nhs mansfield and ashfield and newark and sherwood primary ... · november 2016. support visits...

NHS Mansfield and Ashfield and Newark and Sherwood Primary Care Programme

Exception Report to the

Primary Care Commissioning Committee

Date of committee: 9 March 2017

Introduction

Primary care has an ambitious transformation programme linked to both national and local priorities and funded through a number of initiatives. This paper provides an update on the CCGs’ progress on this programme.

The primary care programme encompasses four strands which include:

• the GP Forward View - Funding streams are now becoming available as part of the national delivery programme for the GP Forward View. There will be in excess of 80 projects connected to this work.

• the national Vanguard programme - £800,000 funding is available for 2016/17 for primary care transformation. The value proposition submitted as part of the Vanguard proposal agreed to pilot one hub in each CCG. Funding was confirmed in July 2016.

• National GP Access Fund – there is up to £6 per head of population available for qualifying schemes to fund existing Prime Minister’s Challenge Fund schemes and implement seven day services in transformation areas, of which Ashfield South is one.

• Delegated budgets transformation and the financial recovery plan – including maximising efficiencies in co-commissioning, enhanced services and diabetes.

A single plan is in place and the Director of Primary Care is the responsible director for the programme.

The standard CCG PMO reports are attached to this report at Addendum A. Addendum B sets out the funding by scheme and is a snapshot of work in progress.

Vanguard Programme

The CCGs have been awarded £800k in 2016/17 and a further £800k in 2017/18 for primary care

I. Hub development – Collaborative meetings continue to be held in both hubs. Ashfield Hub continues to refine its strategy and detailed plan whereas Newark is defined and being progressed. A summary of the hubs and Vanguard plans is included within Addendum A.

II. Best Practice Scheme (BPS) – Practices are working hard and still requesting support visits. Data is currently being analysed and will be available for the next update report. A

1

summary of population coverage is shown as an infographic within Addendum A.

III. Acute Home Visiting Service (AHVS) –Mobilisation is progressing with the first service delivery in Ashfield and Newark starting week commencing 6th March 2017 and a full service from 1st April 2017.

IV. Urgent Care Hub – A centralised nurse treatment room will commence on 7th March 2017.

V. Therapy First – Mobilisation of service has commenced and joint Practice visits with Local Authority Occupational Therapy Service are in progress. First clinics commenced in February at Kirkby Community Primary Care Centre and Brierley Park Medical Centre. Skegby Family Medical Centre and Woodlands Medical Practice have also signed up for the service.

GP Forward View - National GP Access Fund

This is a national scheme which aims to provide access to GP services over 7 days. Monday to Friday 8am to 8pm, and coverage at weekends to meet the needs of the population. Evidence from early pilots in Nottinghamshire have demonstrated there is no demand for services on a Sunday.

1. Funding

There are two opportunities within the national GP Access Programme for funding in 2016/17 with full funding for 2017/18;

I. Continuation of existing schemes 2016/17- Additional Funding of £6 per patient is available for extended Primary Care Access schemes already in place.

National guidance requires that these be in place by 31 March 2017. We have had discussions with the two services concerned. Service implementation dates are being negotiated for mid March.

II. 2016/17 Funding to prepare for full population coverage in 2017/18 – Vanguards have been asked to lead on extending GP Access and have been awarded £1.50 per population to prepare for GP Access full population coverage in 2017/18. These funds can be spent on project management support.

Offered to Practices to start in quarter 4 of 2016/17. A number of discussions have been held. Localities preparing plans for 2017/18 to allow for negotiations and operational preparation.

III. 2017/18 Implementation Across Whole Population - Full funding at £6 per head of population is scheduled to be made available for 2017/18. Estimate of full funding would be £1.9m. Implementation will be phased by readiness of the localities to proceed.

2. Timelines – Implementation Map provided as Addendum C. Each locality will be added to the map as soon as their initial service plan has been provided.

3. Workforce Requirements – A model has been developed identifying the additional clinical time required by each locality to deliver the national GP Access criteria. Localities will be asked to identify the skill mix being used for their service. However the national criterion stipulates that booked GP appointments must be available within the additional hours. See Addendum D.

4. Evaluation Methodology – The evaluation methodology is currently under review, but will include Skill mix appointments offered both within core hours and extended hours, Take up of appointments, A&E attendances for primary care conditions and impact on unplanned admissions. Patient stories will be collected from patients who use the service. A survey of GP Practices and staff working within the services will also be completed. Currently investigating options for an external evaluation to be completed. The Centre for Health Innovation Leadership and Learning at the University of Nottingham conducted the evaluation of the Challenge Fund schemes across Nottinghamshire and Derbyshire on behalf of the Nottinghamshire and Derbyshire NHS England

2

Area Team. The report was published in March 2016.

