Page 1 of 23 Final Version 1.0: SCHEDULE 2 – THE SERVICES Service Specification No. Integrated Consultant-led Community based Dermatology Service Service Dermatology Service Commissioner Lead NHS Eastern Cheshire Clinical Commissioning Group Provider Lead TBC Period 4 th Jan 2016 to 31 March 2019 Updated 30 th Nov 2015 1. Population Needs 1.1 National Context Skin disease in the UK is the second most common disease in adults. Each year 24% of the population present to their GP with a skin problem. Skin cancer is the most common form of cancer in the UK and malignant melanoma incidence rates in Britain have more than quadrupled since the 1970s (Quality Standards for Dermatology, 2011). Dermatology is a specialty specifically identified by the Department of Health (DOH) as being suitable for the relocation of a large proportion of work from secondary to primary care under the ‘Shifting Care Closer to Home’ policy. 1.2 Local Context The local population in Eastern Cheshire of 204,000 people is summarised as: Growing population - Population forecast to increase by 28,000 (14%) by 2035. Ageing population - 20% of population are over 65 compared to national average of 16% & fastest growing over 65s and over 85s in North West. Growing burden of disease - Increasing numbers of people with co-morbidities, particularly in the 65 years and over group - 5,275 people have 3 or more Long Term Conditions (LTCs), 1,619 people have 4 or more LTCs and 409 people have 5 or more LTCs. Hypertension, depression and diabetes are the most common conditions, with the greatest incidence being in GP practices in Knutsford, Handforth, Macclesfield, and Congleton which are aligned to the areas of greatest deprivation. Variation in Life Expectancy - A woman living in Macclesfield Town South is expected to die on average almost 13 years earlier than a woman living a couple of miles away in Tytherington. 1 in 46 people have had a stroke in the local population of Eastern Cheshire https://www.easterncheshireccg.nhs.uk/Prospectus2013 1.3 Model of Dermatology Care The CCG intends to commission a ‘Consultant Led’ specialist dermatology (level 4) service, delivered in the community that will diagnose and treat patients with medically and surgically manageable dermatological conditions. This service specification contains a range of requirements to ensure the delivery of local, effective, patient centred services in line with Eastern Cheshire Clinical Commissioning Groups (CCG) ‘Five Year Plan 2014/15 – 2018/19’ system ambition, to deliver investment in care closer to home. Care closer to home refers to offering patients more choice of provider and more convenient access to services. 1.4 Evidence Base The evidence base to support the development of this service includes the following key documents and policies:
Transcript
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Final Version 1.0: SCHEDULE 2 – THE SERVICES
Service Specification No. Integrated Consultant-led Community based
Dermatology Service
Service Dermatology Service
Commissioner Lead NHS Eastern Cheshire Clinical Commissioning Group
Provider Lead TBC Period 4th Jan 2016 to 31 March 2019 Updated 30th Nov 2015
1. Population Needs
1.1 National Context
Skin disease in the UK is the second most common disease in adults. Each year 24% of the population present to their GP with a skin problem. Skin cancer is the most common form of cancer in the UK and malignant melanoma incidence rates in Britain have more than quadrupled since the 1970s (Quality Standards for Dermatology, 2011). Dermatology is a specialty specifically identified by the Department of Health (DOH) as being suitable for the relocation of a large proportion of work from secondary to primary care under the ‘Shifting Care Closer to Home’ policy.
1.2 Local Context The local population in Eastern Cheshire of 204,000 people is summarised as:
Growing population - Population forecast to increase by 28,000 (14%) by 2035.
Ageing population - 20% of population are over 65 compared to national average of 16% & fastest growing over 65s and over 85s in North West.
Growing burden of disease - Increasing numbers of people with co-morbidities, particularly in the 65 years and over group - 5,275 people have 3 or more Long Term Conditions (LTCs), 1,619 people have 4 or more LTCs and 409 people have 5 or more LTCs. Hypertension, depression and diabetes are the most common conditions, with the greatest incidence being in GP practices in Knutsford, Handforth, Macclesfield, and Congleton which are aligned to the areas of greatest deprivation. Variation in Life Expectancy - A woman living in Macclesfield Town South is expected to die on average almost 13 years earlier than a woman living a couple of miles away in Tytherington. 1 in 46 people have had a stroke in the local population of Eastern Cheshire https://www.easterncheshireccg.nhs.uk/Prospectus2013
1.3 Model of Dermatology Care The CCG intends to commission a ‘Consultant Led’ specialist dermatology (level 4) service, delivered in
the community that will diagnose and treat patients with medically and surgically manageable
dermatological conditions. This service specification contains a range of requirements to ensure the
delivery of local, effective, patient centred services in line with Eastern Cheshire Clinical Commissioning
Groups (CCG) ‘Five Year Plan 2014/15 – 2018/19’ system ambition, to deliver investment in care closer
to home. Care closer to home refers to offering patients more choice of provider and more convenient
access to services.
1.4 Evidence Base
The evidence base to support the development of this service includes the following key documents and
Quality Standards for Dermatology, Primary Care Contracting (2011)
NICE Guidance on the Management of Malignant Melanoma (2015)
National Cancer Peer Review Programme – Handbook (2011)
Revised guidance and competences for the provision of services using GPs with Special Interests (GPwSIs) for Dermatology and Skin Surgery, DoH (2011)
Primary Care Dermatology Society – www.pcds.org.uk
The All Party Parliamentary Group on Skin – www.appgs.co.uk
Improving Outcomes for People with Skin Tumours including Melanoma (update): The Management of Low-risk Basal Cell Carcinomas in the Community, May 2010 (evidence update 2011)
Manual for Cancer Services Skin Measures, Version 1.2; National Peer Review Programme July 2014
Suspected Cancer; Recognition and referral, NICE Guidelines; NG12; (June 2015)
Cancer Waiting Times Guidance; NHS England, http://systems.hscic.gov.uk/ssd/cancerwaiting/documentation#guidance
Multi-professional Guidelines for the Management of the Patient with Primary Cutaneous Squamous Cell Carcinoma, British Association of Dermatologists, 2009
Cancer Outcomes and Services Dataset; http://www.hscic.gov.uk/isce/publication/scci1521
Macmillan; Nine outcomes; http://www.macmillan.org.uk/Aboutus/WhatWeDo/Nineoutcomes/NineOutcomes.aspx
2. Outcomes
2.1 NHS Outcomes Framework Domains and Indicators.
NHS Outcome Framework
Domain 1 Preventing people from dying prematurely
Domain 2 Enhancing quality of life for people with long-term conditions x
Domain 3 Helping people to recover from episodes of ill-health or following injury
Domain 4 Ensuring people have a positive experience of care x
Domain 5 Treating and caring for people in safe environment and protecting them from avoidable harm
x
Adult Social Care Outcomes Framework
Domain 1 Enhancing quality of life for people with care and support needs
Domain 2 Delaying and reducing the needs for care and support
Domain 3 Ensuring that people have a positive experience of care and support x
Domain 4 Safeguarding people whose circumstances make them vulnerable and protecting them from harm
x
Public Health Outcomes Framework
Domain 1 Improving the wider determinants of health x
Domain 2 Health Improvement x
Domain 3 Health Protection x
Domain 4 Healthcare public health & preventing premature mortality x
2.2 Local Defined Outcomes The use of outcomes locally is linked to the 8 Caring Together Ambitions.
Quality standards have been written to align with the 8 Ambitions and record the minimum
requirements that people can expect from local care services. The quality standards for community
based co-ordinated care are currently the lowest level quality standards documented and are most
I will be encouraged and supported by all care staff to take an active part in
my care and the support available to me.
