NHS Islington Clinical Commissioning Group Conflict of Interest Template

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1 Appendix: 3.2a NHS Islington Clinical Commissioning Group Conflict of Interest Template Service: Clinical Commissioning Locally Commissioned Service Question Comment/Evidence Questions for all three procurement routes How does the proposal deliver good or improved outcomes and value for money what are the estimated costs and the estimated benefits? How does it reflect the CCG s proposed commissioning priorities? The Clinical Commissioning Locally Commissioned Service (LCS) (previously named Local Enhanced Service) has been running in Islington for a number of years, and over time it has evolved in order to take into account the CCG s strategic objectives, and other national work-streams such as Quality and Productivity markers under national General Medical Services Contract (around outpatient referrals, A&E attendances and Emergency admissions), and new national Directed Enhanced Services for General Practice on risk profiling and case management. The clinical commissioning local commissioned service is a key enabler to support some of the transformation work is support of the CCG s primary care and integrated care strategies. The service enables the CCG to work with primary care to test out and evaluate new initiatives with a view to then embedding as appropriate. For 2013/14 and 2014/15 it is proposed that the core components are carried forward from 2012/13 to allow overall continuity. Building on 2012/13, in 2013/14 there will be a focus on supporting the work on children s multidisciplinary case conferences (following on from adult case conferences), and using self-care metrics such as patient activation measures as a tool for on-going support to patients in managing their own condition. However the CCG will review the Clinical Commissioning LCS specification, as is the case for all other local services commissioned through primary care in

2 2013/14, with a view to embedding more outcomes in the services that are commissioned in 2014/15. The aims of the 2013/14 Locally Commissioned Service (LCS) are to: Encourage and strengthen clinical involvement in commissioning generally, including assessing local needs, helping to identify local priorities, and proposing new care pathways; Promote partnership working between GP practices and across health and social care; Promote the importance of patient involvement and participation in commissioning and strengthening links with the practice s patients; Strengthen two-way communication and sharing of ideas between Islington CCG Governing Body and constituent practices; Support constituent practices to use data effectively (e.g. referrals and prescribing) to help change and improve outcomes through peer support and in turn drive up quality and reduce variation across primary care; Support risk stratification and care planning as key enablers for integrated care; Support the implementation of systems to develop the understanding of patients activation levels to inform how we commission self-management programmes going forward and signpost patients to those services commissioned The benefits on this Local Commissioned Service wholly supports Islington CCG s commissioning priorities in that it supports Improved collaborative working across member practices and the governing body to support the general functioning of the CCG as a membership organisation with commissioning functions Improved ability for member practices to drive commissioning, as is the importance of any CCG The implementation of the integrated care programme, the embedding of which is one of Islington s key strategic

3 initiatives over the next two years. It support the delivery of the CCG objectives and outcomes for it population with better care and co-ordination. The estimated costs for the full delivery of the service across all 37 General Practices is approximately 538,000 with an average practice awarded approximately 13k (list size of approximately 6000 registered patients). How have you involved the public in the decision to commission this service? The public has not been involved in the development of this specification, however throughout the implementation of primary integrated care, discussions have ensued at locality patient participation groups about how we are developing and shaping primary care and this has helped to inform the specification and other related work streams outside of this specification (like organisational development for integrated care etc). In particular PAM and LTC6 are validated measurement tools and have had considerable amounts of patient and public involvement in their development by Department of Health and Insignia, where the tools originated; The specification supports continued practice engagement in patient and public involvement via locality and pan-islington events, and this will inform commissioning; Care planning has originated with Year of Care, who have done extensive engagement with patients. Additionally, the concept of care planning as part of integrated care has been the focus of past patient and public participation groups when care planning was being implemented in ; Lay members are part of the Governing Body What range of health professionals have been involved in designing the proposed services? What range of potential providers have been involved in considering the proposals? Primary Care team GPs, Practice manager, nurses Medicines management team Public health Local Medical Committee It has been considered whether other providers were viable, but only primary care

4 is able to deliver this service to support the deliver the aims and objectives of the service through being members of the Clinical Commissioning Group and implementing key components through registered population. How have you involved your Health and Wellbeing Board(s)? How does the proposal support the priorities in the relevant joint health and wellbeing strategy (or strategies)? The LCS wholly supports development and implementation of systems required within primary care to drive Islington CCG forward in its commissioning capacity. Public health are a core member of the Primary Care Development Group in the borough and the implementation plan for primary integrated care has been shared with the Health and Wellbeing Board including the proposal to develop and implement the Locally Commissioned Service to support the implementation. The proposal mainly supports two of the main health and wellbeing objectives jointly agreed upon by Islington Health and Wellbeing Board, and Islington CCG i.e. 1. Preventing and managing long term conditions to extend both length and quality of life and reduce health inequalities 2. Delivering high quality, efficient services within available resources Components 3, 4, and 5 provide support for the development and implementation of a successful integrated care system, which is integral for the future management of medium and high risk patients with long term conditions. All 6 components support the ability of primary care to deliver their functions (both as providers in an integrated care system), and commissioners in the CCG and therefore their ability to deliver high quality and efficient services. What are the proposals for monitoring the quality of the service? Primary/Integrated care The Primary/Integrated care programme will be consistently evaluated and monitored in its roll-out as a wider programme. The primary care component of integrated care, which is supported under this local enhanced service will be monitored via Attendance and discussion at quarterly enhanced primary care meetings (re medium/high risk patients)