GP Forward View - GP Resilience Programme

A national programme which has replaced the Vulnerable Practice Scheme has been launched as part of the GP Forward View. Practices identified under the Vulnerable Practice Scheme are not eligible for the 2016/17 GP Resilience Programme. Milestones achieved:

I. A list of eligible Practices has been agreed with NHS England and confirmed with the Practices. 11 Practices have been identified in NHS Newark and Sherwood CCG and 16 Practices have been selected in NHS Mansfield and Ashfield CCG

II. Funding for each CCG has been confirmed as £53,000 for NHS Mansfield and Ashfield CCG and £37,000 for NHS Newark and Sherwood CCG

III. An NHS England memorandum of understanding (MOU) has been circulated to all Practices with a copy of the national guidance in October 2016

IV. Feedback from Practices indicates that more support is required to ensure they are able to identify weaknesses and support they need to overcome these

V. Discussion with NHS England has resulted in an agreement for a much longer period to be allowed prior to formal sign off of the MOUs.

VI. NHS England has agreed to clarify what support can be purchased

VII. A diagnostic tool and simple guidance is being prepared to send out to all Practices in November 2016. Support visits were provided where required.

VIII. 20 Practices completed an MOU and these have been shared with NHS England for their approval. These were sent in three phases the final phase being sent in January 2017 –feedback indicated significant additional information was being requested by NHS England

IX. Agreement was reached with NHS England that a single MOU would be submitted with common themes – this was sent on 13 February 2017 confirmation of acceptance was sent on 27th February 2017

X. Training Providers are currently being identified. The LMC have offered to support CCGs.

XI. The Primary Care Commissioning Committee will be updated on the future progress of this scheme.

Addendum E – Provides the schedule of support attached to the MOU

GP Forward View – Non Clinical Education As part of the General Practice Forward View, a new five year £45 million fund has been created to contribute towards the costs for practices of training reception and clerical staff to undertake enhanced roles in active signposting and management of clinical correspondence. A budget of £27k is available to the Mid Nottinghamshire CCGs. An accredited course has been identified provided by Primary Care Development Centre which meets the criteria of the active signposting by reception staff as described in the GP forward View. The cost of this course for one member of staff pre Practice plus a contribution of £100 towards staff time would cost a total of £12,660. Full details are provided in Addendum F. The team are actively seeking to identify a course which meets the requirements of the management of clinical correspondence as outlined in the GP Forward View and which would come within the remaining budget of £14k.

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https://www.england.nhs.uk/gp/gpfv/

Issues Actions

• GP Forward View over 80 initiatives are being released

• Management Resource to cover both the Vanguard and GP Forward View Initiatives

• NHS England has agreed to provide a list of initiatives already released

• Primary Care Team has been strengthened by the addition of a new senior manager transferred from Finance to act as programme manager

• The Locality Hub pilots will receive funds to support management resource as part of the Vanguard programme

Risks Actions

Primary care risks are managed in accordance with the mid-Notts CCGs risk management policy. Full details of primary care risks are provided within the risk register and assurance framework. Any new risks identified, which do not form part of the risk register/assurance framework are outlined below:

There are number of projects/initiatives which have the potential to overlap

The CCG does not directly control national projects/initiatives

Programme management has been strengthened within the Primary Care Team

The Director of Primary Care Chairs the Primary Care Strategic Advisory Group.

4

1

Addendum A: Urgent & Pro-active Care

Programme - February Programme Update 4.3 Primary Care Hubs

Progress this month: Primary Care Hubs: • Urgent care hub phase one business case approved by PCCC and mobilisation now commencing. All aspects will be mobilised by

end of February. • Following workforce challenges in mobilising the acute home visiting service a solution has been found for both hubs. Both

commence during week 6 March 2017. This success reflects the determination and commitment of the project manager and the positive relationships with the three providers involved.

• Mobilisation of the therapy first service has commenced and joint Practice visits with Local Authority Occupational Therapy Service are in progress. First clinics commenced in February at Kirkby Community Primary Care Centre and Brierley Park Medical Centre. Skegby Family Medical Centre and Woodlands Medical Practice have also signed up for the service.

• Acknowledgement that the delays in mobilisation put the forecast savings at risk however schemes going live in Quarter 4 are well placed to deliver in 2017/18.

Aligning Primary Care Incentives: • Best practice scheme now running for four months with good population coverage in both CCGs (see overleaf for infographic).

Practices are working hard and still requesting support visits. January data due week commencing 27th February 2017, will be available for the next update report.

• Technology solutions are being developed at pace with the decision support tool approved and mobilising. Primary care structures: • The proposal has now been presented to both PLTs with generally positive results. The structure will commence on 1 April.

