Agenda Item: 2.12 Primary Care & Provider Services Directorate Business Plan April 2009 March 2010 Primary Care & Provider Services Business Plan 2009/10: Formal Board 9 June 2009 1/16
CONTENTS Page No. 1.0 Executive Summary 3 2.0 Introduction 4 2.1 Vision 4 2.2 Values 4 2.3 Key Objectives 4 3.0 Current Situation 5 3.1 Organisation & management 5 3.2 Infrastructure 5 3.3 Services 6 3.4 Core Competencies 6 4.0 Environmental Scanning 7 4.1 PESTLE Analysis 7 4.2 SWOT Analysis 7 4.3 Risk Factors 8 5.0 Strategic Planning & Delivery Model 9 5.1 NHS Wirral 5 Year Commissioning Plan 9 5.2 Delivery Model 9 5.3 Monitoring 9 6.0 Financial Analysis 10 6.1 Statutory Duties 10 6.2 Current Position 10 Provider Services Budget 10 Primary Care Budget 11 7.0 Next Steps 12 7.1 Service Operational Plans 12 7.2 Reporting 12 7.3 Closing Comments 12 Appendices Appendix A Primary Care & Provider Services Management Board Membership Appendix B Services directly provided By Primary Care & Provider Services Appendix C - Key Milestones/Objectives from 2008/9 13 14 15 Primary Care & Provider Services Business Plan 2009/10: Formal Board 9 June 2009 2/16
1.0 Executive Summary NHS Wirral Primary Care and Provider Services Directorate s responsibility is to provide high quality, evidence based healthcare to the residents of Wirral. This Business Plan sets out the objectives for NHS Wirral s Primary Care and Provider Services for 2009/10 within its key strategic direction and organisational development plans. NHS Wirral s Primary Care and Provider Services Directorate has a solid foundation for the future provision of healthcare through its staff, services, infrastructure and financial position. The introduction of a contestable market within the NHS means that NHS Wirral Primary Care and Provider Services Directorate must effectively engage staff in the vision for the future and have clearly defined objectives/service priorities, all of which will be underpinned by a strong performance management system and culture. The following strategic aspirations of NHS Wirral have been identified within the Strategic Plan (2008-2013) and adopted by NHS Wirral Primary Care and Provider Services Directorate: - Involve and empower people Target inequalities through effective partnerships Ensure excellence in our health services Be a high performance, high reputation organisation These objectives will be achieved by NHS Wirral Primary Care and Provider Services Directorate by ensuring: - All services are well defined and sustainable Service users and carers views are embedded as part of service provision and quality assurance It is an employer of choice Value for Money and financially robust High levels of professional engagement Integrated services working across professional and organisational boundaries It is a high class, high reputation organisation. Each service within the directorate will produce an operational plan for 2009/10 detailing how they will achieve the objectives discussed in the Business Plan. Individual service operational plans will be reviewed on a quarterly basis and monitored via the Primary Care and Provider Services Management Board. Primary Care & Provider Services Business Plan 2009/10: Formal Board 9 June 2009 3/16
2.0 Introduction NHS Wirral Primary Care and Provider Services Directorate formed in October 2006 and provides healthcare services to patients registered with a Wirral General Practitioner (GP). Services provided include Community Nursing, Therapy Services, Specialist Nursing, Unplanned Care Services, Medicines Management and Sexual Health Services. In addition, the Primary Care element of the directorate provides services to Independent Contractors including GPs, Dentists, Pharmacists and Optometrists. The Primary Care and Provider Services Directorate employs over 1200 staff and manages in excess of 200 independent contractors. In 2009/10 the Directorate has given the following financial commitment to providing healthcare services across Wirral. 47m will be spent on Community Services (e.g. Nursing and Therapy Services) 62m will be spent on Primary Care Prescribing and Pharmacy 62m on Primary Care Services (by primary care independent contractors) 2.1 Our Vision Wirral Primary Care and Provider Services Directorate will deliver high quality, community based health services by promoting excellence in service provision, improving patient experience, reducing health inequalities and supporting well-being and independence. 2.2 Our Values The following values are at the core of the healthcare we deliver: Care and respect for service users and carers Willingness to listen to peoples needs Commitment to professional development and being a good employer Partnership with all organisations that contribute to health and wellbeing Flexibility, collaboration and mutual support Energy and creativity 2.3 Key Objectives The Directorate plans to demonstrate: Well defined services and sustainable core business Service users and carers views embedded as part of service provision and quality assurance It is an employer of choice Value for Money and financially robust High levels of professional engagement Integrated services working across professional and organisational boundaries It is a high class, high reputation organisation Primary Care & Provider Services Business Plan 2009/10: Formal Board 9 June 2009 4/16