I will feel empowered to manage my own health
All contacts with care staff support me to improve and maintain my health
and wellbeing
2. Easy Access:
Access that is
designed to deliver
high quality,
responsive services
and information.
I will have access to information and triage 24hrs per day, seven days a
week and I will be directed to the most appropriate service to meet my
needs
I will be able to use the most suitable access method to access information
and services
3. Support for
Carers:
Carers are valued and
supported.
As a carer I can balance my caring role and maintain my physical, mental
and emotional wellbeing
I will continually be involved throughout the care process
I will have access to an assessment of my own needs as a carer and I will
be given the support I need to continue in my caring role
I have the information and advice I need to fulfil my caring role
4. High Quality Care:
The highest quality
care delivered by the
right person
regardless of the time
of day or day of the
week
I and/or my carer/representative will:
Be dealt with in a courteous and respectful manner
Receive assessment and recommendations for care based on current best
practice.
Be actively informed where there is a change in my health status and/or a
need to alter my current plan of care
Receive specialist input into my care when appropriate, in the most
appropriate setting, delivered face-to-face, by phone or remotely via
technology, in a way which does not unduly delay progress in my care
5. Integrated care:
Staff working together
with the person at the
centre to proactively
manage long term
physical and mental
health conditions
If I have with complex needs
I will be offered co-ordinated care including a personalised care plan which
includes a contingency plan and a named care co-ordinator who will work
with me to organise my care
Multi-disciplinary groups will work together to support and empower me. I
will have input from GPs, primary, community health, social care, mental
health and other specialists to manage co-ordinated care delivery
Care co-ordinators will work with me to assess my health, determine my
needs, and manage and review my care. This may include the use of
technology or portable diagnostics
Where it is in the interests of the myself, care will be managed at my home
and in the local community
My care staff will use shared decision making and make all my contacts
promote health and well being
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My information and care records will be shared to enable care staff to
provide the appropriate joined up care
6. Planned
pathways:
Simplified planned
care pathways
delivered as locally as
possible.
All care staff will follow agreed pathways in order to provide me with consistent high quality care Pathways will be used based on national standards and adapted for local use, according to my individual needs
7. Rapid Response:
A prompt response to
urgent needs so that
fewer people need to
access urgent and
emergency hospital
care.
My carers and I will have access to 7 day 24 hour response for an urgent
care need from one point of access
As a result of triage:
If I have been identified as having a lower level urgent need, I will be given a
timed appointment or visit within an agreed time
If I and/or my Carers have been identified as having an urgent high risk
need, I will have a co-ordinated assessment of my/our needs within an
agreed time of requesting support
If I and my Carers have been identified as having an urgent high risk need, I
will have a personalised care plan set up within an agreed time to support
me with my urgent care needs and care will be delivered at a time agreed
with me.
If I have been identified as not having urgent needs that cannot be resolved
by phone, I will be offered the choice of an appointment with a GP within an
agreed time or an appointment to see a GP in my own practice within an
agreed time
8. Appropriate time
in hospital:
Appropriate time in
hospital, with prompt
discharge into well
organised community
care
During all my hospital stays, discharge planning will start on admission and
will ensure I have a planned and smooth transition back to the community
which fully involves me and is tailored to my needs
When required, care staff working in the hospital and community will work
together with me to facilitate my timely return to the community after a
hospital attendance stay or stay 7 days a week.
(Please note not all of these standards will be applicable to this service specification).
2.3 Service Outcomes By commissioning a ‘Consultant Led’ specialist level 4 dermatology service delivered in the Community, it is intended the following outcomes will be achieved:
Good clinical outcomes
for patients
Improved patients’ experience and high referrer satisfaction.
Provide support, advice and
guidance to the wider NHS to manage patients with
dermatological conditions
Improve/maintain quality of life for patients with long term dermatological conditions.
Improve patient and carers experience of dermatology
services. provision of the service
Increased management pf patients within a community
setting.
Enhanced monitoring and where applicable prevention of
Improve quality of life through the provision of high quality
Improved work up for patients are referred onwards, so they
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complications of the disease, in particular, in cancer-prone
conditions, minimising the interval between onset of symptoms and referral to
cancer multidisciplinary team
information in appropriate and accessible formats including copies of clinic letters and/or
access to a patient-held record
arrive having had the appropriate work up in the pre hospital/tertiary phase of their pathway within the agreed and
defined time frame.
Improved achievement of the Referral to Treatment (RTT) and Cancer Access
and Treatment targets
Improved access to a service that provides services in line with the
NICE Guidance for all patients with suspected skin cancer
Ensure that commissioners have access to high quality performance metrics that
support their commissioning intentions.
2.4 Patient Reported Outcomes Patient-reported outcome measures (PROMs) are measures of a patient’s health. They typically take the form of short, self-completed questionnaires that measure the patient’s health status at a single point in time. They are usually administered before and after health interventions and are used to assess the effectiveness of the treatment, care and support provided. There is a range of dermatology-specific quality-of-life tools that can be used to measure clinical outcomes, such as the Dermatology Quality of Life Index (DLQI) developed at Cardiff University. The provider will be expected to utilise appropriate validated PROMs for patients with chronic conditions. The data captured should include holistic outcomes and experience of the whole clinical pathway. Measures should include overall experiences, access, communication, interaction with professionals, co-ordination, care and respect, privacy and dignity, health information, involvement in health decisions & signposting to relevant voluntary organisations and support groups.
2.5 Service Standards
Principles of dermatology care: Dermatology services will provide consistent, high-quality
care that meets quality standards, such as those developed by NICE. Dermatology services
should have access to a range of supportive services that can help meet the holistic needs of
people with skin conditions - these could include psychological support, access to medical
social workers, camouflage services and occupational therapy.