RAG rating Current month

Previous month

Milestone AMBER AMBER

Financial AMBER AMBER

Key Issues Mitigating Actions

Risk that the full savings will not be achieved in the final quarter of 2016/17 given the mobilisation date and timing of activity information.

Plans in place to mitigate through maximising existing enhanced services, near patient testing, cardiology and health optimisation however risk remains.

Activity increases in NEL admissions Best practice scheme implemented on 1 November 2016. Acute home visiting service mobilising in March 2017.

Primary Care Best Practice

Scheme population coverage

33

34

36

38

39

40

1

23

4

5

6

78

9

10

1112

13

14

15 16

1718

19 23

22

24

2521

20

26

27

28

29

30

31

32

33

34

35 3637

38

39

40

41

REASONS FOR NOT SIGNING UP

Signed up

Capacity

Disproportionate effort v reward

Online access requirements

No perceived benefit for their patients

*Circle size represents

practice population size

Primary Care Vanguard:

model of care

In 2014/15 the CCGs were successful in bidding for Vanguard money and a key part of the plan is the development of primary care. The CCGs received £800k in 2016/17 and will receive a further £800K in 2017/18; these monies will be directed to establishing our vision for strengthening primary care and testing new models of care. Our vision is to create four clinical primary care hubs aligned to Ashfield, Mansfield, Newark and Sherwood. These hubs will respond to the challenges in primary care by facilitating collaborative working in general practice, improving resilience and sustainability and improving access. The proposed model includes the following: • Four primary care hubs, one for each locality of which two, Newark and Ashfield, are going live in early 2017. • Place-based diagnostic care and monitoring • Health optimisation and pre-operative assessments • Population health outcomes on agreed objectives to reduce inequalities.


Newark urgent care hub

Newark Urgent Care Hub Phase One: collaboration and initial mobilisation Phase 2: broadening the out of hospital care offer

Primary care in the Newark area serves a population of 75,000 people and is experiencing escalating demand, increasing complexity and expectations from patients are rising. In particular we identified: • Balancing planned with urgent work is

increasingly difficult, meaning it is harder to give patients the time they need;

• The whole system is struggling with sustainable, affordable staffing;

• The public are using the Minor Injury Unit (MIU) interchangeably with general practice;

• There is an asset in Newark MIU that is not being maximised; and

• Recognising the need to change, general practice in the Newark area has enthusiasm to co-design the solutions.

The contributions, design and mobilisation of the hub has been and will continue to be led by the practices. The GPs and practice managers have devoted time to collaborative working, building relationships and finalising the design. In phase one during the four months of collaborative working we have seen a significant improvement in engagement with Newark. It has also given us a single access point to Newark practices to engage as part of business as usual and share information. This will continue through phase two. Releasing head room for GPs is a common thread throughout our plans.

Phase one has delivered the following at a full year effect cost of £300k: Acute home visiting service - the urgent care hub has acute home visiting providing early home visits for urgent primary care conditions reducing risk of admission or longer stays in a secondary care setting. This is mobilising in March 2017. Centralised Nurse treatment facility - this will initially provide a dressing services, staple and suture removal, drain removal, routine near patient pathology tests and diagnostics. The future intention is to impact on surgical health optimisation and implementation of thresholds in secondary care. GP chambers – the design team has developed a proposal for establishing a GP Chambers. This model has been successful in other health economies and is helping to resolve the short term workforce challenges in the locality. Near patient testing to improve access to diagnostic supported by new ambulatory pathways; already launched in January 2017 (DVT, anaemia, non-injury fall, accidental overdose)

Phase two will continue to develop this in-hours multi-professional hub that will provide same-day urgent care to Newark residents: Ambulatory care pathways – our out of hour’s provider will widen its involvement with ambulatory care pathways at Newark Hospital. This has already started with the establishment of a DVT pathway and will be extended to include mechanical falls and accidental overdose. In-hours primary care presence in Newark Hospital MIU – we are working with our secondary care and out of hours providers to establish GP acute appointments in the Urgent Care Centre by December 2017 with oversight of Newark hospital beds. Supported by the out of hours provider, we will ensure 24/7 provision of primary care. The intention being to broaden the offer of ambulatory pathways traditionally provided in secondary care or the emergency department. Improving GP extended access – through the facilitation of the GP Chambers model the practices will ensure that there is a GP presence in Urgent Care Centre for acute appointments, releasing slots as a directly bookable offer. Mental Health in primary care – recognising one in four GP consultations involve some low level degree of mental health, our plan intends to place mental health practitioners into the localities to support GPs and provide better access to timely intervention. This is proven to improve health outcomes. Our patients who have urgent care needs will benefit through increased capacity of and access to primary care services with a consistent offer across Newark. With the range of services that will be delivered by primary care for Newark residents by 2018/19 the patient experience will improve with fewer required to travel to secondary care services for diagnostics and monitoring and there will be a lower risk of admission. The additional capacity provided by the urgent care centre will allow practice-based primary care services to focus on complex care and those patients with long term conditions who benefit from seeing their named GP.

