NCL Integrated Urgent Care (NHS 111 and GP Out-of-Hours) Mobilisation Assurance Report

Transcription

1 NCL Integrated Urgent Care (NHS 111 and GP Out-of-Hours) Mobilisation Assurance Report 1. Introduction The purpose of this paper is to inform Governing Bodies of progress of the mobilisation and governance process for the North Central London Integrated Urgent Care Service. The Governing Body is asked to note that progress remains on track for the service to commence on 4 October Background The five north central London CCGs (Barnet, Camden, Enfield, Haringey and Islington) agreed to jointly commission a single, integrated NHS 111 and GP Out-of-Hours (GP OOH) service for their collective population. A tender process to select the new provider(s) started on 2 October 2015 and finished in April 2016, allowing six months for the new service to mobilise before the new integrated service commences 4 October The process has been led by Enfield CCG. Enfield CCG will be the lead commissioner for the new contract. During March 2016, the five north central London CCGs agreed the contract award and this was formally announced on 6 April The mobilisation phase commenced on 7 April Mobilisation Assurance The Integrated Urgent Care (IUC) Service mobilisation is directed by the NCL mobilisation delivery group, which is governed by the NCL CCGs IUC mobilisation assurance group. A number of specialist task and finish groups inform the delivery group to inform different aspects of the mobilisation, such as the interoperability and the contract and finance groups. The North Central London (NCL) Integrated Urgent Care (IUC) Mobilisation Assurance Group provides strategic oversight of the mobilisation period for the IUC service ensuring the new service is operational from 4 October 2016 and that it meets all clinical governance, quality, safety and contractual requirements. The assurance group is also responsible for overseeing the risk and issue registers for mobilisation; identifying any further risks and taking appropriate actions to mitigate against these risks The key elements of assurance are detailed within the critical path, a summary of this is given below: Critical Path Operations Clinical Model Staff workforce plan year 1 activity modelling by day standard operating procedures in place confirm critical numbers for go live confirm all staff training complete confirm all pathways 1

2 Human Resources Clinical Governance Estates Technical Contracting Finance Reporting Go Live Countdown confirmation of DBS checks confirm and evidence CQC registration confirm ICO certificate confirm provider business continuity plan approve all policies ratify leases and carry out site visits confirm test plan in place Telephony Infrastructure in place review ITK interoperability confirm DoS content confirm data sharing agreement in place confirm care plan provision including special patient notes confirm direct booking system in place confirm remote working system in place confirm call recording in place confirm readiness for transition contract sign off confirm and evidence sub- contract sign off agree finance reporting schedule agree internal payment process agree financial sanctions start date Minimum Data Set Sitrep Repeat caller service Metrics & KPIs Quality and Governance weekly review of critical path starting 4 weeks before go live All critical path actions are in progress and are on track. NCL Subject Matter Experts are assisting with the approval of standard operating procedures and policies. NCL Clinical Governance Lead will have final approval of these documents. Comprehensive testing will be carried out internally by the Provider and then in collaboration with NHSE to incorporate systems and processes. The focus on testing will be the additional requirements of the IUC service including the clinical hub element and processes around this. This will be achieved by utilising a variety of clinical scenarios to stress test the systems and processes that are in place. If any of the tests fail, the problem will be rectified and then re-testing will be carried out. 4. NHSE Assurance There are a series of checkpoint assurance processes with NHS England which have to be achieved prior to go-live of the new service: Checkpoint 1 Checkpoint 2 Checkpoint 3 Delivery strategy (Pre-tender assurance up to publication of documents) Investment decision (Post-evaluation and before contract award) Operational review (Before go-live of the new service provision) 2

3 The checkpoints are designed to enable assurance at critical stages and to highlight any material risk to proceed to go-live. Checkpoint 1 gateway was achieved in November 2015 prior to ITT commencement. Checkpoint 2 meeting was held on 21 July 2016 with the Regional Director of Operations and the Healthy London Partnership team. Feedback at the meeting included the recommendation to strengthen the mobilisation programme team in order to deliver an assured service on the 4 October This recommendation has been addressed with additional funding and posts agreed. Checkpoint 3 meeting will take place with NHSE on 13 September 2016 however, assurance is ongoing throughout the mobilisation period and an NHSE assurance manager has been assigned to NCL to monitor progress against plan including: Project mobilisation, resource and critical path milestones IM&T, telephony and operational testing Workforce (recruitment, training and planning) Communication, marketing and engagement planning Directory of Service development 5. Go-Live Governance The decision to go-live as planned with the new service will be made on behalf of NCL by the Senior Responsible Officer and Clinical Responsible Officer at the mobilisation assurance meeting which is scheduled for Friday 23 September This will be following NHSE assurance at checkpoint three meeting on the 13 September The assurance group has representation from the five CCGs, commissioners, quality leads, Information Technology and Information Governance leads, clinical leads, patient representatives, Provider and NHSE, who will be present at the meeting and will be able to contribute to the decision making process. 6. Communications and Engagement The Communications strategy was agreed by the Integrated Urgent Care Programme Board on 4th July To reflect the phased approach, communications phase 1 will reflect a soft launch approach as this is not a major service change and access to care outside GP hours remains the same. Communications will include letters to key stakeholders, messages to and engagement with GPs and practice managers, CCG website updates, briefing notes to patient groups and JHOSC/OSC and a media release. Phase 2 communications will include marketing of the service and may form part of the NHS England Stay Well winter campaign which launches at the beginning of November Patient & Public Involvement (PPI) Significant public engagement has taken place on the proposal to develop an integrated NHS 111 and GP Out-of-Hours service across north central London. The draft specification was widely circulated for comment. The document was also available on the CCG public 3

