Thursday 5th March 2015 CCG Clinical Commissioning Forum.

Thursday 5th March 2015

CCG Clinical Commissioning Forum

GP IT Update March 2015

GP IT services

3

How is GP IT funded? What impact will funding changes have on

practices and the CCG? What services are currently being provided? What services are planned for the future? What challenges could the CCG/ practices face

in the future?

IT Funding

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2014/15 brought a new funding formula which reduced the allocation for City and Hackney

Current funding for IT is £721,636, covering “core services”

Everything else governed by the IT operating framework

Impact on practices & CCG

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Some IT services historically provided by the PCT and subsequently the CCG are not considered core items

The IT discretionary budget no longer exists Core services will continue to be funded by the

CCG and some additional services will be funded centrally via the operating framework

The CCG will have to look for savings

Services currently provided

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Managed by North East London CSU (NELC) IT support and assistance with strategic planning Delivery of National programmes and IT

infrastructure projects NELC performance is governed by a SLA and

measured against KPIs NELC quarterly reports since 2014 available on

CCG intranet Monthly City and Hackney IT steering group

meeting

National Programmes

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GPs are contractually obligated from 1st April 2015 to provide:

SCR

GP2GP

Patient access to online services

EPSr2 is a non-contractual national IT programme

What progress has been made?

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EPSr2: 31/43 (72%) practices are live. 12 practices remaining to go-live, 10 of which have go-live dates scheduled.

SCR: 27 of 43 (63%) practices are now uploading summaries for their patients. 16 practices remaining to go-live. Relies on practices to activate consent. All practices contacted or visited to ensure this happens.

GP2GP: all C&H practices were live by Oct 2014. 41 practices actively sending EHRs

Progress (cont)

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Patient Access to online services:

Covers activation of

a) appointment booking

b) repeat prescription requests

c) viewing of core MR data

NELCSU support provided via attendance of the PM forum.

22 practices have completed all parts of the online access programme.

40 practices have enabled online access

Progress (cont)

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Patient online access functionality was checked by NELC staff and training for practice staff given during SCR validation/training visits

Data on practice visits relating to National Programmes given in NELC reports by programme and by site

IT Training

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EMIS Training workshops

EMIS concepts, protocols, GP links, PPA reporting. Generally low attendance from C&H practice Classroom Training

Word, excel, presentations, searches, NHS mail Practice visits

Mainly for EMIS web support or training which included uploading imms to open exeter, running searches & reports EMIS web user group EMIS Mobile workshop

Next session planned - Thursday 23rd April

IT Infrastructure projects

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Server migration roll-out completed at all except 2 sites

Switch to EMIS web – 2 remaining Vision practices. Scheduled to switch to EMIS web

Upgrade from Windows XP to windows 7- completed in all but 2 surgeries. Delayed until Vision to EMIS switch completed.

Key performance Indicators

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Sept to Nov 2014 quarterly report:

95% priority 1 calls responded < 1 hr –failed(2/3)

95% priority calls responded <2 hrs- met

95% priority 3 calls responded < 1 day- failed(11/12)

95% priority 1 calls fixed < 4 hrs- failed (2/3)

95% priority 2 calls fixed < 8 hrs- met

95% priority 3 calls fixed < 4 days- failed (10/11)

Key performance indicators (cont)

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Important that practices keep reporting IT problems

The SLA gives us the power to withhold money from the service contract if standards are not maintained.

IT contacts given on the CCG intranet If problems are not being resolved these should

be escalated to:

Dr Niifio Addy (Clinical IT lead) [email protected]

Laurie Sutton-Teague (Project support Officer PCQB) [email protected]

Future services/projected

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HIE (Health Information Exchange) DXS EMIS- EMIS data sharing EMIS mobile

Future Challenges

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Ensuring that IT helps us to integrate services with local providers

Funding shortfall for IT Maintaining the correct balance of providing

core services and planning local initiatives

Dr Niifio Addy

Clinical lead for IT, City and Hackney CCG

END

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Providing a High Quality Service andHow City and Hackney GPs Can Help

Dr Victoria HoltCHUHSE Medical Director

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“

NQR Compliance

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20

January 2015 NQR12

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Our mechanisms for learning:

SIs (Serious Incidents) and

Incidents

Compliments

Patient Experience

Family & Friends Test

(FFT)

Informs our service improvements

Complaints

Looking back.....

