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Gloucestershire Health and Care Overview and Scrutiny Committee (HCOSC)

15 September 2015

NHS Gloucestershire Clinical Commissioning Group (GCCG) Clinical Chair and Accountable Officer’s Report

1. Section 1: National Update

These are items are for information and noting.

1.1 Department of Health ConsultationsInformation regarding Department of Health consultations is available via the GOV.UK website https://www.gov.uk/government/publications?publication_filter_option=consultations This website also includes Government responses to closed consultations.

IPSIS: call for evidence. This consultation seeks views on how the new Independent Patient Safety Investigations Service (IPSIS) will work.

An Expert Advisory Group (EAG) has been set up to make recommendations on how the new investigation service should work, and is seeking views from a wide range of stakeholder. It wants views on 5 related themes:

independence, governance and accountability engagement and transparency what IPSIS should investigate supporting improvement and learning people, skills, operation

https://www.gov.uk/government/consultations/ipsis-call-for-evidence

This consultation closes on: 31 October 2015 at 11:45pm

1.2 Department of Health PoliciesThe following weblink provides access to Department of Health Policies:https://www.gov.uk/government/policies?keywords=&topics%5B%5D=all&departments%5B%5D=department-of-health&commit=Refresh+results

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2. Section 2a: Local NHS Commissioner Update, Gloucestershire Clinical Commissioning Group (GCCG) excluding Primary Care Commissioning (GP services)

These are items for information and noting.

2.1 Devolution Bid for Gloucestershire

Gloucestershire is facing an opportunity to bring together the experience, skills and enthusiasm within the county, as the Government is looking to devolve more powers and responsibilities locally. Ten of Gloucestershire’s public sector partners, including the CCG, have come together to have a conversation about what potential greater devolution has to improve outcomes for our population.

From the CCG’s perspective, strengthened partnerships have real potential to improve health and wellbeing e.g. links to housing, environment, transport, employment and regeneration. We have agreed in health that we need more focus on prevention and self-care and this proposal would result in greater control of resources to meet the needs of local people.

There is no-one-size-fits-all structured process, or compulsion to do this. However, Greater Manchester and Cornwall have already signed devolution arrangements and a number of other areas are considering their options and developing proposals.

What’s happening in Gloucestershire?

At this point our ideas are just that, no way forward has yet been agreed, or discounted. A statement of intent for devolution (www.gloucestershire.gov.uk/devolution) was submitted to Ministers on 27 July 2015. This provides an overview of the potential scope of devolution locally.

This document was signed by the CCG, the GFirst Local Enterprise Partnership (LEP), the Gloucestershire Constabulary and the Office of Police and Crime Commissioner and the seven councils (County and District). This was done within a tight timescale, but there is no binding commitment from the CCG, or other partners, at this stage.

Since submitting the statement, the Government has confirmed the deadline for detailed bids is 4 September 2015. The Government has set this deadline so it can select and negotiate on bids in time for the Chancellor of the Exchequer to announce further devolution deals in his public spending review statement on the 25 November 2015.

The CCG has been working with partners on this bid, which includes a focus on improved health and wellbeing. It highlights our shared vision of a joined up Gloucestershire where we work in partnership with individuals, carers and local

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communities, to prevent ill health wherever possible and to ensure that high quality care and support can be sustained.

Our understanding of Devolution

Devolution would not replace existing organisations. There would need to be some form of legal partnership body which would be democratic, accountable and effective and would have representation from each organisation.

From a health and social care perspective, this would build on the close working relationships already in place, for example through the Gloucestershire Strategic Forum and the Health and Wellbeing Board.

Next Steps

If the ‘We are Gloucestershire’ bid is successful, local partners would undertake a detailed review before making a final decision. The CCG is clear that its response to any proposed (and detailed) local devolution arrangements would be influenced first and foremost by the needs of patients, carers and communities and the views of health and social care partners.

2.2 Any Qualified Provider (AQP) Process/Cirencester Hospital Day Case Surgery

The procurement process to replace the existing Care UK contract, which is due to expire at the end October 2015, is being led by NHS South, Central and West Commissioning Support (SCWCS). Following the award, the new contracts will begin on 2 November 2015. Gloucestershire CCG will have a separate contract from the other four CCGs, which will stand for one year, with the possibility to extend for a further year if required.

Care UK formally wrote to GCCG on 18 June 2015 to advise that they will not be offering elective day case activity at Cirencester Hospital following the completion of the current contract. However, Care UK have indicated that they are keen to provide outpatient services under an AQP contract option from Cirencester Hospital and are in discussion with Gloucester Care Services (GCS) to discuss landlord issues. Care UK have also indicated that they wish to provide outpatient clinics at Gloucester Health Access Centre (GHAC).

Preliminary discussions have taken place between Gloucestershire NHS Foundation Trust (GHNHSFT) and GCS with reference GHNHSFT undertaking elective day case activity at Cirencester Hospital once Care UK contract expires at the end of October 2015.

2.3 Prime Minister’s Challenge Fund (PMCF)

Members will be aware that the CCG worked closely with Gloucestershire’s 83 GP practices earlier in the year who, through their jointly owned company, G-DOC Ltd., were successful in securing £4m of national funding from the Prime Minister’s Challenge Fund (PMCF) to provide local people with better and more flexible access to GP services.

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This scheme is seeking to increase access to GP care between 8am and 8pm, Monday to Friday, and at weekends with 100,000 appointments at a number of specific locations - booked by calling the normal GP surgery; greater use of technology and online services; increased locality based GP case management; increased specialist nursing, and the extension of social prescribing services across all practices.

As well as offering further choice and convenience to patients it should free up practice staff time to do more planned and complex work with more vulnerable patients and allow staff to develop closer working links with other health, social care and community partners, so that even more support is available for frail patients.

