Governing Body Meeting in Public. Report from Lower Lea Valley Locality Commissioning Group

Transcription

1 Agenda Item No: 7.1 Date of Meeting: 30 January 2014 Board or Committee Name: Governing Body Meeting in Public Paper Title: Report from Lower Lea Valley Locality Commissioning Group Decision Discussion Information Report author: Report signed off by: Dr Alison Jackson & Dr Ed Bosonnet Lower Lea Valley Locality Chairs John Webster Director of Commissioning Purpose of the paper: To provide an update from the Lower Lea Valley Locality Conflicts of Interest involved: There were no conflicts of interest to consider Recommendations to the Board / Committee To note the paper and the locality work being undertaken in Lower Lea Valley Page 1 of 32

2 Report from Lower Lea Valley Locality Purpose of the Paper To update the Governing Body on the priorities and activities in Lower Lea Valley Locality Latest Summary Position, as at date: 18 th January 2014 Executive Summary and Main Body of Paper Who are we? There are 8 GP practices in Lower Lea Valley Locality covering the areas of Waltham Cross, Cheshunt and Broxbourne; providing care for a population of 74,505. Most of the health budget is spent on acute hospital care which includes emergency treatment, planned operations, tests and investigations. The main hospitals used by patients in Lower Lea Valley are; Barnet & Chase Farm Hospitals, North Middlesex Hospital and Princess Alexandra Hospital. The key health priorities are 1. Tackling childhood obesity (obesity in general) 2. Home First (integrating health & social care) 3. End of Life Page 2 of 32

3 Age distribution 93,700 people were estimated to be living in Broxbourne in the 2011 Census. In January 2013, 74,505 people were registered with a GP practice in Lower Lea Valley. Age Structure of Broxbourne District and Hertfordshire, 2011 Census Age Group % of Total Population Males Females Herts Produced by Public Health Information Team, HICS. Source: Census 2011, ONS Figure 1 shows Broxbourne district s resident population and Figure 2 shows Lower Lea Valley s GP registered population split by sex and five year age group compared to the equivalent Hertfordshire population. Age Structure of Lower Lea Valley and Hertfordshire registered patients, January 2013 Age Group % of Total Population Males Females Herts registered Produced by Public Health Information Team, HICS. Source: PSU Herts, Jan 2013 Page 3 of 32

4 Overall, the age structure of the population in Lower Lea Valley is similar to Hertfordshire, although there appears to be a slightly lower proportion of men aged years and women aged years. Activity/Finance 1- First out-patient attendance 2- Elective admission Page 4 of 32

5 3 - A&E attendance 4 - Emergency admissions Variations in activity between the 8 practices have been reviewed to help assist GPs to share learning and to assess how the quality and outcomes for patient care can be improved. Better management of LTC s is being reviewed with proposed new pathways that will require a shift of workforce to community from acute care settings. At month 7 we are currently overspent by 221,000. Page 5 of 32

6 Recent Developments: Homefirst: One of our main priorities was to ensure that the Homefirst service was successfully implemented within LLV. Homefirst is a new integrated health and social care community service to ensure the needs of the frail, elderly are met within the community. So far it has shown 1059 patients have been seen, a reduction in emergency admissions by 4.5% and net saving of 932,312(not including social care costs). The GPs in the LLV have agreed to continue to fund this service from their allocation and it will be business as usual from April The locality is currently exploring options for a Homefirst Plus service to enhance the current service and make it more effective. Carers: As a result of Homefirst we have realised what an important role carer s play in supporting people to stay at home and feel we need a collaborative approach to improving support to carers within the LLV. We are currently, with the help of Crossroads, appointing a project coordinator who will work closely with all 8 practices within LLV. The aim would be to raise awareness of what support is available as well as how important it is to look after the carers needs as well as the person they are caring for. The coordinator will act as a point of contact with PPGs and practices (the aim would be to have a carer lead for each practice) as well as ensuring information within practices are kept updated and carers registers properly utilised. The coordinator will help organise events within the locality for carers as well as liaising with children s centres to try and identify young carers. We will also examine how links can be made with Homefirst in supporting carers on discharge from the virtual ward. Childhood Obesity Project: One of our other priorities is to try and improve the childhood obesity rates within LLV. Broxbourne has the highest prevalence of obesity within ENHCCG for both reception class and year 6 school children. Due to the complexity of the issue we are working on local commitment and have agreed a coordinated, multidisciplinary approach with greater primary care input to see if this can influence families and children s choices about their lifestyle. Page 6 of 32

