NHS City and Hackney CCG Programme Board Commissioning Intentions for 2016/17 City and Hackney CCG and City of London Corporation Commissioning Intentions Event 2016/17 Wednesday 24 th of February 2016 12 pm-2. 30 pm The Bishopsgate Institute 1
Content Children …………. . . Maternity ……………. . Long Term Conditions…………. . Integrated Care and Urgent Care Primary Care Quality…………… Prescribing……………. Mental Health…………. Planned Care…………. . Sustainability and Equality ……. . 2 3 -8 9 -15 16 -19 20 -25 26 -31 32 -39 40 -47 48 -53 54 -58
Children’s Board Commissioning Intentions 2016 -2017
Children’s Services we commission : Homerton Acute (hospital based) services Other Acute Hospital services e. g Royal London and UCLH Homerton Community Health Services Voluntary Sector Community Paediatrics Richard House Hospice Occupational Therapy (respite for Continuing Care and End of Life) Physiotherapy KIDS Sunday club Speech and Language Therapy Audiology Children’s Community Nursing: Generic Children’s Community Nursing: Complex Care Hackney Ark – services for disabled children 4 Tertiary / Specialist care e. g Great Ormond Street (1: 1 respite for disabled Children) Huddleston Centre (escort to and facilitation at leisure centre for disabled children) In addition the CCG Funds: 1) The HUHT ‘Hit Squad’, a team of therapists who support disabled children to access universal settings 2) The Designated Nurse Looked After Children; this post sits within the Looked After Children service commissioned by Public Health Hackney from the Whittington Children’s Mental Health Services are commissioned by the Mental Health Programme Board
Our plans for 2016/17 Service Plan What difference will this make Early Years Our plan is to identify families with medical, psychological and social risk factors early and ensure they have high quality joined up care, pre-conceptually through to school age and beyond. • A consistent service offer, with improved quality of care for our registered patients • Vulnerable women and families’ needs are identified at an earlier point, improving life expectancy and health outcomes • Professionals have clear communication pathways to support women and families, so their experience is of one care pathway across different organisations Our activities with providers will be: • Opportunistic preconception care • Targeted preconception care • Pregnancy presentation – structured appointment • 16 week antenatal appointment • Pregnancy communication and liaison • 6 week postnatal maternal appointment • 6 -7 week baby check appointment • Multi-agency meetings for 0 -5 year olds • Safeguarding responsibilities for 0 -18 year olds • Vulnerable children register and action plans for 0 -5 year olds • Carers register for 0 -18 year olds • 16 th Birthday information pack We want to extend the scope of our Early Years work to: 1)Improve the links between GPs and children’s centres 2)Include the transition to school, and continued communication with the family and relevant key professionals 5
Our plans for 2016/17 continued Service Plan What difference will this make Long Term Conditions • Continue our primary care focus on asthma and diabetes • Ensure all our children and young people with epilepsy have an agreed care plan and access to local clinical support and advice • Extend our offer of Personal Health Budgets to children with long term conditions – make clear and transparent those who are eligible for the pilot • GPs and Homerton Consultants to work on delivering and reviewing new guidelines / pathways for asthma and rheumatology, transition from acute children’s to acute adults services • Review of children and young people with LTCs attending A&E and the provision available to them • Children receive a service that meets their need in the local community, with reduced need to go to hospital • Families know how to access advice and support when they need it • Care is personalised to the individual • Children and their families are supported to make the often big change from children’s to adults’ services Community Health Services • Review services to reflect new responsibilities / focus on integrated care: - Community Paediatrics - Hackney Ark - Occupational Therapy • Continue to maximise the joint delivery of care though Hackney Ark • Explore what community provision we need to reduce unnecessary hospital activity • Review the access all City and Hackney children have to community services • Improved health outcomes achieved through: - Care being delivered closer to home - The scope and accessibility of services being clear - Early intervention based on identified need 6
Our plans for 2016/17 Service Plan What difference will this make SEND • Work with education and social care to deliver Education and Health Care Plans (EHCPs) that meet the needs of children and young people and are co-produced with the child / young person and family • Review what is working well and what needs improvement, leading to an action plan with the City • Contribute to the City’s focus on transition preparation and support • Ensure all relevant health information is on the City Local Offer website • Bring the EHCP and Personal Health Budget (PHB) processes together into one where best for families • Children, young people and their families have joined up care, and have a single process for accessing support and information about local services • The health pathways are clear for all children and young people from 0 -25; including for post 16 s whether or not they are eligible for adults’ services Engagement • Strengthen the engagement we have with existing young people’s and parent / carer forums • Agree an engagement strategy that applies to all children’s services but does not marginalise children with disabilities • The development and commissioning of services are informed by the views of children, young people, and their families • Families have confidence in our approach to engagement 7
Patient and Public Involvement What forms of engagement make most sense in the City? We want to agree an engagement strategy with our Children’s Board PPI Representatives, informed by our recent engagement work: • Children’s Disability Forum - current plans include: Ø Themed forum sessions – proposals include ADHD/learning difficulties/ Epilepsy/Autism and Asperger's/Mental and Physical Health of Parents and Siblings; sessions are expected to be supported by parent testimonies and professional advice Ø Discussion based open group Facebook page Ø Youth forum, working with creative arts organisations Ø Listening posts and feedback from other forums • “NHS Community Voices” meetings, including the “Education and Health Care Plan” meeting held in January 2016; plans to hold a session for young people in the spring • Need to review SEND / EHCP pathways, to include transition to adults services • Early years - engagement via Children’s Centres –intended to support cross health and social care engagement • Work with City Gateway- joining up our consultation and engagement work with established forums well used by young people 8
Maternity Programme Board Commissioning Intentions 2016/17
City of London: Maternity Context • Approximately 110 women registered with a City GP (Neaman Practice) give birth each year. • Approximately 60 women residing in the City of London give birth each year. • The vast majority of these women receive their maternity care from University College London Hospitals (UCLH) – based in the London Borough of Camden / Camden CCG. • UCLH Maternity service as at January 2014 was rated by CQC as overall safe, caring, effective, responsive and well–led. • The main conclusions of the CQC inspection of maternity section showed that: • • • 1 0 • Staff were caring, attentive and professional in their roles. The women felt confident with the care provided. The wards were clean and safe and had good security measures in place to protect women and their babies. Most of the women that we spoke to told us they had positive experiences with the maternity care and felt confidence in the staff that cared for them. Maternity services were being planned to meet the increasing demand by extending the number of beds and recruiting more staff. There was insufficient evidence that all staff learned from incidents and complaints. There was a maternal death in the last year and it was unclear that the lessons learned from the incident had been shared. Midwives were well supported. The ratio of supervisors of midwives to midwives was 1: 16.
