nhs kingston ccg commissioning intentions 2016/17 · obstetrician presence by april 2016 kingston...

NHS Kingston CCGCommissioning Intentions 2016/17

1

Contents1. Introduction .......................................................................................................................2

2. Equality and Diversity ........................................................................................................3

3. Maternity and New-born ...................................................................................................4

3.1 Progress on the 2015/16 Commissioning Intentions and Operating Plan key items: .....4

3.2 2016/17 Kingston CCG Commissioning Intentions..........................................................5

4. Children and young people ...................................................................................................7

4.1 Progress vs 2015/16 Commissioning Intentions and Operating Plan key items: ............7

4.2 2016/17 Kingston CCG Commissioning Intentions..........................................................8

5. Integrated Care and Long Term Conditions ........................................................................12

5.1 Progress on the 2015/16 Commissioning Intentions and Operating Plan key items: ...12

5.2 2016/17 Kingston CCG Commissioning Intentions........................................................15

6. Planned Care .......................................................................................................................17



7. Mental health......................................................................................................................20



8. Urgent and emergency care ............................................................................................26



9. NHS Continuing Health Care ...............................................................................................31



10. Primary Care......................................................................................................................34

10.1 Progress vs 2015/16 Commissioning Intentions and Operating Plan key items: ........34

10.2 2016/17 Kingston CCG Commissioning Intentions......................................................35

11. Prevention & Health Improvement...................................................................................39

11.1 2016/17 Kingston CCG Commissioning Intentions......................................................39

2

1. Introduction

Kingston CCG has previously prepared detailed Commissioning Intentions for 2013/14, 2014/15 and 2015/16. These Commissioning Intentions informed the previous Operational Plans and the existing CCG/RBK Integrated Operating Plan for 2014/15-2015/16. These comprehensive documents provide the baseline for the 2016/17 Commissioning Intentions, which are consequently a refresh rather than a full re-write. Kingston CCG’s 2016/17 Commissioning Intentions reflect increased collaborative working between the CCGs in South West (SW) London, which enabled the publication in June 2014 of the joint SW London CCGs 5 Year Strategy for SW London.

The scale and scope of challenges and opportunities now facing the NHS and social care require more collaboration between commissioners, as well as amongst providers. To enable common progress against the SW London 5 Year Strategy the 6 CCGs have developed joint SW London commissioning intentions which have been relayed in joint commissioning intentions letters to each acute and mental health provider. These provide some broad principles together with service-specific requirements which commissioners will all apply consistently across the whole area. They are summarised in this document because they will apply to arrangements and provision in and for Kingston, along with Kingston-specific commissioning intentions. We will not be bringing forward any proposals for major services change at acute providers in the 2016/17 Commissioning Intentions, though we recognise this is an issue we will need to return to in the years ahead for mental health services. As a commissioner we would like to use CQUIN differently, and have more input into how CQUIN monies are used. The Commissioning Intentions also signal our intent to move towards an umbrella contract with other trusts around areas such as management of dementia payments in urgent care.

Kingston CCG has the budget for, and commissions health services for people living in the Royal Borough of Kingston. In 2015/16 NHS England held the contracts for core GP provision from Kingston’s 26 GP practices. Our intention for 2016/17 is to bring the commissioning of primary care services locally through ‘delegated commissioning’. Delegated commissioning offers us the opportunity to assume full responsibility for commissioning general practice services, greater strategic oversight and the opportunity to shape the way in which primary care develops. This enables the CCG to support practices to maximise the delivery of transformation via improving access, proactive care and coordination of care and localise decisions about primary care, enabling integration of primary care services with Kingston Coordinated Care and the Royal Borough of Kingston to ensure high quality services for patients. NHSE will continue to commission a range specific range of specialised services for people in Kingston. The CCG will continue to work closely with NHSE and neighbouring CCG commissioners to ensure coordinated commissioning and service provision across these different areas of responsibility.

Naz JivaniChair Kingston CCG

3

2. Equality and Diversity

The CCG has an agreed approach to Equality and Diversity which includes incorporating ‘equality impact assessment’ in planning and service change and development work which helps ensure specific needs of these Groups are taken into consideration”.

4

3. Maternity and New-born

3.1 Progress on the 2015/16 Commissioning Intentions and Operating Plan key items:

2015/16 Commissioning intention ProgressProviders to operate 98 hour consultant obstetrician presence as a minimum of providers extend provision to meet target of 114 hours consultant obstetrician presence by April 2016

Kingston Hospital 2015/16 CQUIN - plan and trajectory under development to deliver the required increase in obstetric hours.

Providers develop clear plans for achieving full compliance with London Quality Standards (LQS) workforce standards by 2019 (24/7 (168 hours pw) consultant presence)

SWL Maternity Network exploring options to support delivery e.g. new models of care.

All maternity units to achieve ratio of 1 clinical midwife to every 30 births p.a. by July 2015 o all providers to achieve ratio of 1 consultant midwife to every 900 expected normal births p.a. by end March 2016

Kingston Hospital has an active programme of recruiting midwives to support delivery of these ratios and have successful recruited a cohort of midwives who join the Unit shortly.

By 31/03/16: A minimum of 15% of women’s care to be midwifery led and delivered. Includes antenatal, intrapartum and postnatal care & a minimum of 2% of births to take place at home

Kingston Hospital is achieving these standards.

Women with uncomplicated pregnancies to have no more than 2 midwives providing their antenatal and postnatal care within a community setting

Every effort is made to enable women to receive continuity of care /carer throughout their pregnancy

5

3.2 2016/17 Kingston CCG Commissioning Intentions

CCG clinical lead Dr. Naz Jivani

Commissioning lead Julia Gosden, Director of CommissioningService summary Maternity services provided by Kingston Hospital FT and midwifery services. The aim is to provide a safe and accessible

service for local women, babies and their families in planning pregnancy, during pregnancy and labour, and in the period following the baby’s birth.