Appropriately trained staff: Competence to deliver services: percentage of staff delivering
dermatological services who have successfully completed competence-based training,
according to their job role and scope of practice, and fulfilled relevant update requirements.
(Standard 100%)
Clinical assessment and management: Includes adherence to current national and local
guidelines. Patients will have access, appropriate to their needs, to all treatments approved by
national agencies, e.g. NICE, carried out in a safe, competent and timely manner according to
national and local standards.
Models of care and links to other services: Compliance with NICE guidance and, in its
absence, with acknowledged best practice and/or local guidance. Evidence that a range of
integrated services has been developed using consensus guidance. Adherence to the NHS
Act 2006 and the NHS Constitution.
Diagnostic investigations: Percentage of preliminary reports that are received by clinicians
within seven working days of a specimen being taken.
Clinical governance: Providers of services for people with skin conditions should be able to
demonstrate a named identified clinical governance lead, evidence of annual participation in
local, regional and national audit programmes, completion of an annual audit plan with
guidelines/ protocols as appropriate, evidence that healthcare professionals meet all the
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statutory requirements to practise, including any in respect of continuing professional
development and documented evidence that facilities meet agreed national standards.
Information governance: Service providers must be registered with the Information
Commissioner for data processing and have an information governance policy in place to
ensure legal and national guidelines are followed. (Standard 100%)
Private Practice: Providers should not promote their own private treatment service or an
organisation in which they have a commercial interest.
3. SCOPE
3.1 Aims and Objectives of Service The overall aim of the service is to provide access to a high quality and effective dermatology level 4
service delivered from a variety of community based locations within the boundaries of Eastern
Cheshire CCG.The service will operate in accordance with policy guidance for provision dermatology
services. Based on the Improving Outcomes for People with Skin Tumours including Melanoma (update),
this specification describes a level four service and is supported by provision of services for low risk
BCCs under a minor surgery service for primary care. The service will support the delivery of this
service by allowing attendance at MDT meetings, but the service is not responsible for ensuring the
compliance of service providers with the IOG. Where the service provider is an independent sector
provider, the provider is subject to the relevant parts of the IOG and Manual of cancer services. In
relation to this service specification, any NHS or independent sector provider is expected to fulfil the
guidance requirements for the acute Trust elements of service, including the provision and management
of the local skin cancer MDT.
The provider will also participate in regional (network) priority pathways work and deliver care in
accordance with regionally (network) agreed guidelines and pathway. They will participate in any agreed
regional audit work. The provider will ensure there is a transparent mechanism of internal audit that
enables treatment decisions and processes to be quality assured is in place. the service will also invite
audit from their peers (external to the service)
The service provider will also be expected to operate in accordance with relevant safeguarding
legislation for vulnerable adults and children and will be expected to evidence written safeguarding
policies. The service will comply with relevant national and local guidance in terms of service provision,
including accreditation of its clinicians.
The service will be clinically led by an accredited Consultant Dermatologist who will provide clinical
supervision and mentorship including joint clinics, MDTs and clinical audits where practitioners with
Special Interest are providing the service, in line with relevant policy guidance. The service provider will
share with the CCG information on staffing levels and structure and demonstrate procedures to assess
staff competencies in line with Manual for Cancer Services, Skin Measures Version 1.2, July 2014.
Practitioners with Special Interest working in the service will be accredited according to Department of
Health recommendations detailed in the documents above and will be expected to demonstrate on-going
compliance.
The service will operate under national Payment by Results guidance, however as the service develops
(e.g. the introduction of tele-dermatology) alternative commissioning arrangements to maximise local
value will be applied and the service will move to an outcome based model of provision as opposed to an
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activity based service with the provider applying the ‘Right Care’ principles which include:
New models of commissioning and contracting for value;
Reducing variation across the pathway and looking to standardize care wherever possible;
Focus on outcome based strategy;
Strong emphasis on clinical innovation and patient engagement;
Flexibility to deliver service.
Fairness and transparency demonstrated by the Provider, subcontractors and CCG;
Risk sharing / gain sharing to encourage provider and commissioner to improve efficiency and ensure best value approach;
The approach requires a desire to work differently and in partnership across Eastern Cheshire. To
maximise the use of multi-professional staffing, deliver care in the least restrictive setting and draw upon
technology to enhance local provision.
The provider will be required to enhance this service specification to demonstrate how it will deliver this
new model of care and ensure that it reflects how it will meet all relevant clinical and information
governance requirements.
The service will be patient-focused, provide short waiting times for patients, care closer to home, ensure
timely access to specialist dermatology services, ensure low DNA rates and contribute to a more cost-
effective care pathway.
4. Service Provision
4.1 Service Description The service will provide a comprehensive ‘Consultant led’ dermatology level 4 service within a number of community settings across the whole of Eastern Cheshire and the choice of the venues will contribute to addressing the health inequalities of the local population. GPs will be able to refer all patients with dermatological conditions to the service. The service would be expected to provide:
Dermatology, including 2 week wait cancer referral, services based at a location(s) accessible to the people of Eastern Cheshire and operated at times convenient to patients e.g. during working hours, evening or weekend sessions.
patient-centred service with a strong emphasis on patient education, self-management and prevention to help patients manage their skin disease to improve quality of life
either a face to face or tele/photo based clinical assessment based on the clinical appropriateness of the individual case.
any appropriate diagnostic tests, or clinical photography
appropriate storage for photographs in digital format only, taking into account all Information
Governance requirements.
systems that support direct electronic referral swift access to assessment, investigation and
treatment of patients with dermatological conditions performed by a multi-disciplinary team and
nurse-led clinics (consultant supervised)
provision of prompt diagnosis and treatment of skin conditions and skin cancers resulting in good
clinical outcomes
follow up management when clinically indicated with an appropriate clinician (either telephone or
face to face).
initial prescribing (if appropriate) for 2 weeks.
procedures/surgical interventions where clinically appropriate
comprehensive information to the referring GP enabling them to resume the long term care of
the patient.