Maternity patient surveys • CQC use national surveys to find out about the experiences of people who receive care and treatment. • During the summer of 2015, a questionnaire was sent to all women who gave birth in February 2015 (and January 2015 at smaller trusts). • Responses were received from 184 patients at University College London Hospitals NHS Foundation Trust and 145 from Homerton. • The results from both Trusts are largely comparable to one another, including; • • labour and birth results were worse for both Trusts compared to most other Trusts, Staffing and care results were about the same as most other Trusts. More detailed information can be found at: http: //www. cqc. org. uk/content/maternity- • services-survey-2015 Area of care Homerton scores Labour & birth 1 1 UCLH scores 8 / 10 8. 3 / 10 Staff during labour & birth 8. 4 / 10 8. 3 / 10 Care in hospital after the birth 7. 3 / 10
Local patient and public involvement Maternity Service Liaison Committee (MSLC) • We have used short term funding to buy in voluntary sector support (Social Action for Health) to deliver our maternity patient forum. The emphasis of their work has been on engaging new parents to hear their view on services and helping parents to influence change. This work started in June and has so far reached over 230 parents. Walk the Patch • Our MSLC delivered a patient survey with over 70 brand new mothers and fathers on the Homerton postnatal ward. The report recommendations are being taken forward in our commissioning intentions for 16/17 e. g. • Reviewing waits, triage and the environment for women in labour • Developing projects on advocacy and language support and on compassionate care Involvement in tenders • Our PPI reps have been involved in the development and approval of various short term funded projects. • In addition the reps were panels members for the appraisal of expressions of interests received for the MSLC and targeted antenatal class projects. Maternity Programme Board • We continue to have MSLC patient representatives contributing at our board and now also have feedback from Social Action for health on emerging patient feedback themes at every meeting. • 1 2 We have also reviewed a thematic report on complaints at the Homerton and will be doing this annually from now on.
C&H Maternity plans for 2016/17 • Improve pre-conception care for all women but particularly those with long term conditions and those with several relevant health issues (co-morbidities). • Identify medical, mental health and social risks earlier in pregnancy - by GPs delivering a new Early Years service that includes a dedicated appointment for women to confirm their pregnancy and discuss their needs as early as possible. • Promote and monitor early booking with maternity services (by 10 weeks) to improve outcomes of pregnancy, including timely screening. • Extend continuity of care (seeing the same midwife) into both the antenatal and postnatal periods, to ensure women can develop and maintain a relationship with their midwife. • Ensure we have high quality and safe maternity services; with the aim of reducing neonatal and maternal mortality and severe ill health in light of maternal deaths at the Homerton and the subsequent CQC inspections. This will be achieved by monitoring performance, clinical audits, external review and 1 comparing outcomes to other hospitals. 3
Our plans continued • Ensure women have a good experience of care throughout the pregnancy, during labour and birth and after they’ve had their baby. • Ensure parents can help to shape and influence maternity services in City and Hackney, by listening to patient’s feedback and having a strong patient forum in place (Maternity Service Liaison Committee). • Improve the uptake of the flu and pertussis vaccinations in pregnant women to help stop preventable maternal and infant deaths and severe ill health. • Increase the number of normal births through promoting use of the Homerton birth centre (and home birth teams); emphasising that midwifery led settings are the safest options for women with low risk pregnancies. • Identify vulnerable families earlier and ensure they experience a smooth transition from maternity to early years services, with adequate support in place where needed and input from primary care. 1 4
Our plans continued Joint Hackney Public Health & CCG Maternity Priorities • Improve joint working between Midwives, GPs and Health Visitors • Improve the uptake of healthy start vitamins in pregnant women and children. • Reduce smoking in pregnancy and improve referral rates for women who smoke and want support to stop. City Priorities Provide high quality services in the City to support maternal health, specifically: • Provide high quality perinatal care in the City of London • Assess and identify early maternal mental health concerns and offer subsequent support • Ensure that services are available for any teenage pregnancies in the City of London • All new births in the City are contacted by the Health Visitor • Targeted support for women from low income households to promote good maternal health • 1 An annual birth characteristics report for the City of London 5
Long Term Conditions Programme Board Commissioning Intentions 2016/17
Last year you Said – We Did You Said Extra time with GPs 1 7 “Support the supporters” with training and supervision We have commissioned Hackney Centre for Voluntary Services to provide central training, quality monitoring and support to organisations delivering peer support groups Provide condition specific as well as generic peer support Peer Support We did We are starting with diabetes peer support and focussing on “hard to reach” communities, delivered by community organisations. If successful we hope to roll the programme out more widely Use a range of community venues We need a longer consultation when diagnosed with a long term condition Groups will be delivered from a range of different community venues We commissioned “time to talk” extended GP consultations for people with multiple conditions and extra time for consultation for those newly diagnosed. In the Neaman practice, there are 8860 registered patients, 401 patients with 2 or more long term conditions and 80 “time to talk” consultations have taken place so far (to Jan 2016).