A summary of progress is set out below: Following initial notification at the end of March 2015, the Scheme

successfully passed all necessary due diligence and signed a Statement of Intent to proceed in mid May 2015;

G-DOC has now signed an APMS contract with NHS England and has received its first milestone payment;

A multi organisation delivery board is in place as the main decision making body;

G-DOC has now recruited a delivery team including an operational manager, a nurse manager and two administrative support team members;

For the main service offer: Choice+ (urgent appointments), as well as week days, the service is now available on the weekends in Gloucester. There is a roll out plan for other geographical areas with phased implementation between July and September 2015 so that almost 2,000 appointments will be available each week by autumn. The key constraint relates to the installation of SystemOne Out of Hours module, which is a prerequisite for booking appointments;

The CCG has signed a Memorandum of Understanding with G-DOC to deliver expanded social prescribing services across the County. The roll out continues as planned;

G-DOC is now planning to take forward the implementation of e-consultation through a national process and it is likely that the number of patients to be included will increase from 150,000 and could be as high as 280,000;

The programme of work for the ASAP App and PMCF funding to support this has been agreed;

Detailed plans are currently being finalised for additional GP support for Rapid Response and it is anticipated this would be available from September 2015 onwards in the Forest of Dean and Stroud and Berkeley Vale;

Detailed plans for planned weekend GP visits for high risk patients in the Forest of Dean and Stroud and Berkeley Vale are being finalised. This service is planned to be available from September 2015 onwards;

Progress is being made on the development of Specialist Nursing services. All Practice Nurses have contacted for expressions of interest to be part of a network for providing specific support to Practices;

The CCG is supporting the wider implementation of video consultation;In addition to the standard performance metrics, the CCG is working with GDOC to agree key evaluation criteria and transparent measurement so that any ongoing recurrent investment is supported by evidence based data.

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2.4 Urgent Care Update

A Winter 2014/15 escalation review meeting was held on 26 June 2015 involving all providers within the Gloucestershire health and social care system. The event promoted the learning from last year and trailed the utilisation of an escalation early warning tool. In moving forward, the System Resilience Group on 14 July 2015 focussed on the system modelling for winter, including bed models across the acute and community settings. It is acknowledged that there will also be a need to ensure all critical services have undertaken robust capacity and demand modelling in order to ensure that the system can respond to demand increases across the winter months.

There will also be continued focus upon delivery of the eight High Impact Actions, system wide resilience schemes and 4 hour recovery plan. It is also acknowledged that there needs to be an early focus on promotion of flu and pneumonia vaccination for the public and health, social care and independent sector workforce. Reflecting upon winter 2014/15, it is evident that more work needs to take place in ensuring the containment of Norovirus. Public Health England will deliver a workshop in September 2015 to engage nursing homes, schools and other key providers in the preventative agenda. We will continue to promote the ASAP campaign in order to ensure wider App download and coverage.

The Urgent Care Team will run an extended Governing Body Development Session on 17 September 2015 to provide assurance on the plans for the winter.

2.5 Strategic Planning & Healthy Individuals

A new Gloucestershire Workforce Steering Group has been established by the CCG’s Director of Transformation and Service Redesign, with strong partner involvement. This Steering Group includes representation from statutory commissioners and providers in the county. The aim of the Steering Group is to develop a Workforce Strategy to underpin the work and delivery of the strategic objectives of the Gloucestershire Strategic Forum and our five year plan; Joining Up Your Care. The Group will also develop a work programme for a small number of key priority workforce areas where collective action would enable us to be more effective as a community.

The Healthy Individuals Programme Group has developed a driver diagram that will enable the translation of the Group’s vision into a coherent and shared delivery plan. This will set out the key work streams that need to be taken forward to support self-care, promote wellbeing and prevent illness over the next 3-years. The team are working on a number of key initiatives this year to support the CCG’s ambitions to promote health and wellbeing. These include:

Reviewing the county’s self-management education programmes and developing a model and proposal for 2016/17.

Taking forward the Gloucestershire wide Cultural Commissioning Programme. The CCG, working with local partners, is one of two national pilot sites to assess the potential for embedding arts and culture into improving people’s health. We will shortly be inviting voluntary sector groups to express an interest in piloting arts and culture to

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address specific health needs identified by our CPGs. (Further detail of this Programme is included later in this report).

Establishing a project group to develop a Gloucestershire-wide approach to personalised care planning to support the CCG’s work on care co-ordination and case management. The Group is currently scoping the potential for a single approach and learning from good practice elsewhere.

Reviewing Tier 3 Specialist Weight Management services and developing a new service specification for this. The team are also working closely with public health to agree a programme of work to address obesity across the county and will also identify opportunities for supporting locality ambitions to address this agenda.

Rolling out Florence (remote monitoring) across the county and to other health and social care settings.

Developing an assurance process to review patient information for G Care and reviewing pathways to ensure a focus on prevention is included within these. (Further detail of this Programme is included later in this report).

Working jointly with Public Health on developing the annual Joint Strategic Needs Assessment (JSNA), developing and monitoring the agreement we have with Public Health for support to the CCG and actively taking part in the Health and Wellbeing Strategic Implementation Group, which is refreshing the Health and Wellbeing Delivery Action Cards and developing a Health Inequalities Strategy for the county.

2.6 Sign up to Safety

Sign up to Safety is a national campaign designed to harness the commitment of staff across the NHS in England to make care safer. It is one of a set of national initiatives to help the NHS improve the safety of patient care. Collectively and cumulatively these initiatives aim to reduce avoidable harm by 50% and support the ambition to save 6,000 lives. The campaign and its mission are bigger than any individual organisations’ programmes or activities. The aim is to establish and deliver a single vision for the whole NHS to become the safest healthcare system in the world.

Sign up to Safety is for everybody, in every part of the NHS united by the common goal; to make the care we give our patients as safe as possible.

The CCG was approached by the national Sign up to Safety lead, who requested the CCG become a beacon CCG. There will be ongoing support from the national team as a critical friend.

The official local launch took place on 31July 2015.

By taking part in Sign up to Safety, Gloucestershire CCG will be sharing our passion, knowledge and experience in patient safety with others, to help create broad-based learning that’s shared throughout the NHS. Our dedicated patient safety website will highlight Gloucestershire CCG projects where we are working to reduce harm and also share our providers’ safety and quality initiatives so that learning can be shared.

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As part of Gloucestershire CCG’s commitment to Sign up to Safety we will support our providers in their safety campaigns and also support primary care to Sign up to Safety and develop safety initiatives.

In signing up the CCG is required to identify the actions our organisation will undertake in response to the five Sign up to Safety pledges as defined by the Department of Health, and agree to publish this on our organisation’s website for staff, patients and the public to see.

The CCG is also committing to turn the proposed actions into a Safety Improvement Plan, which will show how our organisation intends to save lives and reduce harm for patients over the next three years.