4 website, along with information about how to comment. There was also a patient and public reference group established to contribute to the development of the service specification. Seven members of the patient and public reference group contributed to the procurement process with three representatives as members on the evaluation panel and four separate representatives as members of the assessing teams on the Objective Structured Clinical Examination scenario day. Three members of the patient and public reference group are also members of the mobilisation assurance group and the communication task and finish group. These three members will continue to participate with the service and will join the contract monitoring groups post go live. 8. Contract Management The NCL Collaborative Commissioning and Procurement Agreement was approved and signed by the five Chief Officers on 1 December The Agreement sets out how the commissioning contract will be managed throughout its term. Enfield CCG is the host commissioner and will lead the contract management as per current arrangements, with monthly contract performance and quality review meetings. The contract performance meeting will be chaired by Enfield CCG Director of Commissioning, the CQRG meeting will be chaired by NCL Clinical Governance Lead for the new Service. This process will continue to be supported by NELCSU via Enfield MDT. Performance reports will reflect both national and local metrics and key performance indicators and will be reported at both NCL and at borough level. There will also be a requirement for close monitoring of the new service for a period of one month in the first instance, following launch. There will be a daily Sitrep call between senior commissioner, clinical lead, NHSE and Provider. This will facilitate discussion and resolution of any issues as they arise. The Sitrep calls and representatives are currently being scheduled. 9. Risks The key risks associated with the mobilisation are around workforce and recruitment of sufficient clinicians to deliver the additional clinical assessment requirement and contingency should assurance not be given to go live on 4 October GP recruitment to the new IUC service Recruitment events have taken place across NCL The Provider has presented at GP forums across NCL All NCL GP practices have received a letter from the Provider Information has been given in GP bulletins NCL are continuing to engage with GPs. Current GP rota fill is at 65%, this is being monitored on a weekly basis. Contingency measures for not achieving critical rota fill include; Staff leave suspended, extended shifts and additional shifts. 4

5 Subcontract with other Urgent Health UK provider - contingency contract agreed and piloted. 2. Go-live Assurance not given by NHSE or Senior Responsible Officer and Clinical Responsible Officer. This could be a result of failure of any of the testing processes or other external factors beyond NCL control as one of the first integrated urgent care services to go live. Consequence of not going live on 4 October 2016 is a gap in GP Out-of-Hours provision for Camden and Islington CCGs as current Out-of-Hours Provider (Care UK) exit the contract on this date. Contingency position is for LCW to provide Out-of-Hours cover for these 2 boroughs as per the rota fill issue above. 10. Future Developments The IUC service will deliver the local specification requirements at go-live. However, there are a number of developments which will not be in place at go-live but which will be taken forward as part of phase 2 development (post go-live). The reason for phase 2 development is the recent publication of clinical hub guidance and associated additional requirements; and the interoperability standards which are expected to be published post go-live along with national interoperability solutions that are not yet available, necessitating short term local solutions. Examples of developments include: Access to the Directory of Services from within the clinical hub (currently only possible from NHS pathways) Direct booking into primary care services across NCL with pilots planned to test the process from go-live. Record sharing across NCL Detailed planning and associated timeline for these developments will be available following the publication of these documents. Additional costs are expected for these developments which will be covered by the contingency funding within the agreed contract envelope. The contract value for the Provider is 50m, however the contract baseline agreed by the five NCL CCGs is 55m. This was agreed by CCGs at respective Governing Bodies in March 2015 and is a commitment to phase two development which is binding. NHSE mandated a minimum 10% contingency in all IUC services. For NCL this figure is 5m. This requirement equates to 1m per year for the duration of the contract (pro rata for years one and six) and is to be split proportionately across the NCL CCGs following the same methodology as the contract value split. 11. Summary This paper has informed Governing Bodies of the progress of the North Central London Integrated Urgent Care Service mobilisation. The NCL Integrated Urgent Care Service golive date is 4 October Assurance to go live with the service will be expected from 5

6 NHSE at the Checkpoint 3 meeting on 13 September 2016 and from the Senior Responsible Officer and the Clinical Responsible Officer on 23 September There are a number of developments which will not be in place at go live but which will be taken forward as part of phase 2 development (post go-live). 6