Our plans for 2016/17 • • Continue work on our “virtual clinic” in conjunction with the renal team at Barts hospital for people with renal disease to help identify them early and prevent progression to dialysis or transplant • Provide peer support for people with long term conditions including those with diabetes and the orthodox Jewish community • Roll out the social prescribing service to all GP practices in City and Hackney to help tackle social isolation • Move any patient with a learning disability or autism who is in a long stay hospital out into the community, where it is safe to do so • Provide specialist rehabilitation programmes for those with specific conditions such as heart and lung problems • 1 8 Continue to commission GPs to deliver extra high quality care for people with long term conditions including extra support and treatment targets such as blood pressure control Support people with sickle cell disease to live full lives with input from psychologists and social care professionals
Patient and Public Involvement Over the last year we have consulted with patients and the public in the following ways: - Patient representatives sit on our main Long Term Conditions programme board and many of our condition specific sub boards - Engagement with the public at events including the CCG’s Annual General Meeting, Winter Warmers and Self Care events on our plans and achievements and views on exercise groups at GP practices - Discussions on specific areas such as heart failure services with healthwatch and the Older People’s reference Group - Consultation with the CCG’s patient and public involvement on our plans and service developments - Attendance at community voice events to discuss specific topic areas, such as sickle cell disease - Review of patient experience surveys submitted by many of our services such as “time to talk”; heart failure and sickle cell. We plan to continue discussion via all these mechanisms in the year ahead 1 9
Integrated Care and Urgent Care Commissioning Intentions 2016/2017
What you asked for and what we have put in place for Urgent Care? 1. You wanted - Better access for patients to see their GP for urgent care. Our response. 1. Duty Doctor service ( dedicated GP that takes urgent calls from patients and health care professionals during working hours) are now open earlier and later during the weekdays and also some are open on Saturdays and Sundays) 2. Enhanced access service – most practices 3. Non-clinical Navigators – based at the Homerton accident and emergency department give advice and signpost patients to register with their GP practices and also offer advice around other community based services that patients can self-refer to rather than going to A&E or the Urgent Care Centre 4. Primary urgent care centre – situated at A&E and is a GP led service for urgent illnesses that can be treated by GP’s and nurses. 5. Out of Hours services 2. You Wanted - Better response to patients suffering from crisis at home Our response. 1. 2 1 Para. Doc service – a GP will go to the patients home when they are in a crisis and help them so that they don’t need to go to A&E.
What you asked for and what we have put in place for Urgent Care? 3. You wanted – Improved pathways of care to enable services to work together better in the community – better coordinated care Our response. 1. 2. 3. 4. 5. 2 2 One Hackney & City – lots of different health care professionals working together to help patients receive better care that is joined up Integrated Independent team – A range of services, including rapid response, intermediate care rehabilitation and home-care reablement. Frail Home visiting service run by your GP practices for patients that are housebound and need more coordinated care. More GP’s in the emergency department Social care workers in hospital departments to help patients over 75 that have been admitted to hospital to get back home as soon as possible and prevent delays in discharge.
What we want to do in 2016/2017 for Urgent Care Better Access to GP’s Monitor and develop: Duty doctor, Enhanced access, Out of hours services To communicate more with community pharmacists so they can help shape the Urgent Care Strategy and are fully informed on what services are available so patients can be given the right information whilst in the pharmacy. Continue to explore more opportunities for working across the new urgent and emergency care networks that have evolved from NHS England, to ensure patient are seen in the right place at the right time by the right clinician. Maintain the Primary Urgent Care Centre as a service for patients with urgent care needs so they can be treated by primary care clinicians 2 3
What we want to do in 2016/2017 for Urgent Care Better response for patients suffering a crisis at home. • Support the delivery of the newly developed Para. Doc pathway to ensure complex, frail and elderly patients are treated at home when appropriate to do so. • Work with other borough commissioners to ensure the Local Ambulance Service (LAS) performance continues to improve for its urgent and emergency/Red 1 cases • Engage LAS with continued work to refer into City and Hackney’s community crisis response pathways • Ensure on-going referrals to the newly developed Para. Doc pathway, to improve experience for patients with complex health needs • Continue to support the delivery of the Integrated Independence team and its links with urgent care access points, ensuring patients are treated by the right clinician when in crisis • Monitor the delivery of the action plan to engage care homes and housing with care schemes with the overall crisis response pathway • Continue to work with our patient groups and patient representatives to raise awareness around the right care at the right time every time including self care, primary care and urgent and emergency care when in crisis In addition we also want to improve Secondary Care by; • Continuing to work with the local hospital to ensure the A&E department continues to meet the 4 hr performance target • Explore opportunities to develop outpatient services in the emergency department and look at new models that will improve the patient journey, experience and outcomes 2 4
What we want to do in 2016/2017 for Integrated Care Pathways of care to enable services to work together better in the community - coordinated care. We will continue to develop and support ; • Patient wishes captured in their care plan – care plan shared across all services electronically (if patient consents) • One access number to co-ordinate crisis services across health and social care • Practice MDTs co-ordinate care, supported by a new co-ordinator role • Quadrant working to ensure quality In addition we want to be able to offer better access to end of life services for patients so that: • Patients will be identified as approaching end of life where appropriate • Patients will be supported to express their wishes about care at end of life (these shared where appropriate) and supported to die in the place of their choice • There will be better communication between secondary and primary care about prognosis and conversations about this 2 5
Primary Care Quality Programme Board Commissioning Intentions 2016/17
Commissioning Primary Care Services q In City & Hackney, NHS England is responsible for the commissioning of core Primary Care services q The CCG can fund GP practices to improve the quality of existing primary care services provided that: q the improvement can be expected to improve wider outcomes for the CCG’s population; and q the area team agrees it is over and above what it would expect a GP practice to provide under its existing GP contract. 2 7
Improving Quality in Primary Care Clinical Commissioning & Engagement Contract q 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. q This is 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. q There are 20 domains in which practices are required to adopt certain best practice behaviours and carry out pieces of work, including: q q q In-house discussions of non-urgent referrals Attendance to education sessions Recording of duty of candour issues Reviews of referral activity Audits of care pathways 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 – this directly impacts patients in that they are able to benefit from services closer to home and in community settings. 2 q The contract has been in operation over the past 5 year. We plan to recommission this 8 contract in 2016/17.