The aspiration for Newark is simple: ‘Anyone with an urgent care need, who lives in Newark, should remain in Newark; unless they need an emergency ambulance transfer to the secondary care hospital’


Ashfield pro-active care hub

Case for change and benefits Services

The hub serves a population of 83,000 people. Primary care in Ashfield has many similar challenges to Newark and as one of the first hubs it recognises there are: • Additional challenges of a deprived area with 23% (5,100) of children living in low

income families, life expectancy for both men and women lower than the England average (9.8 years lower for men and 10.0 years lower for women).

• Workforce is a significant risk with problems of recruiting GPs and other health professionals exacerbated by the levels of deprivation.

• Patients tell us they have difficulties accessing appointments when they want them. • The locality includes a significant proportion of small practices – 10 out of 14 practices

have less than 6,000 patients reducing their resilience and capacity. The hub has developed a strategic model setting out those services to be delivered on a joint locality basis. Ashfield residents will benefit from this proactive model with greater support and focus by their named GP and an integrated team for those with complex care needs and long term conditions. They will benefit through increased capacity and better access in primary care services with a standardised approach across the locality. With the range of services that will be delivered by primary care for Sutton and Kirkby residents by 2018/19 the patient experience will improve with fewer emergency admissions to secondary care services in response to critical episodes or for diagnostics and monitoring.

Acute home visiting service – this service will be providing early home visits for urgent primary care conditions reducing risk of admission or longer stays in a secondary care setting. This is mobilising in March 2017.

Centralised Nurse treatment room - this facility will initially provide a five-day dressing services, staple and suture removal, drain removal, routine near patient pathology tests and diagnostics. The future intention is to develop the health optimisation role and impact on surgical follow up thresholds in secondary care.

Diagnostics hub – this will initially target respiratory and cardiology presentations as the two highest pathways of greatest benefit identified in Right Care data.

Mental health in primary care – a new approach to realign roles of Mental Health Nurses and widen access to lower level mental health and to support GPs in caring for their patients before more acute measures are required.

Clinical Pharmacists – we have gone live with 7 pharmacists working as autonomous practitioners in general practice – reducing workload burden on GPs. We have submitted a bid into wave 2 as our plan is to expand the clinical pharmacist offer in primary care.

Care Homes Service – providing a focused proactive level of support, aligned to practices.

Direct Access to Physiotherapy – avoiding the need to see a GP for common MSK presentations

Occupational therapy first – a scheme that provides an OT for GPs to refer into at point of triage or during consultation.

Social worker hot clinics – based in a centralised hub for practices to refer into either at point of triage or during consultation.

Our plans for phase 2 include working with the voluntary sector to broaden social prescribing and health optimisation opportunities.


population wide services

Place-based diagnostic and monitoring services Health optimisation and pre-operative assessment

Our vision is to bring care closer to home aligned to the primary care hub locality areas.

Our plan will shift diagnostic and monitoring healthcare services that have traditionally been delivered in secondary care into a primary care setting. This will enable primary care practitioners to take greater clinical risk, supported by quicker access to a range of diagnostics. We are also taking the opportunity to achieve whole population coverage for existing enhanced services by March 2018.

Phase one will provide a cardiology 24 hour ECG diagnostic service. Remaining services will be implemented through the lifetime of the plan. The next phase going live in early 2017/18 will include near patient testing, diagnostics such as INR, CRP, D-Dimer blood tests. There will then be further expansion to additional ECG tests (Event monitoring/12 lead ECGs) and additional blood testing.

Patients will benefit from care delivered closer to their homes either in their local practice or at a local hub such as the urgent care hub. Many of the diagnostics are designed to provide results either immediately or significantly quicker than current secondary care based diagnostic services with clear benefits for patients through rapid treatment and peace of mind. As well as the reduction in unwarranted variation in antibiotic prescribing and earlier detection of sepsis, delivering quicker access to secondary care and overall reduced length of stay.

We forecast that in 2016/17 the services will save approximately £200k across Mid Notts with the potential for greater savings in the future as other services are transferred from secondary care.

Our outcomes from surgery are not always positive with many patients re-referred for the same speciality within six months of surgery.

Working with our secondary care and social care providers we are adopting a holistic approach to improve surgery outcomes. We will promote shared decision making and optimising fitness for surgery prior to referral to surgical specialties. The focus will be on healthy lifestyles and for patients to be the best they can be for their operation. The pre-referral assessment is an opportunity for this to be addressed. We will also streamline access to active interventions including smoking cessation and weight management.