Family & Friends Test (FFT)

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A total of 63 FFT feedback forms have been received in this last quarter.

Excel-lent

(37 = 58%)

Good (20 = 32%)

Fair (1 = 2%)

Poor(1 = 2%)

Q3. Please rate your / the patient’s experience

No response(4 = 6%)

Extremely likely(42 = 67%)

Likely(18 = 28%)

4. How likely are you / the patient to recommend our service to friends and family if they needed similar care

or treatment?

No response(3 = 5%)

What they had to say!

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“We were seen to within 15 minutes of appointment and doctor was thorough.”

“I received a very warm, quick and

courteous response call

back.”

“I have been a patient in this unit several times; the way they dealt with me was absolutely awesome.”

“Utterly charming people, from doctor on phone/receptionist/doctor @ Homerton.”

“Most staff we have seen at CHUHSE are excellent.

How you can help

• GP recruitment• Lab results (especially blood sugars• Special Patient Notes especially Care Plans• Promote CHUHSE to patients especially those with

nursing needs: overnight nurse now• Advance prescribing of Diamorphine• Death Certificates: Family Expectations• Remove 111 from answer phone• Answer phone messages

24

25

Integration Synergies

Productivity

Safe Environment

Service users

Partnerships Partnerships

Communication Staff

StakeholdersMembers

END

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PCPCS NEW CARE PLANNING SERVICE

Ms Carolyn Walker, Care Planning and One Hackney Service ManagerDr Kimberley Barlow, Consultant Psychiatrist in PsychotherapyDr Dorota Jagielska-Hall, Clinical Psychologist

PCPCS RANGE OF CLINICAL PROVISION

Main service psychological assessment and brief treatments

Community project groups for the Turkish community

A&E Project for frequent attenders

Care Planning Service

One Hackney contribution –systemic approach to care planning and MDT working

New ‘Care Planning’ service:

Aims to reach a broader range of patients who may not meet the threshold for current service provision within PCPCS

Complex and multiple needs:

medical/social/emotional

Patients who are: at risk of unplanned admission/ diffi cult to engage/ house-bound / using multiple services across health, social and voluntary sector in an un-coordinated way

WHAT WE CAN OFFER YOU

Embedded within the well- established local Tavistock primary care clinical service

Staff working across services, maximising resources and synergies within and between teams

Based around visiting patients in their homes

Includes focus on family members and carers

Promotes more eff ective interagency working, signposting

Encourages the patient to work towards their own recovery

KEY FEATURES OF THE SERVICE

Rapid, expert assessments in the patients' home

Risk assessment and management

Outcome-based support plans / enhanced care plans

Brief interventions (scope to extend for most complex cases)

Therapeutic case management model NOT psychotherapy

Aims to support and strengthen links between the patient, GP and wider professional network

SERVICE MODEL

Who could benefit from PCPCS Care Planning Service?

complex medical complaints for which no clear medical explanation has been found but who would struggle to engage with PCPCS in the first instance

PATIENTS WITH

mental health complaints who struggle with frequent crises but who don’t meet criteria for secondary mental health

PATIENTS WITH

medical conditions who have frequent preventable crises who decline primary care treatment

PATIENTS WITH

primary care relationships are problematic and whom the GP practice request support to meet their health needs

PATIENTS WITH WHOM

END

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LTC Confederation ContractAMENDMENTS FOLLOWING FEEDBACK AT FEBRUARY CCF

2014/15 LTC Contract

At the LMC and forum it was suggested that the contract was an all or nothing one – i.e. if one practice failed then all practices failed and all would be paid nothing. This is simply not the case and never has been the case. If practices meet minimum standards (and higher standards) they should be remunerated in-line with the remuneration model set out by the GP Confederation. Practices are advised to check the Confederation’s remuneration model. Practices are reminded that the CCG no longer pays practices directly for this contract.