What else do we plan to do in 2016/17? q GP IT - support practices to run efficiently through effective IT support. We will commission services from NELCSU for: q q q q IT support staff costs (NELCSU) Helpdesk and engineers (IT support) GP Systems of Choice (EMIS, Vision) Project management (National IT programmes) Management and reporting on IT service Strategic management support Asset management, IT procurement, software licensing Overheads (e. g. hardware upgrades, servers, printers, network security) q Commission support from the Clinical Effectiveness Group - support clinical improvements in primary care through working with CEG to translate new initiatives and research on quality and clinical excellence into general practice in City & Hackney q Quality dashboard – continue to develop and update the primary care quality dashboard to allow identification of areas where practices may need additional support 2 9
Primary Care Strategy This year, the Primary Care Quality Board has worked to develop a strategy for Primary Care in City & Hackney for the next 1 -3 years. Following extensive consultation with our patients and the public, our members, and local stakeholder organisations, the strategy sets out that these are the aims we want to achieve for City and Hackney: ü Be in the top 5 CCGs in London in terms of quality ü Be an attractive place to work for existing and new primary care staff ü Delivery of safe services ü Services that are resilient by being productive, efficient, safe and value for money ü Services that are the first port of call for highly quality, comprehensive patient support ü Services that are accessible ü Reduce health inequalities 3 In 2016/17 we plan to work in partnership with local stakeholders towards 0 delivering the outcomes in line with the Primary Care Strategy.
Key Questions Ø How can patients contribute towards the quality and sustainability of primary care? Ø How can we communicate to the public that primary care in C&H is (generally) good? What are your thoughts on: Ø Saturday morning opening / 7 day opening Ø Booking appointments online Ø Electronic consultations Ø Ordering prescriptions online Ø Are there other priorities 3 1 ?
Prescribing Programme Board Commissioning Intentions 2016/17
You Said – We Did 3 3 You Said Medicines review should be provided e. g. through lunch clubs, Older Peoples Reference groups Dr’s should explain the side effects of drugs. Some patients feel they get given meds they don’t take as they should Patients should be able to ask their Pharmacists what they can expect from their drugs – 10 minutes with the Dr is not enough to find out about their meds Need more information on- drugs that must NOT be stopped suddenly and need to gradual tapering off and also more info on drugs that need step wise loading Medication R/v dates- Patients don’t understand this very well; Those on many drugs – have problems with having to request various medicines at different times – as they all run out at different times – need system to try and ensure patient doesn’t have to make repeated trips to order different meds Patients want to have warfarin testing done at their GP surgery or their community pharmacy. They do not want to test their own blood or change warfarin dose. There are unacceptable waiting times at HUHFT of typically 2 -3 hrs but up to 4 hours We did Much of the feedback we received points to need to help support patients in how to take their medicines From January 2016, we have started to pilot a Domiciliary Medication Review Service. We plan to expand this pilot from the SW Quadrant of the CCG Working with practices to encourage medication review We have also continued to provide a respiratory pharmacist specialist medication review to support those with asthma and COPD (Chronic Obstructive Pulmonary Disease) to make better use of their inhalers and other medicines We plan to work with practices regarding training for non-clinical practice staff on the management of repeat prescriptions. We hope if agreed, the Training Programme will include how non-clinical staff can support patients with advice on repeat prescribing systems. NHS City and Hackney CCG is undertaking a tendering exercise to identify a provider for a new Consultant led Community Warfarin Service in 2016. The new Community Warfarin Service will be a comprehensive, community based, consultant led service for patients on warfarin and will aim to provide a more convenient service, as close to patients’ homes as is appropriate, with reduced patient waiting times.
Reducing Antimicrobial Resistance Why • Antibiotic resistance is driven by over-using antibiotics and prescribing them inappropriately. Keeping levels of antibacterial prescribing low, by only prescribing antibiotics when appropriate, will help reduce the spread of the antibacterial resistance that can be a serious threat to patients who have infections that do not respond to antimicrobial drugs. Why? • Broad spectrum antibiotics need to be reserved to treat resistant disease and should generally be used only when standard antibiotics are ineffective. • In 2015/16, NHS England set targets for CCGs to improve their antibiotic prescribing in primary care by: • Reducing the number of antibiotics prescribed in primary care • Reducing the proportion of broad spectrum antibiotics prescribed in primary care by 10%, or to be below 11. 3% • Identified as a clinical priority in NHS Planning Guidance for Delivering the 5 year Forward View Proposed Service Change The Prescribing Programme Board will lead on this crucial Public Health issue through • Development of patient posters & leaflets promoting antimicrobial awareness in those languages most commonly spoken & read across C&H • Requirement for Practices to undertake 2 sets of Audits to show appropriateness/ prudence of antimicrobial prescribing • Supporting GP antimicrobial awareness education events & provision of training tools • Encouraging practices to reduce range & volume of antibiotic prescribing in line with national requirements • Recruiting a GP Antimicrobial lead to champion this workstream • Developing with Homerton Hospital, local antimicrobial guidelines 3 4
Prescribing for Learning & Disabilities Why In December 2012, the Department of Health (DH) publication “Transforming Care: A national response to Winterbourne View Hospital” highlighted concerns on the over-use of antipsychotic and antidepressant medicines and subsequently commissioned 3 pieces of work to be undertaken by Care Quality Commission (CQC) , Public Health England (PHE) and NHS Improving Quality (NHSIQ) Why? Following the publishing of these 3 reports, NHS England issued a letter in July 2015 to healthcare professionals calling for rapid & sustained action to be taken in order to tackle the over-prescribing of psychotropic drugs to people with learning disabilities after three separate reports highlighted the need for change. In response to these findings, NHS England recommended that: o Healthcare professionals caring for people with learning disabilities assess and keep under review the medicines requirements for each individual to determine the best course of action for that patient, taking into account the views of the person wherever possible and their family and/or carer(s). o Services should have systems and policies in place for that patient to ensure that this is done safely and in a timely manner and should carry out regular audits of medication prescribing and management, involving pharmacists, doctors and nurses. • This is In line with the National Must-Do’s for 2016 -17 in the Planning Guidance for Delivering the Forward View Proposed Service Change 3 5 A learning and disability audit would be undertaken by Practices to assess whether information relating to patient’s level of challenging behaviour, capacity to make decisions about their psychotropic medication and medication review have been recorded. • The learning and disability audit will: o Identify areas in which record keeping needs to be improved in order to determine the best course of action for that patient, taking into account the views of the person family and/or carer(s). o Identify how to improve the management of prescribing medications in this group of patients. o strengthen integrated pathways of care.