7 We are working closely with 4 other practices from ULV to actively target children and their families who are identified as being obese from the National Child Measurement Programme. They will be offered 2 appointments over 3 months with a healthcare professional well as the opportunity to be referred to the local MEND programme at the local leisure centre for the age 5-7 year old age group. We also want to clarify where we can signpost children and their families within the LLV for ongoing support. Close collaboration with the local childrens centre is crucial and we are currently recruiting a family support healthy lifestyle liason worker who will work closely with the practices and families to ensure motivation and maintaining behavioural change continues. These families will be followed up to evaluate the impact of this intervention. In Practice Pharmacist: This is a one-year pilot supported by the CCG transformation fund. A full time pharmacist has been recruited to support the 8 practices in the Locality. The expectations of the pilot were to provide practices with an additional resource to ensure cost effective and appropriate use of medicines, improve quality, reduce errors, develop systems to improve practice efficiency and reduce waste. The pilot started in July An initial performance report in November has shown that since implementation, 557 patient records had been reviewed with 287 medication changes. These changes realised a saving of 47,000 through appropriate use of more cost effective medication. The pharmacist has also supported practices in issues relating to drug safety, doses and effectiveness of medication. We expect the project to build and continue to focus on these key areas. A future focus will be relating to antibiotic prescribing in the community and ensuring guidelines are in place to reduce antibiotic related complications and resistance. Patient Access Pilot: The CCG has supported one practice in the LLV and one in SVV locality to pilot a triage based model of primary care. The pilot practices now offer an initial call back from the GP to discuss their issue and allow them to manage the problem together. If an appointment is needed the vast majority of patients will be offered an appointment on the same day The pilot is based on the principal that a significant proportion of contacts in primary care can be safely and appropriately managed without the need for a face to face appointment. This enables the GP to deal with more patient contacts and with more efficient appointment management improve access to primary care. NHS England has also identified the use of remote access and Technology as a key development area for primary care. Page 7 of 32

8 The objectives of the pilot is to address a patients problem more quickly and efficiently, reduce waiting times for appointments and allow patients remote access to a Doctor. A further objective is to reduce unnecessary Accident and Emergency attendances. The pilot began in May It has proved a challenging transition for the two practices in the locality to provide this model of care. Early findings have shown marked reduction in DNA rates and reduction in waiting times for appointments. Early data also indicates a reduction in A+E activity. The pilot remains under evaluation with active monitoring of A&E activity and patient survey and satisfaction results awaited. Conclusion There is a wide range of work taking place across the locality to meet the CCG s objectives. The locality meetings are used as an effective forum to ensure all work streams are aligned. Recommendations To note the paper Page 8 of 32

9 Agenda Item No: 7.2 Date of Meeting: 30 January 2014 Board or Committee Name: Governing Body Meeting in Public Paper Title: Report from North Herts Locality Commissioning Group Decision Discussion Information Follow up from last meeting Report author: Report signed off by: Purpose of the paper: To provide an update from the North Hertfordshire Locality Conflicts of Interest involved: There were no conflicts of interest to consider Recommendations to the Board / Committee To note the paper and the locality work being undertaken in North Hertfordshire Page 9 of 32

10 Report from North Herts Locality Commissioning Group 1 Purpose of the Paper 1.1 To update the Governing Body on the priorities and activities in North Hertfordshire locality 2 Appendices 2.1 Summary of key actions 3 Terms / Acronyms Used in the Report this section is mandatory as papers are made available to the general public Initials CCG CQUIN HMMC N Herts PCMMG PMOT QP In full East and North Herts Clinical Commissioning Group Commissioning for Quality and Innovation payment Hertfordshire Medicines Management Committee N Herts locality of ENHCCG Primary Care Medicines Management Group Prescribing and Medication Optimisation Team Quality and Productivity 4 Latest Summary Position, as at date: 20 th January Executive Summary and Main Body of Paper 5.1 Who are we? 12 Practices covering Hitchin, Letchworth, Baldock, Ashwell, Whitwell, Knebworth and part of Stevenage. Population-weighted and this represents 20.49% of total for whole CCG. Locality has slightly higher elderly population. 27% of the CCG s patients who live in a care home live in N Herts. Age 65 to 74 Age over74 North Herts Locality 9.45% 8.91% CCG 8.59% 7.88% 5.2 Finance The financial position, month on month, has improved from an over-spend at Month 6 of 208k to an under-spend of 423k, an improvement of 630k year to date (M7). 5.3 Performance Out patient First attendances & Procedures have increased year on year by 8.5% Page 10 of 32

