NHS City and Hackney CCG Programme Boards Part 1

Training session for Patient and Public Involvement

Representatives

Training for Patient and Public Involvement Representatives

This session is part of on-going training to support CCG’s patient and public involvement representatives in their roles.

Training sessions can be opened up to our partners and stakeholders in the community and voluntary sector where there are free places left.

Six training sessions will take place during March, April and May 2015 (see hand-out) on Public Health in City and Hackney Programme Boards Part 1 Programme Boards Part 2 Commissioning Cycle: Commissioning, Procurement, Contracting, Evaluation and Quality Patients in Control: Shared Decision Making, Co-design& different ways to be involved Patient Leaders: Representing your community

The aim of today’s session is for attendees to gain an understanding of the programme boards and their

priorities, their role within the CCG and how they work with patients and members of public.

Programme Boards Part 1 1pm Welcome and Introductions

1.15pm Urgent Care

1.55pm Long Term Conditions

2.35pm Coffee &Tea break

2.50pm Primary Care Quality

3.30pm Integrated Care

4.10pm Prescribing& Medicines Management

4.50pm Close

There will be opportunities to ask questions throughout the session. Where we are unable to answer your questions at today’s session we will make a note of it and provide a response later.

Urgent Care PROGRAMME BOARD – CITY AND HACKNEY CCG

RYAN O’CAMPO (PROGRAMME BOARD MANAGER)

Urgent Care Programme Board

Our services

Our priorities

Our plans

What we’ve been told by patients

How patients can help us realise our plans

Position in City and Hackney

Emergency Department

Primary and Urgent Care Centre

Observational Medical Unit

Acute and Surgical teams

Patient navigators

CHUHSE

London Ambulance Service

Paradoc

Social and community care

GP Confederation

HACKNEY CoL

Discharge

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London vision for Urgent and Emergency Care

What is our vision?

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1. Keep Homerton A&E ‘outstanding’

2. Commission new urgent care services

3. Simplify Urgent Care for Patients, GPs and clinicians: patients are seen in the right place at the right time, first time

4. Co-develop an urgent care system which is safe, affordable, easy to access, and improves patient experience

What we’ve been told we need to focus on for this year

Clear - and stable/longterm - message about the doorways to all Primary out of hours care

Information centred around patient rather than individual service - one leaflet explaining simply how to access all Primary care out of hours (including pharmacies and emergency dentists)

Priority to make sure these clear messages reach those who do not speak English well or at all, or have other communication needs. And that there is explanation and support to then reach the service (eg Language Line@@@).

Out of Hours – do people know about it and can they get to the service centre?

Clarify for patients the Duty Doctor service - including cover and opening hours.

Generally request that services approach community organisations to reach more marginalised residents. (Healthwatch Hackney to liaise with Practice Managers) - see below

Involving patients and patient reps

Continued commissioning of our new services

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Helping to maintain Homerton emergency services

Helping us to deliver the message to patients around all of our great services

GP first, whether its in hours or out of hours

Any Questions?

Primary Care Quality PROGRAMME BOARD – CITY AND HACKNEY CCG

LAURIE SUTTON-TEAGUE (PROGRAMME BOARD PROJECT SUPPORT OFFICER)

What is primary care? Primary health care provides the first point of contact in the health care system.

In the NHS, the main source of primary health care is general practice.

The aim is to provide an easily accessible route to care, whatever the patient’s problem.

Primary health care is based on caring for people rather than specific diseases. This means that professionals working in primary care are generalists, dealing with a broad range of physical, psychological and social problems, rather than specialists in any particular disease area.

Primary care in City & Hackney GP registered population = 297,073

There are 43 practices in City & Hackney

Practices are grouped into 6 consortia groups

Practice lists sizes ranging from 863 – 13,508

What is ‘good quality’ primary care?