Domiciliary Medication Reviews Why • • Patients/public have given feedback that more time is required to discuss their medicines and also medicines wastage needs to be reduced. A recent medicines review survey found that 83% of patients said that there was a need for more support to help manage their medicines better. GPs have highlighted problems with medication use (including oversupply of medicines). Findings from other areas in London who provide domiciliary medication reviews have shown positive results such as reduced acute hospital admissions and subsequent potential cost savings Proposed Service Change • To provide a City and Hackney wide Domiciliary Medication Review (DMR) service by clinical pharmacists, ensuring there is an extensive medication review using patient records, evidence based guidelines and assessments of how medicines are used. This service will help vulnerable patients get the best out of their medicines • To extend this to practice based clinics for patients who are able to come to practices • To work with Practice Support Pharmacists in increasing the number of medication reviews Proposed Implementation The pilot DMR service started in January 2016 and will finish in March 2016. Two DMR pharmacists work closely with GPs, Community Matrons and PSPs to identify and provide support to the following high risk vulnerable patients: • • • Patients who have frequent hospital admissions Patients on complicated medication regimens Patients on ‘high risk’ medicines (e. g. warfarin, digoxin, antipsychotics, opioids, antihypertensives, injectable or medicines via feeding tubes, medicines requiring extensive monitoring) 3 Post review recommendations are discussed with patients and their GP. To ensure integrated care, other healthcare professionals are contacted if needed (e. g. social care, specialist nurses, community pharmacists) with the patients 6 consent.
Disease-Modifying Anti-Rheumatic Drugs (DMARDs) Why • Disease-Modifying Anti-Rheumatic Drugs (DMARDs) are a group of medicines that are used to treat rheumatoid arthritis. They are also used to treat other conditions such as chronic inflammatory skin or bowel disease. Why? • DMARDs require regular monitoring as they can cause side-effects which can be serious therefore patients are required to have regular blood tests. • DMARDs have now been around for a number of years and there an increasing number of patients being prescribed DMARDs. Currently, many patients continue to receive routine monitoring in the hospital which may be inconvenient for patients as prescribing is carried out by their GPs. • By enabling GP’s to carry out both prescribing and monitoring in the community, this would reduce the need for patients to have one set of appointments with GPs for their prescriptions and another set of appointments at a hospital for the monitoring of the drugs prescribed. Proposed Service Change 3 7 • The aim is to review the options for a community based DMARD monitoring service for clinically appropriate patients prescribed a DMARD who have been stabilised in secondary care • The review will involve working collaboratively with secondary care and primary care colleagues and aims to look at the following: • improved patient access offering a more convenient service, with care offered closer to home and with reduced waiting times • strengthened integrated pathway of care • This review will be used to inform the CCG and determine a business model for 2017/18
Consultant Led Community Warfarin Service Why • Currently, patients continue to receive routine care in the hospital and do not have equitable access to community based warfarin services • The current mechanism for warfarin service provision could be more cost effective Proposed Service Change • The new Community Warfarin Service will be a comprehensive, community based, consultant led service for patients on warfarin • The new Community Warfarin Service will be delivered to all appropriate patients registered with GP practices in NHS City and Hackney CCG and will ensure equitable access and quality of service to the entire population group • The overall aims of the service are to improve patient access to safe and effective warfarin initiation and monitoring by providing a more convenient service, as close to patients’ homes as is appropriate, with reduced patient waiting times Proposed Implementation • NHS City and Hackney CCG is undertaking a tendering exercise to identify a provider for a new Consultant led Community Warfarin Service • The new service is anticipated to start in autumn 2016 3 8
Patient and Public Involvement The topic of medication reviews was presented & discussed at July 2015 Patient & Public Involvement Committee & also at the Older People's Reference Group (OPRG) in August 2015. The representatives of both groups were supportive of the concept of medication reviews and a patient & public engagement plan on the proposed service has been developed which includes: Articles for newsletters for Healthwatch City and Healthwatch Hackney. Patient survey using paper forms and Survey Monkey. Presentations to local groups to obtain feedback, e. g. 50+; Community Voice and Barbican Tuesday Club Stalls at the annual conferences for Healthwatch City, OPRG and Hackney Homes winter event. 3 9
Mental Health Programme Board Commissioning Intentions 2016/17
Mental Health - Life in City &Hackney…Starting off well MHPB Commissioning Intentions 16/17 We will… Impact Coordinate improvements to Perinatal Mental Health services • Emphasising the importance of perinatal mental health in early years development and establishing better links with parenting/children’s centre • Introduce evidence-based Parent-Infant Psychotherapy work as part of early years transformation. • Support parents with premature babies to prevent future mental health problems and deliver better pre-conceptual care through early identification of women at risk through pre-conception clinics and Edinburgh screening • Work with the Children’s programme board to promote Mental Health in Antenatal classes and develop Homerton hospital as perinatal mental health friendly. Vulnerable parents are identified and supported early on to ensure mental health and well-being of family is considered. Launch an Autism Assessment service in City and Hackney as part of the borough wide Autism Strategy with a focus on ensuring effective transition and support provision across schools and the local authority. Children with an ASD diagnosis and their families will have recommendations from the assessment service and formal link to SEND plans and school pathways Reducing potential developments of mental health problems in children. Principles of emotional well-being embedded early on through ante-natal class. Adults with an ASD diagnosis will have access to support provision and a specialist assessment service which can advocate for needs of this group 41