2015/16 LTC Contract

The CCG will pay the GP Confederation 100% of the available budget (£2,461,299) although it is proposed that there will be some adjustments made at a Confederation level for missed targets.Following feedback we have amended the wording of the indicator from patients attending smoking cessation to patients being referred to the smoking cessation hub, if agreed by the patient. We will monitor numbers of patients with LTCs who attend but there are no targets associated with this. We’ll share the data as part of the dashboard and learn, hopefully, from those who are really good at promoting smoking cessation.Following feedback we’ve separated out “Time to Talk - £788k” and “Cancer - £137k” from main the LTC contract.

END

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LUNG SCREEN UPTAKE TRIALHackney CCG forum meeting

5th March 2015

Professor Jane Wardle, Professor Samuel Janes, Dr Angshu BhowmikMamta Ruparel, Samantha Quaife

_______________

Karen Sennett (Islington), Lucia Grunn (Camden), Eleanor Hitchman (Hackney & City)

0

5

10

15

20

25

30

35

40

Q1: Mostdeprived

Q2: Aboveaverage

deprivation

Q3: Average Q4: Belowaverage

deprivation

Q5: Leastdeprived

Po

siti

ve r

esp

on

se r

ate

(%)

Current smokers Former smokers All approached

IMD rank McRonald et al (2014)

PARADOX IN UPTAKE: FEWER HIGH RISKUKLS Trial

RESEARCH QUESTION

• Screening demonstration pilot

• Testing informed uptake of screening with two different invitation strategies (randomised)

• Lung health check appointment (multi-intervention)

• CT screening at Homerton (and UCLH)

TARGETED INVITATION STRATEGY

• Targeted: reduce fear, fatalism and stigma– emphasise support– early treatment – avoid mention of smoking at invitation stage

• Stepped: provision of information – engage consider decide

• Low burden: low literacy and numeracy– difficulties communicating risk, uncertainty, overdiagnosis– informed decision-making approach

• Social marketing: creative and engaging design

WHAT WE ASK OF YOUSITE INITIATION

Researcher visits practice- study explained & contracts signed Practice administrator runs pre-developed search

GP screens patient list (one week)

RANDOMISATIONAdministrator removes personal information; Researcher randomises and allocates appointments

1st MAILINGSResearcher visits practice

Administrator uploads patient details and specifies mail packs to be sent by Docmail (secure 3 rd party)

2nd MAILINGSAdministrator removes attenders & cancellations from listRepeat of 1st mailings process (to send reminder letters)

REIMBURSEMENT & TIMEService support costs to practices are in the region of £260

Administrator time 5-6 hoursGP time 1-2 hoursPractice manager time 1 hour

ELIGIBILITY

Inclusion Criteria Exclusion CriteriaAge 60-75 Inability to consent

(eg dementia)Current Smoker (recorded anytime since 2010)

On palliative care register

Metastatic cancerLung CancerCT thorax in past yearGP deems unsuitable

WHAT WE ASK OF YOUSITE INITIATION

Researcher visits practice- study explained & contracts signed Practice administrator runs pre-developed search

GP screens patient list (one week)

RANDOMISATIONAdministrator removes personal information; Researcher randomises and allocates appointments

1st MAILINGSResearcher visits practice

Administrator uploads patient details and specifies mail packs to be sent by Docmail (secure 3 rd party)

2nd MAILINGSAdministrator removes attenders & cancellations from listRepeat of 1st mailings process (to send reminder letters)

REIMBURSEMENT & TIMEService support costs to practices are in the region of £260

Administrator time 5-6 hoursGP time 1-2 hoursPractice manager time 1 hour

WHAT WE ASK OF YOUSITE INITIATION

Researcher visits practice- study explained & contracts signed Practice administrator runs pre-developed search

GP screens patient list (one week)