Commissioning primary care services

Planning the optimum services which meet national standards and local ambitions, ensuring that patients, carers and the public are involved in the process alongside other key stakeholders and the range of health professionals who contribute to patient care;

Securing services, using the contracting route that will deliver the best quality and outcomes and promote shared decision-making, patient choice and integration; and

Monitoring, assessing and, where necessary, challenging the quality of services; and using this intelligence to design and plan continuously improving services for the future.

NHS England is responsible for the commissioning of core Primary Care services

Where does the CCG fit in? CCGs can fund GP practices to improve the quality of existing primary care services

provided that:

the improvement can be expected to improve wider outcomes for the CCG’s population; and

the area team agrees it is over and above what it would expect a GP practice to provide under its existing GP contract.

Primary Care Quality programme board

Members:

Mark Rickets CCG Primary Care Quality Clinical Lead GP

Jan Harley-Doyle CCG Practice Manager Representative

Lucy Carter LMC input to PCQB

Fiona Sanders LMC input to PCQB

Nyamka Marsh CCG Practice Nurse Representative

Catherine MacAdam CCG Public and Patient Involvement Lay Member

Niifio Addy CCG Information Technology Clinical Lead GP

Paula Stanley CCG GP Education & Training Lead

Clinical chair for the PCQ board is Dr. Mark Rickets

Attendees:

Richard Bull CCG Primary Care Quality Programme Director

Teresa McInerney CCG General Manager

Philippa Lowe CCG Chief Financial Officer

Sunil Thakker CCG Deputy Chief Financial Officer

Anna Garner CCG Outcomes Manager

Laurie Sutton-Teague CCG Project Support Officer

Laura Sharpe City & Hackney GP Confederation

Fiona Erne NHSE Deputy Head of Primary Care

Keith Prescott Clinical Effectiveness Group (CEG)

Jo Tissier Clinical Effectiveness Group (CEG)

Sandy Miller LBH Consultant in Public Health

What does the PCQ board do? Clinical Commissioning & Engagement contract - promoting positive commissioning behaviours in clinicians in order to continue developing the quality of patient care in City & Hackney

GP IT - support practices to run efficiently through effective IT support

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

Quality dashboard – develop a quality dashboard to allow identification of areas where practices may need additional support

Co-commissioning – developing a primary care strategy to support any potential future applications to take on greater responsibility of primary care commissioning

Clinical Commissioning & Engagement

AIM: Increase positive commissioning behaviours among member practices, ultimately improving the quality of patient care, and to ensure member practices are fully engaged in the aims and objectives of the CCG.

20 domains of Clinical Commissioning and Engagement contract covering:

Review of outpatient referrals

Adherence to referral guidelines including Procedures of Limited Clinical Value (POLCV)

Attendance to CCG/consortia meetings and education events

Analysis and reflection on referral behaviour

Clinical Commissioning and Engagement Contract: 2015/16 Tracker

The CCE Contract TRACKER is designed to help practices track their CCE Contract activity during the year in support

of payments and is based on the contract specification. Each sheet can be printed out separately to review progress

internally or for wider discussion in Consortium meetings. This tool is for use by practices and your Consortium Lead to

review and monitor practice activity for the 2015-2016 contract. It also forms part of the evidence in support of end of

year payments and it is therefore essential to update it regularly with your CCE contract activity

How to use the tool

Listed below you will see all the key domains of the CCE contract specification 15/16. Click on each domain title to go

to its own page

1. Contact lead

2. Routine discussion of all non urgent referrals

3. Attendance at Education Sessions

4. Use of Consultant Services

5. Routinely review locums and juniors referrals and activity

6. Adhere to procedure of limited clinical value 15/16 (POLCV)

7. Practice Nurses attendance at targeted PN Education Sessions

8. Information Sharing & Governance

9. Attendance at Consortium meetings

10. Attendance at Clinical Commissioning meetings

11. Acting on newsletters

12. CQUIN feedback

13. Review A&E Attendances (high attenders)

14. Biannual Reviews of referrals

15. Participation in a CCG review meeting

16. Medicines management and prescribing incentive scheme

17. Pan C&H audits

18. PPI

19. Duty of candour

20. Ethnicity

2. Routine discussion of all non urgent referrals

Write here in full how the internal system

for peer discussion works before a referral

is made:

Evidence:

The practice will have a system in place to ensure non-urgent OPD

referrals are discussed with another GP prior to being made, to ensure

these are in line with agreed pathways, enhance clinical care and use

resources most efficiently (all to support the gate-keeper role).