Commissioning intention for 2016/17Relevant

Provider(s)

Specific action / implementation

required from the provider

Timeframes for implementation

Status

Expected outcomes (has

to be measurable)

Deliver the SWLCC Commissioning Intentions for Maternity Services

Implementation of a SWL Maternity Service specification & network

Ensure local providers meet the trajectory to achieve obstetric hours – London Quality Standards (LQS).

Ensure local provider meet the trajectory to achieve LQS settings of care standards – Midwifery led and home births

Ensure breastfeeding is promoted by Midwives

Kingston Hospital FT Epsom & St Helier Hospitals St Georges

Deliver the requirements

March 2016 CIs discussed with KHFT Dir of Strategy and DOF at SWL Acute Provider meeting The requirements are drawn from the SWL CC 5 year plan which are being taken forward by the SWL Maternity Network of which the Trusts a member

Quality

Delivery of the LQS for maternity

6

4. Children and young people

Lead Clinician for children and young people: Dr. Pete Smith Senior Responsible Officer: Julia Gosden, Director of CommissioningCommissioning lead: Elizabeth Brandill-Pepper

We aim to improve the health and wellbeing of children in Kingston, through early identification of children and families with problems, and appropriate provision of help to enable all children to reach their full potential.

4.1 Progress vs 2015/16 Commissioning Intentions and Operating Plan key items:

2015/16 Commissioning intention ProgressCommunity therapy services - complete a review and re-specify to ensure sustainability within resources YHC (Your Healthcare) to implement a revised Children’s Speech and Language Therapy specification jointly commissioned via a pooled budget between the CCG and Royal Borough Kingston (RBK)

Kingston CCG and BRK have pooled the budget for Speech and Language Therapy and streamlined the contractual arrangements with the provider in order to give the provider greater flexibility in the use of the funding available.

A joint service specification has been drafter to underpin the pooled budget and commissioners continue to work with providers to ensure the use of the available resources is maximized and to identify any potential gaps in provision in light of growing demand for these services.

Safeguarding – maintain as a focus and commissioning priority; ensure investment maintained and the health outcomes of looked after children and care leavers is improved; respond to findings of July 2014 CQC inspection once available

An action plan has been co-produced with providers by the CCG to ensure the findings of the CQC report are responded to in a timely and appropriate manner. Good progress has been made and the Integrated Governance Committee (IGC) continues to monitor delivery of the action plan.

Children and Families Bill – review impact and learning from initial implementation after September 2014, action accordingly for 2015/16

Good progress has been made to implement the reforms under the Children and Families Bill. This has been recognized both by central Government and NHS England.

7

The take up of Personal Health Budgets (PHB) continues to grow albeit at a slow pace. Families in receipt of a PHB report that this has had positive impact.

The Local Offer published by RBK has a wide range of comprehensive information relating to local health services.

Work continues with families to define and clarify expectations relating to the sections with the Education, Health and Care Plans with regard to the provision and agreement relating to meeting health outcomes.

Children and Young People’s mental health services – review and consolidate on 2014/15 actions around the introduction of single point of access and changes to local provision in the community for children and young people with (i) emerging emotional wellbeing problems or (ii) who require assessment and treatment for mental health disorders Disabled children – continued focus on commissioning integrated provision from the Integrated Disabled Children’s Service, part of arrangements with the new children’s services provider ‘Achieving for Children’

The impact of the single Point of Access continues to be monitored in terms of effectiveness and impact. The anticipated reduction in waiting times for access to treatment from both Tier 3 services and Tier 2 services as a result of the SPA has not been as significant as first predicted.

The re-commissioning of the targeted CAHMS posts for vulnerable groups such as Looked After Children, Young Offenders and Children with Disabilities was successful but there have been delays in recruitment for the provider.

Disabled children – continued focus on commissioning integrated provision from the Integrated Disabled Children’s Service, part of arrangements with the new children’s services provider ‘Achieving for Children’

The Governance arrangements for the Integrated Service for Disabled Children has been reviewed with Achieving for Children resulting revised dashboard of key performance indicators and the development of a comprehensive service improvement plan.

8


CCG clinical Dr. Pete Smith

Commissioning lead Julia Gosden, Director of Commissioning, Elizabeth Brandill-Pepper, Lead Commissioner for Children’s ServicesService summary Bespoke healthcare services for looked after children to identify early and address any unmet health needs. Education for

families in managing long term conditions and promoting healthy lifestyles. Support the implementation of the SEND reforms in partnership with RBK.


Provider(s)




Status


to be measurable)

Continue to develop a whole system approach to Child and Adolescent Mental Health Services through the implementation of the CAMHS Transformation Plan and commissioning of new activity targeting :

Early Intervention and support in schools

Eating Disorders and Crisis Care Transition

South West London & St George’s Mental Health Trust, Achieving for Children1, Voluntary & Community Organizations

Partial service re-designImplementation of newly specified services

April 2016/17 Partially agreed Reduction in unplanned Tier 4 admissions.

Reduction in ‘crisis’ presentations to A&E.

Reduction in waiting times to treatment.

Re-commission the Community Pediatrics and contract in partnership with RBK ensuring all

Kingston Hospital Foundation Trust

Engagement in the procurement

July 2016 Agreed Compliance with EU

1 Community Interest Company covering Kingston and Richmond

9


Provider(s)




Status


to be measurable)

statutory clinical posts are filled. process procurement regulations.Improved quality of services Reduction in access waiting times

Explore commissioning an ‘All Aged’ services in partnership with RBK for children and young people with physical and learning difficulties.