11 Elective Admissions. There is a decrease in the number of planned admissions, possibly caused by an increase on out-patient procedures which could account for the increase in the outpatient figures. When this was discussed at the monthly commissioning meeting in December, it was agreed that further work would be carried out on the figures to see if this is indeed what is happening, as this is a positive move to more cost effective treatment. The number of A&E attendances are projected to show a reduction of a reduction of 0.1% compared with Emergency admissions have increased by 4.2% at the end of the Month 7. The overspend has decreased to 311k at month 7 compared with 369k in month 6. Page 11 of 32

12 5. What Have We Been Doing? At our monthly practice leads meetings, finance and performance of the locality is discussed, picking up on the variations between practices performance. Quality is always on the agenda. There is really good engagement and input from all of our practices- - both GP principals and practice managers. This has led to grass roots ideas being taken to the Governing Board and implemented, an example being the introduction of locality based out-of-hours sessions at weekends which will help to ease A+E pressures. There has also been input to the 2014/15 CQUIN schemes. HPFT attend our meetings quarterly. We liaise well with them and recently fed back the view that generally our patients receive high quality mental health services. There are monthly practice managers meetings which one of the 3 GP leads attends. We are focussing on putting the engagement framework into practice. The priorities have been: working to improve outcomes for the frail elderly, patients with long term conditions and patients identified to be within the last 12 months of life. There has been steady progress in all these areas and this work is reviewed each quarter. The locality patient group meetings are alternate months, supported by our locality patient participation champion. There are really engaged patient representatives who also sit on some of the CCG committees. We also have locality leads for long term conditions and mental health and they report to the locality meetings each month. One of our practices is engaged in a telehealth pilot project for patients with COPD, and members of the practice s patient participation group have installed equipment in patient s homes as part of the project The locality prescribing group meets alternate months, again with excellent cross practice participation and support from our PMOT. There is involvement from the CCG prescribing advisor and excellent input from the local community pharmacist representative who is taking on the chair s role and who is also the smoking cessation lead for the locality. The outgoing prescribing lead was active on the drugs and formulary committee at ENHT the PCMMG and HMMC and the new chair will work to maintain this influence. We have held two target meetings since April 2013 and a number of priority themes have been worked through in facilitated discussions. These include End of Life Care; Quality and The Francis report; the use and development of the Contract Hotline, more effective working with the HCT Integrated Point of Access and how we might improve the provision of care for patients in nursing and care homes. Our next target day, in February, will concentrate on Home First as N Herts is going to be the next locality to pilot this integrated health and social care project. N Herts consistently appears to send a high number of reports, relative to other localities, to the contracts hotline. Practices are encouraged to report contract and quality issues via this hotline. A Quality and Productivity (QP) meeting held in January was attended by representatives from all 12 practices to discuss the work they have carried out to review out patient referrals, A&E attendances and emergency admissions. Themes identified include: How do we educate schools to advise parents to contact GP surgeries or NHS 111 for advice rather than taking them directly to A&E? Page 12 of 32

