Agenda Item: LSEGB2014/06 FOI Exempt: No NHS Leeds South and East CCG Governing Body Meeting Date of meeting: 23rd January 2014 Title: Primary Care Engagement Lead Board Member: Dr Jackie Campbell, Director of Clinical Engagement Report Author: Dr Jackie Campbell/Sue Jones Senior Locality Manager Category of Paper Discussion and Approval Receive and discuss For information only Tick as appropriate ( ) SUMMARY This report provides the Governing Body with an overview of the key issues and actions being taken to encourage and improve engagement from primary care in commissioning issues and decisions made by NHS Leeds South and East CCG. BACKGROUND Areas currently covered and being developed by the Primary Care Engagement Team are: 1. Primary care engagement incentive schemes 2. Member consultation 3. Education and training 4. Clinical services 5. Quality and safety RECOMMENDATION The Governing Body is asked to accept the report. 1
1.0 Primary Care Engagement Incentive Schemes The Practice Engagement Scheme is an annual incentive scheme to encourage greater involvement of GP practices in the commissioning agenda of the CCG. At the time of writing 95% of practices (41 of a total of 43) within the CCG boundary had signed up to the scheme. The CCG has made additional funding available for an Enhanced Practice Engagement Scheme has been developed. The current take up rate for this scheme is at 65%(28 out of 43 practices have signed up so far). Themes covered include working with practices to embed best practice for Chronic Pulmonary Obstructive Disease (COPD), dementia, stroke reviews and diabetes care. 1.1 Flu vaccine invitations to over 65s The CCG has supported our GP practices to proactively invite all people aged over 65 to have their flu vaccination. The invites have been sent using a number of methods and are designed to reach 40,451 patients aged over 65 who are registered with our 43 member practices. 1.2 Quality Productivity (QP) indicators for Quality and Outcomes Framework (QOF) Quality Productivity indicators are designed to secure more effective use of NHS resources through improvements in the quality of primary care. Member practices continue to work towards the QP indicators and have been supported by the CCG through external peer review discussions. There are three areas that practices are working on: reducing urgent and A&E admissions and reducing outpatient activity and referrals. The CCG is supporting practices to achieve one aspect of QP through the delivery of a taster workshop relating to Year of Care and Advanced Consultation Skills. 1.3 Winter Planning To ensure patients had access to primary care services over the recent holiday period a scheme was made available for GP practices to sign up to. This enabled GP practices to have the opportunity to open on 28 December and be able to offer primary care services to registered and non-registered patients. As a result capacity was created for 420 face to face consultations. 2.0 Member Consultation Members Clinical Commissioning Meetings Bi monthly members clinical commissioning meetings continue at a number of locations across the city. The meeting in November 2013 focused on cancer diagnosis and survivorship. One of the issues raised by GP practices was the need to commissioning of ultrasound services so that patients could be directly booked in for a scan. 2
2.1 Primary Care Nurse Meetings Primary care nurse meetings allow any practice nurse to represent their member practice and attendance has increased from 16 (18%) in Quarter 1 to 22 (51%) in Quarter 3. We have established a primary care nurse database which shows that there are 143 nurses within our boundary (91 practice nurses, 43 health care assistants, 10 nurse practitioners and 9 phlebotomists). In October the Leeds CCGs organised the first ever conference for practice nurses working in Leeds. Of the 108 delegates attending almost half (47%) the nurses worked within our boundary. Speakers included the Chief Nursing Officer of England Jane Cummings who spoke about the importance of the practice nurse role in the community and the national 6Cs strategy aimed at improving nursing care for now and the future. A full paper is available on request. 2.2 Primary Care Strategy For 2013-2014 funding has been identified to allow the CCG to examine the future of primary care. Outcomes of the work have been discussed with key participants and the full paper has been shared with the board at a workshop. Discussions continue with NHS England's Local Area Team and the other Leeds CCGs. 2.3 Review of Practice MOTs Practice MOTs are designed to provide key information and data to GP practices so that they can continue to make improvements to support patient care and make the most of NHS resources. Additional information has been requested for inclusion in the MOT reports which will support practices with the engagement schemes. It will continue to develop during the year. 3.0 Education and Training (Target) A review of the education and training programme, often referred to as Target, is being undertaken by the city wide CCG education leads in Q3/Q4 of 2013-2014. The review aims to challenge and refresh clinical content, and ensure that value for money is provided by the training sessions. 3.1.1 Workforce Planning Tool The Workforce Planning Tool has been designed by the Yorkshire and Humber Local Education and Training Board (LETB) so that they can commission appropriate training. We have asked our practices to submit workforce information and to date just over half have responded with the remainder expected to submit their information by end of March 2014. This review will provide valuable information on current workforce issues and help identify future training needs. 3