Your Healthcare, Achieving for Children

Engagement in the development, design and delivery of an integrated all age service

Sept 2017 Early exploration with RBK

Reduction in the use of long term residential placements.

Improved patient experience.

Improved transition between services

In collaboration with other South West London commissioners, commission an effective and comprehensive health pathway for asthma

Primary Care,Your Healthcare,Kingston Hospital Trust

Engagement in the development, design and delivery of an integrated health pathway for asthma

Sept 2017 Partially agreed Reduction in unplanned A&E admissions

Develop an effective and meaningful Healthwatch Engagement in the Dec 2016 Initial discussions Improved

10


Provider(s)




Status


to be measurable)

participation strategy to engage children and young people in the commissioning activity of the CCG

development, design and delivery of a participation strategy

patient experience

Improved quality of services

11

5. Integrated Care and Long Term Conditions

Lead Clinician: Dr. Annette PautzSenior Responsible Officer: Rachel Bartlett, Director Integrated CareCommissioning lead: Julia Gosden, Director of Commissioning

During 2016/17, Kingston CCG and Royal Borough of Kingston along with providers of health and care services will continue to deliver the ambitious programme of work to provide integrated health and social care services called Kingston Coordinated Care. The programme aims to: Support the development of active and supportive communities in which people are enabled to stay healthy and well, living independently

as part of thriving and resilient communities Develop truly customer-centred care that supports people with complex needs to achieve the best possible quality of life and the goals

that matter to them with an increased focus on prevention, proactive care and self-reliance


2015/16 Commissioning intention ProgressCommunity therapy services - complete a review and re-specify to ensure sustainability within resources Your Health Care (YHC) to implement a revised Children’s Speech and Language Therapy (SLT) specification jointly commissioned via a pooled budget between the CCG and Royal Borough Kingston (RBK)

Child Speech and Language Therapy is commissioned by Royal Borough Kingston (RBK) from Your Health Care (YHC). RBK ‘Achieving for Children’ is actively working with YHC on a viable specification for this service with the last update on this to be provided on the 24th September at the YHC Performance Meeting.

Kingston at Home - Support both admission avoidance and timely discharge from hospital through joint commissioning between the CCG and RBK of the Kingston at Home portfolio, reviewing and refining pathways e.g. for reablement, rehabilitation, intermediate care, care home provision, rapid response and community therapy services, as well as a review of medical provision in support of these services

A Task & Finish Group was established to consider and implement finding of Kingston at Home Phase 1. A report was produced July 2015 and work continues, to deliver on actions identified.

12

Further consolidation of Kingston at Home will be achieved by taking forward the recommendations from reviews in late 2015/16 of (i) YHC’s integrated health and social care team (ii) Universal day care model (iii) Amy Woodgate residential care and day services (iv) Risk stratification, care co-ordination and multi-disciplinary team working.

Roll-out the learning from the 2014/15 pilot project ‘Optimising Risk Stratification’ and MDT (Multi-Disciplinary Team) working in primary care to at least 40% of the CCG’s GP practices in 2015/16.

Risk stratification of patients by general practice has continued.

Kingston’s Better Care Programme - integrated commissioning and provision models are being explored with the aim of aligning provider incentives and agreeing risk sharing arrangements. This may impact on how hospital, community and other services are commissioned in the future, possibly as early as 2015/16.

Evaluation of the 2014/15 pilot indicated that, although there were benefits for patients and improvements in staff working relationships, the evidence of impact was not sufficient to justify scaling up the pilots.

The Better Care Fund Plan for 2015/16 details a reduction in expected unplanned hospital admissions to be achieved by a range of actions, service changes and integrated working amongst health and care providers and the 3rd sector. The intention is to release approximately £900,000 of expenditure on hospital services for investment in provision out-of-hospital.

The 2 main areas for investment are (i) proactive early intervention and prevention with patients at risk through risk stratification, care co-ordination and multi-disciplinary team working, and (ii) expansion of the ‘admission avoidance’ components of Your Healthcare’s Kingston at Home services esp. rapid response services – more detail below

For (i) see aboveFor (ii) see below

Self-care and shared decision making - Based on work in 2nd half of 2014/15, implement a more comprehensive package of ‘Patient in Control’ arrangements, building on the existing Expert Patient Programme and other self-management and shared decision making approaches

This year a total of ten Expert Patients Programme (EPP) Courses have been planned. To-date, five courses have been run and a sixth is due to start on the 6th of October. The remaining four courses will be completed by year-end.

13

Community Rapid Response Service - Increase community rapid response provision to longer working days and 7 day provision, ensuring complementary to other services e.g. community and twilight nursing

A project is underway to signpost people living with long-term health conditions to the means of better managing their condition(s) and life in general. This will include signposting people to the Expert Patients Programme.

Work is in-hand to extend the scope of EPP to the mental health community.

£220k Better Care Fund (BCF) Investment extending Community Rapid Response services has enabled an increase in activity from this service through extended working hours.

Discharge to Assess - Pursue the ‘Discharge To Assess’ (D2A) model as part of wider Whole System Transformation arrangements. The intention is to increase capacity and capability in the community to accommodate further early supported discharge (whereby medically fit, stable patients can be discharged from acute beds in a timely way with suitable support at home or in other settings for continuing recovery and assessment prior to decision about longer term arrangements). Other actions which support D2A will be completion of a joint review of ‘community bed’ provision including short term placements for assessment; and continued inter-agency use of the comprehensive geriatric assessment

Due to transformation work underway within Kingston Hospital Foundation trust (KHFT), work streams to support discharge continue to develop. Two test wards have been identified that will work with community providers to enable approaches such as D2A and/ or discharging when medically stable to a safe home package of care (e.g. UTIs not requiring acute care).

