other protected characteristics set out in the 2010 Equality Act, possibly

extend to other characteristics such as class; risk factors, etc.

CCE 16/17 requirement: for newly registered patients (only): practices to

request patients complete a CCG form (to be made available) to collect and

record protected characteristics (disability; gender reassignment; marriage

and civil partnership; pregnancy and maternity; religion and belief; sexual

orientation; sex; ethnicity/race; age).

Practices will enter data onto the EMIS system (the CCG will provide coding

guidance). Practices will need to demonstrate that they are offering patients

the form (i.e. they will not be judged by the number of completed forms etc).


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