The Five Pledges

• Putting safety first: Commit to reduce avoidable harm in the NHS by half and make public our locally developed goals and plans;

• Continually learn: Make our organisation more resilient to risks, by acting on the feedback from patients and staff and by constantly measuring and monitoring how safe our services are;

• Being honest: Be transparent with people about our progress to tackle patient safety issues and support staff to be candid with patients and their families if something goes wrong;

• Collaborating: Take a lead role in supporting local collaborative learning, so that improvements are made across all of the local services that patients use;

• Being supportive: Help people understand why things go wrong and how to put them right. Give staff the time and support to improve and celebrate progress.

2.7 Approach to Planning 2015/16

The NHS has been through an intense period of transition over the last few years. The CCG believes that the NHS in Gloucestershire is in good shape to move forward, but that there remain many significant challenges that we need to work through to deliver a sustainable future for health and social care services in Gloucestershire. Our strategy, Joining Up Your Care (2014-2019) sets out the ambitions we seek to achieve across the Gloucestershire community on behalf of our population.

In October 2014 Simon Stevens (Chief Executive of the NHS) published a compelling vision and strategy for the NHS, the Five Year Forward View. This vision describes the opportunities and challenges facing the NHS for the future and urges local health and care communities not to rely on "short term expedients to preserve services and standards" at a time which calls for true leadership and transformational change of our health and care systems. The strategy described three critical gaps that risk being perpetuated if we fail to grip the scale of change required (the Health and Wellbeing Gap, the Care and Quality Gap and the Funding and Efficiency Gap).

The CCG has developed an Operational Plan for 2015/16 that is focussed on delivering the next steps of our strategic plan, but that also responds to the new challenges laid down by the Five Year Forward View. Our health community continues to evolve, and as we move forward with delivering our Operational Plan we will need to identify the best time to refresh our five year plan.

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The Planning Cycle The CCG follows a relatively standard cycle of planning activities which allow for ease of communication with a wide range of stakeholders. The Planning Cycle describes the required planning activities during each month of the year. Each circle represents a different type of planning activity, namely:

The commissioning cycle

The business case prioritisation cycle (including the principle of prioritisation of most business cases in late January/early February and two additional prioritisation opportunities throughout the year)

The business planning cycle including writing and refreshing our strategic plan JUYC, and the Operational Plan

The engagement cycle

Our Approach to Engagement in PlanningThe CCG is committed to patient and public engagement in the Planning Cycle as set out in the CCG’s Engagement and Experience Strategy: “Our open culture – a strategy for engagement and experience”. The CCG is committed to engaging with its membership and localities, partners and staff in the development of its priorities.

Strategic Planning The national planning guidance for 2013/14 asked CCG’s to develop a five year strategic plan supported by a two year Operational Plan. The local strategic plan for Gloucestershire, Joining Up Your Care (JUYC), was completed in line with national timescales in mid-July 2014. A considerable amount of work was put into developing the strategy, supported by extensive engagement with a wide range of stakeholders, including patients and the public. Whilst the plan sets out a vision for the development of health services in Gloucestershire over the next 5 years, it inevitably represents a ‘point in time’ assessment and will need to evolve throughout the five year period to ensure that the plan remains relevant.

Locality Planning: Integration with CCG Planning Cycle There is agreement that the Locality and CCG Planning cycles will benefit from being more closely aligned in future. This will enable both more clarity for localities on direction of travel around CCG strategic programmes but also better integration of key messages from localities into CCG thinking as new priorities are identified and developed.

2.8 Locality Development Planning 2015 – 2017

Locality Development Plans were initiated in 2013 to create a structured approach for localities to develop proposed priorities and two year delivery plans.

Gloucestershire’s seven CCG localities, and the supporting infrastructure for localities, have developed significantly over these two years.

Localities have developed stronger links with District and Borough Council colleagues during 2013 – 15. This has resulted in strong partnership working

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emerging across the county, both in terms of planning and shared priorities but also in the development of joint projects by working in a more integrated way.

Each locality has an established Executive, which includes a Clinical Commissioning Lead GP and GP Chair, and is now supported by a Senior Locality Manager, a Locality Development Manager, and specific Finance and Information leads.

Localities function under the guidance set out within the Locality Operating Framework, which describes their four key delivery objectives:

i. Producing a Locality Development Plan for 2015-17 that details priorities, alignment with countywide priorities and the actions the locality will take for implementation;

ii. Monitoring and responding to locality performance and variation;iii. Operating within the financial resources available each year; andiv. To be the conduit through which member practices can engage with the

GCCG Governing Body, and vice-versa, to ensure GCCG remains a clinically-driven organisation with a clear membership focus.

As the locality plans are quite detailed, the seven plans are being presented in two parts. Therefore, this report provides detail on the process undertaken and then introduces the locality plans for Forest of Dean, North Cotswold and Tewkesbury, Newent & Staunton. The remaining four locality development plans (Cheltenham, Gloucester, South Cotswold and Stroud & Berkeley Vale), will follow at the November 2015 meeting of HCOSC.

Key achievements to date

Forest of Dean locality Social Prescribing – A ‘Social Referral Hub’ was set-up to support people who attend GP surgeries and require services beyond clear medical need. Patients are referred to the Hub by the surgery and are signposted to an appropriate service within the local area. The project, involving GPs, the Forest of Dean District Council, Gloucestershire County Council, Age UK Gloucestershire, Independence Trust, Careers, and Gloucestershire Rural Community Council, successfully rolled out across the locality and the model now being adopted countywide.

Mental Health – the locality have focused on increasing support for patients with long term mental health conditions and those with medically unexplained symptoms. This has included developing closer links with 2gether Intermediate Care teams and dedicated GP educational sessions to enhance primary care knowledge for the benefit of better patient care.

COPD review – following a review of COPD patient care, a Prepare Programme pilot will shortly commence for newly diagnosed patients to offer them education and support with managing their condition. Two hour sessions will run during days, evenings and weekends.

North Cotswold Locality Healthcare Checks for Carers – Carers’ Health Checks were identified as a priority due to the increasing number of elderly carers within the locality for who an episode of illness can have a devastating impact on their personal lives and the people they care for. Thirty minute appointments for carers with a healthcare

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professional were introduced, exploring the general health and social needs of each carer, undertaking examinations, investigations and medication reviews as required.