13 How do we influence patients to reduce unnecessary A&E attendance? Practices have tried a variety of ways of raising this with patients and felt that these have not been effective. Suggestions included raising this in A&E and also having a concerted publicity campaign to improve understanding of how best to access services appropriately and alter health seeking behaviour. Effective methods of peer reviewing of referrals at GP practice level Up skilling medical practitioners by inviting consultants to meet specific learning needs Who makes the decision to admit patients? Could universal consultant assessment reduce same day admissions? How do we educate carers and care homes to refer to advance care plans and to contact GP surgeries/nhs 111 for advice rather than calling 999 in order to reduce A&E attendances The QP report has been shared with practices and within the CCG to see if there are any ideas that can be taken forward to improve care and cost effectiveness. To help improve the quality of discharges from the Lister Hospital, a discharge letter audit was undertaken by all 12 practices regarding the timeliness and quality of discharge letters after emergency admission. The audit results showed 94% of letters were received (range 87 to 100%), 85% were clinically accurate ( range 50 to 100%) and in 82% the discharge summary corresponded to the coding applied in the hospital reporting (range 50 to 100%). Coding at ENHT remains an area of concern for us and we look forward to improvements with the changes currently being introduced at the Trust. Whilst the locality was initially against the development of the Acute In Hours Visiting Service, we can report that it has been a huge success. Practices report that the quality of service to patients is excellent. Patients receive a responsive service by visiting GP who is able to give more time to address the patient s problems. It appears that this service is contributing to the reduction in our emergency admissions to hospital. Each of the three co-leads liaises directly with 4 of the 12 N Herts practices. Each practice has had at least one visit from a co-lead and they generally demonstrated good engagement. We discuss with them peer review of referrals, in-house case discussion, financial and activity data and the enhanced framework. There is definite evidence that the practices are all working together to achieve excellent patient care while attempting to live within budgets. There is on-going dissatisfaction with the provision of district nursing services and locality GPs have requested we explore alternative providers. There is a feeling that interaction between primary and secondary care clinicians needs to improve. An example, of this is in the discharge planning of the elderly/vulnerable. This is poorly communicated to GPs who do not receive any warning that patients are returning home. We recognise that there are capacity issues in the GP practices and a number have voiced concerns regarding increasing workloads, relating to the complexity of patient s needs, high care home population and increased expectations. They have voiced their worry regarding recruitment and significant reductions of income. Some practice buildings are too small, limiting the services that can be provided for their patients. Outline plans for the development of homes to the north of Letchworth are likely to put general practice under severe pressure if they go ahead without the development of primary care premises and we have tried to engage the planners in discussion about the issues. These issues are linked to the locality s ability to support more patients in the community and as a locality we are really keen to roll out the Home First service out to our patients. There is presently a deficiency in pro-active out of hospital care for a certain groups of Page 13 of 32

14 elderly/vulnerable patients and we feel this urgently needs addressing. Constraints in primary and community care and lack of integration with social care contribute to these difficulties, and to avoidable emergency admissions. We anticipate that the Home First pilot in N Herts will enable some of these difficulties to be overcome. 6 Conclusion There has been a positive contribution of all practices to the locality and support for the priorities that we are developing in the CCG. This will now focus on the implementation of Home First, the new nursing/care home service and linking with new developments at the Trust including the interface geriatric service for frail elderly. We are keen to support the development of a CCG primary care strategy and to encourage the further collaboration between practices which will improve access, quality of care and management of workload in primary care. 7 Recommendations To note the paper Page 14 of 32

15 Agenda Item No: 7.3 Date of Meeting: 30 January 2014 Board or Committee Name: Paper Title: Governing Body Meeting in Public Report from Stevenage Locality Commissioning Group Decision Discussion Information Follow up from last meeting Report author: Dr.Russell Hall, Dr.Prag Moodley Report signed off by: Dr.Russell Hall, Dr.Prag Moodley Purpose of the paper: This is the report for the public CCG meeting We continue to have locality monthly management board meetings where we discuss items we wish to bring to the larger locality meetings to have discussion and agreement We also continue to have monthly locality meeting with representatives from each practice. At these we have individual reports from each practice on their financial and clinical performance.we discuss the entire practice performance including referral rates, non-elective and prescribing performance and how we can improve individually and as a locality We also discuss any other issues that practices feel affect them both at locality and CCG level. The locality leads continue to have regular visits to each practice to meet the doctors and staff who cannot manage to attend locality meetings and to see the practices themselves. At the end of month 7 Stevenage locality had a relatively minor deficit of 8000 and within the locality as a whole two practices were in surplus,one on budget and six were in deficit.we continue to work hard and review our practice performances and discuss any local issues Page 15 of 32

16 We are continuing to bring forward the nursing home project of logically dividing the nursing home beds within the locality amongst the practices to improve care of residents At the last locality meeting our locality asked their representatives to discuss again at board level their dissatisfaction with the performance of HCT. The locality have also agreed for each practice to perform a one day audit of ten random patients on medianlytics to assess the accuracy tariff charges and extrapolate up this across the locality to have an idea if it would be conceivable for the locality to employee someone to do it the behalf of the locality Stevenage was successful in its application for additional winter pressures help over the next three months with two doctors to help practices cope with extra demand and an additional doctor to help with nursing homes work Recommendations to the Board: The Governing Body is asked to note the report Page 16 of 32

