Commissioning update. The Governing Body is asked to:

Transcription

1 Agenda item: 7.1 SUBJECT PRESENTED BY Commissioning update Mark Burgis, Head of Clinical Pathway Design SUBMITTED TO Governing Body, 18th June 2013 PURPOSE OF PAPER The Governing Body is asked to: Note the current development of the NNCCG Operation Plan IMPACT ON PATIENTS OUTCOME OF EQUALITY IMPACT ASSESSMENT The projects detailed within this report have been designed to improve outcomes for North Norfolk patients No adverse impact identified EXECUTIVE SUMMARY: This short paper is prepared to provide the Governing Body with a high level update of some of the key projects and commissioning work currently being conducted by the CCG. The North Norfolk CCG Operational Group continues to monitor progress of this work which includes both Quality, Innovation, Productivity and Performance (QIPP) and non- QIPP projects. At the time of writing we still await finalised April activity data which will allow us to report more fully on how each of the projects are performing against the planned trajectories, however we do expect this information to be available imminently. The following gives further detail of some of the main projects in each of the five main commissioning priority areas as detailed in the NNCCG Commissioning Strategy Older People Integrated Care and Long Term Conditions Programme Significant progress has been made in the last two months with the restructure of the integrated community health and social care teams now having been agreed by the Council of Members (CoM), and with Norfolk Community Health and Care (NCH&C) and Norfolk County Council (NCC). A map detailing how these new area teams are being re-aligned is attached to the report for information. The aim is that the health and social care practitioners will now work more closely with their linked practices which while enable the overall system to provide more joined up and seamless care for North Norfolk patients. Page 1 of 5

2 Three additional Integrated Care Co-ordinators are currently being recruited (to give a total of four, one for each area team) who will act to further improve the co-ordination of care for patients with complex care needs. In addition, the Long Term Conditions project continues to test new ways of working in this area, in particular around risk stratification and self care / self management. Continuing Health Care (CHC) This continues to be a significant financial risk area for the CCG given the high costs associated with supporting people who become eligible for CHC. To address this there are a number of county-wide and local work streams that the CCG is involved with that seek to deliver cost efficiencies required, whilst maintaining high quality service provision. This includes a Market Management programme of work that will develop a clear understanding of the current market, through analysis of provision, costs (benchmarked to social care costs), demand-forecasting and the development of associated savings targets. This will inform the development of service specifications in order for new, better value, CHC-related support services to be commissioned (with clear pricing and banding options) for In addition, local operational work continues to ensure that those people currently in receipt of a CHC-funded provision, or who become eligible, have care packages that are financially reasonable whilst meeting their individual support requirements. This includes a focus on reviewing all high-cost CHC-funded packages, and ensuring that quality and value of that care remains appropriate - and where it is not, looking for better alternatives which includes identifying those whose needs would be best supported through a Personal Health Budget. North Norfolk Community Beds - North Norfolk has inherited the highest number of community based intermediate care beds in Norfolk. These total 79 and are located as follows: Pineheath at Kelling with 24 beds North Walsham Cottage Hospital with 24 beds Benjamin Court at Cromer with 18 beds Cranmer House at Fakenham with 13 beds The community beds are staffed by the nurses and health care assistants of NCH&C and medical input is provided by local GPs. At the June Council of Members (CoM) meeting a workshop was held to try to define what the GPs wished for from their local Community bed provision. Very good feedback was received which will now be shaped into a proposed redesign project which will be taken to the July CoM for approval. Planned Care Audiology - In collaboration with Norwich and South Norfolk CCGs we led an Any Qualified Provider tender for adult hearing services in late This was driven by the CCG s strategy of bringing care closer to home and increasing patient choice. Contracts have been signed with the six providers who have been qualified and five are currently delivering services; one is still searching for suitable premises. This has increased the Page 2 of 5

3 number of locations where hearing services are available from four to 22, of which 7 are in the North Norfolk CCG area. Patients in North Norfolk are now being offered this wider choice of locations through the RMC, and can also utilise services in Norwich or Great Yarmouth. Providers have signed contracts which commit them to deliver timely access to services, free aftercare for three years, regular patient satisfaction surveys and accreditation with a national scheme run by the Royal College of Physicians. We will be closely monitoring activity at all providers to ensure that: activity does not increase above that expected from demographic change; and all quality standards around access times and patient satisfaction are met. In the next year we will discuss whether to increase the number of commissioning partners to include NHS West Norfolk and NHS Great Yarmouth & Waveney CCGs to deliver a Norfolk-wide service. Orthopaedics (Knee) - At the request of the Acute Commissioning Board, North Norfolk CCG led a group with representatives from the three central Norfolk CCGs to review and improve the pathways for patients with knee problems. This reflected a concern that there was a lack of clarity about the services available for referral and that access times for both physiotherapy and surgery were excessive. A pathway for the diagnosis, treatment and management of these patients in primary care has been designed which provides guidance on analgesia, referral to exercise classes or physiotherapy and on the appropriate referral forms to be used for patients requiring knee replacement. This pathway, which will be largely transferable to patients with hip pain was approved in autumn 2012 and placed on Knowledge Anglia. The group await the report of the Intensive Support Group on the outcome of their visit to NNUH before restarting work on referral mechanisms between primary care and community or acute care. Orthopaedics (Spine) Working with clinicians and managers from primary care, NCHC, NNUH and NSFT, we aim to produce a seamless pathway for patients presenting with acute or chronic spinal pain, where they receive the most appropriate information, investigations, referral and treatment in a timely fashion. It will be based on NICE guidance and incorporate best practice experience from other parts of the NHS. Currently the pathway is still in draft form and meetings are planned to: finalise input from the Pain Management service and NSFT concerning support to patients identified as having psychosocial problems with their pain that may inhibit their recovery; and to develop a structure and membership for multi-disciplinary teams (including changes to consultant job plans) that will review and signpost treatments for patients with complex needs or intractable pain. It is expected that this pathway will be ready to pilot in early autumn with a view to full rollout by the end of the year. Unplanned Care Emergency Admissions Review - The emergency admissions dashboard has been developed to provide practices with information relating to the activity and costs of their emergency admissions and to allow a comparison with other practices in North Norfolk Page 3 of 5