Unplanned Admissions – Having identified a locality variance for an excess of emergency admissions, the practices have collaborated in an audit to determine action points and learning that could be shared between partners and between practices. Emergency admissions are now reducing for the locality year-on-year (1.9% reduction from 2013/14 to 2014/15), while the learning will be taken forward through engagement in the CCG Practice Variation Programme for 2015/16.

Tewkesbury, Newent and Staunton Locality Pharmacy First Minor Ailment Scheme – Along with Gloucester City, the two localities have pioneered this scheme which encourages use of experienced local pharmacists to help patients manage common minor ailments. This is freeing up time for GPs to manage more complex cases and chronic disease management.

Increasing patient engagement – The locality has established a Locality Reference Group including Patient Participation Groups from the five practices, local councillors, Healthwatch, and other local stakeholders. This has enabled a stronger patient voice in the review and development of local plans and initiatives.

Locality development planning process To inform the planning round for 2015-17, each of the seven localities met with representatives from Public Health, CCG Business Intelligence and their District / Borough Councils during April and May 2015 to understand any significant indicators or variation for their respective populations.

‘On the ground’ feedback from a mix of GPs, Practice Managers and PPGs was also included within this evidence base.

The Locality Development Managers were instrumental in co-ordinating this work and ensuring presentations delivered a consistently high quality evidence base, with joined-up priorities presented where clear linkages could be made from the range of source data. This was also framed within the context of the wider CCG priorities and plans.

The Locality Development Managers and Senior Locality Managers have been working with their Locality Chairs and Executive GPs to develop their two year plans, gaining buy-in from the wider GP membership.

Key emerging themes and alignment with CCG programme areas

The priority themes identified from this process have been triangulated with the CCG operational plan and QIPP (Quality Innovation, Prevention and Productivity) schemes. The table below maps the emerging themes from the three localities against their correlation with existing CCG Programmes.

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Localities and CPGs will take an aligned approach to the development and implementation of locality based projects and work-streams so that neither is acting in isolation. This will encourage greater collaboration between the CPG’s and locality GP’s, helping to deliver shared priorities together in a joined-up way, while supporting delivery of the CCG Operational Plan and QIPP.

New Locality PlansAs Locality Development Plans are widely shared, such as with the public, patient participation groups, local stakeholders and all GP practices, we have been working with the Graphics Team to develop a new, more aesthetically pleasing and engaging format. Copies have been made available to HCOSC members for information.

Ongoing Reporting and GovernanceEach priority theme area will be developed using the CCG project methodology and include both quantitative and qualitative Key Performance Indicators to measure outcomes

2.9 Learning Disability Services Update

Learning Disability Services continue to work towards joining up care to improve the lives of people with a disability. Work to actively return people back home who were placed out of county is continuing, as is the follow-up to the Winterbourne Joint Improvement Programme. The reshaping of the facilities in Stroud District at Hollybrook and Westridge has similarly provided opportunities to improve outcomes for people who may have been cared for lengthy periods in hospital settings. These efforts are supported by an integrated team working on a community level called LDISS (Learning Disability Intensive Support Service).

The Learning Disability Quality Assurance Team, with its partners was awarded a Municipal Journal Award as recognition of its achievement in protecting the safety and well-being of all people with a learning disability placed in supported living or

Locality Emerging themes mapped to CCG Programme Areas

Forest of Dean

Children’s – Oral Health Healthy Individuals – Healthy Lifestyle

Programme and Social PrescribingRespiratory - COPD

Urgent Care – addressing variation

North Cotswold

Community Hospital – Increasing appropriate utilisation

Healthy Individuals –Social Prescribing and Physical Activity

Prescribing – addressing variation Urgent Care – addressing variation

Tewkesbury Newent & Staunton

Children’s – outreach outpatientsCommunity Hospital – Increasing appropriate

utilisation Healthy Individuals –Social Prescribing and Adult

ObesityMental Health – Perinatal

MSK – addressing variation in elective admissionsUrgent Care – addressing variation

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residential care across the health and social care domains. This work has ensured that people with disabilities and those who support them are fully involved in the quality of services.

A highly successful Health Check Day was held in May 2015 with well over a attending. This was the most successful Health Check day held to date and included both social care and health related services. In other related activities a Disability Hate Crime Event for people with disabilities was held in partnership with Gloucestershire Constabulary and the Police and Crime Commissioner’s Office. Plans in the coming months include looking at how to improve services to some of our high needs people and looking at ways to prevent unnecessary hospital admissions for people with a learning disabilities living in community settings.

2.10 Clinical Programmes

The Clinical Programmes team remain very active over the summer leading on a range of collaborative service transformation work. Some examples of our latest works are as follows.

The MSK (Muscular Skeletal) team are directing an extensive change programme and have been running a highly successful series of workshops to inform recommendations and service specifications. Recent workshops include Pain Service, Podiatry and Orthotics. In addition, a high level plan service model for falls and bone health has been developed.

The Cancer team has launched a new season of Macmillan GP Masterclasses, with over 70 GPs attending a Breast event. The Living With and Beyond Cancer Programme is also progressing with service redesign to integrate the Recovery Package and shift to a needs-based follow-up model. Workshops were held for Breast and Colorectal. New NICE Guidelines were published for Suspected Cancer and a new Joint Working Group has been established with the Gloucestershire Hospitals NHS Foundation Trust GHNHSFT) to co-ordinate the changes to referrals and diagnostic requirements.

The Circulatory Clinical Programme Group (CPG) has reviewed the Stroke Service Improvement Plan, which is focused on a range of priority acute care actions at GHNHSFT. The circulatory team are also initiating a major new project on Cardiology with a service walk through in July 2015. Gloucestershire is also a leading site for the ‘Don't Wait to Anti-coagulate’ campaign and our programme manager, has commenced a one day a week secondment with the Academic Health Science Network.

We are also delighted to announce that the new G-Care platform went live in July 2015 providing a valuable new resource for all our GP members.

2.11 Cultural Commissioning Grant Programme

In July 2015 the cultural commissioning grant programme was launched inviting arts and culture organisations from the Voluntary Community and Social Enterprise sector (VCSE) to test out and develop innovative approaches to address priorities within our clinical programme groups. The aim is to interrogate a series of emerging key area and opportunities on:

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Commissioning Operational models of delivery Workforce development

The cultural commissioning programme is a key enabling project within the healthy individuals programme with the aim to raise awareness amongst public service commissioners of the benefits which arts and culture can bring to people’s health and wellbeing.

