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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
4
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
5
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
6
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
7
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?
8
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)
9
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)
10
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
11
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
12
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
13
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)
14
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
15
HIE (Health Information Exchange) DXS EMIS- EMIS data sharing EMIS mobile
Future Challenges
16
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
17
Providing a High Quality Service andHow City and Hackney GPs Can Help
Dr Victoria HoltCHUHSE Medical Director
18
“
NQR Compliance
19
20
January 2015 NQR12
21
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)
22
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!
23
“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
26
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
37
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
41
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
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
73