Phase one has commenced for those patients assigned ASA level 1 who will complete a pre clinic questionnaire before referral to enable timely identification of risk factors and direct patients to active interventions as necessary.

Phase two (ASA level 2 to 5) is under development and will be aligned to hubs with face to face with patients identified as being ASA level 3+. A management plan is determined regarding their existing morbidities if not already in place. This links back into the GP and community teams to optimise the patient.

These developments have significant benefits for patients with shared decision making and better patient understanding. With health optimisation interventions taken much earlier in the pathway patients will wait less time with fewer operations delayed or cancelled due to high risks. The health care system will also benefit from low risk patients not requiring a pre-operative assessment and fewer surgical procedures cancelled. There is also the potential that if patients improve their health through self-management the need for the surgery may reduce.

As a PACS vanguard area we are testing new models of care with general practice. Asking practices to focus on population outcomes for the combined population they serve.

Addedum B

INVESTMENT COSTS --->>> FINANCIAL BENEFITS --->>>

Mid Notts Mansfield &

Ashfield CCG

Newark &

Sherwood CCG

Mansfield & Ashfield Newark & Sherwood CCG

2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17

Programme area FRP Scheme / GP

Forward View Scheme

Primary care project Funding Source Status Project lead Funding -

Confirmed /

unconfirmd

TOTAL £,000 TOTAL £,000 TOTAL £,000 Mile-

stone

RAG

SAVINGS PLAN

(£,000)

FRP (£,000) Forecast

outturn (£,000)

YTD delivered

(000)

Mile-stone

RAG

SAVINGS PLAN

(£,000)

FRP (£,000) Forecast

outturn (£,000)

YTD delivered

(000)

GP FORWARD VIEW

Primary care co-

commissioning

National NHSE 2015/16 Vulnerable practices Vulnerable practices

scheme

Design stage Hazel Taylor Confirmed 0.0 0.0 0.0 GREEN 0.0 0.0 0.0 0.0 GREEN 0.0 0.0 0.0 0.0

Primary care co-

commissioning

GP Forward View Resilience Fund GP Forward View:

workload

Ideas stage Hazel Taylor Unconfirmed 0.0 0.0 0.0 GREEN 0.0 0.0 0.0 0.0 GREEN 0.0 0.0 0.0 0.0

Primary care co-

commissioning

Vanguard Productive general practice GP Forward View:

workload

Design stage Hazel Taylor Unconfirmed 0.0 0.0 0.0 GREEN 0.0 0.0 0.0 0.0 GREEN 0.0 0.0 0.0 0.0

Primary care co-

commissioning

Estates and technology

transformation fund

Estates and technology

transformation fund

ETTF Mobilisation Paula Longden Confirmed 0.0 0.0 0.0 GREEN 0.0 0.0 0.0 0.0 GREEN 0.0 0.0 0.0 0.0

Primary care co-

commissioning

Pharmacy Pharmacists in General Practice CCG Baseline Live Cathy Quinn Unconfirmed 0.0 0.0 0.0 GREEN 0.0 0.0 0.0 0.0 GREEN 0.0 0.0 0.0 0.0

Primary care co-

commissioning

GP Forward View Non-clinical education GP Forward View:

workforce

Design stage Hazel Taylor Confirmed 0.0 0.0 0.0 GREEN 0.0 0.0 0.0 0.0 GREEN 0.0 0.0 0.0 0.0

GP Forward View Total 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

PRIMARY CARE VANGUARD

Urgent and proactive care Urgent Care NCM

(Primary Care)

Proactive hub Vanguard: primary care Design stage Paula Longden Confirmed 0.0 0.0 0.0 AMBER 299.6 299.6 0.0 0.0 AMBER 0.0 0.0 158.8 6.6


(Primary Care)

Urgent care hub Vanguard: primary care Approval Steph Haslam Confirmed 0.0 0.0 0.0 AMBER 0.0 0.0 161.8 0.0 AMBER 196.7 196.7 161.8 0.0


(Primary Care)

Place-based Vanguard

developments

Vanguard: primary care Design stage Steph Haslam

Chris Sewell

Confirmed 0.0 0.0 0.0 AMBER 0.0 0.0 0.0 0.0 AMBER 0.0 0.0 0.0 0.0


(Primary Care)

Best practice scheme Vanguard: primary care Live Jacqui Kemp Confirmed 0.0 0.0 0.0 GREEN 0.0 0.0 123.0 73.9 AMBER /

GREEN

0.0 0.0 431.7 259.1

Planned care Elective Referrals -

Service Review and

Referral Mgmt

Referral management Vanguard: primary care Live Chris Sewell Confirmed 0.0 0.0 0.0 GREEN 0.0 30.0 22.8 5.1 GREEN 0.0 20.0 56.8 12.3