As mentioned earlier in this report, The CCG’s 2015/16 operational plan outlined the CCG’s intention to commit additional resources to the prevention agenda in line with the activities and projects set out in the Healthy Individuals Programme, with a view to expanding the level of investment in 2016/17 to encompass a broader remit to commission a range of prevention and health and wellbeing interventions from the voluntary sector. As part of this commitment, £150,000 was allocated to commission a small number of pilot interventions through the voluntary and community sector where appropriate.

As the project moves into the second phase we will be extending communication and engagement, both within the CCG, and to partner GPs and organisations.

A grant programme will be to deliver approximately 10 – 15 small scale pilots between September 2015 and November 2016. The pilots will increase our knowledge and understanding on the role of non-traditional providers and the impact they have on the health and wellbeing of our communities.

Once the grants have been awarded to the successful bidders, it is anticipated that the Clinical Programme Groups (CPGs) will work alongside clinicians, lay members and the VCSE to co-develop appropriate and effective service models. This will provide the opportunity for commissioners to ensure that the pilots are designed in a way that provides meaningful and measurable outcomes.

The grant programme will be evaluated using a mixed-methods approach combining qualitative and quantitative methodology.

2.12 Arts and Health Forum, Gloucestershire

A new arts and culture forum was launched on 7 July 2015. The primary aim of the joint forum was to provide people with the latest information about the Cultural Commissioning Programme and the grant programme.

The forum is a partnership between the VCS Alliance and CREATE Gloucestershire and provides a future platform for arts and culture organisations to come together and look at opportunities within public sector commissioning to achieve positive health and social outcomes. The initial meeting was attended by over 20 arts and culture organisations and there was significant interest in the forthcoming CCP grant programme.

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2b Section 2b: Local NHS Commissioner Update, Gloucestershire Clinical Commissioning Group (GCCG) -Primary Care (GP services)

2b 1 National GP Patient Survey

In the July 2015 publication of the National GP Patient Survey results the majority of Gloucestershire practices were recorded at or above, the national average for overall experience.

The results of the national GP Patient Survey can be triangulated with other sources of feedback, such as feedback from Healthwatch Gloucestershire, Patient Participation Groups, local surveys, Care Quality Commission Reports and the Friends and Family Test (FFT), to develop a fuller picture of patient journeys though primary care.

Background information about the survey

The GP Patient Survey (GPPS) is an England-wide survey, providing practice-level data about patients’ experiences of their GP practices. Ipsos MORI administer the survey on behalf of NHS England.

The GPPS measures patients’ experiences across a range of topics, including:

Making appointments Waiting times Perceptions of care at appointments Practice opening hours Out-of-hours services

The GPPS provides data at practice level using a consistent methodology, which means it is comparable across organisations and over time.

The data referred to in this report is based on the July 2015 GPPS publication. This combines two waves of fieldwork, from July to September 2014 and January to March 2015, providing practice-level data. In NHS Gloucestershire CCG, 23,647 questionnaires were sent out, and 9,765 were returned completed. This represents a response rate of 41%.

The survey has limitations:

Sample sizes at practice level are relatively small. The survey does not include qualitative data which limits the detail provided by

the results. The data are provided twice a year rather than in real time.

However, given the consistency of the survey across organisations and over time, GPPS can be used as one element of evidence.

Overall experience of GP surgeries in Gloucestershire

The following question tests overall satisfaction with the services provided by GP practices.

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Overall, how would you describe your experience of your GP surgery?

Date Gloucs. Av Good

England Av Date Gloucs. Av Poor

England Av

July 2015 89% 85% July 2015 4% 5%

July 2014 89% n/a July 2014 2% n/a

Practice range in CCG – % Good

Lowest performing 61% Highest performing 98% 72 out of 84 Gloucestershire practices recorded on or above the national

average for overall experience. 12 out of 84 Gloucestershire practices recorded below the national average for

overall experience.(* Note: Some practice response rates may be very small.)

Detailed results from the survey can be found at https://gp-patient.co.uk/slidepacks/July%202015

Healthwatch Gloucestershire GP Survey 2015

The July 2015 publication of national GPPS results for Gloucestershire Practices are broadly in line with the results recorded in the recent Healthwatch Gloucestershire GP Patient Survey, with high levels of satisfaction generally reported by patients.

Application of the Results

The results of the national GPPS can be triangulated with other sources of feedback, such as feedback from Healthwatch Gloucestershire (as above) Patient Participation Groups, local surveys, Care Quality Commission Reports and the Friends and Family Test, to develop a fuller picture of patient journeys though primary care.

These results and the other forms of patient and public feedback will be discussed at the Primary Care Clinical Quality Review Group and with Locality Executive Groups. Individual practice feedback will be discussed on a 1:1 basis between practices and commissioners as part of quality monitoring arrangements.

2b2 St Luke’s Medical Practice Closures (Stroud and Tuffley Surgeries)

Background

NHS England recently received formal notice from the GP Partners of the St Luke’s Medical Practice of their decision to stop providing NHS GP services with effect from 1 October 2015.

As the organisation now responsible for ensuring access to GP care, the CCG has been working alongside NHS England and the practice to achieve the best outcome for the patients (approximately 4,000) registered with St Luke’s.

Communication with patients

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Communications with patients have been developed by the Practice and the CCG, with the support of the Practice Participation Group and Healthwatch Gloucestershire. Personalised letters from the Practice, together with information from the CCG regarding registration with a new GP practice, were sent to all patients in July 2015. A first reminder letter was sent during August 2015 to patients who had not started the new registration process and a further reminder will be sent in September 2015. The reminder letters mirror the information included in the original letter, and encourage patients to allow sufficient time to register with a new practice.

CCG Advice Line and PALS

The CCG has established a Freephone Advice Line and email service to handle contacts from registered patients, to assist them with the process of registering with a new NHS GP Practice. Existing CCG staff received training in handling calls. Whilst working on the Advice Line (up to 5 staff at any one time) all staff are able to continue with their own work during times when they are not responding to patient calls.

The Advice Line went live from 9 am on Tuesday 28 July, and is open days of the working week 9am-5pm, with extended hours to 7pm on Wednesday’s. A messaging service is available when the Advice Line is closed.