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advice and guidance service & on-going education for local GPs to ensure effective primary care
diagnosis and management
patients with full information on the range of treatment options available and proposed
treatments. The service provider will ensure that consent for procedures is obtained.
swift onward referral to tertiary care. A lead provider would be expected to ensure a smooth and
uninterrupted transition of care.
a reduction in morbidity from skin disease and decrease in long term complications
a service which demonstrates cost effectiveness and clinically based interventions using
technology innovatively to improve and enhance the service.
services that support Commissioners to manage demand
services where patients are seen and receive their definitive treatment within the 18 week
pathway time framework and national cancer waiting time standards including the delivery of a
two – week cancer waiting time pathway.
services that ensure that where suspected or diagnosed cancer is identified and investigations
or interventions are not available in the Provider’s service, arrangements are put in place by the
Provider for their referral via the HSC 1999/205 route to tertiary care. The Provider must ensure
that this can happen safely and efficiently and have agreed protocols in place to manage onward
referral for diagnostics or treatment in order to comply with the nationally defined cancer waiting
time/treatment standards.
a local Cancer Multi-disciplinary Team meeting that delivers care in line with NICE IOG
framework
a service that ensures timely submission of Somerset Cancer Registry reporting
a service that works in partnership with other health care professionals and statutory/non
statutory agencies to provide a seamless service to patients.
an efficient and effective service through adherence to operational pathways, this must be
supported by written and regularly updated protocols and procedures for diagnosis, treatment
and referral.
a service that promotes self-care and self-management especially for those with long term
conditions
patients with appropriate self-help guidance.
and sustain MDTs for the care of cancer patients by integrating with plastics/maxo-facial
oculoplastic, pathology and radiotherapy
processes that support discharge, with relevant treatment and management plans to the
originating referee.
Integrated services for cancer treatment, and where treatment from other clinical specialists is
required the service should ensure fast track pathways so that the patient is referred into tertiary
care promptly for urgent treatment.
Phototherapy
accommodation for the dermatology service. The accommodation must be located within the
boundaries of CCG.
A compliant service i.e. with NICE IOG for skin cancer, MDT & cancer peer review measures that
performs against the nationally defined Cancer Waiting Times Standards applicable at that point
in time.
A service that ensure all clinical models comply with NICE guidelines where appropriate and all
locally and nationally developed Map of Medicine pathways.
4.2 Service Model
The service model will deliver a service in line with national and local guidance. The service provider is responsible for providing detailed pathways, in line with current Map of Medicine pathways, for each of
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the most common reasons for dermatological referral. The main diagnostic and monitoring methods including within this service specification include:
clinical examination by an expert experienced in the dermatological disease baseline pathology bloods mycology dermatoscopy microbiology urinalysis virology clinical photography for tele-dermatological consultation and MDT discussion skin biopsy and histological examination Radiological imaging Contact allergy testing Biological testing Microbilogical sampling and culture Haematological examination Radiological imaging
Additional diagnostic and monitoring methods via a tertiary referral could include:
genetic testing of blood and skin cells Other investigations specific to subspecialty areas e.g. photo-testing, immunohistochemistry
Treatments offered to patients of all ages may include
topical therapy systemic medicine phototherapy surgical excision cryotherapy Photodynamic therapy - general advice including education about the condition and any
associated conditions. Patients will be sign-posted appropriately to other resources in particular patient support groups and social care resources. Patients will be diagnosed and assessed in an outpatient setting and where appropriate in an inpatient (ward or day unit based), with carefully monitored shared care arrangements in place. 4.3 The General range of Conditions and treatments covered by this service are: Consultant Led Community Dermatology Service
Patients meeting the following criteria should be referred to the Specialist service
Acne - severe nodulo-cystic or scarring requiring Roaccutane treatment (providing relevant blood and pregnancy tests have been done)
Acne fulminans
Moderate acne that fails to respond to treatment
Rosacea – where there is doubt over diagnosis or disease servere.
Allergic contact dermatitis for patch testing
Blistering disorders
Cutaneous vasculitis / auto-immune disorders
Patients ill with a rash (e.g. if urgent referral has been ruled out)
Other suspicious lumps outside the 2 week wait e.g. BCC (head and neck)
Primary care conditions that are severe
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Keloid scarring unresponsive to treatment
Where specialist opinion is sought
Suspected BCC
Inflammatory disorders (unresponsive)
Severely disabling Viral Warts despite six months of treatment
Significant warts of molluscom contagious in immunocompromised patients
Scabies – where patients have not responded to two courses of treatment and the itching continues after six weeks of topical treatment.
Impetigo - Severe and/or unresponsive to treatment
Urticaria - Severe or unresponsive to treatment
Extensive/severe or disabling/failing to respond to treatment psoriasis
Unstable and generalised pustular psoriasis
Extensive acute guttate or plaque psoriasis
Severe Eczema (Atopic, Contact, Asteatotic, Seborrhoeic Dermatitis, Pompholyx & Atopic Eczema) not responding to current therapies
Solar Keratoses where there is a suspicion of malignancy or where the lesions have not responded to treatment or if the individual is on immunosuppressant’s.
Medical Mycology- Severe and/or unresponsive to treatment
Genetic Dermatology
Hidradenitis suppurative - Severe and/or unresponsive to treatment
Pityriasis amiantacea - Severe and/or unresponsive to treatment
Hair and Nail Disease - Severe and/or unresponsive to treatment
Melasma (Cholasma) - Severe and/or unresponsive to treatment
Occupational dermatoses and contact dermatoses - Severe and/or unresponsive to treatment
Leg ulcers ( with underlying pathology such as malignancy)
Lesions (including the development to transfer BCC’s back into the community)
Bacterial Infection - Severe and/or unresponsive to treatment
Cracked painful lips - Severe and/or unresponsive to treatment
Insect Bite - Severe and/or unresponsive to treatment
Fungal Infection (skin and nail) - Severe and/or unresponsive to treatment
Cellulitis - Severe and/or unresponsive to treatment
Cold Dermatology (Chilblains & Frostbite) - Severe and/or unresponsive to treatment
Hand Foot Mouth Disease - Severe and/or unresponsive to treatment
Perioral dermatitis - Severe and/or unresponsive to treatment
Lichen Planus - Severe and/or unresponsive to treatment
Herpes Simplex - - Severe and/or unresponsive to treatment
Milia - Severe and/or unresponsive to treatment
Pitted keratosis - Severe and/or unresponsive to treatment
Rhinophyma
Malignant Lesions
If melanoma or SCC is strongly suspected - refer to service via 2 week wait
High risk BCC’s or lesions above the clavicle and any children under aged 24 years. Send other atypical moles by routine referral
Please note all referrals should be in accordance with the CCG Commissioning Policy. Link to CCG Commissioning policy below; http://www.easterncheshireccg.nhs.uk/downloads/publications/policies/commissioning/FINAL%20Eastern%20Cheshire%20CCG%20Commissioning%20Policy%2013.05.2015.pdf . 4.4 Services that will be provided by other Providers: 4.4.1 General Practice
The following should be treated in Primary Care (General practice/pharmacy) as per the guidelines and
refer only in cases of diagnostic doubt or where a second opinion is required (these should be referred to
an accredited GPSI):
Alopecia areata (mild)
Fungal Infections
Mild eczema/psorasis
Rosacea
Scabies
Skin tags
Viral exanthum
Urticaria
Mild hyperhidrosis
Note: Mollescum contagiosum and viral warts/verrucae rarely need any treatment and should only be
referred in exceptional cases & GMS/PM contract is subject to change Nov 2015.