Mental Health…Living healthy and Staying Well MHPB Commissioning Intentions 16/17 We will… Impact Improve communication on physical health monitoring between primary and secondary care Promote the importance of prevention in supporting mental health and well-being and embed these principles across all care pathways for example: - depression screening for diabetic template in Primary Care, - MH component of young person’s health check offer in primary care, -5 To Thrive well-being reminder in Recovery Care Plans -Antipsychotic drug monitoring Use existing resources and universal public services to anticipate deteriorating mental health and promote wellbeing to: ensure that all local public services promote positive mental health, support those with mental health needs Greater recognition of importance of both physical and mental health Social resources and networks are in place and recognised to support local people at transition points in residents’ lives (for example, moving house, having a child, losing work, bereavement) Availability of transferable resources on promoting City and Hackney 5 To Thrive – the five ways of well-being for use across health services, community groups, schools, Primary care Work with Providers to consider community-based assets and provision that can provide innovative and / or holistic support to local MH service users Statutory sector services delivered from more accessible, less stigmatised community based locations eg libraries Develop a coordinated and consistent approach to Peer Mentoring / support programmes as early intervention Improved mental health resilience in young people 42
Mental Health Getting help and support when you need it… MHPB Commissioning Intentions 16/17 Establish coordinated employment support for with specific focus on recovering from ill-mental health Through the IPS Model (Individual Placement Scheme) for residents with a severe and/or enduring mental illness co-ordinated through Ways into Work. Lead the 8 borough European Social Fund initiative to procure employment support for people with mental health needs in City & Hackney, as part of an East London-wide project and ensure outcomes monitoring in supported living on access to education, training and employment Impact People recovering from ill-mental health have better access to a more coordinated employment support offer Ensure all local Mental health services are developed in a coordinated way whereby services understand all components and models behind mental health service delivery Alliance working across services with cross-cutting pathways Single point of entry for ease of referral and access Develop a system for Service User Involvement and participation in local commissioning and service design Community groups are adequately represented in participation activities This is across demographics, seldom heard groups, BME communities Ensure culturally sensitive, relevant and inclusive provision Services are designed with local people in mind, therefore increased likelihood of access and continued engagement Support development of coordinated, recovery focused rehabilitation accommodation and implemental health accommodation review Ensuring a recovery-based model of support, enabling Clients to take ownership of their lives and supporting social recovery. Commission a framework agreement for spot placements for mental health supported living The mental health supported living services are key preventative services enabling people to establish and maintain independent living and prevent or delay the need for costlier care interventions e. g. directly contributing to reduction in demand for residential care. Clearer pathway into housing with support in City & Hackney, avoiding the need to move into residential care. Review and update the pathway to ensure access and throughput based on assessed need: Customer journey pathway: improving information (knowing what is available) and access, enabling smooth discharge, links with home treatment and assertive outreach, dual diagnosis, case tracking Improved preventative housing and advice service helping people to maintain or achieve independence Develop local support provision for people with personality disorders Crisis café evening support open to all (i. e. no eligibility criteria), mainstream SUN group projects and integrate PD pathways and have more primary care focus / education and in the longer term, in order to continue reducing PD related admissions Recommission crisis services across CH and include psychiatric liaison in HUH and develop a small pilot in paediatric mental health liaison to assess need. Residents receiving quick timely support for their needs.
Mental Health - Supporting the later years… MHPB Commissioning Intentions 16/17 Ensure a sustainable, holistic approach to dementia support and care The Dementia Alliance will ensure improved outcomes for people with dementia and their carers by ensuring an holistic approach to assessment and effective co-ordination of care and support. The Alliance will continue to promote awareness of dementia and to support the development of dementia friendly communities and environments e. g. by piloting dementia friendly swimming and working with local businesses. Improve hospital discharge processes and community based support Priority will be given to improving hospital discharge processes by supporting GPs and providers to improve care coordination through One City & Hackney and the Dementia Alliance, and by improving access to accommodation Develop effective systems for information sharing between practitioners Short and medium term strategies will be agreed and implemented by commissioners and providers to ensure that IT and other systems support appropriate and effective information sharing between practitioners. Improve carer assessment and support Following implementation of the Care Act, 2014, more work will be done to ensure that all carers are offered an assessment of their needs, and that the help to which they are entitled is provided. Commissioners will work with carers and provider partners to develop a workplan with targets and milestones. The carer’s information pack provided when someone is admitted to hospital will be promoted. Improve access to information, advice, signposting and guidance A co-ordinated approach to providing information about dementia services to City & Hackney residents will be developed across the dementia care system. All providers will be asked to provide up-to-date and accessible information about their services. We will work to increase the % of older people using psychological therapies (incl. digital services) Ensure that services are fit for purpose in the future Commissioners and the Dementia Alliance will refresh the City & Hackney Dementia Strategy working in partnership with other providers and people with dementia and their carers in order to improve outcomes from care and support and meet the needs of the increasing number of people with dementia in City & Hackney to be met 44 Impact The experience and outcomes for people with dementia and their families living in City & Hackney will be positive and will continue to improve. The needs of people with dementia and their carers and families will be identified and addressed in a person centred, personalised way. People with dementia will be supported to live at home and to be active members of their families and communities for as long as possible. Treatment and support will be well co-ordinated and responsive. Crises will be prevented wherever possible; the necessary support and care will be available when they do occur with emergency hospital admissions minimised. Best use will be made of available resources.