Feedback from patients received by the St Luke’s Practice Manager has been that the Advice Line has been very helpful, and other practices have also indicated that the Advice Lines has been useful in managing practice administrative workload.

The CCG PALS team are responding to more complex calls, when patients are requiring a greater degree of support to register with a new practice or if they have more complex queries. Queries referred to PALS have in the main related to access to anthroposophy1 medicine. Individuals have been advised to contact St Luke’s Medical Practice direct to discuss the future of anthroposophical services going forward.

Registrations

During the first month of the CCG has assisted with approximately 1000 new registrations, with the vast majority of contacts via the Advice Line.

The overall spread of new registrations with practices the patients are choosing is relatively even, with patients advised both in the letter, and by the staff working on the Advice Line, that they must live within a GP Practice’s boundary to be eligible to register with a particular practice. The Advice Line staff are supported by a software programme, which enables them to use the patient’s postcode to identify the practices they can choose from.

3. Section 3: Local Providers’ updates This Section includes updates from Gloucestershire Hospitals NHS Foundation Trust (GHNHSFT), 2gether NHS Foundation Trust (2GNHSFT) and Gloucestershire Care Services NHS Trust (GCSNHST).

These items are for information and noting.

1 Anthroposophy: http://www.anthroposophy.org.uk/

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3.1 Gloucestershire Hospitals NHS Foundation Trust (GHNHSFT)

3.1.1 Care Quality Commission

On 17 June 2015, The Trust was rated as “requires improvement” by the Care Quality Committee. The associated report included recommendations to comply with regulatory breaches (“must dos”) and recommendations to help the Trust reach a higher assessment level (“should dos”). The “Must do” recommendations were reviewed by the Directors and Chief of Services and the action plan developed and formally agreed by the Quality Committee on 10 July 2015 and submitted to CQC on 16 July.

The action plan will continue to be monitored by the Quality Committee and formally sign off by the Trust Board on completion. The action plan progress will be presented at the GHNHSFT Quality Committee in September 2015, where it is anticipated most actions will be completed, after this date the updated action plan will be available to other stakeholders. Towards the end of the year when the action plan is complete the evidence for closure will be audited by the Trust’s Internal Auditors and reported to the Audit Committee.

The actions arising from the CQC Quality summit were focussed on three main issues, working with our partners to resolve countywide emergency pathway issues, workforce planning and crisis mental health care. The actions will be part of the plan established by the Joint Planning and Resilience Group, chaired by the CCG, and progress will be reviewed as part of the Countywide Board to Board meeting in October 2015.

3.1.2 Pharmacy team award

GHNHSFT Pharmacy Team has won the Musculoskeletal Care Award at the national HSJ/Nursing Times Patient Safety Awards. The award was presented to the team for their pilot programme to improve safety in orthopaedic elective admissions which reduced length of stay, saving almost £400,000 across both GRH and CGH. Importantly it also improved patient experience and released junior doctor time.

3.1.3 AGM success

For the first time GHNHSFT changed the format of the AGM in July 2015 to make it more interactive and engaging for members of the public.

Members of staff displayed some of the extraordinary care, procedures and treatments that are carried out every day in the county’s main hospitals in Cheltenham, Gloucester and Stroud. The themed workshops, at Kingsholm, proved popular with the public.

3.1.4 Gold award for health & safety

GHNHSFT won a gold award in the RoSPA Occupational Health and Safety Awards 2015. The RoSPA Awards encourage improvement in occupational health and safety management. Organisations that gain recognition for their health and safety management systems contribute to raising standards overall.

3.1.5 Gloucestershire Apprenticeship Awards 2015

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GHNHSFT’s Lifelong Learning Team took the award for Employer of the Year at the Gloucestershire Apprenticeship Awards. GHNHSFT’s Apprentice Liam Southgate won two awards, including the top individual accolade as Gloucestershire Apprentice of the Year. He was also Outstanding Apprentice of The Year in the Health, Education and Care (Private or Public Sector). The Gloucestershire Apprenticeship Awards 2015 is staged by Local World Gloucestershire, the publishers of the Gloucestershire Echo, Gloucester Citizen and Stroud Life.

3.1.6 Art exhibition brightens up hospitals

An exhibition showcasing and celebrating the artistic talents and skills of the staff of GHNHSFT has gone on show. For the second year running, the ArtWorks project invited staff to submit their own paintings, prints, photography and 3D works of art to be shown in exhibits at both Cheltenham General and Gloucestershire Royal Hospitals.

The initiative proved such a success last year that it was launched for 2015 by popular demand. Sixty works have gone on show across a range of categories. Some of the work in the exhibition is for sale. A proportion of each sale is donated to support the Trust’s Art Fund – a charitable fund which helps keep and refresh the large collection of permanent art work in our hospitals. This art improves the environment and provides great pleasure to patients, visitors and staff. The ArtWorks staff exhibition is being held at the Trust’s gallery spaces:

Gloucestershire Royal Hospital: Foster’s Gallery (adjacent to Foster’s Restaurant, ground floor Tower Block)Outpatients Gallery (adjacent to the outpatient main entrance).

Cheltenham General Hospital: The Link Gallery (the corridor between West Block and St Paul’s Wing)Star Gallery (in St Paul’s Wing just around the corner from the Link Gallery).

3.1.7 NHS thanksgiving service

NHS staff in Gloucestershire have made an enormous contribution to the health and wellbeing of people in our county. In recognition of this a thanksgiving service in Gloucester Cathedral will be held on Wednesday 21 October 2015 at 5.30pm. The service is aimed at all staff (past or present) who have made a positive contribution to the NHS whether it is within our organisation or across primary care, secondary care or the third sector (charities etc). The service is open to all faiths and we do hope that you can join us for this very special occasion.

3.1.8 Greener hospitals

Carbon emissions at GHNHSFT for 2014/15 dropped by 7.1% compared to the previous year. The overall target for 2015/16 requires a further reduction of 7% based on this year’s outturn. The combined heat and plant facility at CGH is forecast to meet the lion’s share of this. Reducing our carbon footprint is important and our Trust is committed to realising the environmental benefits associated.