The following should be treated in primary care using cryotherapy, cautery, curettage, excision, or shave
and snip as appropriate and paid for as part of additional services under the GMS/PMS contract.
Benign moles and other benign lesions
Seborrhoeic Keratoses/Solar Keratoses
Small epidermal cysts Skin tags, warts and known benign moles do not usually require removal or treatment unless there are appropriate clinical reasons.
4.4.2 Minor Surgery Directed Enhanced Service (DES)
Lesions as listed for GPSI services (below) can also be treated by practices under the Provision of Minor
Surgery Directed Enhanced Service. This includes aspirations, excisions & incisions
4.4.3 Local Enhanced Service (LES) for the Provision of Minor Surgery through inter-practice
referral
Practices that can also access the following services through the Local Enhanced Service (LES) for the
Provision of Minor Surgery through inter-practice referral. This includes Cutting procedures.
The agreed list of minor surgery procedures in scope include
Symptomatic and troublesome sebaceous cysts**
Lipomas**
Low risk BCC’s in accordance with NICE guidance. The Minor surgery DES is currently being updated to take account of NICE guidance**
Benign naevi**
Troublesome skin tags**
Seborrheic keratosis**
The scope of the LES does not include the removal of Squamous Cell Carcinomas or Malignant
Melanoma
*Note Primary Care Transformation discussions currently taking place around Community Based primary
care services.
**Note This procedure will be subject to the PLCV policy.
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4.4. 4 Other Specialities
The Following range of conditions will be provided by Other Specialities
Under 16 years with eczema – refer to paediatrics
Under 16 years requiring Dermatology surgery – refer to paediatric dermatology at St Marys Manchester or Salford
Under 16 years with vascular birthmark – refer to Salford
Hirsutism (with suspected endocrine disorder) – refer to Endocrinology Lipoma (May need Prior Approval in line with PLCV policy) – refer to General surgery
Leg ulcers – refer to Vascular/Community
Patients with Urgent Dermatological Condition requiring admission – refer to Salford Royal Infirmary or other Hospital with Specialist Dermatology in-patient beds.
Severe Ocular Rosacea with Keratitis or Uveitis – refer to Ophthalmologist 4.5 Exclusion Criteria
Exclusion criteria for the service:
Wounds/leg ulcers to be referred to the tissue viability service.
Cosmetic skin tags and warts
Laser service
Dermatology emergencies that require inpatient care
In- patient Consultant review for hospital patients with skin problems
Patients not considered suitable for a surgical procedure within the local service will be referred on to tertiary facilities i.e. Christie, Salford (for Mohs) or plastics as necessary.
Paediatric exclusions include:
Initially children aged under 16 years of age with eczema should be referred to paediatrics (who will then make a decision if to refer on).
No surgery to be undertaken on children aged 16 years to be undertaken in the Eastern Cheshire service.
Children under 16 yrs. with extensive or serious dermatological conditions
Children under 16 years with vascular birthmarks would be referred to tertiary facilities as appropriate
Those referrals which come under the remit of tertiary services include;
BCC’s and SCC’s requiring plastic/reconstructive surgery by SSMDT core member
patients requiring general anaesthetic,
Patients requiring biologics having tried and failed other treatment options
Patients requiring radiotherapy
Metastatic SCC on presentation or newly metastatic
Malignant Melanoma stage IIb or more or <19yrs or metastatic on presentation or newly metastatic or
recurrent or for approved trial entry
Cases for adjuvant therapy
Mohs surgery
Immune-compromised skin cancer patients
Skin cancer in patients genetically pre-disposed incl. Gorlin’s syndrome
Referrals of patients without a diagnosis of one of the above listed conditions or who can be managed in the local setting will be returned to the referrer. Patients should not be referred to the specialised level 4
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dermatology service until the referrer can demonstrate that the diagnosis remains unclear and/or all appropriate management options have been exhausted. Infections including HIV, cancer services and palliative care are not included in this specification, because they are specified elsewhere. However, specialists in these areas are included in MDTs reflecting the considerable overlap between these specialties and specialised dermatology. Patients of the specialised dermatology service who require these services will be referred accordingly. Also, patients with infections, cancer or receiving palliative care can be referred to the specialised dermatology service if they otherwise fulfil the referral criteria. 4.6 Equality The Equality Act 2010 places exacting duties on CCG’s to meet the needs of patients and communities across protected characteristics and improve their access and outcomes to health and wellbeing services. The availability of care and quality of service afforded to individuals must be based on an individual’s clinical need and equally available to all. The Provider must therefore ensure that services deliver consistent outcomes for patients regardless of gender, race, age, ethnicity, income, education, disability or sexual orientation.
The Provider shall have reasonable parking on site (or in the very near vicinity) to accommodate patients attending the service and the premises must be easily accessible by public transport.
The Provider shall offer access to appropriate translation services for patients speaking little or no English. If required, longer appointments should be offered for these patients or those with disabilities. 4.7 Geographic Coverage/Boundaries This specification encompasses all services for adults and children, contributing to the care of patients with dermatological conditions who are registered with a General Practitioner in the CCG areas laid out in the “Particulars” of the NHS Standard Contract, or those patients for which the Commissioner is otherwise responsible for under the ‘Who Pays’ guidelines. 4.8 Interdependence with Other Services/Providers The service will routinely work closely with other providers in both primary and specialist tertiary care settings. The majority of patients will be referred by and then returned to the care of their GP with minimal requirement for other service involvement. However for a small number of patients serious pathology will be found and they will require onward referral to tertiary care. In addition the service will be accessible to all clinicians and so will need to facilitate and develop robust two-way mechanisms for patients to move between different parts of the system when required.
The dermatology service will be expected to work alongside numerous partners including:
General Practitioners
Practice Teams
Patient Groups/Advocates
Service Users
Carers
Commissioners/Service redesign teams
Managerial and clinical leads
Community teams where appropriate.
Other provider services
Tertiary care providers and Consultants from a range of specialties
4.9 Relevant Networks and Screening Programmes There is a local Greater Manchester (GM) networks that the service will be expected to link into in order to maximise patient effectiveness. E.g. cancer networks, voluntary sector. Where appropriate, patients will be referred to either the voluntary sector for additional support with their condition(s).
All practicing clinicians within the service must comply with local MDT arrangements.
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4.10 Training/Education/Research Activities To develop the experience, knowledge and skills of all healthcare professionals involved in the provision of care contained within this service specification and to ensure high quality sustainable provision of the service the provider is required to maintain evidence of continuing professional development in relation to this service and will be included in job-planning, and specific training posts developed.