Enablers Primary Care - Enablers Project management Vanguard: primary care Live David

Ainsworth

Confirmed 800.0 800.0 0.0 GREEN 0.0 0.0 0.0 0.0 GREEN 0.0 0.0 0.0 0.0

Primary care Vanguard Total 800.0 800.0 0.0 299.6 329.6 307.6 79.0 196.7 216.7 809.2 278.0

GP ACCESS FUND

Primary care co-

commissioning

GP Forward View Review of Primary Care Access National GP Access Fund Live Hazel Taylor Confirmed 0.0 0.0 0.0 GREEN 0.0 0.0 0.0 0.0 GREEN 0.0 0.0 85.0 85.0

GP Access Fund Total 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 85.0 85.0

DELEGATED BUDGETS AND CCG PRIMARY CARE TRANSFORMATION

Primary care co-

commissioning

Co-Commissioning Co-commissioning Delegated Commissioning

Budget

Live Hazel Taylor n/a 0.0 0.0 0.0 GREEN 60.0 60.0 109.0 84.0 GREEN 109.0 109.0 225.0 182.0

Planned care Elective Referrals -

Service Review and

Referral Mgmt

Primary care - enhanced services

and pathways

CCG Baseline Live Chris Sewell n/a 0.0 0.0 0.0 GREEN 60.0 60.0 132.1 87.9 AMBER 40.0 40.0 238.5 156.2

Delegated budgets and CCG primary care transformation Total 0.0 0.0 0.0 120.0 120.0 241.1 171.9 149.0 149.0 463.5 338.2

Grand total 800.0 800.0 0.0 419.6 449.6 548.8 250.9 345.7 365.7 1,357.7 701.1

Date printed: 02/03/2017

Location: Z:\Mansfield & Ashfield CCG\Primary Care\Projects - LIVE\1. Programme documents\Primary care workstream - projects master plan v5

PCTF/010/MLocality Implementation

Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18

PhasesPhase 1 Ashfield South and Willowbrook

Meet with Dr Prabu to discuss National requirements.Dr Prabu to discuss with locality GP'sDr Prabu to submit proposal plan including go-live dateLocalities to implement communications plan with support from CCGPractices to have installed GPAT software

Service to go-live whole population coverage aligned to National guidelines.

Service live, monitor access to service and appointment frequency based on utilisation ratesConsider use of digital approaches

PHASE 1 Willowbrook Medical PracticeMeet with WMP to discuss National requirements.Willowbrook to discuss internallyWMP to submit proposal plan including go-live dateWMP to implement communications plan with support from CCGPractice to install GPAT softwareService to go-live whole population coverage aligned to National guidelines.Service live, monitor access to service and appointment frequency based on utilisation ratesConsider use of digital approaches

Phase 2 Locality based total population coverageCirculate Communications to localities Discussions with localities regarding impelmentation plans - SDM led

Localities to submit proposals for delivery plansLocalities to implement communications plan with support from CCGPractices to have installed GPAT softwareService to go-live whole population coverage aligned to National guidelines.Service live, monitor access to service and appointment frequency based on utilisation ratesConsider use of digital approaches

Mid Nottinghamshire CCGs

Annex DPractice Manager

GPPop Dec

2016

Locality Population

Locality Total Minutes

Locality Total Hours p/wk

Total Cost @ £4.50 p/p (30 mins per 1000)

Total Cost @£6.00 p/p 45 mins per 1000)