The practice may decide to deliver this element of the service preferably

via regular (BUT at least weekly) referral meetings involving clinical staff

or via an at least weekly one-to-one buddying arrangement.

Following the discussion, the code "EMISNQPE50": "peer review of

prospective referral carried out" will be entered into the patient’s notes. It

is suggested that either this is done immediately if the discussion is

occurring around a computer or a list of those patients discussed is given

to an administrator for data entry (NB we acknowledge that the discussion

may happen after the referral has been made on Choose and Book so it

won't be "prospective" but please use this code anyway)

The practice will run a search on this code twice a year.

The Contract lead will ensure that the process for referral discussion and

the 2 data sets form part of a more general review of referral behaviour

(see Domain 14) at a clinical meeting twice during the year (and where

relevant, fedback to individual clinicians if their undertaking of referral

discussions differs significantly from their peers).

E.g. Results of searches and minute

notes when discussed at practice clinical

meeting and (if relevant) an anonymised

note made when one-to-one feedback is

discussed with individual colleagues, to

be recorded on the tracker.

How can you measure ‘quality’?

Quality Dashboard Name Indicator 1 Indicator 2 Indicator 3 Indicator 4c Indicator 5 Indicator 7 Indicator 9 Indicator 10 Indicator 14 Indicator 15 Indicator 16 Indicator 17 Indicator 21 Indicator 22 Indicator 23 Sum of ranks Quality Ranking