This may be required to be produced as evidence for re-accreditation. Clinical updates/training could include supervised practice, liaison/clinical audit sessions or attendance at appropriate postgraduate meetings/ lectures including research, teaching and training events etc. There is a requirement for audit of skin excisions – and close working with wider GP’s on skin cancer.
The Provider will be expected to offer advice, support, education and training to primary care (GPs).
4.11 Data Management
Clinical records will be kept on an electronic patient record in order to;
Ensure high quality continuous care for the patient where required
Satisfy the audit requirements of this specification
Comply with NHS data protection standards
All information must be reported in line with schedule 6.
4.12 Location(s) of Service Delivery
Services will be provided at the following locations:
Macclesfield District General Hospital
Waters Green Medical Centre
Handforth Clinic
Congleton War Memorial Hospital
Knutsford District Community Hospital
Other locations as agreed
4.13 Days/Hours of Operation
The appointed provider will be expected to offer appointment times that best meet the patients’ needs
including evenings and weekend. The service will be available throughout the year at a frequency that
ensures that sufficient capacity exists to meet demand and that waiting time standards are achieved.
4.14 Referral Criteria and Sources
Referral thresholds for the Consultant led Community Based level four Dermatology Service are that the
patient must be:
registered with a GP from Eastern Cheshire CCG or from other pre-defined commissioners as laid
out in the “Particulars” of the NHS Standard Contract..
confirmed to have a Dermatological condition that the service has deemed suitable to treat
considered to have a condition that may require further investigation and expert review
4.15 Response time and prioritisation – receipt of referrals
Routine patients will be contacted and offered an appointment within eight weeks
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The following principles therefore will apply
Referrals should be dealt with on a first come, first served basis and prioritisation will be made purely on clinical grounds.
Patients who do not attend (DNA) a new appointment, or up to 2 DNA for follow up patients; will be returned to the GP, unless otherwise clinically indicated
The provider will work to ensure that waiting times are kept as short as possible and will ensure they comply with national diagnostic, 18 week and cancer waiting time standards.
The provider will ensure that systems are in place for the timely transportation, analysis & reporting of diagnostic tests.
Any routine post-operative care of wounds and changing of dressings may be sent back to the referring GP where appropriate with a management plan and associated equipment e.g. dressings to ensure that any necessary follow up is timely and appropriate.
4.16 Referral Processes
GP Referral and Nurse Practitioner
Consultant to Consultant.
GPs will book patient appointments through the National E-Referrals service indicating urgency of
referral on the referral form to aid prioritisation of treatment. The referral should include the patient’s
preferred treatment site.
GP referrals will be accepted via paper and fax, however it is expected the provider will actively
encourage referrals to be made electronically via NHS e-mail. The provider will develop electronic
referral templates compatible for use with local GP EMIS and EMIS Web systems. A minimum data set
for referrals will be required.
4.17 Discharge Processes
The provider will be responsible for ensuring that the referring GP and patient are sent a discharge
summary letter following each patient consultation. This should be sent to the referring GP and patient
within 5 working days of discharge. Delivery of discharge summaries to GPs include:
Results of diagnostic tests.
Summary of treatment.
Outcome of treatment (including medication prescribed).
Treatment plan of recommendations for management.
Clearly identified primary care actions if required
Patient advice offered
Patients should be discharged from the service when the desired clinical outcomes have been reached
and/or it is deemed that a patient could derive no further benefit from continuing the course of treatment.
Upon discharge patients are to be provided with a written maintenance programme and advice specific
to their individual needs. The service will be required to support discharge and discharge
communications to the originating referrer, as per agreed discharge protocols.
Which are:
The patient DNA’s without contacting the service to explain reasons within two days of missed
appointment.
The patient wishes to be discharged from the service
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The patient requires a surgical intervention and has been worked up as much as possible (e.g.
Diagnostic tests)
The patient is been sent to another service (To include skin camouflage or tertiary treatment)
The patients treatment plan, goals or objectives have been met.
Patient does not comply with treatment recommendations.
Patient does not attend for requested investigations.
Prior to discharge the patient must ;
Have received knowledge of how to self-manage their condition
Be aware of their condition and subsequent causes, etc.
Have received treatment advice and health promotion given
Have had a report is compiled and sent to the referring GP.
Have received relevant advice and literature.
The service will only make onward specialist referrals where clinically appropriate along locally agreed
and established pathways. Reasons for onward referral will be communicated to the referring GP within
two working days.
4.18 Patient Information
The service provider will be asked to provide evidence of methods they regularly use to capture patient
experience in order to improve their service, the outcomes of which should be shared with the CCG. The
Service provider will also be required to provide evidence on how they ensure any issues or areas of
concern are identified and addressed and ideas taken forward. They should ensure that views on patient
satisfaction and changes made as a result of the information collected are communicated to patients and
other stakeholders.
The Provider shall ensure that, patients are well informed about their condition and about what to expect within the Service. They should be given information about any procedures and recovery process, including information on aftercare and how they can access other relevant services out-of-hours and also reassurance that the clinician caring for them is suitably qualified/experienced.
The information should also be available on the internet and should include detailed patient information about all conditions and all procedures. Where possible, this should be diagrammatic and visual and include real patient stories. The Provider shall also ensure that the patient is given an opportunity to ask questions and receive reassurance as necessary. Patients (particularly those who require ongoing care within the Service) should be supplied with
contact details for a named clinician who will be able to respond to queries and concerns and where
necessary give clinical telephone advice.
4.19 Training/education/research activities
The service provider shall be responsible for service launch events and marketing to raise awareness
amongst GPs, identifying the educational needs of Eastern Cheshire GPs and will be responsible for
overseeing and coordinating a varied programme of educational activities/events each year aligned to
local health priorities supporting GPs in the initial management and diagnosis of patients in primary care.
4.20 Monitoring of the Service by Commissioners
The service will be monitored on a monthly basis from date of service commencement. Regular
monitoring reports will be required to enable measurement of the service against Key Performance
Indicators, as per the NHS Standard Contract.
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4.21 Expected Resources
The following list describes the minimum resources expected of a dermatology service:
A named senior clinician, Consultant Dermatologist, with overall responsibility (including clinical governance) for the total hub and spoke service and the clinical staff engaged in its provision;
Ready access to a clinical specialist for queries/complications that arise during clinics;
A named senior clinician responsible for decontamination and infection control procedures; clinic facilities should have established decontamination and infection control procedures
Access to expert infection prevention and control advice;
Access to consultation rooms and appropriate facilities for diagnosis and treatment procedures;
Administrative support for clinics e.g. booking clinics, managing and reporting waiting times, management and storage of patient records, provision of the necessary statistical returns; facilities for text messaging to reduce DNA rates;
Resources to support compliance with relevant Information Governance legislation and DOH protocols and procedures covering records/data lifecycles;
Adequate Information Technology and arrangements that meet appropriate standards and arrangements for IT support;
Records are maintained by the service and a discharge letter/treatment report is sent to the referring GP and patient;
Information technology and arrangements for IT support;
Access to technological advancements to improve the service for patients e.g. tele-dermatology within community clinics etc.