Individual Practice Funding

Individual Practice Potential hours based on 30 mins

Individual Practice Potential hours based on 45 mins per

Debbie Partlow Dr P Macdougall 6001 27,005£ 3.00 4.50Sue Jackson Dr Dar 3913 17,609£ 1.96 2.93Tracy Dudley Dr Prabu Raman 4080 18,360£ 2.04 3.06Jane Wardle Dr S Barish 5319 23,936£ 2.66 3.99Dawn Rose Dr S Bassi 4946 22,257£ 2.47 3.71Mel Yorke Dr P Oza 4098 18,441£ 2.05 3.07Mel Lindley Dr Brown 3782 17,019£ 1.89 2.84Sally Haywood Dr G Lunn 5683 25,574£ 2.84 4.26Mohammed Islam Dr J Jenkins 14876 66,942£ 7.44 11.16Patricia Brown Dr N Pound 9750 43,875£ 4.88 7.31Louise New Dr D Chakraborty 5190 23,355£ 2.60 3.89Liz Griffin Dr H Lovelock 8945 40,253£ 4.47 6.71Nicole Keeling Dr R Hook 8994 40,473£ 4.50 6.75Jackie Brittlebank Dr J Jenkins 3524 15,858£ 1.76 2.64Sharon Atherton Dr S Ward 5992 26,964£ 3.00 4.49Nicola Ryan Dr R Park 14555 65,498£ 7.28 10.92Gillian Slack Dr J Murphy 13362 60,129£ 6.68 10.02Kerry Walker Dr H Field 8255 37,148£ 4.13 6.19Alison Bailey Dr B Rahman 2850 12,825£ 1.43 2.14Ros Reavill Dr P Frith 13419 60,386£ 6.71 10.06Sandra Chatwin Dr R S Sharma 2726 12,267£ 1.36 2.04Rebecca Tate Dr R Sheikh 18816 84,672£ 9.41 14.11Denise Mcphee Dr S Patel 3287 14,792£ 1.64 2.47Philippa HutchinsonDr A Kaistha 4384 19,728£ 2.19 3.29Jill Towns Dr H Masud 5914 26,613£ 2.96 4.44Jackie Jones Dr S Allen 6143 27,644£ 3.07 4.61Denise Mcphee Dr S Patel 2768 12,456£ 1.38 2.08Rick Gooch Dr MJ Dalton 11875 53,438£ 5.94 8.91Julie Moyes Dr K Bolsher 6008 27,036£ 3.00 4.51Karen Mee Dr Leah Robinson 3145 14,153£ 1.57 2.36Amanda Brown Dr IC Jairam 3010 13,545£ 1.51 2.26Jonathan Cummins Dr Walden Effingha 12550 56,475£ 6.28 9.41Diane Addy Dr J Smith 15309 68,891£ 7.65 11.48Jacquie Mikhail Dr W Mikhail 6324 28,458£ 3.16 4.74Sally Dixon Dr Mark Hunter 13897 62,537£ 6.95 10.42Gill Bullimore Dr JE Selwyn 14159 63,716£ 7.08 10.62Debbie Swain Dr D Wathern 18178 81,801£ 9.09 13.63Julie Reid Dr Lisa Terril 6954 31,293£ 3.48 5.22Frances Chater Dr K Sallis 5432 24,444£ 2.72 4.07Gillian Wainwright Dr K Moloney 4039 18,176£ 2.02 3.03Nigel Kenward Dr S Reeves 12204 54,918£ 6.10 9.15

1350.42

1723.7157,457

58,221

£449,178.00

£170,199.00

£230,755.50

£202,563.00

£258,556.50

37,822

51,279

45,014

18.91

25.64

22.51

28.73

1134.66

1538.37

74,863

1,747 29 261,995

2,246 37 336,884

£226,932.00

£307,674.00

£270,084.00

£344,742.00

£349,326.00

Category SupportNumber of Practices

Outcome MeasuresNHS England Contribution

Practice 'in kind' Contriburion

Key Objectives

Diagnostic services.Diagnostic Review of Practice to establish support requirements

12Identification of support requirements for individual Practices which fit GP Resiliance

FundingTime of nominated

staff working towards future sustainability

Estates Review with identification of future options

2Clear Estate Plan for the Practice.


staffworking towards future sustainability

HR specialist to review staff records and policies

31. All Staff Records Reviewed and updated2.HR Policies and Procedures in place which meet current legislative requirements


staff Securing operational sustainability

Finance -Review of finacial health and advice on maximising income

1 Action Plan to improve financial health of the Practice FundingTime of nominated

staff Securing operational sustainability

IT - Mobile working, staff training, IG and System 1 Templates

41. Mobile Wokring In place2. IG Training completed3. Systm1 training inculding templates completed


staffSecuring operational sustainability

Support with Palliative Care Register Case Finding

1 Practice identifies all patients who are potentially in the last 12 months of life - 1%


staff working towards future sustainability

Capcity and Demand Management 1 1. Capacity and Demand Review2. Action Plan to improve appointment availability


staffDeveloping effective ways of working

Health and Safety1 1. Review of Health and Safety within the Practice

2. All Health and Safety requirements metFunding

Time of nominated staff

Securing operational sustainability

Coaching / Supervision / Mentorship

Mentoring3

1. Mentorship needs identified2. Programme of mentorship completed3. Survey of benefits - Individuals and Practice



Business case writing 31. Attended Course2. Evidence of application of skills Course fees


working towards future sustainability

ILM Award for Leadership1 1. Completion of Course

2. Learning Outcomes ReportedFunding



Review Workload Pressures increase effectiveness 2

1. Review of PM workload2. Action Plan to increase Effectiveness Funding Time of nominated

staffworking towards future sustainability

PN - Enhance skills through training eg minor illness, triage and chronic disease, family planning, spirometry