Mental Health - You Said – We Did CAMHS: Need wider access and support for young people and extend CAMHS threshold to 0 -25 years Dementia : Early diagnosis , Aftercare, treatment and support should be readily Ensuring a range of support options available including online and face to face support. Involve carers in the diagnosis Lack of autism specific services in the borough. and ensure dementia suffers have care, support and Need continuing support for high threshold communication of resources autism and information for parents on autism available Formed a CAMHS Alliance, focus on embedding use of Outcome measures across all CAMH services, reducing waiting times across all providers, Implementing a Single assessment process for children and families with no wrong door Local Autism Implementation Plan now in place. Have a high functioning ASD assessment service for children aged 5 -13 yrs and Adult Autism assessment service piloting support groups such the one for social skills. 4 5 One City & Hackney Dementia alliance – focusing on improved access and early intervention, working towards a shared register. Community based care packages and dementia friendly communities and Dementia Advisor service to reduce waiting times. Redesigning Dementia pathways to improve access in primary care and community teams. Reminiscence Pods Piloted in 4 residential/inpatient settings. Community action plans to make public spaces dementia friendly. Primary Care: Better integration and use of voluntary sector groups by primary care. Incorporating /prescribing complementary therapies such as meditation and mindfulness and promoting nutrition and prescribe exercise to boost mental and physical health Commissioned ELFT, HUH and voluntary sector providers to provide services that support treatment and recovery of mental ill health. Examples include launch of City & Hackney Wellbeing Network in collaboration with other voluntary sector organisations to support wellbeing and recovery of local residents. Recovery focused Enhanced Primary Care service fully embedded interface between primary, secondary care & community, supporting clearer pathways & linked to the Mental Health Network. Carers and other Vulnerable groups: Extend IAPT to include assessment of substance misuse patients by the CMHT. There should be out of hours support for IAPT with possibility of at home provision. There should be peer mentors and peer support for carers Commissioned with HUH as part of the IAPT programme to provide a range of services to patients. Access via GP and self-referral. All boroughs have a crisis resolution team and we now have a crisis line
Mental Health - Improvements our residents’ will experience by the end of 16/17 Primary Care • More mental health care in primary care by providing more comprehensive services at primary care level more people to treat locally in a familiar setting. • Better links to other services. Through working in partnerships and alliances, barriers between services will be removed creating smoother transitions for patients and more comprehensive care packages • Early Identification and treatment: implementation of mental health register and use of primary care mental health workers will support the early intervention and management of people with MH problems • Mental Health and Physical health – the identification and referral to treatment for people with long term conditions or medically unexplained symptoms will be improved 46 CAMHS • No wrong door. Referrals reviewed across organisations with clearer transitions between tiers and reduction in inappropriate referrals • Increasing Resilience. Work with families and communities to increase resilience. • Stronger community services for eating disorders and perinatal services • Standardised outcome measures across all organisations regularly reported. • Youth justice and crisis pathway better integrated and coordinated. • Autism - Have a high functioning ASD assessment service for children aged 513 yrs • Strong links with schools and community groups including informal parent support for families with children who have disabilities Psych. Therapies • No wrong door. The alliance organisations work together and patients can enter through any organisation. • Closing gaps. The alliance organisations are working together to close gaps in service provision e. g. BME community based therapies. • Better access. More organisations will provide therapies for common mental health problems particularly for hard to reach groups. • Reduced waiting times. Alliance organisations are pooling resources and supporting each other to reduce waiting lists. • More comprehensive care. treatment that might combine psychological interventions with social interventions such as employment work and meaningful activity. Dementia • Pathway re-design to reduce duplication and coordinate care across organisations so patients receive the right treatment in the right place at the right time • Early diagnosis and treatment. Dementia Alliance is piloting two forms of early treatment - cognitive impairment group programme and cognitive stimulation therapy • Improved post diagnostic support and sign posting through the dementia advisory service • Dementia register. More consistent information shared across organisations. • Dementia friendly environments. Reminiscence pods in residential settings and public places made more dementia friendly (DAA) • Staff training in identifying and supporting dementia sufferers - LTw. D training. • More support for carers of people with dementia • Better community resilience through awareness raising
Mental Health - Improvements our residents’ will experience by the end of 16/17 Prevention • Promote importance of prevention in supporting mental health and well-being and embed these principles across all care pathways e. g. depression screening for diabetic template in Primary Care, MH component of young person’s health check offer in primary care, 5 To Thrive well-being reminder in Recovery Care Plans • Suicide prevention 47 Crisis • Create a more integrated pathway across teams and organisations that delivers clinically effective value for money services • Improved communication, information sharing and joint working with police and ambulance • Better and more direct access to crisis service users and carers • A responsive service which sees people in the most appropriate setting and where possible, reduced use of A&E
Planned Care Programme Board Commissioning Intentions 2016/17 PLANNED CARE HOSPITAL & COMMUNITY SERVICES Inc. CANCER