17 Agenda Item No: 7.4 Date of Meeting: 30 th January 2014 Governing Body Meeting in Public Paper Title: Stort Valley and Villages Locality Commissioning Group report Decision Discussion Information Follow up from last meeting Report author: Report signed off by: Dr Deborah Kearns Co-Chair SVV LCG Dr Deborah Kearns Co-Chair SVV LCG Purpose of the paper: To update the Board about the activities being undertaken by the LCG Conflicts of Interest involved: None Recommendations to the Board / Committee To note the report Page 17 of 32

18 REPORT FROM STORT VALLEY AND VILLAGES LCG SVV is made up of 5 practices, 3 in Bishop's Stortford and the Sawbridgeworth and Much Hadham practices with approximately 58,000 patients. The local practices have spent the last year working closely with the CCG and addressing their overspent 2011/12 financial position, we have achieved an underspend on 2012/13 by better management of referrals to secondary care, trying to improve prescribing and reduce unscheduled emergency admissions where possible. Several of the Practices have been tackling access problems and have made improvements in their patient satisfaction scores. 2 of the practices have been running pilot schemes partly funded from the CCG transformation fund to test different ways of working, namely Patient Access telephone triage of all contacts in SBW and Productive General Practice in South Street Surgery Bishop's Stortford. After 11 months of this way of working the SBW practice team have seen a reduction in patients attending A+E in surgery opening hours but have found the model almost unsustainable and are now moving to a mixed appointment and telephone triage system. Some patients complained about 0844 numbers and the practices have responded by switching to local telephone numbers. Practices are beginning to explore collaborative ways of working in the future and are interested in looking at opportunities to deliver aspects of primary care as a locality rather than 5 separate organisations. There is increasing pressure on resources and the challenge of meeting the needs of patients, particularly the frail elderly needs to be met by innovative ways of working. We would also like to place more emphasis on prevention and promote health and wellbeing of all our patient groups. I am a member of EHDC Local Strategic Partnership and attend quarterly meetings at the district council with other representatives from education, employment, voluntary sector and council colleagues to share issues affecting East Hertfordshire residents. To achieve better patient outcome we need to work more closely with colleagues in community services and social care. We hope to develop the Home First model of integrated health and social care services in the next 12 months. We also have a close relationship with our GP colleagues in West Essex CCG who are lead commissioner of services at PAH, our main provider of secondary care and they and the Trust have consulted us in developing their 5 year plan for the development of local services and clinical pathways. We have set up patient groups in all practices and now have a locality patient group that is actively supporting the commissioning agenda. We are just beginning a project with Carers in Hertfordshire to identify a carers champion in each surgery to better meet the needs of our patients who are carers, we are interested in trying to identify our young carers as their needs are more difficult to anticipate. This work may increase the opportunity to collaborate with the voluntary sector. Page 18 of 32

19 We will continue to manage variation and support best clinical practice; we made improving cancer diagnosis a locality priority and are working to achieve this by using the Practice Cancer Profiles produce by the local cancer network. We are promoting reduction in antibiotic use by auditing prescribing and making sure it is in line with Hertfordshire antibiotic policy. The locality have been running a transformation funded pilot of enhanced pharmacist support to the practices. We have appointed a part time practice pharmacist who spends a session every week in each practice working on a variety of projects to improve the quality, safety and cost effectiveness of prescribing. The locality has appointed local GPs as leads in Patient Participation, Long Term Conditions, Mental Health and Medicines Management, we also have appointed a Locality Nurse Lead who represents practice nurses on the locality board, supports the long term conditions work and the nurse education agenda. Page 19 of 32

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21 Agenda Item No: 7. 5 Date of Meeting: 30 January 2014 Board or Committee Name: Governing Body Meeting in Public Paper Title: Report from ULV Locality Commissioning Group Decision Discussion Information Follow up from last meeting Report author: Report signed off by: Dr Nicky Williams and Dr Mark Andrews, ULV Clinical Leads Dr Steve Kite, ULV Chair Purpose of the paper: To update the CCG on key issues within ULV locality, implementation and locality engagement in CCG activities. Conflicts of Interest involved: No conflicts of interest identified Recommendations to the Board / Committee Board to note Page 21 of 32