Collection of outcome data and regular auditing.
4.22 Facilities and equipment requirements:
Premises must be fully approved for infection control and be stocked with the required equipment which meets Health and Safety standards.
Suitably equipped and compliant procedure/treatment rooms should be available as required
Relevant staff should be trained to the appropriate standard to manage an electronic booking and appointment system.
5. Standards
5.1 Applicable National Standards Providers will be required to comply with all National Quality Requirements of the NHS Standard
Contract, these can be found at www.england.nhs.uk/nhs-standard-contract
The provider will adhere all relevant NICE guidance relating to the effective management of skin conditions and is expected to deliver services in line with the following guidance:
The NHS Constitution (2012)
Shifting care closer to home dermatology report (DH 2006)
Implementing care closer to home, Parts 1 – 3 (DH 2007)
Revised guidance and competences for the provision of services using GPwSI (DH 2011)
Commissioning Guidance – BAD (British Association of Dermatologists 2008) Quality standards for dermatology
Improving Outcomes for People with Skin Tumours including Melanoma (NICE 2006)
Model of Integrated Service Delivery in dermatology
Improving Outcomes Guidance for Skin Tumours including Melanoma (NICE updated May 2010)
Skin cancer Peer Review Measures (NCAT 2008 and update 2011) Referral guidance for skin cancer (NICE 2005)
Primary Care Dermatology Society – www.pcds.org.uk
The All Party Parliamentary Group on Skin – www.appgs.co.uk
Improving Outcomes for People with Skin Tumours including Melanoma (update): The Management
of Low-risk Basal Cell Carcinomas in the Community, May 2010 (evidence update 2011)
Suspected Cancer; Recognition and referral, NICE Guidelines; NG12; (June 2015)
Cancer Waiting Times Guidance; NHS England, http://systems.hscic.gov.uk/ssd/cancerwaiting/documentation#guidance
Multi-professional Guidelines for the Management of the Patient with Primary Cutaneous Squamous Cell Carcinoma, British Association of Dermatologists, 2009
NHS National Cancer Action Team. National Cancer Peer Review Programme. Manual for Cancer Services 2008: Skin Measures.
Cancer Outcomes and Services Dataset; http://www.hscic.gov.uk/isce/publication/scci1521
Any other relevant guidance that has been published or issued insofar as it is applicable to the Services.
Please note, these guidance documents are not an exhaustive list and providers will be expected to work
to new and emerging policy guidance which relates to, and links with, the delivery of dermatology acute
and community services and the well-being of local populations.
The provider will ensure that all healthcare professionals who are involved in performing or assisting in any procedure are/will:
Competent in resuscitation
Demonstrate that their skills are regularly updated
Demonstrate a continuing sustained level of activity
Conduct regular audits
Participate in appraisal of dermatology activity
Participate in supportive educational activities
The provider will carry out a minimum of two audits per year. Examples of topics to focus on include clinical outcomes Rate of infection, complications of cases, completeness of care episode, patient satisfaction and instrument/ surgical equipment are up to date.
5.2 Applicable Standards Set Out in Guidance and/or Issued by a Competent Body (e.g. Royal
Colleges)
The provider will adhere to the following guidance: Royal College of Physicians guidance CQC Provider Registration British Association of Dermatologists clinical guidelines. The entire list of guidelines is
available at http://www.bad.org.uk//site/622/default.aspx
5.3 Applicable Local Standards The service provider shall act in accordance with local guidelines on dermatological conditions which will include the Local Skin Cancer Multiple Disciplinary Teams/Specialist Skin Cancer Multi-disciplinary Teams, Maxillo-facial and Plastics Teams and other relevant groups.
The provider will adhere to the NHS Eastern Cheshire CCG Commissioning policy document and agree to abide by any future amendments of the document which may affect the provision of the service.
5.4 Applicable Quality Requirements (See Schedule 4 - NHS Standard Acute Contract) Full records of each patient contact should be maintained in such a way that aggregated data and details of individual patients are readily accessible in electronic and / or written form. The provider should maintain access to the database as part of the regular service reviews, which will be carried out in conjunction with the CCG on a minimum of a quarterly basis.
The provider will gather information on activity on a weekly basis, and provide monthly reports to commissioner on activity carried out within the dermatology service. Provider will be subject to a governance review during the lifetime of the contact. 5.5 Staffing Standards
In order to meet minimum safe staffing standards NHS Eastern Cheshire CCG requires that the
Consultant- led service employs at least two whole time equivalent consultants however it also
recognises that a new service will require an opportunity to build and develop the service before
appointing a second Consultant. Therefore it is particularly important that this service is well supported
by an appropriate range of trained and skilled professionals, e.g. specialist nurses, pharmacists,
Specialty Doctors and GPwSIs who will provide support to the Consultant. We would also expect
network arrangements to be explored to ensure Consultant cover is provided during periods of leave.
The service provider will be responsible for ensuring that it maintains a staffing complement which allows
it to meet the objectives set out in this specification. In particular, all staff will be required to work flexibly
to ensure continuity of care and equity of access across all sites and treatment pathways
The service provider shall ensure that all practitioners who provide the service are competent and should
be able to provide demonstrable evidence of competence.
The service provider will be responsible for ensuring that all clinical staff hold current professional registration, are current members of their respective professional bodies and have current DBS clearance.
The CCG requires evidence that all personnel providing the service through the contract have appropriate indemnity cover to meet in full claims made against them as individuals working within independent contractor status and independent or third sector providers are also appropriately indemnified.
All employed clinicians must have significant previous experience in providing the services similar to the proposed service and who satisfy at appraisal and revalidation that they have such continuing clinical experience, training and competence as is necessary.
The provider must ensure that any healthcare professional who is involved in providing care or assisting in provision of care has the necessary experience, skills and training with regard to provision of care e.g. resuscitation skills.
Staff employed must have:
relevant certificate of any external postgraduate courses or accreditation. certificate or a sign off letter from the mentoring Consultant(s) for any clinician working within
an extended scope of practice, e.g. Nurse Specialist or PwSI. evidence of ongoing and continued competence. evidence of completion of statutory and mandatory training and dates of refresher/review
training have an annual appraisal and an agreed personal development plan. confirmation that appropriate supervision arrangements for all levels of staff will be in place,
including induction and clinical supervision. confirmation that competent practitioners will assess referrals and patients in accordance with
agreed protocols and pathways which are based on national clinical guidelines and evidenced good practice.