You Said – We Did You wanted more access in the community to Specialist Services: We are developing new multi-location specialist services such as Ear, Nose and Throat (ENT), Minor Surgery, Gynaecology and Ophthalmology which should all be in place during 16/17. You wanted to provide blood samples in your own practice: From Jan 2016 - We commissioned improved blood collection services which will be available to every patient either from their own practice or one nearby (Neaman practice is expected to start services from April). You wanted improved post operation wound care: We are in discussion with GPs around providing a bespoke service for post operation wound care so all non – housebound patients will be able to attend their practice or another close by for this service. We aim to have services up and running from April 2016. You wanted longer GP Appointments: We commissioned from April 2015 half hour appointments from GP practices so every patient diagnosed with cancer could have extra time to talk about their cancer and related issues 4 9
Our plans for 2016/17 The pilot of the expanded Pain Management Service has been successful and it will now be commissioned as a permanent part of the Locomotor service Community services: • Introduce a new gynaecology service model with the Homerton providing a stepped approach across GP practices, community services and secondary care* • New service (s) for urgent eye problems as an alternative to A & E, GP and outpatient services* We have been working with City Healthwatch on how these are developed • With the Homerton plan and develop services to improve care and outcomes for patients with Leg Ulcers • Create a virtual service for dermatology allowing GPs to get specific patient advice from specialists so they can diagnose and start some treatments in practice rather than or before referral* Note: *These support the 18 week pathway as part of the ‘must dos’ for 2016/17 as set out in the elivering the Forward View: NHS planning guidance D 2016/17 – 2020/21) 5 0
Our plans for 2016/17 (cont) Cancer: • Improve access to investigations for GPs (MRI/Ultrasound/Endoscopy etc) • Improve follow up pathways and patient experience – build on time to talk Misc: • Improve the services for patient interpretation services (deaf and non. English speakers) • A new pathway/service for Tier 3 weight management service to ensure appropriate patient access to bariatric surgery. • A new service (on behalf of Public Health England) for latent TB testing in GP practices 5 1
Response to 2016/17 Intentions We are looking for your feedback specifically on the following: 1. Pre operation assessments although essential are time consuming for patients and create an extra step in the pathway to surgery. How do you feel about generally healthy patients being assessed virtually (online/telephone) for some kinds of operation or patients with more complex conditions being assessed by their GP instead of at the hospital? 2. One of our aims is to improve GP access to specialist/consultant advice so some diagnosis and treatments can start before a referral to another service is needed. We may introduce some special photography (dermatology) or video (skype? ) consultations. Would you be happy for new technology to be part of your GP service to enable them to treat you for some conditions in practice rather than refer to the hospital? 3. What other areas of outpatient or community services could be improved? 5 2
Patient and Public Involvement The Planned Care board has done significant engagement with patients in 15/16 including the following: All agreed community service developments have been discussed with the PPI Committee and we will continue to work with City Healthwatch and City patient representatives to develop improvements to planned care services. Ophthalmology: Engaged Healthwatch’s (Both City and Hackney) to consult patients who use current hospital services for their views on providing more eye care in community services. A clinical workshop has involved local patients on possible models for delivering services. Gynaecology: Discussions with various community groups including the Jewish community and travelling community. Community Voice raised the menopause issues and our clinical lead has engaged Hands Inc about the types of these issues that can be addressed in the service design. 5 3
City and Hackney CCG - Eliminating Waste and Inequality
££Stability Reduce CO 2 Eliminate Resilience Equality & Diversity Waste Social Economic Growth Adaptation Value Companionship Resilience Fairness Giving Supporting communities time Access to services Volunteering People’s time Creativity & Potential Social Diet & Exercise Access to Green Spaces Active Travel Inclusion Mobilisation Training & Education Well workforce Health & Wellbeing Living Wage Biodiversity Environment Economic Buying social, ethical Growing Food Innovation & Improve Air Quality Reduce congestion 55 Responsible employer Buying local ££C&H Quality & Compliance Technology Efficient services / operations
Equality & Sustainability Why equality & sustainability Significant overlap between Equality Agenda and many aspects of social value / sustainability. Equality and Diversity is a work stream in Sustainable Development Management Plan. Help staff and stakeholders understand importance of workstream, help to widen the reach of the Equality agenda and avoid duplication. Promote the Equality Delivery System with this SDMP.
Sustainability Commissioning Intentions 16/17 1. Develop & agree commissioning intentions with all providers Input: All contracts develop and agree improvement targets against SC 18 with providers to enhance environment and social improvement. Outcome: Sustainable development, and ‘reducing waste and inequality’, is understood and integrated into service delivery of large providers as a priority improvement area with the CCG commissioning cycle. Improvements will be measurable, and will meet Provider resource capacity. 2. All alliances with C&H sustainable objectives Input: All alliances understand sustainable achievements and priorities, opportunities for providers to share and learn from best practice, and identify support needs. Outcome: Providers of small contracts / alliances agree to implement a sustainable development framework that aligns to C&H CCG objectives (taking own business objectives as a priority). 57
Sustainability Commissioning Intentions 16/17 3. Internal Training & Development Input: Direct and bespoke support to the key leads within the CCG to support the delivery of their SDMP activity, and support wider staff engagement. Outcome: Staff are upskilled to improve delivery of sustainable healthcare; sustainable development and the ‘reducing waste and inequality’ ethos is embedded into CCG operations. 4. Patient and Public Engagement Support Input: Engage the public with C&H CCG SDMP with support from PPI Outcome: Patients / the public engage with and contribute to C&H CCG sustainability plans. 5. Develop SDMP and Annual report Input: Evaluation of the above work programmes to support and develop 2016/17 sustainability plans Outcome: C&H CCG meets requirements of National Sustainability Strategy; Continuous improvement of sustainable development integration in CCG operations. 58
Скачать презентацию NHS City and Hackney CCG Programme Board Commissioning
e9580e597a22c5702cbdd59da9b7a516.ppt