22 East & North Hertfordshire Clinical Commissioning Group Board Meeting 30 th January Purpose of the Paper To update the CCG on key issues within ULV locality, implementation and locality engagement in CCG activities 2 Appendices Appendix 1 LCG Action Tracker 3 Terms / Acronyms Used in the Report Initials In full ULV LCG Upper Lea Valley Locality Commissioning Group MVCN Mount Vernon Cancer Network QE2 Queen Elizabeth 2 HCT Hertfordshire Community Trust IC Intermediate Care H&WB Health and Wellbeing Board PPG Patient Participation Group NAPP National Association of Patient Participation 4 Latest Summary Position, as at January 2014 This paper gives an update on activity within ULV LCG which has taken into consideration the National, CCG, Public Health, Health and Wellbeing Board and locality priorities. Please see attached as appendix 1 the LCG action tracker. 5 Executive Summary and Main Body of Paper Locality Priorities Cancer Management Frail elderly Obesity TARGET An event was held in November with excellent attendance by all clinicians. The above priorities were supported by round table discussions involving the CCG Cancer lead and MVCN lead on the variability of diagnosis and early referral for early cancer between Practices, with specific discussion on early diagnosis of skin cancer. There was also a discussion on the proposal for a new contract to support work within local care homes, which would help achieve our ambition to improve the quality of care to the frail elderly within our area. Other areas covered during the afternoon were an update of the new QE2 and appropriate use of radiological investigations. Our Practice nursing colleagues collaborated with the District nursing teams for a joint event to discuss the new Wound Care Formulary and the local issue of a lack of Tissue Viability service in the locality. This has now been highlighted as a priority for the locality going forward. Page 22 of 32

23 Obesity Public health data shows that Broxbourne Borough has high levels of both adult and childhood obesity, with significant rises in obesity rates between starting and finishing primary school in some areas of Upper Lea Valley. A recent Target event was used to raise awareness and consider strategies that might be commissioned. Clinical leads attended a seminar run by Broxbourne Borough Council, the result of which is the current development of a District strategy to tackle this area. Various local initiatives have been started or are in development including subsidised weight loss programs (using commercial providers such as Weight Watchers and Slimming World) and exercise programs at local sports centres. Work is now taking place to explore the development of better links with Children Centres for mother and child education, as well as looking at input into Primary Schools. Westgate House Local discussions have taken place with HCT and the GP providers of care for the IC beds. The locality are keen to maximise the use of these beds and make the process to acquire the beds for step up purposes more efficient. Health and Wellbeing Fund The fund delegated to localities from the H&WB was discussed. It was agreed to look at training Carers champions within Practices, with ongoing support and mentoring to ensure embedding of principles within the Practices. Work is now underway to commission a workshop. Prescribing The prescribing lead for ULV has now completed visits to all over spent Practices, with Medicines Management Team support. These were felt to be supportive in nature and well received by prescribing leads. It is hoped that this will help achieve financial balance at the end of the year. The locality is also very keen to implement Electronic Prescribing and have organised a roll out to all interested Practices over the next few months. Upper Lea Valley PPG Discussions have taken place as to how the Locality PPG, through Practice PPGs could help support the Locality priority areas identified, possibly through Practice public awareness campaigns. Regular feedback is given at every meeting from the Patient network for Quality, allowing discussion and areas of concern to feed back. Transforming Urgent & Emergency Care Services in England (the Keogh Review) has been discussed as well an update received on the New QE2. Some group members are members of NAPP (National Association of Patient Participation) and have found the resources of this organisation to be very helpful. PPG reps also recently attended an Unscheduled Care Strategy/Vision event at Lister Education Centre and report feeling very pleased to have been included. Practice engagement The ULV Leads have now nearly completed (1 visit currently outstanding, but has a planned visit date) visits to all constituent practices within the locality. The feedback from these has been very positive there was a high level of engagement observed with CCG policy and activity. There are, however, some Practices that are beginning to struggle, especially with recruitment of clinical staff and with premises issues. Page 23 of 32

24 These have been noted and will be taken into account in a future local Primary care strategy. A review of activity by the Practices in the ECF was also undertaken the majority were performing well against target, whilst where achievement was slow advice was offered to improve activity. Practice Network/Federation Working Over the past 2 months, this has been a priority working area for our Practice Managers. Options for future working arrangements have been considered and a working group are looking at a formal collaboration of Practices as a Provider organisation. A meeting of all stakeholders is planned for the end of January for agreement, with possible implementation before year end. This approach is supported by the Locality leads as it is in line with the national direction of travel and could support Primary care to deliver on the commissioning agenda. 5 Conclusion ULV LCG continues to work to support their identified priorities as well as identify areas for future commissioning. Engagement with member practices remains a priority for the locality commissioning team. 6 Recommendations The Board is asked to note the activities described in this paper Page 24 of 32