5 Monitoring of Non-elective admissions and A&E attendances and length of stay Number of care plans developed for medium risk patients Attendance and discussion at MDT meetings for children / team around child meetings Involvement in, and number of returns of LTC6 and PAM questionnaires, and the change in overall scores / activation levels, per practice. Commissioning forums and patient group meetings The attendance at these meetings will be monitored closely. Since the backfill for these meetings has been paid, there has been consistently good attendance from most practices at these events. Plans are being created from the ground up through discussion between practices at commissioning forums, and patient experience is consistently reviewed at patient group meetings, whether that be through gaining their feedback at patient group meetings, improving their ability to voice their concerns about services, and strengthening their links with their practices and the health services generally. Board Link meetings Strong, supportive relationships will be fostered between practices and the governing body, and this will further enhance the ability for practices to influence commissioning and have two-way dialogue. It is intended that these meetings will also drive improved quality in primary care as practices will be Supported through general discussion and peer to peer learning on a range of areas including acute activity as detailed in data reporting; Supported through development of action plans to improve. What systems will there be to monitor and publish data on referral patterns? A refreshed data dashboard is being developed, so that more accurate, informative, benchmarked data can be provided to practices on a monthly basis around referrals (amongst other acute data), grouped by specialty. This will allow practices to carry out their own in-house reflection (with the advantage of being able

6 to see month on month trend), and this will also inform discussion at Board Link meetings, and subsequent action plans which practices must follow and deliver. Have all conflicts and potential conflicts of interests been appropriately declared and entered in registers which are publicly available? Our register of conflicts of interest is published on our website at: The governing body are required to positively make a declaration, whether there is something to declare or not. Staff and GP practices are invited to declare any interests they have, but declarations from all members are not compulsory. Why have you chosen this procurement route? This service is specifically designed to support General Practice involvement in commissioning and patient participation Development and implementation of integrated care at the primary care level. There are no other qualified providers who would be suitable to deliver the service as it is aimed specifically at supporting and improving primary care delivery through implementation of collaborative working principles which are embedded in the Islington CCG constitution. Additionally, the delivery of care planning, and involvement in MDTs for complex adults and children must be done by GP practices for their own patients as they: a) are the most appropriate people to create such a care plan for their own patients; and b) hold the practice lists and patient records. What additional external involvement will there be in scrutinising the proposed decisions? How will the CCG make its final commissioning decision in ways that preserve the integrity of the decision-making process? The specification has been shared with the Primary Care Contracting Team at NHS England and they have been invited to give feedback. As outlined in our Constitution, where there is a clear conflict of interest, discussion and decisions on commissioning will be undertaken in part 2 of the Governing Body

7 meetings with the statutory Vice Chair acting as chair. Additional question for AQP or single tender (for services where national tariffs do not apply) How have you determined a fair price for the service? Backfill for clinical time to attend meetings (GP link meetings, commissioning forums, organisational development meetings, patient group meetings, MDT meetings) are determined as per the agreed sessional rate with the Local Medical Committee. Note that Component 4a subsumes the national Risk Profiling and Case Management DES, which specifies the payment amount under that Component. Creation of action plans and delivery of such are at the standard rate estimated on the time taken per practice and agreed with the Local Medical Committee. With regards to the integrated care components, the price paid for care planning has been calculated by reviewing the pricing paid and systems used in other CCGs, and also standard sessional rates for time spent in producing care plans, against number of eligible patients identified through risk profiling. Additional questions for AQP only (where GP practices are likely to be qualified providers) How will you ensure that patients are aware of the full range of qualified providers from whom they can choose? N/A Additional questions for single tenders from GP providers What steps have been taken to demonstrate that there are no other providers that could deliver this service? It is clear from the intended outcomes of the service, i.e.: Improved GP commissioning Improved relationships within the CCG Improved quality in primary care Improved management of patients with long term conditions (via better and more primary care management)

8 that GPs are the only providers who could deliver this service. In what ways does the proposed service go above and beyond what GP practices should be expected to provide under the GP contract? GPs are required to go above and beyond the GMS / APMS provider contract in the following ways Invest their time in being stronger clinical commissioners Invest time in developing themselves as providers within an integrated care system, to: o o Develop care plans Involve themselves in developing further integrated systems with other practices and their community services. These ways of working are not within the GMS / APMS contract. What assurances will there be that a GP practice is providing high-quality services under the GP contract before it has the opportunity to provide any new services? There is strong dialogue currently between Islington CCG s primary care team and NHS England s primary care contracting team. Any issues that NHS England has contractually with a practice will be notified to the CCG team.

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