3.2 Self Management The primary care engagement team has met with the Public Health leads to implement a scheme so that GP practices can support patients with long-term conditions take greater control of their own health. To raise awareness among clinicians a taster workshop for Year of Care was held in December 2013, signposting individuals and clinicians to the complete Year of Care training and additional Long Term Condition management in 2014. Two members of the team will become Year of Care trainers in 2014 to support further training requirements of the practices planned for February and March 2014 4.0 Clinical Areas Chemotherapy Bloods Work is being undertaken to review the usage of the service level agreement (SLA) for Chemotherapy Bloods alongside other venepuncture requests being undertaken by primary care on behalf of secondary care. The CCG is aware that the SLA will no longer be valid from April 2014 and notice is required to be given to practices of any change to procurement of services in the future. The risk register will be updated to reflect this pending outcomes from current discussions. 4.1 Integrated Health and Social Care South Leeds Initiative: Leeds Community Healthcare NHS Trust and Leeds City Council Adult Social care are proposing to test out some areas of work to shape how they complete the final phases of the integrated health and social care programme. This initiative team will focus on information gathering and testing work in the following neighbourhood teams: Kippax, Beeston, Hunslet and Middleton. Project teams will continue to work with front line staff to support the development of the rapid response service, out of hours service, expansion of the neighbourhood team and the rehabilitation, recovery and re-ablement service. The South Initiative will be looking to align the following teams into the integrated neighbourhood team model: district nurses including out of hours, community matrons, out of hospital care; adult social care including care management teams, disability services team, domiciliary physiotherapy and falls team. Consideration needs to be given as to how we ensure primary care is aware of these changes and how they can influence and shape the final model. 4.2 Long Term Conditions Directed Enhanced Services The CCG has been working with its member practices to ensure they sign up to directed enhanced services (DES) for people with long-term conditions. Almost all, 39 out of 43 practices, have signed up to the remote monitoring scheme although the decision on which long-term condition they will focus on is based on the needs of the GP practice's patients. Members of the primary care engagement team sit on the citywide tele-health steering group and recently attended a workshop to consider the current service and future provision requirements. 4
4.3 Enhanced Services in Care Homes without Nursing (Formerly Residential Homes) The project provides more proactive people-centred care plans and anticipates any potential health problems which could result in preventable hospital admissions. The number of patients being covered by the project continues to increase and it involves 17 GP practices and 26 care homes. Data collection required to demonstrate project benefits continues to be protracted and this has been identified as a risk to the evaluation of the outcomes. The risk has been reported through the CCG's reporting mechanism, Datix. Running alongside the roll out of the project is a patient engagement exercise that is being used to capture the experience of patients and their carers and to date we have received 50 responses. 5 Quality and Safety CCG Yellow Card Scheme (Pilot) The CCG has engaged with its member practices to lead the way in the city to trial this new way of working. The Yellow Card Scheme is a pilot project that is looking at developing a more effective way of capturing any soft or hard evidence of quality and safety concerns identified by healthcare staff working in primary care. This in turn will help staff working in quality and safety to highlight any areas of concern and trends that could affect the care provided to patients. It is anticipated that all member practices will have signed up to the scheme by end of March 2014. 5.1 Mind the Gap Long Term Conditions Care for the Housebound The CCG is supporting a three month scoping exercise amongst all its member practices that will look at the perceived gap in services for patients who are declared housebound and require review of long-term conditions, leg ulcer management or phlebotomy. An initial report has been issues following the initial analysis undertaken by 33 of our 43 member practices. Executive Management Team Meeting Approval: Checked by Finance: Equality Impact Assessment completed Yes No Not applicable 5