3.0 Current Situation This chapter details the current organisational structure of NHS Wirral Primary Care and Provider Services Directorate 3.1 Organisation and Management The Primary Care and Provider Services Directorate formed in 2006. A management board structure was developed to implement the strategic and operational objectives of NHS Wirral PCT Board in relation to the provision of high class primary and community services. This is called the Primary Care and Provider Services Management Board (PCMB) In order to facilitate the achievement of governance principles, the PCMB is authorised by the PCT Board to investigate any activity within its terms of reference. Minutes of the PCMB are presented both to the Board and the Integrated Governance Committee for noting. Appendix A shows the membership of PCMB. The following groups report into PCMB: Nursing Policy Group Locality Birkenhead Locality Wallasey Locality Bebington & West Wirral Wirral Wide Services Group Patient Safety & Integrated Governance Pharmacy Development Group Dental Directorate Board Medicines Management Group Heads of Service Group Following the publication and launch of Transforming Community Services: Enabling new patterns of provision (DOH, 2009), NHS Wirral PCT Board and PCMB have approved the proposal to transform and develop the services provided by the Primary Care and Provider Services Directorate, under an arms length agreement with NHS Wirral. Building on the already successful model of locality structures, work will continue to develop services ensuring that they provide high quality, value for money services that meet the needs of the local population. 3.2 Infrastructure The management function of the Directorate is currently based at: 3 Port Causeway Bromborough Wirral Merseyside CH62 4NH All services are delivered from a variety of locations across Wirral including 23 community clinics ensuring services are offered equitably across the three localities of Bebington & West Wirral, Birkenhead and Wallasey. The main hubs and administration offices for services are currently at St Catherine s Hospital, Birkenhead and Victoria Central Health Centre, Wallasey. Primary Care & Provider Services Business Plan 2009/10: Formal Board 9 June 2009 5/16
Information Management and Technology Services are provided by Wirral Health Informatics Service (WHIS). A Directorate IT System (Lorenzo) is due to be installed throughout 2009/10. This will support clinical services in collecting and recording information which will be utilized in the planning of future service delivery and the achievement of key performance indicators. 3.3 Services The Primary Care and Provider Services Directorate provides 39 services (Appendix B). All services are commissioned by NHS Wirral via service specifications and are included in the NHS Community Contract for 2009/10. The contract is monitored on a monthly basis via the achievement of key performance indicators (also see 5.3). 3.4 Core competencies The Primary Care and Provider Services Directorate works in partnership with Human Resources to ensure the workforce is fit for purpose and appropriately skilled. Dedicated training and investment is allocated annually to ensure this is achieved. The Service Improvement and Patient Experience Unit will support Provider Services in demonstrating how staff provide safe, effective and personalised care within the appropriate robust governance framework and in enabling new patterns of service provision. The Unit s key work streams are organised around the three key themes from High Quality Care for All; evidence based care, patient safety and patient experience. The Unit will do this through developing a centre of excellence in systematic quality improvement within nursing and allied health professions to support frontline clinicians and managers in quality care delivery. The Unit works in partnership with Chester University as a Practice Development Unit to support and increase the amount of research being undertake within the Primary Care and Provider Services Directorate. Primary Care & Provider Services Business Plan 2009/10: Formal Board 9 June 2009 6/16
4.0 Environmental Scan To develop a comprehensive environmental scan it was important to draw from a number of models to compile relevant information. By utilizing and internal understanding of the organisation and external environmental factors the direction of travel of the Directorate can be explored. 