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access to a clinical lead for the service who will be responsible for overseeing the clinical governance framework and processes including Medicines Management and Prescribing.
evidence that they have the experience and qualifications to undertake the procedure/s and all personnel providing the service are competent to provide those aspects of the service for which they are responsible and will keep their skills up to date.
Clinical staff within the dermatology service should also demonstrate a continuing sustained level of
activity, conduct regular audits, be appraised on what they do and take part in necessary supportive
educational activities.
Nurses assisting in the provision of care should be appropriately trained and competent, taking into
consideration their professional accountability and guidelines on the scope of professional practice.
The provider will also be required to demonstrate that they have safe recruitment procedures in place.
5.6 Patient Satisfaction and Complaints Patients must at all times be respected and treated in a kind and considerate way by staff who should at all time demonstrates a professional and patient friendly attitude.
The Provider shall conduct a six monthly patient satisfaction survey using a questionnaire agreed with NHS Eastern Cheshire CCG. The sample should be drawn from new patients seen during the six month period and should represent at least 10% of the activity. Both parties will need to give consideration to the utilisation of Patient Related Outcome Measures (PROMs) to support the measurement of the patient experience.
The Provider shall operate a complaints procedure that is in line with existing NHS complaints standards and shall promote this to patients, providing clear details of who to contact and how to escalate complaints to NHS Eastern Cheshire CCG if they do not feel that their concerns have been addressed.
In addition to providing NHS Eastern Cheshire CCG with a monthly summary of complaints received, the Provider shall keep appropriate records of all complaints (verbal or written), which shall be available for audit.
5.7 Patient Consent The Provider shall ensure:
Written informed consent is provided for all procedures carried out, in compliance with Department of Health and regulatory body standards;
if English is not the first language, the patient is supported by a translator from a provider recognised by NHS Eastern CCG;
It has an alternative mechanism for explaining the procedure, after- effects and risks of the procedure to patients who have a sensory impairment (e.g. hearing) that represents a barrier to understanding verbal explanations.
5.8 Medicines Management The provider will ensure prescribing, supply and administration of medicines is safe and cost effective,
and will have in place, safe and robust systems, processes and policies for managing all activities
relating to medicines management; in line with relevant medicines legislation, and national and local
The Provider will be required to follow the ECCCG policy, High Cost Drugs and Technologies Summary
of Commissioning Arrangements Policy, for the prescribing of non PbR Medicines. In line with this policy,
the Provider will be required to:
use the web-based system, Blueteq, to notify and provide ongoing assurance to the CCG that any
individual patient commenced on a PbR excluded medicine is done so in accordance with the
relevant NICE Technology Appraisal and that on-going assurance of continued eligibility is provided
at pre-determined intervals.
provide monthly drug level data as outlined in the policy.
The Provider will have a formal process for sharing incidents with Eastern Cheshire CCG including
documentation with planned action.
The Provider will have a process in place to report Adverse Drug Reactions online at
www.yellowcard.mhra.gov.uk
The Provider should have a process in place to action new safety alerts - e.g. MHRA alerts, drug recalls
to ensure patient safety in relation to their preferred list of medicines.
5.9 Safeguarding and Quality Framework
The provider will be compliant with Eastern Cheshire CCG Safeguarding Policies.
5.10 IM&T
The provider should have the ability to support the booking of appointments and receipt of referrals by either indirectly or directly bookable e referral systems.
In the event of cancellation of the contract the Provider will be required to maintain systems to allow continued access, in a timely manner, to all of the patient information, images and associated patient records.
The Provider must put in place appropriate governance and security for the IM&T Systems to safeguard
patient information. The Provider must ensure that the IM&T Systems and processes comply with
statutory obligations for the management and operation of IM&T within the NHS, including, but not
exclusively:
Common law duty of confidence;
Data Protection Act 1998;
Access to Health Records Act 1990;
Freedom of Information Act 2000;
Computer Misuse Act 1990; and
Health and Social Care Act 2001.
The Provider must meet prevailing national standards and follow appropriate NHS good practice
guidelines for information governance and security, including, but not exclusively:
NHS Confidentiality Code of Practice;
Information governance in line with the NHS IG Toolkit Level II, as a minimum requirement;
Use of the Caldecott principles and guidelines;
Appointment of a Caldecott Guardian
Appointment of a Privacy Officer
Policies on security and confidentiality of patient information; and
Risk and incident management system.
5.12 Clinical information
To ensure the quality and safety of patient care, the IM&T Systems must also support:
Management of all clinical services including ordering and receipt of diagnostic procedure
results and reports;
Maintenance of individual electronic Patient health records;
Inter-communication or integration between clinical and administrative systems for use of
patient demographics;
Access to knowledge bases for healthcare, such as Map of Medicine, at the point of patient
contact;
Access to research papers, reviews, guidelines and protocols; and
Communication with Patients, including hard-to-reach groups to support provision of quality
care, including printed materials, telephone, text messaging, website, and email.
5.13 Disaster recovery
No failure of Eastern Cheshire CCG or any other subcontractor supplying IM&T services or infrastructure
will relieve the Provider of their responsibility for delivering the service. Therefore, the Provider must
have an IM&T Systems disaster recovery plan to ensure service continuity and prompt restoration of all
IM&T Systems in the event of major systems disruption or disaster.
5.14 Applicable CQUIN Goals
To be Confirmed in NHS Standard Contract Schedule 4 Part e
5.15 Data Reporting & Statutory Returns The Provider will be expected to provide data as outlined within the information schedule of the NHS Standard Contract agreed with the commissioner. The Provider will be expected to complete all relevant data submissions to national bodies including:
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18 Week Referral to Treatments 6 week Diagnostic waits SUS (secondary user services) Cancer Wait Times Cancer Outcomes
The provider must ensure compliance with statutory reporting obligations e.g. cancer waiting times, diagnostic test times, patient experience, Somerset Cancer Registry, staging activity, first out-patient attendances, Referral to Treatment waiting times for non-urgent consultant-led treatment, Incidence of healthcare associated infection, Serious Untoward Incidents, etc.
Never Events are serious patient safety events that are largely preventable. Guidance is available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/213046/never-events-policy-framework-update-to-policy.pdf
5.16 Patient & Public Involvement The CCG has a responsibility to make arrangements to involve and consult with service users and the
public in the planning and organisation of services. The service provider will therefore be expected to
take into account the views of people who use the services when making decisions about how services
are delivered and improved. The Provider should have a patient panel which is involved in service