SANDRINGHAM 4 10 8 9 1 1 30 2 1 1 3 1 2 5 2 80 1

ONS CLUSTER AVERAGE 20 16 17 16 11 12 18 24 5 15 9 9 13 4 20 209 2

LONDON CCG AVERAGE 22 17 19 18 12 13 19 24 6 13 13 8 22 1 22 229 3

BEECHWOOD AND PITFIELD 13 15 25 19 6 10 38 19 3 20 8 2 5 39 9 231 4

GADHVI PRACTICE 16 9 3 12 3 29 9 16 19 47 1 12 16 29 18 239 5

BARRETTS GROVE 23 13 14 22 2 8 28 8 8 47 5 14 26 10 12 240 6

SORSBY 1 3 6 1 43 36 34 24 13 2 47 11 4 13 4 242 7

WELL STREET 42 32 12 25 7 5 15 31 7 27 6 16 12 11 5 253 8

STAMFORD HILL 37 11 1 11 29 31 5 3 2 3 18 5 44 20 43 263 9

LOWER CLAPTON 14 14 2 8 15 4 39 14 22 12 47 32 10 21 16 270 10

ELSDALE 11 4 7 7 27 30 28 12 47 9 4 47 9 25 11 278 11

CEDAR 3 1 4 2 5 14 41 35 26 21 2 21 31 37 36 279 12

ENGLAND AVERAGE 35 26 24 30 16 11 23 33 11 11 15 10 36 2 8 291 13

C&H CCG AVERAGE 24 23 22 21 23 16 22 24 23 16 14 22 17 23 19 309 14

WICK 45 25 33 27 19 9 35 6 30 17 23 18 3 27 3 320 15

DALSTON 32 8 21 6 22 18 45 36 21 4 18 24 11 30 27 323 16

QUEENSBRIDGE 43 45 34 44 4 3 21 19 19 7 26 15 23 7 15 325 17

HERON 21 22 9 14 33 21 43 20 27 24 12 27 20 3 30 326 18

NEAMAN 34 37 35 35 19 6 24 10 20 14 23 3 46 6 39 351 19

ALLERTON ROAD 8 2 13 4 26 45 32 1 31 47 47 7 41 20 35 359 20

BARTON HOUSE 31 28 23 20 31 34 11 44 12 6 19 38 37 14 14 362 22

ATHENA 30 27 11 39 14 15 13 38 36 19 47 6 15 26 26 362 22

LONDON FIELDS 36 36 28 29 9 29 29 29 11 26 7 25 35 24 13 366 23

TOLLGATE 15 30 40 31 13 19 17 25 4 47 47 13 18 17 31 367 25

ABNEY HOUSE 2 6 16 3 43 37 44 5 41 5 47 30 28 16 44 367 25

SOUTHGATE AND WHISTON 18 24 31 33 30 27 14 28 39 18 24 19 30 40 7 382 26

CRANWICH ROAD 38 35 10 32 24 2 2 4 15 47 47 4 47 35 46 388 27

NIGHTINGALE 25 42 29 36 35 20 6 19 33 28 20 34 19 28 21 395 28

GREENHOUSE 10 31 46 34 20 43 26 7 16 47 47 20 1 47 1 396 31

ROSEWOOD 19 21 37 15 47 33 2 11 45 47 10 39 7 38 25 396 31

HOXTON 9 20 15 17 17 23 28 26 17 47 25 26 40 45 41 396 31

LEA 17 30 39 28 39 17 34 42 28 25 29 36 8 9 23 404 32

HEALY 33 19 26 38 37 41 4 40 42 47 21 29 14 22 6 419 33

CLAPTON 5 4 5 6 44 38 10 34 39 47 47 41 38 42 45 445 34

ELM 46 41 27 45 8 41 38 13 24 47 12 28 32 8 38 448 35

SPRINGFIELD 28 12 32 10 32 41 28 28 29 22 47 37 42 34 33 455 37

BROOKE ROAD 12 7 18 13 47 47 9 16 33 47 47 42 34 41 42 455 37

STATHAM GROVE 47 47 42 46 10 7 40 39 14 47 16 17 43 12 40 467 38

KINGSMEAD 41 38 36 42 21 44 32 32 37 47 47 23 6 15 10 471 39

RIVERSIDE 27 40 44 41 38 24 46 31 34 10 47 35 24 18 17 476 40

LAWSON 29 39 45 38 25 32 17 47 44 8 30 31 33 32 30 480 41

TROWBRIDGE 6 34 47 24 41 25 13 37 25 47 47 43 21 43 37 490 42

LATIMER 7 18 38 23 40 42 9 43 43 47 47 45 27 46 24 499 43

SHOREDITCH PARK 40 43 43 40 28 22 20 41 11 47 28 33 39 36 32 503 44

RICHMOND ROAD 26 34 20 26 47 47 3 45 40 47 47 46 29 31 34 522 45

SOMERFORD GROVE 44 44 30 43 36 35 36 46 35 23 28 44 25 33 28 530 46

DE BEAUVOIR 39 46 41 47 34 26 43 9 46 47 47 40 45 44 47 601 47

GP IT Provision of core GP IT services – commissioned from NELCSU to ensure practices have good quality IT systems.

IT support staff costs (NELCSU)

Helpdesk and engineers (IT support)

GP SoC (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)

Health Information Exchange – joint project with the Homerton Hospital to allow the sharing of patient data between primary and secondary care in order to facilitate integrated care and improve outcomes.

DXS ‘Best patient pathway’ – project to ensure that GPs have easy and convenient access to locally agreed care pathways, guidelines and patient information.