4.1 PESTLE Analysis Table 1.0 shows a PESTLE Analysis for the Directorate and can assist in the analysis of factors affecting the delivery of services. Table 1.0: PESTLE Analysis for Primary Care and Provider Services Directorate Political National Drivers Commissioning a Patient Led NHS, Standards for Better Health, Transforming Community Services Developing shared services for the management of patients suffering from chronic disease Patient Choice 18 Weeks Referral to Treatment (RTT) Economic Future consideration around community tariffs Practice Based Commissioning Schemes of delegation Separation of financial systems budgets and cost centres Social Ageing population Health Inequalities Changing ethnic population Care closer to home/individualized care Technological Modernising patient care pathways Impact of technology transfer Implementation of Community IT System IM&T solutions to provide care out in the community/patients homes Legal NHS Operating Framework 2009/10 & Community Contract (3 year) PCMB Governance Structure with PCT Board Overview & Scrutiny Committee NICE Guidelines Environment Locality working model Infection Control Issues Links with Local Authority Estates To ensure the environmental scan fully considers all influencing factors on the Primary Care and Provider Services Directorate a SWOT (Strengths, Weaknesses, Opportunities, and Threats) analysis has been undertaken. This will enable all influences and their impact to be considered. 4.2 SWOT Analysis Table 2.0 shows a SWOT analysis for the Directorate and is useful in determining factors affecting the delivery of services. Primary Care & Provider Services Business Plan 2009/10: Formal Board 9 June 2009 7/16
Table 2.0: SWOT analysis Primary Care and Provider Services Directorate Strengths Proven ability to change through re-design Stakeholder support Positive relationships with Commissioners Strong Management structure Agreed Community Contract for 2009/10 Opportunities Ability to review local needs and with key stakeholders Opportunity to strengthen infrastructure Development of patient choice areas Scope to deliver new areas of work Develop stronger PPI links\ Weaknesses Possible financial constraints due to economy Patient Choice (unpredictability) IT Infrastructure Structure Corporate functions allocation/division not formalized. Threats Competition Other NHS, private providers, voluntary sector Commissioning/tender process Practice based Commissioning change in service delivery/fragmentation 4.3 Risk Factors The Primary Care and Provider Services Directorate is supported by the Governance Team of NHS Wirral. This arrangement ensures that the Directorate is compliant with all relevant healthcare legislation and standards and will be monitored via a robust service level agreement.. Primary Care & Provider Services Business Plan 2009/10: Formal Board 9 June 2009 8/16
5.0 Strategic Planning & Delivery Model 5.1 NHS Wirral 5 Year Commissioning Plan 2009-13 In 2009, NHS Wirral published its Commissioning Plan setting out ten key strategic goals: Health Inequalities Life Expectancy Alcohol Cancer Cardiovascular Disease (CVD) Chronic Obstructive Pulmonary Disease (COPD) Mental Health Obesity Sexual health Smoking The Primary Care and Provider Services Directorate will support NHS Wirral s achievement of these objectives through this Business Plan and the subsequent service operational plans. 5.2 Delivery model The Primary Care and Provider Services Directorate will continue to build on the successful locality structures, promoting the integrated working of independent contractors (GPs, dentists, chemists and opticians) and employed staff within provider services. There are six closely linked business units within the Directorate, with integrated clinical and managerial leadership. Locality Business Units Bebington & West Wirral Locality Birkenhead Locality Wallasey Locality Wirral-Wide Business Units Provider Services Dental Services Medicines Management (prescribing and community pharmacy) Each service will have annual objectives and quality measures to achieve, the objectives will from Directorate Operational Plan to support this document. These will be aligned to the business plan objectives and monitored via six monthly service reviews. In addition, the Directorate will support the PCT s Clinical Networks (formerly Modernisation Teams) by supporting clinical employed staff to become active members of the Networks. 5.3 Monitoring Key Performance Indicators (KPIs) have been developed for Provider Services and agreed as part of the Community Contract 2009/10. Achievement of KPI s will be monitored by PCMB. Quality Indicators and Profiles for General Practice, Pharmacy and Dental are currently being developed for 2009/10. Primary Care & Provider Services Business Plan 2009/10: Formal Board 9 June 2009 9/16
6.0 Financial Analysis 6.1 Statutory Duties NHS Wirral has four core statutory financial duties. These are: - To manage within its Revenue Resource Limit To manage within its Capital Resource Limit To remain within its Cash Limit To demonstrate Full Cost recovery for Provider Services The Primary Care and Provider Services Directorate works within these guidelines when discharging its duties. 6.2 Current Position NHS Wirral Financial Plan 2009/10 Provider Services Gross Misc Net Budget Income Budget '000 '000 '000 Locality Managed Services 12,516 (8) 12,508 Nursing 4,959 (203) 4,756 Therapies & Specialised Services 10,227 (1,389) 8,838 Unplanned Care/Out of Hours Care 7,570 (1,574) 5,996 Other Services 7,504 (519) 6,985 Estates, Facilities & Other Budgets 6,953 (1,053) 5,900 Provider Services Management 1,685 1,685 TOTAL 51,414 (4,746) 46,668 The table details the Provider Services financial plan for 2009-10; Points of Note: Approximately 68% of the cost base for Provider Services listed above relates to direct pay with the balance [32%] being attributable to non pay items Primary Care & Provider Services Business Plan 2009/10: Formal Board 9 June 2009 10/16