RANDOMISATIONAdministrator removes personal information; Researcher randomises and allocates appointments

1st MAILINGSResearcher visits practice

Administrator uploads patient details and specifies mail packs to be sent by Docmail (secure 3 rd party)

2nd MAILINGSAdministrator removes attenders & cancellations from listRepeat of 1st mailings process (to send reminder letters)

REIMBURSEMENT & TIMEService support costs to practices are in the region of £260

Administrator time 5-6 hoursGP time 1-2 hoursPractice manager time 1 hour

WHAT WE ASK OF YOUSITE INITIATION

Researcher visits practice- study explained & contracts signed Practice administrator runs pre-developed search

GP screens patient list (one week)

RANDOMISATIONAdministrator removes personal information; Researcher randomises and allocates appointments

1st MAILINGSResearcher visits practice

Administrator uploads patient details and specifies mail packs to be sent by Docmail (secure 3rd party)

2nd MAILINGSAdministrator removes attenders & cancellations from listRepeat of 1st mailings process (to send reminder letters)

REIMBURSEMENT & TIMEService support costs to practices are in the region of £260

Administrator time 5-6 hoursGP time 1-2 hoursPractice manager time 1 hour

WHAT WE ASK OF YOUSITE INITIATION

Researcher visits practice- study explained & contracts signed Practice administrator runs pre-developed search

GP screens patient list (one week)

RANDOMISATIONAdministrator removes personal information; Researcher randomises and allocates appointments

1st MAILINGSResearcher visits practice

Administrator uploads patient details and specifies mail packs to be sent by Docmail (secure 3 rd party)

2nd MAILINGSAdministrator removes attenders & cancellations from listRepeat of 1st mailings process (to send reminder letters)

REIMBURSEMENT & TIMEService support costs to practices are in the region of £260

Administrator time 5-6 hoursGP time 1-2 hoursPractice manager time 1 hour

WHAT WE ASK OF YOUSITE INITIATION

Researcher visits practice- study explained & contracts signed Practice administrator runs pre-developed search

GP screens patient list (one week)

RANDOMISATIONAdministrator removes personal information; Researcher randomises and allocates appointments

1st MAILINGSResearcher visits practice

Administrator uploads patient details and specifies mail packs to be sent by Docmail (secure 3 rd party)

2nd MAILINGSAdministrator removes attenders & cancellations from listRepeat of 1st mailings process (to send reminder letters)

REIMBURSEMENT & TIMEService support costs to practices are in the region of £260

Administrator time 5-6 hoursGP time 1-2 hoursPractice manager time 1 hour

• Multiple health intervention: Lung health check

• Informed consent to study/ screening• Spirometry• Smoking cessation• Data collection• Proceed to LDCT scan• Management and follow up in

secondary care

OPPORTUNITY FOR QOF POINTS

SCREENING OUTCOMES

• Negative result

• Indeterminate result We will contact the patients and arrange any further scans and relevant

follow up.

• Suspicious Finding We will refer patients to the local Thoracic MDT and outpatient service. You will be kept informed throughout the process.

• Incidental Finding Patients may be advised to see you to discuss this further and seek a

referral to another specialty if required. You will be informed of the report and given advice on further

management.

IF INTERESTED….

Mamta Ruparel / Samantha QuaifeLungs for Living Research Centre, UCL Respiratory

Health Behaviour Research Centre, UCL

07469 118 308

[email protected]

END

57

Integrated Mental Health Network:

Recovery and Wellbeing Pathways:Time- Limited Group-Based Interventions

Leading to Positive Health Outcomes, Social Inclusion and Greater Self-Reliance

Nichola Lauder City and Hackney Mind

Integrated Mental Health Network Model

Wellbeing Pathway

Mild: Prevention/

Early Detection

Recovery

PathwayComplex:Improved Social and

Daily Functioning

SPOE&

Network

Navigation

Network Eligibility

General eligibility criteria:

• The Wellbeing Network is for adult (18 years +) residents of the City and Hackney whose primary service

need is due to their mental ill health or risk of mental ill health*

• The Wellbeing Network is designed to support individuals who are not well-supported by other services

• The Wellbeing Network is activity-based and goal-oriented, and therefore is designed for people

whose daily and social functioning skills enables them to make good use of group courses that are

skills-based

• The Wellbeing Network activity is delivered in community settings, and is not suitable for

individuals who require immediate specialist intervention e.g. individuals with a high level of risk

of suicide, self-harm or harm to others

• The Wellbeing Network is available to:

▫ residents with common mental ill health symptoms relating to e.g. depression and anxiety in both boroughs of the

City and Hackney and for

▫ residents with severe and enduring mental ill health in the borough of Hackney only

• Clients on community CPA are not necessarily excluded, eligibility will be based on screening of

daily and social functioning**

Network EligibilityExclusions• Individuals with a primary diagnosis of dementia, a

severe learning disability, or for whom drug and alcohol misuse is their primary problem will access specialist services outside of the Wellbeing Network and should not be referred to the Wellbeing Network in the first instance.

• Individuals in hospital on CPA are not eligible however clients on CPA in the community may be eligible if they are deemed by the referring agency to be moving towards discharge and whose daily and social functioning are high enough to make appropriate use of goal-oriented group activities.Referral agencies can liaise closely with the Single Point of Entry team to determine whether the network will help the clients improve their quality of life and prevent future hospital admissions.

Network ActivitiesThe Wellbeing Network offer a range of modular psychosocial group activities, which are

goal-oriented and person-centred and will operate two time-limited pathways:▫ a Wellbeing Pathway for people with emerging and common mental health issues (such

as depression, anxiety and stress) and will receive an average of 12 hours of support across one year

▫ a Recovery Pathway for people with more severe and enduring mental health conditions and will receive an average of 50 hours of support per year for up to 2 years.

The network will focus on helping people achieve positive outcomes in 4 main domains:• mental wellbeing,• physical health,• social networks and• daily living skills.

One named ‘net work na vigat or’ will follow each client’s progress throughout their journey across the pathway to ensure that people receive the right kind of support at the right time and that support is well- coordinated. We will ensure that we avoid duplication of services by interfacing closely with statutory services within both primary and secondary care.

Sample Course OfferThe Network is offering over multiple courses throughout the year, including culturally competent activities.These include:• Mindfulness - Art Therapy - Eco-therapy - Managing anxiety and low mood - CBT -

Employment Bootcamp• Mind/Body Wellbeing - Mood & Food classes - Money Management and Debt

Prevention

Network KPIs• Increased levels of mental well-being

• Increased physical well-being• Increased independence• Improved emotional resilience to tackle social

factors• Reduction in relapse & crisis• Reduction in self harm• Reduction in the number of visits to a GP• Increase in settled accommodation• Increase in employment & volunteering.• Interventions to support independent living &

move-on• Increase in new skills & confidence• Development of interpersonal skills & social

engagement• Increased inclusion & acceptance in the wider

community• Involvement of service users in evaluation of

services• Effective working partnerships with Comm, ASC,

PC, SC

Integrated Mental Health System

Integrating Non-MH Network Services• Advocacy for All Hackney

• TPS Wellbeing (Norwood)• Carers are the Bedrock• Integrated Substance Misuse Network• One Hackney - Older People• Connect Hackney – Older People• Young People’s Wellbeing & Employment – Hackney and

WF• CAB Welfare Rights• LBH Crisis Discretionary Support Scheme• ACT Job Retention• IAPT Employment• Learning Trust Adult Education• IMHA – East Wing and John Howard Centre• CHMT Welfare Rights• Appropriate Adults Police Custody• Peer Leadership: Peer Recovery, Peer Debt

Prevention,etc• Talking Therapies – private practice• Gang Prevention Programmes – Hackney and Waltham

Forest

Single Point of Entry & Network Navigators• Referral Screening Script

▫ Eligibility Criteria for Network and Non-Network

• Assessment Script and Support Plan Meeting▫ Resilience Compass for Wellbeing Pathway▫ Recovery Compass for Recovery Pathway