Seek a step change in the adoption of systems and IT which better facilitate sharing of information (i) amongst providers (to enable integrated provision) and (ii) between providers and commissioners

Ongoing programme of work developing Kingston Health Passport with access to GP records now available in Kingston Hospital A&E.

14


CCG clinical lead Dr. Annette Pautz

SRO & commissioning lead Rachel Bartlett, Director Integrated Care & Julia Gosden, Director of CommissioningService summary Kingston Coordinated care covers health and adult social care services.


Provider(s)




Status


to be measurable)

Kingston Coordinated Care: a key element of the programme is developing a new model of health and care and operating model for Kingston. The model is being developed by a core design team of health and care frontline staff, working on a full-time basis. In August 2015, the Kingston Coordinated Care programme board, of which the Trust medical director is a member, approved the initial conceptual design and mandated the design team to begin a paper-based testing phase. In mid-October, the programme board will review the output of the paper-based testing phase and decide whether to proceed to live testing between October – December in order to seek proof of concept.

GP ChambersYour HealthcareKHFT, SWL & St George’s MHT, Staywell and other voluntary and community sector organisations

All providers will be expected to continue to be strong partners in the Kingston Coordinated Care programme. This will include co-creating a shared programme of staff culture change; enabling staff to participate in the Care Exchange (multidisciplinary team) as this is implemented;

As the results of the live testing become available, plans will be made for a three year programme of implementation. This will begin in 2016/17. These plans will be discussed at the Kingston Coordinated Care programme.

All providers are members of the Kingston Coordinated Care programme board and are making staff available for the design of the new model of care.

These will be defined by December as part of the live testing phase.

15


Provider(s)




Status


to be measurable)

A commissioning and contracting workstream is underway in parallel, reviewing the current portfolio of contract and establishing which might be in scope for the new model of care.

enabling staff to adopt new roles and responsibilities as these are developed.

16

6. Planned Care

Lead Clinician for planned care: Dr. Naz JivaniCommissioning lead: Julia Gosden, Director of Commissioning, Roberta Cole, Commissioning & Redesign Manager


2015/16 Commissioning intention ProgressKingston Community Cardiology Service - consideration of a new approach for GP direct access requests for cardiology diagnostics, is being piloted from October 2014 for 9 months after which a decision will be made regarding longer term arrangements

The KCCS went live November 2014 and a full evaluation will be undertaken November 2015 that will detail next steps and proposals. A small cohort of patients has been seen the service and patient

feedback forms received indicate a positive patient experience. To support an increase in patient numbers through the service

since April 2015 .clinical triage is being piloted for cardiology referrals received in KCAS.

Kingston Hospital runs a variety of diagnostics now from the Surbiton Health Centre site and this has enabled a successful ‘one stop’ cardiology service since September 2015.

As part of the KCCS, Kingston Hospital has run since November 2014 a well received and utilised email service whereby GPs can email with queries that then avoids unnecessary outpatient referrals.

A GP Education Programme has been run that again has been well received and attended by primary care. An additional HESL funded Specialist CVD GP Education Programme will commence October 2015.

Direct access audiology – review the direct access audiology service pilot for under 60s in late 2014, with likelihood that it will become a mainstream commissioned service in 2015/16.

The direct access audiology service for adults aged under 60 years has been mainstreamed in 2015/16

17

Community Diabetes - Implement the 2014/15 review of community diabetes services, which includes re-procurement, and which may impact on Kingston Hospital services, as well as diabetes education services provided by Your Healthcare (Desmond and Walking Away), and the incumbent tier 3 provider Kingston GP Chambers.

A review has been undertaken of diabetes services to understand the services that could be and how they could be best provided in the community. This understanding will inform the tender and procurement process that will be completed within 2016/17.

Respiratory - Review 2014/15 respiratory health coaching demonstrator and if effective commission in 2015/16.

A review of this service was undertaken and a subsequent decision made to no longer commission this service.

Angina - Review 2014/15 angina self-management project and if effective to commission in 2015/16.

This service has been recommissioned in 2015/16 and continues to receive referrals.


CCG clinical lead Dr. Naz Jivani

SRO & commissioning lead Julia Gosden, Director of CommissioningService summary Planned care covers services and treatments which are not carried out in an emergency, often those which patients are

referred to by their GP. We want our planned care services to deliver high quality, personalised care, which enables patients to see the right person, in the right place, at the right time.

18


Provider(s)




Status


to be measurable)

Kingston Community Cardiology Services Kingston Hospital FT, Kingston CCG Primary Care

Tbc post evaluation review

In year Following the 2015/16 evaluation of the 2015/16 KCCS Pilot, work will be undertaken from these learnings to further develop the community cardiology service offering

Community Cardiology Services

Commission Community Ophthalmology services

Kingston Hospital FT, Kingston CCG Primary Care

Response to the procurement

March 2016 Procurement has started

KPIs included in the contract

Commissioning Community Diabetes service Kingston Hospital Your Healthcare Kingston GP Chambers

Response to the procurement

March 2017 Business plan agreed

KPIs included in the contract

19

7. Mental health

The transformation of mental health services in Kingston is one of the top priority areas for 2016/17. We are working with public health colleagues to promote resilience and to reduce self-harm and suicide. We have an ambition to embed mental health – promoting it, maintaining it, supporting and treating those with problems – within the community. We are up-skilling existing primary care, commissioning new primary mental health services both for functional and organic mental health and working with existing mental health providers to integrate their services in the community with primary care.