NHS Wirral Financial Plan 2009/10 Primary Care Services Gross Misc Net Budget Income Budget '000 '000 '000 GMS / PMS Services 42,976 (1,713) 41,263 Prescribing 57,172 57,172 Pharmacy 5,262 5,262 Primary Care Dental Services 22,118 (5,043) 17,075 Other Primary Care Services 7,291 7,291 Optometry 3,300 3,300 TOTAL 138,119 (6,756) 131,363 The table details the Primary Care Services financial plan for 2009-10; For 2009/10 the Directorate has financial plans as listed above which total 178m. During 2009/10 all Services will consider Cost Improvement Plans to drive a programme of efficiency savings to support the Directorates objective of ensuring financial robustness and stability. The main source of income is from NHS Wirral. However, the Provider Service arm maintains relationships with other organisations who also contribute to the running costs; examples, include Wirral Borough Council and Western Cheshire PCT. Primary Care & Provider Services Business Plan 2009/10: Formal Board 9 June 2009 11/16
7.0 Next Steps 7.1 Service Operational Plans To underpin the Business Plan all services provided by the Primary Care and Provider Services Directorate will devise operational plans supporting the delivery of the business plan and strategic objectives. The achievement of these objectives will be monitored on a quarterly basis via PCMB. Key areas of focus for the service operational plans will be: Patient and Public Involvement and Empowerment Service redesign and development Financial balance and improvement In the 2008/9 Operational Plan all services set objectives focusing on Public and Patient Involvement (PPI), Service Development and Cost Effectiveness. The Key Milestones achieved from the 2008/9 Operational Plan can be found in Appendix C. 7.2 Reporting The implementation of the Business Plan will be overseen by the Primary Care & Provider Services Management Board (PCMB) and incorporated into the Board s work programme for 2009/10. 7.3 Closing Comments This first Directorate Business Plan is the start of a longer journey as set out by local and national policy. Transforming Community Services is critical to the Directorate s thinking but sits alongside the thinking and aspirations of the PCT commissioning intentions, Practice Based Commissioners and other key stakeholders. Increasingly, the Directorate s focus and attention should be on taking the views and comments of our patients, into consideration which will feature in our future models of care. Primary Care & Provider Services Business Plan 2009/10: Formal Board 9 June 2009 12/16
Appendix A Primary Care and Provider Services Management Board (PCMB) Membership The PCMB will comprise the following members: Chair (Non Executive Director) Director of Primary Care & Provider Services (Executive Lead & Vice Chair) Director of Finance (or representative) Medical Director Bebington & West Wirral Locality Medical Director Birkenhead Locality Medical Director Wallasey Locality Medical Director / Director of Infection Prevention & Control Head of Medicines Management PCT Dental Lead / Dental Public Health Consultant Business Managers Primary Care & Provider Services Head of Provider Services Head of Locality Bebington & West Wirral Head of Locality Birkenhead Head of Locality Wallasey Care Services Manager Adult Social Services Representative - Patient & Public Involvement (Non Executive Director) The Committee will also invite representation (in a non voting capacity) from the following key posts within the PCT: Director of Human Resources (or representative) Director of Public Health (or representative) Head of Nursing Strategy Head of Governance Information Management representative Other senior managers will attend when they have papers to present Primary Care & Provider Services Business Plan 2009/10 (Appendix A): Formal Board 9 June 2009 13/16
Appendix B Services directly provided by Primary Care & Provider Services Directorate Provider services Dental Services Locality Services Primary Care Services Service Admission Avoidance Team Community Discharge Team Community Equipment Service Case Management Service (Matrons) District Nursing Service GP-Led Health Centre GP Out Of Hours Service Health Visiting Service Heart Failure Service Heart Intermediate Centre Heart Wirral Service Integrated Continence Service Infection Control Service Learning Disability Service Minor Injuries Service Nutrition and Dietetics Palliative Care Service Parkinson Disease Team Physiotherapy and Rehabilitation Service Podiatry Service Primary Care Access Unit Safeguarding Service Sexual Health Service Single Point of Access Service Speech and Language Service Tissue Viability Service Walk-In-Centre Service Wheelchair Service Dental OOH Service Wirral Community Dental Service Dermatology Service Intermediate Gynecology Service Intermediate Musculoskeletal Service Memory Clinic Service Minor Surgery Service GP services Independent Dental services Medicines Management and Community Pharmacy Optometry Primary Care & Provider Services Business Plan 2009/10 (Appendix B): Formal Board 9 June 2009 14/16