• Pathway Allocation▫ Determine level of daily and social functioning

• Menu of Courses and Client Choice

• Pathway Navigators –▫ Review Resilience and Recovery Compass▫ Readiness for Move On

• Outcomes and Client Satisfaction Monitoring

Wellbeing Pathway Overview• Prevention and Early Detection within 12-months

▫ Average 12 hours of support to combine with Targeted Preventative Services for up to 28 hours▫ Each 10-hour group course to target all wellbeing outcomes▫ Max 12 months of support

• Integration with GPs and other PC professionals• Support client self-management skills around MH and phys health

The menu of interventions include :• Specialist advice and information

▫ SPOE/Network Navigation triage, signposting & liaison with Mental Health agencies▫ Consultation around preventing Mental Health issues from deteriorating▫ Outreach

• Group work (generic and BME specific)▫ Physical and mental health promotion▫ Self-help support▫ Physical and mental wellbeing (self mgmt techniques, healthy living initiatives)

• Move-On Support– employment, volunteering, education & mainstream leisure activities

• Talking Therapies – Step 2 IAPT group therapy to address stress, depression or mixed depression/anxiety

Recovery Pathway Overview• Support recovery/social inclusion and move on from Mental Health services

▫ Average of 50 hours per year for up to 2 years, with additional Recovery College support

• Modular courses to prevent relapse & enable clients to take more control of lives.

• Coproduction with clients to identify achievable goals & create Recovery Compasssupport plan

• To reduce relapse, inappropriate use of A&E and delay take-up of secondary care

• To assist clients to access community activities and facilities, reducing social isolation

Activities shall include :• Limited 1:1 sessions to problem-solve around achievement of Recovery

Compass supportplans

• Group sessions in modules▫ Employment, volunteering support and pre-ESOL provision▫ Accessing mainstream education, creative arts and community leisure pursuits▫ Leadership training and peer volunteering opportunities▫ Developing and improving activities of daily living▫ Developing social networks and community participation

• Network Navigators: review Recovery Compass support plans & prepare clients for graduation

• Talking Therapies, where appropriate▫ 12-session 1:1 model to reduce mental health symptoms and increase clinical recovery rates

Service User Journey in a Nutshell

Single Point of Entry

Single Point of Entry Telephone & Online Referrals Via GP, CMHT, Self, Family, Friends, Council, Housing Support

Face to Face meetingwith dedicated Network Navigator Complete needs Assessment, Support Plan, Assist w ith selecting activitiesEnsure all participants are given appropriate support to achieve their chosen outcomesSupport clients to move on from Network services and refer to other services as appropriate

Graduation Meeting - Support clients to move on from Network services and refer to other services as appropriate at the end of Year 1 or 2

Initial Telephone Meeting -with Single Point of Entry Team Provide a range of information about the Network links to other services such as primary care and specialist mental health services, information about what to do in an emergency

Review Meeting -Monitor attendance, progressand satisfaction of clients ontheir recovery journey bytelephone and face to facereviews

Start Activities

1 2

5

Evidence-Based Approach• Client Feedback

▫ Yearly survey▫ Per Intervention/Pathway▫ Monthly Service User Committee Meeting

• Outcome Monitoring▫ Resilience Compass for mild to moderate mental health needs▫ Recovery Compass for moderate to severe mental health needs▫ WEMWBS for mild to moderate mental health needs▫ Resilience outcome measures

• W.R.A.P. for Risk Management & Relapse Prevention

• Behavourial and Motivational Approaches:▫ Mindfulness▫ Motivational Interviewing▫ Acceptance and Commitment Therapy▫ CBT Coping with Life courses

• National Audit of Psychological Therapies

Useful Contacts• Single Point of Entry Free Phone – 0800 612

6585

• Single Point of Entry Telephone – 020 8525 2301

• Online: WWW.chwellbeingnetwork.london

• Enquiries: WWW:[email protected]

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END

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