2015/16 Commissioning intention ProgressPersonality Disorders - carried forward from 2014/15: agree plans for personality disorder services for implementation in 2016/17;

This is work in progress with the Trust delivering its community transformation programme

Capacity - strengthen community focus for adult mental health provision, including:

Enhance primary care provision Expand the home treatment service Introduce a single point of access to more specialist services Increase IAPT capacity and linkages with primary care Ensure focus for Community Mental Health Teams (CMHTs) is

on those with more severe illness Strengthen hospital - community liaison, including crisis

intervention Reserve hospital referral for those with high level / acute

needs

Enhanced primary care mental health provision has been commissioned for both functional and organic mental health

The Home Treatment service in Kingston has been expanded to meet the original Department of Health Guidance over numbers of staff required for our population.

The IAPT (Improved Access to Psychological Therapies) capacity has been recurrently increased. Kingston is currently meeting all the national targets for this service.

We are working closely with the Metropolitan Police to agree a mental health model that works aligned with them. The police are often the first point of contact with people who are experiencing a mental health crisis.

Community wellbeing services – continued development to enable shift of emphasis and provision, reducing specialist, often hospital-based services,

This work is established through Kingston’s delivery of the Crisis Care Concordat. Kingston has developed a five year action plan against this

20

increasing generalist community provision, especially in primary care and involving 3rd sector provision

national directive.

Seek to consolidate provision of community wellbeing and substance misuse services from single base and derive benefits from this realignment

Following public consultation the transfer of substance misuse services to Hollyfield House in Surbiton was not implemented. The CCG will look at other ways of treating patients who may have co-morbidities within one service.

Redesigned services for older adults, shifting some resource from inpatient and specialist services to enhanced generic, community services (likely requirement for short-term pump-priming to enable transition):

(i) implementation of community-based Dementia services, key components being:

primary care focus, practice lead GPs / mental health champions

additional Dementia Adviser posts working with primary care Kingston community-based memory service (including clinics) strengthen links with / capacity in 3rd sector

(ii) strengthen community services and support to allow revised model of inpatient provision (towards assessment and short term treatment), reduce inpatient beds, reduce average lengths of stay

Consulted on a dementia strategy for Kingston and agreed July 2015.Negotiating long term funding for Dementia Advisor and Dementia development post with CCG and RBK.Commissioning a new community based memory clinic which will review and support people with dementia who have been diagnosed by South West London & St. Georges Mental Health Trust (SWLStGs) but who do not require ongoing secondary mental health care.Building capacity in Kingston Dementia Alliance to establish a Dementia Friendly Kingston and we are asking the dementia development worker to take a strategic overview to determine what is required in terms of local support and servicesReview the role of Social Workers within SWLStGs and potentially realign into generic health and social care services which are community based

21


CCG clinical lead Dr. Phil Moore

SRO & commissioning lead Julia Gosden, Director of Commissioning / Sylvie Ford, Mental Health CommissionerService summary Mental health services are provided by primary care, a range of voluntary and community groups, specialist mental

health teams and inpatient beds.


Provider(s)




Status


to be measurable)

Prevention GP, Third Sector, Primary care Mental Health Services (Camden and Islington FT)

Ensuring that primary care and other community services have a proactive approach to Prevention services at Kingston Wellbeing Service

March 2016 Current Reduced referral into Secondary mental health care services.Shortened lengths of stay within secondary mental health servicesImproved penetration and recovery rates within primary care/

22


Provider(s)




Status


to be measurable)

Access SWLStGs, Camden and Islington FT, Kingston Hospital FT, Third Sector

Develop and implement plans which address EIP access to services and access to robust crisis services when required in our delivery of the MH Crisis Care Concordat

March 2016 In development Delivery of the new national access standards.That people are not turned away from services when they are experiencing a mental health crisisThat patients experiencing a mental health crisis are never detained in police cells

Innovation SWLStGs, Camden and Islington FT, Kingston Hospital FT, Third Sector

Ensuring that people who use mental health services are in control over their treatment and care plan and eligible to become expert patients in the management of

March 2017 In development Inclusion to the Expert Patient programme for MH patientsBetter co-ordinated services which complement each other and deliver

23


Provider(s)




Status


to be measurable)

their own condition e/g Prevention services at Kingston Wellbeing Service and participation in the Expert Patient Programme

seamless care and required outcomesServices are developed which meet national best practice models of care

Quality SWLStGs, Camden and Islington FT, Kingston Hospital FT, Third Sector

Co-design and production of services which lead to collective quality outcomes with services demonstrating achievement of performance indicators and value for money

March 2016 In development Improved patient and carer feedback regarding the services they useDeliver of the Crisis Care Action plan for the borough of KingstonDeliver of new MH national indicators and standards

Tackling Inequalities SWLStGs, Camden and Islington FT, Kingston Hospital FT, Third Sector

Implementing ‘Time to Change’ national progamme in reducing stigma,

March 2016 In development Improved % of physical health checks.Increased user

24


Provider(s)




Status


to be measurable)

valuing mental health patients as active citizens and achieving Parity of Esteem

and carer involvement in the design of new services and quality indicators

25

8. Urgent and emergency care

Urgent and emergency care covers A&E, Out of Hours GP services, 111, Walk in Centres, Urgent Care Centres, Minor Injuries Units. We recognize that there is an increasing demand on the urgent and emergency care nationally and locally. There are challenges associated with helping patients and others chose the right service, making sure alternatives to A&E are available and accessible and enabling responsive community services which help avoid unplanned hospital admission where appropriate. We are working with our partners to design a health care system that enables patients and carers navigate for the right service at the right time.


2015/16 Commissioning intention ProgressImplement new GP Out of Hours and NHS111 contract(s) based on specification and procurement completed in 2014/15

A new integrated 111 and Out of Hours GP (OoH) service contract and service specification, according to national NHS England (NHSE) requirements, went out to market on 30th September 2015 for tendering in 2015/16 as a one SWL CCG contract for Croydon, Wandsworth, Merton, Sutton, Richmond and Kingston CCGs, and for integrated 111 & OOH services for Wandsworth, Merton, Kingston and Sutton CCGS.