Co-commissioning In January 2015 CCGs were invited by NHS England to put in applications to take on greater responsibility for the commissioning of primary care. There were three options available to CCGs:

Greater involvement in primary care decision making

Joint commissioning arrangements

Delegated commissioning arrangements

Anticipated benefits identified as a result of co-commissioning include improved access to primary care and wider out-of-hospital services, with more services available closer to home, and a better patient experience through more joined up services. Co-commissioning would also enable a more optimal decision making process regarding Primary Care resources.

City & Hackney CCG’s application for delegated commissioning was accepted by NHS England, however, after further consultation with members regarding the ‘offer’ from NHSE, the CCG Board have declined this opportunity for the time being.

There will be future opportunities to re-apply……

Any Questions?

Thank you for listening!

Long Term Conditions PROGRAMME BOARD – CITY AND HACKNEY CCG

CHARLOTTE PAINTER (PROGRAMME BOARD MANAGER)

Examples of long term conditions?

What do they have in common?

What is a long term condition? “A Long Term Condition is defined as a condition that cannot, at present be cured; but can be controlled by medication and other therapies. Examples of Long Term Conditions are diabetes, heart disease and chronic obstructive pulmonary disease. There are 15.4 million people living with a long-term condition in England. Numbers are expected to rise due to an aging population and unhealthy lifestyle choices”.

Department of Health

In City and Hackney we have approximately 70,000 people with a long term condition

Why does it matter? Living with a long-term condition can have wide ranging impacts including:

family roles

relationships

ability to work

education

accommodation

finance

and others….

Which conditions do we cover? Diabetes

Hypertension

Coronary Heart Disease

Heart Failure

Atrial Fibrillation

Stroke

Peripheral arterial disease

Chronic Kidney Disease

COPD

Asthma

Sickle cell disease

Epilepsy

Parkinson’s disease

Multiple Sclerosis, Motor Neurone Disease, other neurological conditions

Learning Disabilities

Cross over with other boards e.g. depression / dementia / cancer

Clinical leads and sub-boards….. Area Clinical Lead Meetings

Diabetes Dr. Kathleen Wenaden Diabetes Ops and Local Strategic Advisory Group (each 3X / year)

Cardiac and stroke Dr. Chris Carvalho Cardiac LIT and stroke board each 3X /year

Respiratory Dr. Meena Krishnamurthy Respiratory board 3X /year

Learning Disabilities

Vacant Regular joint LD commissioning board (with LBH) bi-monthly

Sickle Cell Dr. Jenny Darkwah Regular commissioner / provider meetings

Social Prescribing Dr. Patrick Hutt Steering group quarterly

Renal New area – being covered by Dr. Clare Highton

Steering group set up

Overall clinical lead for LTC board is Dr. Clare Highton

Patient and Public Involvement 2 PPI reps on the LTC board with a wide range of experience and skills between them

Consultation with PPI committee on specific plans such as commissioning intentions or service specification

Wider consultation with members of the public e.g. Commissioning intentions event

Consultation on specific issues with specific groups e.g. stroke unit review

Work with Healthwatch e.g. sickle cell

LTC Board – overall aim

“To help people with long term conditions feel more supported to manage their own condition”

Why?

Because….. People with long term conditions account for:

50% of all GP appointments

64% of outpatient appointments

70% of all inpatient bed days

In total, around 70% of the total health and care spend in England is attributed to caring for people with long term conditions

This means that 30% of the population account for 70% of the spend

More importantly….. It improves quality of life and reduces complications of disease and ill health

Patient.co.uk say:

“Research suggests that the people who do best are those who take responsibility for managing their own long-term condition in partnership with their doctors”

How do we work towards our aim? Long Term Conditions locally enhanced service – ask GPs in City and Hackney to carry out a range of activities to provide additional support to people with long term conditions such as: Case finding

Annual reviews / health checks

Controlling risk factors such as blood pressure and high cholesterol – very important in extending years of healthy life and preventing complications of disease

Additional consultation time for people with multiple problems

Referring to services such as smoking cessation and exercise on referral

Commissioning support services such as TLC stroke care, Ability Bow, community heart failure nursing and Acute COPD Early Response Service (ACERS)