4 CCG. The dashboard is being sent to practices at the beginning of each month, with the first distributed in May. Practices have been encouraged to review the information to identify any possible causes for periods of either low or high rates of emergency admissions and then to share this information with the rest of North Norfolk CCG. It is hoped that lessons learned from this piece of work will help to deliver improved pathways of care for our patients, through more efficient use of the integrated care teams, whilst also helping us to provide the financial savings we are under significant pressure to achieve by reducing the unplanned admission rate the North Norfolk CCG area. Several practices have already responded to the information reported in the dashboard in a positive manner and have stated their intentions to review the dashboard at practice / partner meetings. We expect to receive the more detailed feedback from these meetings over the coming months. A sample dashboard is attached to this report for information. IV Therapy service A CQIN funded a joint pathway project which is underway to establish an IV Therapy service for Norfolk through NCH&C and NNUH. With support from a consultant Microbiologist from the NNUH clear patient groups have been identified whose care could be supported within the community rather than by daily attendance to NNUH or actual inpatient admission. It has been proposed that this service will encompass patients requiring routine IV therapy for Cellulitis, Longer term infections such as Osteomyelitis, Chronic Respiratory infection with other options for consideration in the future - community rehydration and care and management of Central venous catheters. In the first instance only patients clinically reviewed by the NNUH will be referred to the service; however a review date will be agreed to look at GP referral with an appropriate IV Therapy protocol to support this. In the first instance it has been agreed that the focus will be directed towards patients with Cellulitis to enable the service to establish and develop. It will be delivered across North, South and Central Norfolk by a discrete team with recruitment currently underway. Which it is envisaged will be in place by 1 st September. Milestones for this CQIN are not yet agreed and will need to reflect the potential slow expansion rate required to build confidence and encourage referrals to the service. For future commissioning we will need to reflect upon how these skills can be better directed to develop a service which will be effective for North Norfolk. Mental Health Dementia Modelling of the prevalence of dementia across NHS North Norfolk CCG shows that it is currently being under-diagnosed. An earlier diagnosis can provide a better quality of life for both the person with dementia and their carers; ensure the right support for carers and families is delivered at the right time; and enable people to remain in their own home for longer, delaying the move to a care home. Page 4 of 5

5 Thus, in line with the five-year National Dementia Strategy and the Prime Minister s Challenge on Dementia, the CCG has committed to increase the rate of diagnosis of dementia and to improve the availability of support to people diagnosed with dementia, their carers and families by March To ensure that the CCG is able to achieve its stated targets for increasing the diagnosis rate for people with dementia and that adequate support, advice and services are available to those diagnosed and their carers, the CCG is working with a wide range of stakeholders including local authorities and voluntary sector organisations to devise and deliver an action plan based on national best practice. IAPT re-procurement Working with the Mental Health Commissioning team and other Norfolk CCGs, we are currently conducting a re-procurement project for the IAPT service which is due to expire in There is an option for the current contract with the Norfolk and Suffolk Foundation Trust to be extended till March 2015, but we continue to conduct the re-procurement work in parallel. A Programme Board for this re-procurement exercise has now had the first meeting Chair by Dr Penny Ayling, Mental Health lead for NNCCG, and an IAPT service redesign workshop is planned for July. The aim of the workshop is to bring together Clinical Commissioners, Commissioning Officers and representatives from primary care to discuss the future provision of the IAPT Service in Norfolk. The output from this redesign workshop will help create an overarching commissioning vision which will specify the requirements for a future service model. Children Supporting Children to live Health Lifestyles We are currently working in collaboration with colleagues from Public Health, North Norfolk District Council and Broadland District Council through the recently established North Norfolk and Rural Broadland Strategic Partnership Group in order to try to improve outcomes for young people in North Norfolk. There are considerable differences in National Child Measurement Programme outcomes between the best and the worst Mega Super Output Areas (MSOA) in the NNCCG area and we have defined this as a priority for us to work together to try to address. This group has now tasked the North Norfolk Health Improvement Forum with producing a combined project plan which promotes a multi-agency approach to improving outcomes for children in this area. The Governing Body are invited to comment on any of the project work-streams identified in this report. Appendix 1 Proposed Appendix II NNCCG Groupings.pdf-Emergency admission Page 5 of 5