The new service will go live in September 2016/17 after a period of mobilization.

Include the Acute Care Physician service (whereby GPs and other providers outside hospital have direct phone access for consultant advice for patients with urgent care need) in the Kingston Hospital core contract, assuming positive further evaluation in late 2014/15

The Acute Care Physician service has been mainstreamed within KHFT.

Fully implement the ‘Paramedic and Rapid Response Nurse in Ambulance Car’ (service being piloted with London Ambulance) if 2014/15 pilot demonstrates effective in at reducing A&E attendances and admissions

The pilot evaluation showed positive impact to those patients treated. However, the volume of activity made the scheme not cost effective and hence did not realise value for money. Therefore, the scheme in the pilot format was not be continued in 2015/16 and nor beyond.

26

Subsequently, through the SWLCC out of hospital work stream, ‘CrisisResponse’ was identified as a priority focus area for Winter2015/16 but via a different delivery model to the above pilot.

The new proposed pilot service will provide a dedicated GMC registered GP, with a driver in a car, responding to clinically appropriate Green (C1-C4) category triaged calls from 999/111 (acting as a referral pathway as piloted in Sutton that saw a 75% reduction in conveyances) and be uniquely dispatched from the LAS clinical decision making hub.

The GP will assess, diagnose, prescribe and treat in the home, without requiring a paramedic response or conveyance to hospital. Close links will be formed between the GP service and CCG’s existing community Rapid Response services, so packages of care can be put in place when required, reducing any risk of simply ‘delaying’ a conveyance to hospital.

It is planned to be piloted across SWL for six months from mid-October 2015.

27


CCG clinical lead Dr. Vince Grippaudo

SRO & commissioning lead Julia Gosden, Director of CommissioningService summary A&E, Out of Hours GP services, 111, Walk in Centres, Urgent Care Centres, Minor Injuries Units.


Provider(s)




Status


to be measurable)

Commission for 2016/17 a new GP Out of Hours and NHS111 integrated service via single SWL CCG contract - based on 2015/16 re-procurement

The re-procurement in 2015/16 and 2016/17 will determine new provider (currently Care UK)

The new provider would have to provide an integrated NHS 111 and OoH service in line with the new service specifications and KPIs/ Outcomes for a new one SWL CCG contract for Wandsworth, Merton, Kingston and Sutton CCGS.

Out to market 30 September 2015.

New integrated service starts September 2016

Out to market 30 September 2015

New contract in place September 2016/17 working to new KPIs and Outcomes according to NHSE national requirements and local requirements

SWL crisis response pilot in 2015/16 with view The provider is Run pilot and 6 month pilot Business case See

28


Provider(s)




Status


to be measurable)

to commissioning in 2016/17 if successful – [for more detailed see Commissioning Intentions 12 for Out of Hospital (OOH) services]

SELDOC.

Sutton CCG is the contract lead with SWL DoCs overseeing implementation and monthly reporting of activity and key KPIs and outcomes.

evaluate in 2015/16, and if successful commission in 2016/17

approved end of September 2015 – formal sign off of pilot early October – live from 19/10/2015

Commissioning Intentions 12 (OOH)

GP in A&E pilot, providing a primary care stream to fully see-and-treat minors attending Kingston Hospital A&E during peak demand from 5.00pm to 10.00pm each day, 7-days per week.

Kingston Hospital Foundation Trust (KHFT)

To evaluate the 2015/16 GP in A&E pilot with Kingston CCG, and if successful for KHFT to set up a provider agreement to employ GPs/ nurse practitioners to mainstream the pilot

Evaluation will take place in October 2015/16.

If successful the service will be commissioned for 2015/16, and then reviewed in March 2016.

Re-commissioned for 2016/17

Pilot is live A&E target met for minors and contributing to meeting overall A&E target

Reduction in minor A&E breaches as well as all breaches

Patient satisfaction

29


Provider(s)




Status


to be measurable)

with the service

Enact the outcomes of the public consultation on the future of Gosbury Hill WiC

Malling Health Actions dependent on the outcome of the consultation

Public consultation September to November 2015

Service go live January 2016 with a 3 year contract

Public consultation New GP led walk-in service at Surbtion Health Centre operating Saturday to Monday, 8.00am to 8.00pm, subject to public consultation

Pilot the UCC tariff, consistent with the SWL commissioning intentions

KHFT Agreement to use the UCC tariff

April 2016 In draft

Develop and implement an Urgent and Emergency Care Strategy

Kingston UECN Commitment to delivery of the UEC strategy

April 2016 Current KPIs are included in the Strategy

30

9. NHS Continuing Health Care

Clinician lead for Continuing Health Care: Dr. Phil MooreSenior Responsible Officer: Julia Gosden, Director of CommissioningCommissioning lead: Laura Jackson, Quality Manager

NHS continuing healthcare means a package of ongoing care that is arranged and funded solely by the NHS where the individual has been found to have a 'primary health need’. Such care is provided to an individual aged 18 or over to meet needs that have arisen as a result of disability, accident or illness.


2015/16 Commissioning intention ProgressThe CCG has funded an expansion of YHC’s nurse assessment team in 2014/15. This is to provide additional nursing capacity for initial assessments, care planning and management and on-going review. It will also ensure placements outside of the Borough can be managed by YHC, reducing risk to individuals.

YHC nurse assessment team has continued to support the assessment, care planning, management and ongoing review. Q4 of 15/16 will include a strategic review of the current operating model with a view to working jointly with RBK for an integrated model for 16/17.

A new NHS Continuing Healthcare Social Worker post has been added to YHC’s assessment team, to provide social care components to needs assessment and care planning for those who are CHC eligible. The post holder can request a personal health budget and facilitates improved communication within and between health and social care teams.