3.1.9 Sustainability champions

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More than 30 members of GHNHSFT staff have volunteered to become sustainability champions. Highlights of being a champion will include:

Identifying energy saving initiatives within departments. Promoting and facilitating greater recycling. Promoting and raising awareness of the sustainability agenda.

3.1.10 Promoting Ambulatory Emergency Care (AEC)

At the beginning of September 2015, ahead of the busy winter, GHFT will be promoting the Ambulatory Emergency Care (AEC) units at both hospitals. AEC is a national initiative designed to reduce admissions, take pressure off Emergency Departments and, most importantly, to improve the quality of care for our patients.

The AEC departments’ web pages have been completely redesigned to include sections for patients and referrers, and will be promoted externally to patients and particularly to GPs through a number of channels. Short films designed to answer questions about AEC are also available on the new pages.

The AEC service means that patients can be assessed, diagnosed, treated and are able to go home the same day, without being admitted overnight. Both units get excellent feedback from patients, which is also reflected on the new web pages. As well as hoping for more GP referrals, we are also keen to drive up internal referrals.

3.1.11 Walk for Wards Sunday 11 October 2015 in Cirencester Park

Join us for a family friendly 3k or 10k walk in the beautiful surroundings of Cirencester Park whilst raising money for the ward or department of your choice. The walk is free to enter, we just ask that you raise a minimum of £20 per person taking part. Dogs are welcome on leads. Refreshments will be provided. To register for the walk, please email fundraising@glos.nhs.uk or call us on 0300 422 4716.

3.1.12 Friends fund new heart monitoring equipment

The Friends of GRH have purchased a twelve lead electrocardiograph (ECG) machine for use in the Post Anaesthetic Care Unit (PACU) at GRH. The equipment was purchased as part of the £3.5k the Friends raised at this year’s summer fete in July. The new equipment will help to improve the care of patients who are recovering from Anaesthesia and Surgery as well as improving efficiency.

3.1.13 Fairview Ward refurbishment

A refurbished Fairview Ward at Cheltenham General Hospital (CGH) is due to open next summer (2016) and will provide much needed additional outpatient space in ophthalmology.

The new facilities will enable us to improve patient services within in a number of sub-specialties in ophthalmology and will create dedicated space for retinal services including injecting capacity, as well as providing better facilities for casualty and glaucoma patients.

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During the refurbishment the Ophthalmology services provided there – Local Anaesthetic Pre-Assessment and Cataract Pods (a one-stop outpatient clinic where patients have a consultation with the clinician, a same day pre-assessment & agree admission date) – will be provided at the Orchard Centre, Gloucestershire Royal Hospital (GRH). Patients have been informed via their appointment letters.

3.1.14 Midwives in partnership

Midwives from GHNHSFT joined up with colleagues from Gloucestershire CCG during World Breastfeeding Week in August 2015. The CCG’s Information Bus stopped in Stroud, Gloucester and Cheltenham and included information for women and their families, encouraging them to use GHNHSFT’s maternity web pages plus social media channels for information and advice.

The Midwifery Partnership Teams (MPTs), where midwives work with health visitors and children’s centre teams, are being visited by Baroness Cumberlege, who is chairing the National Maternity Review. By working together in MPTs, midwives, health visitors and Children’s Centres are able to offer more flexible and intensive support to families. This can include joint home visits, enhanced antenatal education to support women to have a healthy pregnancy and a normal birth and access to midwifery appointments within the children’s centre.

3.1.15 Little Apples rated as ‘good’ by Ofsted

The Little Apples nursery at CGH, which looks after the children of our staff, has been rated as 'good' by Ofsted following their inspection in July. A key finding in the report concluded: “The quality of teaching is good. The experienced and well-qualified staff team provides stimulating and interesting experiences based on the children’s interests, both inside and out. Consequently, all children make good progress in all areas of their learning from their starting points on entry.”

Staff at GHNHSFT can choose to enrol their children at one of our two on-site nurseries, Little Apples (CGH) and Little Oaks (GRH), both of which are Ofsted-regulated nurseries with a 'good' rating. The aim of the Trust’s childcare is to work in partnership with parents and carers to provide high quality childcare for each individual child and family and to provide a happy and stimulating environment for the children of working parents and carers.

3.2 2gether NHS Foundation Trust (2GNHSFT)

3.2.1 Greyfriars PICU Accredited as ‘Excellent’

Greyfriars Psychiatric Intensive Care Unit (PICU), in Gloucester, has been accredited as ‘excellent’. The unit, in Horton Road, has been awarded the grading by the Royal College of Psychiatrists and the National Association of Psychiatric Intensive Care Units (NAPICU). It is the third consecutive time that the unit has been awarded the top grading under the Accreditation of Inpatient Mental Health Services (AIMS) scheme.

The application for AIMS accreditation includes service users and family carers checking progress against a number of care and organisational standards.

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Accreditation is only granted following a visit from Royal College of Psychiatrist assessors who check current practice within the Unit.

Two other 2gether services have also recently received accreditation from the Royal College of Psychiatrists. These are the Electroconvulsive Therapy (ECT) clinic at Wotton Lawn Hospital and the ECT clinic at Stonebow Unit, Hereford. Both services were also accredited as being ‘excellent’ by the Royal College of Psychiatrists.

3.2.2 Recovery College

New courses are being offered by the Severn and Wye Recovery College. The latest courses include Mindfulness, Pathways to Recovery, Mental Health First Aid and Step Up for Confidence. They will run from September in Stroud, Gloucester and Cheltenham. More information is available in the prospectus which is available on the college’s website www.swrecovery.org.uk

3.2.3 Time to Change

2gether has been success along with another mental health trust, to participate in a national research project to help tackle mental health stigma. The project is being led by Time to Change (www.time-to-change.org.uk) and stems from national research which shows that while stigma and discrimination among the general population has reduced, service users report that their experience from health professionals has stayed the same.

A series of workshops involving Experts by Experience will be held throughout the trust to talk with staff about their impact, either positively or negatively, on discrimination and stigma. 2gether’s involvement in the project builds on its previous work in tackling stigma and supports the Trust’s values and aspirations.

3.2.4 New Medical Director

Dr Paul Winterbottom 2gether’s Medical Director, has decided to return to full time clinical practice from March 2016. Dr Chris Fear, who has worked for 2gether since 1996, has been appointed as the Trust’s new Medical Director. Dr Fear is currently Clinical Director in Herefordshire, Associate Medical Director and lead for psychosis. He is a member of the Board of Trustees and Council of the Royal College of Psychiatrists, and Chair of South West Division.