25 ULV LCG Action Tracker Appendix 1 Subject Decision/action Responsible clinician/manager Deadline Current position Status ECF Agree a template for practices to use - quarterly Hayley/Martyn Finalised and in use Complete submissions. Discuss at practice vists and spot audits. Monitoring on a quarterly basis TARGET (July) Arrange TARGET day to have 3 working groups to discuss and agree how to progress local priority targets. Tom May, Sue Beck and Anke Johnson agreed to facilitate obesity working group, Jayne Dinngeman contacting AMBER project manager re facilitating Cancer management table, Martyn Davies and Jayne facilitating Hayley/Jill O'Brien Complete Counselling Priority 1 - Cancer Management Priority 2 - Frail/Elderly frail elderly group. Provide practices with a breakdown of spend on a quarterly basis - to be discussed at Practice Manager meetings. Use of MVCN educational films for educational events/target Hayley Information to end of December provided. Fiona Tearle and Meena Chana now manage contract in CCG and prepare counselling spend reports to send out Ongoing Mark Mar-14 Head & Neck - 12th July 2013 Ongoing Bowel screening kits to be held in surgeries Mark Mar-14 MA to follow up with Liz Jones Assurance from Trust that consultants review all 2ww Mark Mar-14 MA to follow up with Liz Jones referrals Telephone access to consultant advice Hayley Sep-13 Feed into commissioning intentions complete Continuity of care in care homes - nominated doctors? Nicky Nov-13 To be considered as part of new spec complete Weekly ward rounds for N&R homes Training and support for care home staff to manage Nicky Mar-14 Delegated to Jacqui as part of work complete patients within the home with care home providers Sharing of proformas for visit requests and prevention of Nicky Nov-13 To follow up at locality and PM complete admission plans meetings Closer working links between practices and social care Nicky Mar-14 Liaise with Jacqui Bunce to follow up complete (especially for patients identified via risk stratification) through intermediate care board Priority 3 - Obesity Practices to make better use of the IPA and need clarification and understanding of current processes in places Practices to undertake ACP for the 1% and proactive Nicky/Hayley Sep-13 Chris Badger to attend locality 12th September Completed Nicky Mar-14 Delivered via ECF Ongoing end of life care Encourage health checks and brief interventions Steve Mar-14 Delivered via NHS Health Checks and monitored by Public Health Page 25 of 32 Ongoing

26 Subject Decision/action Responsible clinician/manager Deadline Current position Status All practices to follow the BMI policy for routine elective Steve Mar-14 Delivered via QP indicator Ongoing surgery Joint working with Public Health and Local Authority (Broxbourne) and Lower Lea Valley Lucy/Mark Mar-14 Preliminary meetings in place. Childhood obesity project being taken forward in conjunction with LLV (Alison Ongoing Leg Ulcer Service Review options for commissioning a local weight management service All practices encouraged to refer into local exercise schemes Clarification of current funding allocation and consider options for commissioning Steve Steve Nicky/Hayley Jackson leading) Mar-14 Await outcomes of Stevenage Pilot and any joint working opportunities with Public Health. Weight management service commissioned by Public Health (referral for 12 week programme to weight watchers or slimming world) complete Mar-14 HT to speak to Tom May about current complete levels of activity Mar-14 Discussed at PMO and priority status Ongoing elevated. HT working with Jawad and Lucy to put together business case for a local service Patient Rep Identify patient representative for locality board meetings Funmi Nov-13 to be raised at the next ULV PCG (16th Sept) Lead Roles - Feedback to board Mental Health - May 2013 Steve/Jay Mar-14 first feedback completed complete Prescribing - July 2013 Nick/Avril Mar-14 first feedback completed complete Patient Engagement - June 2013 Funmi Mar-14 first feedback completed complete LTC - October 2013 Martyn Mar-14 first feedback booked complete QP Outpatient Attendances Mar-14 discussed at the November meeting complete A&E Mar-14 to be discussed at February 14 meeting Emergency Admissions Mar-14 Discussed at November meeting complete TARGET (November) Practice Visits 2013/14 Practice visits to be booked in for all locality practices To agree an agenda for the day Jill/Hayley Sep-13 Topics included radiology, new QEII, care homes model, cancer screening CCG Leads/Tracey Mar-14 All practices have had a visit apart from Watton Place - this is to be arranged before the end of the financial year 2014/15 Practice visits to be booked in for all locality practices CCG Leads/Tracey Nov-14 To be booked complete Page 26 of 32