The Continuing Healthcare Social Worker continues to support the YHC assessment team.

The London-wide ‘any qualified provider’ tariff for NHS continuing care patients in nursing and residential homes has been adopted. It is in place for a number of nursing homes and the SW London CHC group is actively recruiting others. It may take time to bring more on board and there are issues around the inclusion of 1:1 support when the tariff is introduced.

There continue to be capacity issues concerning the number of available beds in Kingston and a solution is being proactively worked upon.

Systems and processes have been introduced to support ‘Personal Health Ongoing work to increase the uptake of Personal health Budgets.

31

Budgets’ which are now available for people who meet the NHS continuing care criteria and who are not living in a nursing or residential home.

An NHS Continuing Care Commissioning Support Manager has been appointed and will take up post in November 2014, to provide dedicated day to day operational leadership of the service and all allied elements (e.g. nurse assessment), as well as assisting in longer term planning for improvement

Support Manager is in post.


CCG clinical lead Dr. Phil Moore

SRO & commissioning lead Julia Gosden, Director of Commissioning / Laura Jackson, Quality ManagerService summary NHS continuing healthcare is ongoing care that is arranged and funded solely by the NHS where the individual has been

found to have a 'primary health need’. Such care is provided to an individual aged 18 or over to meet needs that have arisen as a result of disability, accident or illness.


Provider(s)




Status


to be measurable)

Complete a strategic review of the existing CHC service model with a view to moving to an integrated model with RBK that provides a joint assessment, review, care planning and management model of care.

YHC, RBK Service redesign may be required following the outcomes of the strategic review

Q1- Q2 Initial stage. Options currently being worked up.

Quality indicator tbc

32

10. Primary Care

Around 90 per cent of people’s interaction with the NHS is with primary care. Primary care covers GP practices, dental practices, community pharmacies and high street optometrists. Enabling primary care to meet the challenges of increasing population health needs is a priority area of work for Kingston CCG.

10.1 Progress vs 2015/16 Commissioning Intentions and Operating Plan key items:

2015/16 Commissioning intention ProgressPrimary Care Quality and Development Group to oversee implementation of a ‘Transforming Primary Care Strategy’ – building on baseline assessment (e.g. practices’ status vs. 17 GP development standards) and strategy development work in 2nd half 2014/15, and linked to wider SW London work. This to include all aspects of primary care support, development and commissioning, all with a view to ensuring primary care provision in Kingston is as good as it can be, and that patients receive the range of quality of services which they expect In light for work in 2nd half 2014/15 implement a model of primary care co-commissioning with NHS England colleagues which is suitable for tackling specific issues and opportunities in Kingston

Kingston Primary Care Strategy currently in draft form and out for public consultation.

Co-commissioning has been in place for 2015/16. Kingston CCG has expressed interest in moving to level 3 / delegated commissioning for 2016/17.

Having reviewed the portfolio of locally commissioned services in autumn 2014, ensure an appropriate range of services are specified and commissioned for 2015/16, at the same time ensuring projected increases in demand are allowed for in the budget

2015/16 locally commissioned services ‘commissioned’. To be reviewed for 2016/17.

Take necessary actions to enable GP practices to deliver their lead role for people who are aged 75 or over, and to play their central role in risk stratification, care co-ordination and care planning. Build on the pilot work in 2014/15 to replicate good practice in at least 40% of practices during

All patients aged 75 or over have a named GP.

33

2015/16.

In early 2015 review the impact of the 2014/15 near £1m investment and, taking into account national requirements, consider whether / how to take forward into 2015/16 and beyond, ensuring any commitment of resources in aligned with wider CCG priorities and complements other service developments

The review of locally commissioned services to be completed by financial year end as part of the Primary Care Strategy objectives.

Use commissioning tools to support primary care centred provision of a number of re-focussed services including dementia, adult and older people’s community mental health and cardiovascular services, building on service redesign and provider education initiated during 2014/15

Locally commissioned services include CVD services. A business case for primary care based memory clinics has been approved and primary care is included in the new model of care going forward through the Kingston Coordinated Care programme.

Utilise direct and indirect primary care workforce development funding to deliver a range of education and training which will help address identified gaps and priorities.

Ongoing programme of education and training for primary care staff including training at specified education providers, CCG provided training and HESL supported training for primary care mental health.

If resources are available take forward a primary care estates review, potentially in collaboration with neighbouring CCGs

Primary care estate is part of the CCG Estates Strategy to be completed for December 2015. A 1st draft profile of the Kingston primary care estates has been compiled.


CCG clinical Dr. Phil Moore

SRO & commissioning lead Rachel Bartlett, Director Integrated Commissioning / Kathryn MacDermott, Head of Planning & Primary Care Development

Service summary GP practices, dental practices, community pharmacies and high street optometrists

34


Provider(s)




Status


to be measurable)

Delivery of the Accessibility Specification priorities for KCCG:Increase the uptake of online bookable appts.Increase the uptake of ordering repeat prescriptions onlineEnable patient records to be accessible on lineImplement expended hours in-week for GP appts.