3.2.5 Annual General Meeting

An open invitation is extended to join 2gether’s Executive Team and Governors at the Trust’s Annual General Meeting, which will take place on 21 September 2015 at the Kindle Centre, Hereford, more information is available by visiting http://bit.ly/1JJJj3J

3.3 Gloucestershire Care Services NHS Trust (GCSNHST)** Gloucestershire Care Services NHS Trust also contributes to the joint GCC/GCSNHST report.

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Gloucestershire Care Services NHS Trust (GCS) performance remains good overall and the Trust continues with a wide range of its service development and improvement programmes.

3.3.1 Leg Ulcer Service Development

As previously reported to HCOSC, GCS has been commissioned to provide an enhanced leg ulcer service for across the county. This service commenced at Cirencester Community Hospital at the end of August 2015, where patients were guided to the new unit by volunteers and treated by the Trust nurses who have expertise in this area of care. It was good to see 20 patients being seen during the first session. The Trust will now progress to its next Locality – Cheltenham, and have been successful in recruiting six additional nurses to support this new service.

3.3.2 CQC Inspection

The Trust has, since the last HCOSC meeting, had its dental service inspected and this was the final part of the wider CQC inspection process. GCS is awaiting the outcomes report and rating from the inspection which will be published on 22 September 2015. The findings will also be presented to the Trust alongside Commissioner and other stakeholders, including at the November 2015 HCOSC meeting. Whatever the rating issued by the CQC, the Trust is confident that any report will be a rich source of information and feedback, which will undoubtedly support GCS colleagues to improve or enhance its services to the people of Gloucestershire.

3.3.3 Community Hospital Developments

Over and above what will be presented at the September 2015 HCOSC meeting about GCS’s Community Hospitals, there are a number of key developments that should be highlighted:

Cirencester Community Hospital – the Minor Injuries and Illness Unit (MIIU) will become a nurse-led unit from 1October 2015. This will align to the other six MIiUs across the county and will continue to be run using the expertise of emergency nurse practitioners (ENPs). The unit at Cirencester will continue to be open 24 hours a day

All the Trust’s Community Hospitals have participated in Patient-Led Assessments of the Care Environments (PLACE), which has involved environmental assessments of where patients are cared for, whether this has been undertaken with compassion and dignity and that environments are clean and safe. GCS is delighted to report that the 2015 PLACE outcomes have indicated overall improvements against national benchmarks and pleasingly, positive praise for what the Community Hospital and GCS colleagues provide in terms of the care and environment for those people living with dementia

GCS continues its roll-out of its clinical record IT system across its Community Hospitals. Since the last HCOSC meeting, its Stroud and Vale hospitals have successfully gone ‘live’, the Forest of Dean hospitals will transfer to SystmOne by mid-September 2015 and then North Cotswold and Tewkesbury hospitals by November 2015.

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3.3.4 Community Nursing

As previously reported, GCS continues its activities within both service development and risk management within its Community Nurses workforce – one of which is the recruitment of nurses with the district nurse qualification, which remains a local and national challenge. GCS remains supportive of its nursing colleagues wishing to progress to new roles such as the leg ulcer service, but at the same time do not wish to de-stabilise Community Nursing. As at the end of June 2015, the Community Nursing staffing for the Trust was 0.25 wte – one over establishment and for District Nurses, there were 12.9 wte vacant posts. GCS will continue to focus on a number of activities which include:

‘Growing our own’ senior nurse/district nurse workforce – five nurses will commence a bespoke educational programme

Running and participating in national and local recruitment fairs

3.3.5 Healthy Lifestyle Service

GCS’s Healthy Lifestyle Service consists of the specialist Stop Smoking Service, Oral Health Promotion, the Expect Patient Programme and Health Improvement Specialist. The team continues to work across the county to deliver ongoing quality improvements that put the needs of Gloucester people first and ensures that they receive the highest standard of care. All this activity has been encapsulated into the annual report attached and indicates what proactive services GCS has within its organisation.

3.3.6 System-wide Capacity and Winter Preparations

Community Services continue to support the wider health and care system so that the national 95% access target is met. This four hour Emergency Department (ED) target continues to be the system-wide barometer and the Alamac System continues to be one of the key enablers for managing information about patient flows. GCS now inputs a considerable amount of information into Alamac which includes:

Single Point of Clinical Access (SPCA) Rapid Response Service Capacity Community Hospitals Inpatient Wards

The aim of Alamac continues to involve a daily ‘diagnosis’ on any system-wide issues and helps to inform actions (via the daily conference call) that key organisations are involved with to effectively manage these issues and meeting of standards; for GCS this includes for example, availability of its 196 community hospital beds and patients being transferred safely to its Community Hospitals.

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GCS - Patient Transfers to Community Hospitals (pending list)

GCS – Community Hospital Bed Admissions

In addition to this, GCS continues to progress with its winter planning arrangements and this has included:

Reconfirming its Priority 1, 2 and 3 (critical) services – this has been done in light of new service developments such as the GCS’s Rapid Response Service

Refreshing GCS’s trigger points and actions at each level of escalation and ensuring that the learning from last winter is taken forward

Being clear what services should ‘stop’ when facing heightened escalation – this has involved GCS clinicians and service managers

Ensuring internal and external communications are timely and joint with other stakeholders (where appropriate) – again, embedding learning from last year.

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3.3.7 Minor Illness and Injury Unit (MIIU) Attendance

As part of GCS’s support to the wider urgent care agendas, GCS continues to work with Commissioners and its wider plans about what the people of Gloucestershire can expect from their local MIIUs and overall activity within the Trust’s units continues to increase month on month.

GCS – Attendance at MIIU

3.3.8 National Audits

GCS has continued its commitment to participate in National Clinical audits and these include:

Chronic Obstructive Pulmonary Disease (COPD) and Pulmonary Rehabilitation Parkinson’s Disease Audit Stroke Intermediate Care Diabetes Foot Care

4. RecommendationsThis report is provided for information and HCOSC Members are invited to note the contents.

Dr Helen Miller Mary Hutton Clinical Chair Accountable OfficerNHS Gloucestershire CCG NHS Gloucestershire CCG

September 2015

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