27 Agenda Item No: 7.6 Date of Meeting: 30 January 2014 Board or Committee Name: Governing Body Meeting in Public Paper Title: Report from Welwyn and Hatfield Locality Commissioning Group Decision Discussion Information Report author: Report signed off by: Dr Hari Pathmanathan and Dr John Constable, Co- Chairs of Welwyn and Hatfield Locality John Webster Director of Commissioning Purpose of the paper: To provide an update from the Welwyn and Hatfield Locality Conflicts of Interest involved: There were no conflicts of interest to consider Recommendations to the Board / Committee To note the paper and the locality work being undertaken in Welwyn and Hatfield Page 27 of 32

28 Report from Welwyn and Hatfield Locality 30 th January Purpose of the Paper To update the Governing Body on the priorities and activities in Welwyn and Hatfield locality 2. Latest Summary Position, as at date: 18 th January Executive Summary and Main Body of Paper Who are we? The locality is made up of 9 practices, including the GP led Health Centre. There a weighted population of 112,154. This represents 20% of total for whole CCG. Age distribution Page 28 of 32

29 Activity/Finance 1-First out-patient attendance 2-Electice admission Page 29 of 32

30 3-A&E attendance 4-non elective admission Variations in activity between the 9 practices have been reviewed to help assist GPs to share learning and to assess how the quality and outcomes for patient care can be improved. Better management of LTC s is being reviewed with proposed new pathways that will require a shift of workforce to community from acute care settings. Dr Dansie is a member of the Acute In Hours Visiting (AIHV) Steering group and the locality are reviewing the impact of the AIHVS in providing GPs the ability to deliver responsive urgent health care to patients. It appears that this service is contributing to the reduction in our total admissions to hospital during the Monday to Friday period. At month 7 we are currently underspent/ by 35,000 Page 30 of 32

31 Recent Developments Patient Involvement The Welhat patient involvement group chaired by Peter Wilson is a very active group. There has been patient attendance at the recent CCG commissioning intention event and the CCG visioning event. In addition Welhat have a patient member is actively involved in the provider quality visits providing the perspective of a patient. Members attend monthly meetings where they feedback. The last 2 meetings focused on commissioning stroke services and end of Life Care. Nursing Home Equity Hatfield nursing homes have been distributed amongst Practices. Work has been undertaken to look at nursing home provision in the Welwyn area. Arrangements will be finalised and ratified at the Welwyn Hatfield Implementation Panel meeting on the Preparing to introduce the model for Home First The outcomes of the Home First pilot have been reviewed by all member practices and the clinical time required in implementing a new model of integrated health and social community care fully explored. The locality has confirmed their request to implement this new model at the earliest opportunity. Pathway development to improve the management of Heart Failure All practices are currently working to develop a new integrated heart failure pathway that will incorporate quality end of life care. Dr Sachin, the clinical lead for this work has shared the pathway work with the CCG s long Term Condition (LTC) Group to ensure there is extensive clinical engagement. This work stream is due to be presented to the Planned Care Programme Board (PCPB) in February. Clinical involvement with the New QE2 The established locality forums have been utilised to ensure that there is clinical leadership directing the urgent care and elective services that will be commissioned from the new QE2 site. Working in Partnership with Public Health The latest locality meeting focused on collaborative working with public health to improve patient outcomes. In particular the continuation of successful smoking cessation programmes was discussed and the need for all member practices to be fully engaged. At Q3 Welwyn Hatfield quitter rates were top of the East & North Herts area, these included referrals from GP, Pharmacy & Other. Q3 quitter rates for GP referral alone were at 244, which has WelHat positioned 2 nd across the Localities behind Upper Lea Valley at 334. Page 31 of 32

32 Federated models for practices The locality commissioning group have discussed the potential interface with federated provider models and have recognised the need to understand the potential conflicts this could cause if the two functions are not kept separate. Conclusion There is a wide range of work taking place across the locality to meet the CCG s objectives. The locality meetings are used as an effective forum to ensure all work streams are aligned. Recommendations To note the paper Page 32 of 32