Appendix C Key Milestones/Objectives achieved 2008/9 Key Milestone for Primary Care & Provider Services Date Milestone Progress Jun-08 Report 2007/8 Patient Survey results to PCMB Information shared with practices and PCMB in July 2008 Implement training in MH for 100% of Health Visitors Motivational interviewing training completed by Health Visitors to enhance skills to support Sep-08 Review Health Visitors Coordinator pilot Achieve certificate of commitment for UNICEF Baby Friendly Accreditation Open Enhanced Service - Sexual Health Advice & Emergency Hormonal Contraception to all Wirral pharmacies Education events for GP s & Nursing around antibiotic prescribing for C.Difficile Develop Nursing Strategy Deliver unplanned nursing care teams to provide 24 hour cover Redesign of Community Nursing teams Pilot centralised booking service within Podiatry Begin service review of Speech and Language Therapy Begin recruitment and tender process for Primary Care Access Centre Implement Telephone Assessment Software in GP Out of Hours Increase opening times and medical cover in Victoria Central Hospital Walk in Centre Redesign of all Safeguarding teams into one service Implement Delivering Better Oral Health preventative tool kit Dental Specialties Review completed Implement GP Extended opening across Wirral practices (DoH guidance) Pilot community dressing clinics On going implementation of Integrated Care at Home Model vulnerable clients in November 2008 Wallasey & Seacombe team pilot evaluated. Presentation to PEC with HV proposal approved in 2009. Certificate of Commitment achieved. Enhanced Service was offered to all pharmacies from September, with rolling programme of training continuing. By April 2009, 8 practices were participating Educational events held successfully. Nursing Strategy developed, consultation undertaken and launched in January 2009 Gap between day services and night services closed. Wider workforce plan to be developed in line with Nursing Strategy. Community Nursing Teams successfully undergone re-design in 2008. Initial IT system identified for Community Services Bookings not progressed to now form part of Lorenzo Project Plan. Review undertaken. Report completed by Healthcare Solutions in March 2009 Recruitment of Clinical Director completed, tender for GP manpower successful. Implementation completed in timeframe. Opening times and increased medical cover available to VCH site by September. Safeguarding team successfully relocated and adults and children merged. Training programme now being delivered by Dental Nurses. Review still on-going Oral Surgery completed by September. Orthodontic review planned for 2009. Extended Hours DES and LES in place and shared across Wirral Practices. Achieved DH target of 50% by December 2008. The current level is 61% Evaluation completed on Community Dressing Clinics Pilot Outcome showed demand not sufficient for new service. Continued joint working with localities on model. Primary Care & Provider Services Business Plan 2009/10 (Appendix C): Formal Board 9 June 2009 15/16
Date Milestone Progress Develop Workforce Plan based on Objective successfully completed Nursing Strategy Establish Communication Awareness User feedback gained, model reviewed and Drop in Session for Stroke Clients implemented in response to feedback. Dec-08 Mar-09 Unplanned care to work on redesign of triage process for children attending A&E Establish Community Equipment Satellite stores. Provide dental service to Clatterbridge Centre for Oncology Develop falls pathway and training package for community nursing Pilot for Choice appointments in Physiotherapy at Victoria Central Hospital Implement Postural Stability Classes (contributing to Falls Service Pathway). Primary Care Access Centre to accept patient registrations Complete PDS Dental Contact Negotiations Wirral Heart Beat Out Reach clinics established Health Visitors to achieve UNICEF Stage 1 Accreditation Develop training programme around MH conditions and implement tools in community nursing Increase OOH Call handling across other PCT Services Objective successfully completed and dedicated pathway implemented. CES Satellite stores successfully implemented in 2 sites. Service now available for patients attending Oncology Centre. Implementation of a falls pathway and training within community nursing underway. Pilot delayed due to IT systems and infrastructure issues to form part of Lorenzo Project in 2009/10. Classes commenced in October 2008 Opening delayed due to building work. Recruitment of GPs commenced early 2009. Centre opened March 2009 Dental Contract Negotiations undertaken; majority moved from PDS to GDS (5 remain PDS) completed by April 2009 6 Outreach clinics established across Wirral Accreditation achieved. Completed according to plan. New location supports call handling for Dental OOH, DNs, Phlebotomy Primary Care & Provider Services Business Plan 2009/10 (Appendix C): Formal Board 9 June 2009 16/16