11. Nurses attended training2. Evidence of application of New Skills

Course fees

Time of nominated staff working towards future

sustainability

Review Skill Mix with a view to free up GP time/Increase workforce capacity

41. Individual Practice Workload Review2. Action Plan to deliver improvments3. Increase in GP capacity Funding

Time of nominated staff working towards future

sustainability

Recruitment Support 4 Successful recruitment of staff FundingTime of nominated


HCA - Additional training1 1. Successful completion of training

2. Evidence of Application Course fees



PN - Training for nurses entering PC from a different sector

1Successful completion of Course Course fees



Change and project management support. Change and project management

support8

1. Identify changes required through Process Mapping2. Agree Actions Required to delivery Improvements3. Measure benefits delivered Funding

Time of nominated staff Developing effective ways of

working

Personal resilience trainingPersonal resilience training

6 1. Resilienace training delivered2. Survey of benefits - Individuals and Practice Funding



Patient Education 11. Plan for Delviery of Patient Edcuation with the Practice2. Benefits to the Practice Measured Funding



Infection Control 1

1. Infection Control Training Delivered to Practice2. Infection Control Plan in place3. Positive infection control audit outcome None



Total Funding 2016/17 £90,000.00

Specialist advice and guidance.

Other

Practice management capacity support

Coordinated support to help with workforce issues

Addendum E

GP Resilience - Schedule of Support

Addendum F - Mid Notts Non Clinical Education – GP 5Y Forward View Background and context

As part of the General Practice Forward View, a new five year £45 million fund has been created to contribute towards the costs for practices of training reception and clerical staff to undertake enhanced roles in active signposting and management of clinical correspondence.

Active signposting by reception staff (extract from the GP FV)

This provides patients with a first point of contact which directs them

to the most appropriate source of help. Web and app-based portals

can provide self-help and self-management resources as well as

signposting to the most appropriate professional. Receptionists acting

as care navigators can ensure the patient is booked with the right

person first time.

Reception staff are given training and access to a directory of

information about services, in order to help them direct patients to the

most appropriate source of help or advice. This may include services

in the community as well as within the practice.

Benefits for practices: This innovation frees up GP time, releasing

about 5 per cent of demand for GP consultations in most practices. It

makes more appropriate use of each team member’s skills and

increases job satisfaction for receptionists.

Benefits for patients: It is easier for patients to get an appointment

with the GP when they need it, and shortens the wait to get the right

help

This funding is allocated solely for the purpose of supporting the training of reception and clerical staff in GP practices. The training should cover

The task of active signposting for patients. As described above, this is

an enhancement to normal good customer service. It requires the

receptionist to be skilled and confident in sensitively ascertaining the

nature of the patient’s need and exploring with them safe and

appropriate options. These options will usually include sources of

advice and support outside the practice as well as within, and will

often be drawn from a directory of services. Training should ensure

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https://www.england.nhs.uk/gp/gpfv/

receptionists are confident in communicating available options

Educational session overview and content

Non-Clinical Triage and Signposting -

• Develop communication skills to undertake preliminary telephone triage

• Consider how to categorise the urgency of the patient’s condition

• Signpost patients to the most appropriate member of the registered practitioner team

• Allocate appointments and home visits in an appropriate manner to make best use of resources

Content:

• What telephone triage is • Legal responsibility in telephone triage • Correct documentation • The use of established protocols • Communication skills: techniques and conversation

management • Active listening • Questioning styles • Effective and efficient telephone triage call management • Questioning to identify clinical emergencies • Questioning to identify common red flag symptoms • Questioning to categorise the urgency of the patient’s

condition • Clinical case scenarios for minor and major conditions. • Referral to appropriate team members • Risk management • Clinical Governance

Aimed At

Non-Clinical Admin and reception staff in Mid Notts general practice. Events aimed at Team leaders, Reception managers, Assistant Practice managers and Practice Managers (if appropriate)

Dates/Times/Venue

The course is held over 2 days – plan to hold sessions in July and October 2017. Dates are waiting for confirmation from the CCG. The course will be held in 2 venues, Forest Medical (M&A) and Balderton (N&S)

Refreshments and Front of House

PCDC provide lunch and refreshments PCDC provide front of house service including any equipment

Procurement Checked with Neil Moore regarding procurement rules. Based on the course costs and content the session meets the brief. Confirmed booking and invoice received

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Provider

Primary Care Development Centre – contact is James Cutler

Costs

Budget for 16/17 (must be used by end of March 17 confirmed by Marcus) £27K of which £10K has been used for the Practice Manager Master Class) Remaining £17K to pay for course and contribution to back fill of staff. £100 per practice. Full course costs £ 8560 for 2 sessions.

Communication and Engagement

Course costs include the advertising and promotion of the course by PCDC via their Website Plan to attend Practice Manager meetings in each locality Primary Care Team to promote on Practice visits etc.

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