GPs Implementation of Patient online; agreement on expended primary care coverage

April 2016 Started London Specification KPIs, patient experience,

Facilitate appropriate referrals to out-patient appointments

GPsKHFT

Referral guidelines developed / agreed / implemented

April 2017 In development 1st to OP target

Deliver year 1 of the 3 year Implementation plan for the Strategic Commissioning Framework primary care specifications of Coordinated and Proactive care

GPsChambers

Implementation plans drafted March 16

April 2017 In development KPIs to be set

Delivery of the Primary Care Strategy enablers: Workforce development Estates strategy IT - Application of the Primary Care

Infrastructure Fund (investment

YHC (GPIT providers)Chambers (host for CEPN)NHSE/CCG for estates

Implementation plans drafted March 16

April 2017 Started Project milestones to be set

35


Provider(s)




Status


to be measurable)

programme to accelerate improvements in GP premises and infrastructure such as Information Technology); E-discharge summaries used and fed back to GPs

Clinical Leadership

Work with Kingston GP Chambers to deliver primary care at scale, enable the shift of activity from the acute to primary care setting, increase access to primary care,& ensure continuity of care

Chambers Primary Care Strategy agreed December 2015Implementation plans March 16

April 2017 In development Project milestones to be set

GP presence in KHFT A&E building on the learning from the GP in A&E pilot

KHFT KHFT to consider provider to provider contract:

April 2016 In discussion Minors target

Take forward delegated commissioning of Kingston primary care, linked to local population need, focused on improving outcomes

GPsChambers

Application for delegated commissioning approval March 16

April 2016 In development Implementation of delegated commissioning

36

11. Prevention & Health Improvement


Prevention

A key element at the heart of the NHS Five Year Forward View is prevention of non-communicable disease (‘long term conditions’). Implemented systematically, the evidence suggests prevention programmes can be important enablers for reducing acute NHS activity and capacity over the medium termi, and will help make the NHS sustainable.

The NHS can play its role in encouraging behaviour change in the local population to prevent lifestyle-related diseases developing (primary prevention), ensuring those in the early stages of disease do not progress to more severe disease (secondary prevention), and supporting those with established and complex illnesses to stay as well as possible (tertiary prevention). This requires concerted collaborative effort between partners in the health system, at a local and national level.

The CCG will respond to leadership from the NHS Prevention Programme Board, which has priorities for diabetes prevention, health of the NHS workforce and identifying public health interventions which will contribute to the NHS efficiency programme.

The top health issues in Kingston reflect the national picture and are ischemic heart disease and stroke, cancer (bowel and lung), mental health (including dementia), and to a lesser extent chronic obstructive pulmonary disease and asthmaii. The conditions affecting the most people are high blood pressure and obesity.

In 2016/17, the CCG will commission and work to ensure primary, secondary and tertiary prevention activities are in place:

(i) PRIMARY PREVENTION (preventing the development of disease)

Work with South London CCGs and local organisations including Kingston Council, to deliver the NHS Diabetes Prevention Programme (NHS DPP), either as part of the first wave, or soon thereafter.

Work with partners to improve the health of the local NHS workforce on the learning from the NHS England programme which is developing new workplace initiatives to promote employee health and cut sickness related absence

Work with partners, including local authority Public Health, on behavioural change to prevent physical illness, specifically to maximise the use of public health interventions, including behavioural change, that contribute to the NHS efficiency programme, are embedded locally.

Require providers to make every contact count, and offer brief advice and interventions as set out by NICE, with onward referral for patients who will benefit from:

o Smoking cessation o Obesity prevention / lifestyle interventions.

37

o Alcohol reduction o Reduction in sedentary behaviour / physical activity promotiono Sexual and reproductive health

Work with partners, including Public Health, on prevention of mental health problems by:

o Ensuring the forthcoming prevention recommendations of the NHS England Mental Health Taskforce enacted locally.

o Ongoing investment in training and awareness such as suicide prevention training and mental health first aid, and other activities to respond to people in crisis (see also Mental Health section)

o Explore joint commissioning of prevention interventions for people at risk of physical and mental ill health for example the Good Energy Club

o Supporting young people’s mental wellbeing, though the CAMHS Transformation Plan

Work with partners to ensure the prevention recommendations of the NHS England Cancer task force are enacted locally

(ii) EARLY IDENTIFICATION AND SECONDARY PREVENTION (preventing progression of disease)

The CCG will focus on secondary prevention of the major causes of health and disability: cardiovascular diseases, respiratory diseases (especially COPD) cancers (especially bowel and breast cancers), and mental health by:

Preventing the progression of disease through identification and management, specifically:

o Optimal primary care management of people identified through the Health Checks programme (identifying high BP, diabetes, heart disease, dementia)

o Maximising people being screened for cancer (breast, bowel, cervical), abdominal aortic aneurysm, and diabetic eye disease to identify disease early and offer interventions

Improving care by:o Ensuring brief advice and interventions as set out by NICE are included in care

plans for all people with long term conditionso Optimising the medicines received by people with atrial fibrillation to prevent

cardiovascular disease and strokeo Commission targeted preventions for people with diabetes such as Walking

Away, which will be aligned to a new Integrated Diabetes service.o Identifying and treating undiagnosed/diagnosed high blood pressureo Developing primary care capability in cardiovascular disease management by

investing in training eg a GP Diploma in Cardiovascular Disease o Ensuring appropriate treatments are available to people with obesity, and

working with partners to complete the obesity pathway, which will include a review of Tier 2 and 3 services.

o Dementia, Mental healtho (MSK)o COPD and asthma

38

o Diagnosing cancers early by improving public and clinical awareness of signs and symptoms, timely referral practices, improved access to diagnostics and increasing uptake of screening

(iii) Tertiary prevention (preventing complications/deterioration in people with established illnesses, including inappropriate hospital admissions, and promoting recovery)

These are covered in other sections of this Commissioning Intentions document and includes Out of hospital commissioning and Kingston Co-ordinated care. Tertiary prevention is also about reducing illness through rehabilitation programmes.

i NHS England (2013) A Call to Action; Commissioning for Prevention https://www.england.nhs.uk/wp-content/uploads/2013/11/call-to-action-com-prev.pdfii Based on mortality and morbidity (not DALYs) Source Kingston JSNA

nhs kingston ccg commissioning intentions 2016/17 · obstetrician presence by april 2016 kingston...

Documents