Commissioning a “step-down” unit for people with brain injury to transition from a hospital environment to home by learning more community skills and independence in daily living

How do we work towards our aim? (2) Non-recurrent funding and innovation grants such as Epilepsy Society – self-management course

Additional support for sickle cell team – psychology, social care liaison, and a 24 hour telephone helpline

Additional resources for the diabetes team to help people with foot problems, young adults with diabetes and people not engaging with health care

Funding training for local health care staff to learn how to deliver the Certificate in Diabetes Care training course to other local staff

An Asthma specialist nurse working with patients with brittle asthma at high risk of hospital admission

Cardiac rehabilitation in the community and a new rapid access service for people with Atrial Fibrillation

Long Term Conditions Programme Board Meets every other month including clinical leads, patient representatives, hospital representatives, Public Health (London Borough of Hackney), finance, prescribing, and outcomes lead

Receives reports from sub-boards on their work

Reviews bids for non-recurrent funding; audits in clinical areas; national guidelines such as NICE; service specifications and performance metrics; budget review; risk register; conflicts of interest

Presentations on research or locally applicable services

Partnership working Across programme boards e.g. prescribing, Mental Health and planned care

We work closely with colleagues in the London Borough of Hackney on Public Health issues (prevention of disease and healthy lifestyles), Learning Disabilities, Continuing Health Care for people requiring ongoing care from the NHS and social prescribing

Voluntary sector organisations including HCVS; Sickle Cell Society, Epilepsy society; TLC stroke services, Ability Bow and others

Any Questions?

Integrated Care / Better Care Fund PROGRAMME BOARD – CITY AND HACKNEY CCG

REHAN QURESHI (PROGRAMME BOARD MANAGER)

What is Integrated Care?

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Your views on Integrated Care

For frail older people and those with long-term conditions, care is too often fragmented when it should be co-ordinated around their needs. Addressing this means providing integrated care, with health and social care professionals working together to co-ordinate the care these people need to live healthy, fulfilling and independent lives.

What is Better Care Fund (BCF)? National initiative

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Promote Integrated care closer to home

Better Care Fund Services

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One Hackney – Local initiative

CHUHSE

City and Hackney Together/

third sector

East London Foundation Trust

The Homerton

LB of Hackney/ Social care

City of London

Tavistock and Portman

St Joseph’s Hospice

Marie Curie Cancer Care

Healthwatch

GP Confederation

Individual and

their family

CHUHSE City & Hackney Urgent

Healthcare Social Enterprise

City and Hackney Together/

third sector

East London Foundation Trust

City of London

Tavistock and Portman

St Joseph’s Hospice

Health watch

GP Confederation

BCF Patient/User Experience Group (PUEG)

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The BCF patient/user experience group was set up to recommend a range of patient experience metrics with which to best measure services that are part of Better Care Fund

Ensure that the voice of patients/service users, their carers and City and Hackney public is embedded within the Better Care Fund services

The Group has recently recommended a metrics to measure integrated care (Next Slide)

The Group has also started to look into services under Better Care fund with the aim of proposing Key performance indicators for each service from patients’ perspective

The Group is now supported by Healthwatch Hackney

The Group is linking into other community groups through service users

Patient/User Experience Metrics

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PUEG is formed of a patient representatives, service users and commissioners across City and Hackney. The group has recently agreed the following metrics to measure the impact of integration pilot in City and Hackney.

Proportion of people who feel as much involved as they want in decisions about their health and social care

Proportion of people who feel in control of their health and social care

Proportion of people who know who to contact if they need help

Proportion of people who think health and social care staff work well together

Proportion of people who think that in the last 12 months health and social care staff have offered information about other available services.

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Would you like to be involved?

Please contact Eeva Huoviala

Tel. 020 7683 4222

eeva.huoviala@nhs.net

Any Questions?