Schedule 2 Part A SERVICE SPECIFICATION

Transcription

1 Schedule 2 Part A SERVICE SPECIFICATION Service Specification Ref Care Pathway/Service Commissioner Lead 03/CVDS/0031 Podiatry Services Cardiovascular Disease Services Clinical Commissioning Programme Provider Lead Period 1 st December 2012 to 31 st March 2013 Date of Review 1. Purpose 1.1 Aims The purpose of the Podiatry Service is to provide professional care in the community, keep people who have pedal circulatory deficiency or nerve damage mobile and independent, prevent unnecessary admission to hospital and facilitate early discharge from hospital by: providing a responsive service; promoting patient independence; planning specialist input with patients, their carers and other appropriate health and social care professionals; teaching and supporting patients and their carers to provide aspects of podiatry where appropriate; promoting ongoing health education including keeping individuals mobile and independent; working in partnership with others to improve local health care. 1.2 Evidence Base The following Department of Health policy documents are of relevance to the Service: Transforming Community Services, DH, January 2009 High Quality Care for All, NHS Next Stage Review Final Report, DH, June 2008 NHS Next Stage Review, Our Vision for Primary and Community Care, DH, July 2008 Health Inequalities: Progress and Next Steps, DH, June 2008 Developing the NHS Performance Regime, DH, June 2008 NHS Next Stage Review: Leading Local Change, DH, May 2008 The Strategic Framework for Improving Health in the South West 2008/09 to 2010/11, NHS South West, May 2008 Long Term Conditions: Compendium of Information, DH, January 2008 Our Health, Our Care, Our Say The Older People NSF 24 May 2001 The Diabetes NSF09/01/2003 The Musculoskeletal Framework, A joint responsibility: doing it differently (July 2006); Care Closer to Home: Meeting the Challenge

2 The following NICE guidance is of specific relevance to the podiatry Service: CG66: Diabetes (Type 2) NICE guidelines for Diabetes 1.3 General Overview The specialist podiatry services are for patients in Bournemouth, Poole and East Dorset and include: Provision of a Diabetic service which links in community care through protected high risk clinics provision of Community Nail surgery Biomechanics service Homeless clinic in Bournemouth locality An appliance laboratory to support these services in East Dorset The West Dorset service provides for patients with co-morbidities and podiatric conditions which put the foot at risk. 1.4 Objectives The objectives of the Service are: To provide effective and evidence based podiatric management for patients with clinical conditions, to improve outcomes and prevent further complications; To promote patient independence through evidence based practice including health promotion programmes; promoting ongoing health education including keeping individuals mobile and independent To develop and inform local care pathways and protocols, ensuring an integrated and effective approach to podiatric related issues; To act as a specialist resource for health, social care and education professionals, including the provision of education and training; teaching and supporting patients and their carers to provide self care aspects of podiatry; To provide a responsive service; Planning specialist input with patients, their carers and other appropriate health and social care professionals; Working in partnership with others to improve local health care 1.5 Expected Outcomes To: reduce the incidence of acute infections in the diabetic high risk patient and consequently reduce admissions to acute hospital care; treat patients, especially those living with long term conditions and those with either vascular or neurological deficiencies, to maintain their mobility and improve patient-related outcomes; improve awareness both amongst health professionals and patients of the importance of appropriate foot health; influence attitudes towards podiatry to empower individuals and the local community to make appropriate food and lifestyle choices; ensure that all referrals will be dealt with in a quick efficient manner with an assessment date being offered for priority patients to ensure compliance with national RTT targets offer a choice of morning or afternoon appointments wherever possible; demonstrate that clinical activities undertaken will be evidence based and delivered according to local and national clinical guidance;

3 provide any required interpreting and communication support services necessary, either by direct provision or by contract with a third party, in order to: - minimise clinical risk arising from inaccurate communication; - support equitable access to healthcare for people for whom English is not a first language; support effectiveness of services in reducing health inequalities. 2. Scope 2.1 Service Description The Community Podiatry Services will cover Bournemouth, Poole and East Dorset. The specialist services are provided to East Dorset only. The West Dorset wide service provides for patients with co-morbidities and podiatric conditions which put the foot at risk. Clinical (a) Provision of a Diabetic service which links community care through protected high risk clinics (b) A consultant led Rheumatology service which triages patients into community care as appropriate (c) Community Nail surgery (d) Peripheral Vascular Disease Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust clinic linked to community high risk podiatry clinics (e) Mental Health and Learning Disability service for Dorset Health Care NHS Foundation Trust Biomechanics service (f) An appliance laboratory support these services for East Dorset, Bournemouth and Poole. Public Health and Health Promotion Public health and health promotion to service users when appropriate. (g) Education and Training The education and training programme for staff to ensure comptence 2.2 Accessibility/acceptability The Service covers the populations of Bournemouth, Poole and Dorset. The service operates from around 45 different localities and is based in Health centres, hospitals and GP practices. There are different appointment systems as GPs manage this in certain areas. The Bournemouth locality and part of the Poole locality have been centralised with multi practice clinics and a central service making the appointments. Around 18% of all appointments are domiciliary. The biomechanics service and the nail surgery services are via Choose and Book 2.3 Whole System Relationships The service relates with Primary Care, Community Services and clinics in the acute hospitals in the delivery of this service. 2.4 Interdependencies Referrals are received from GPs and other health professionals for Community clinics Specialist services receive referrals from Consultant led clinics in both EastDorsetAcuteHospitals, GPs and other health professionals

4 2.5 Relevant networks and screening programmes The Stroke and Diabetes Networks ARMA (a patient led musculo skeletal network) 3. Service Delivery 3.1 Service model Community Service Chart Appendix A 3.2 Care Pathway(s) Annexes 1,2,3, 3a, 4 and 5 4. Referral, Access and Acceptance Criteria 4.1 Geographic coverage/boundaries The podiatry service will see any patient registered with a GP in the NHS Bournemouth and Poole and NHS Dorset area except for those practices that have other arrangement for podiatry services. Diabetic community high risk clinics accept referrals for all appropriate patients from the diabetic hospital high risk clinics. 4.2 Location(s) of Service Delivery The Service is based atdiscovery Court, Wallisdown Poole.. Clinics are held in at least 45 community clinics and in the acute hospitals. A percentage of work is undertaken in care homes or in the patient s own home. 4.3 Days/Hours of operation Monday to Friday 8.30 am to 5 pm 4.4 Referral criteria & sources Criteria/Condition Refer to Special note Community podiatry Provision of a Diabetic service which links in community care through protected high risk clinics GP referral (99%) direct to local service Appointment system is centralised or via in house GP appointment GP referral Patient once deemed high risk stays in the high risk clinics Community Nail surgery Biomechanics service treating patients (and a GP referral Through Choose and Book GP referral

5 children s clinic) with mobility problems of a musculo- skeletal nature Through Choose and Book 4.5 Referral route Via GP, Consultants and other Health professionals 4.6 Exclusion criteria See Response time & detail and prioritisation to ensure compliance with national RTT targets 5. Discharge Criteria and Planning All patients are offered a course of treatment and if appropriate the Discharge policy is used. Due to the nature of certain medical conditions a large percentage of patients are for life Review is ongoing via reassessment of need 6. Prevention, Self-Care and Patient and Carer Information Leaflets are available. Working towards patients being given a personalised written care plan Clinical staff provide 1:1 advice during treatment sessions Foot health educator train people on how to cut toenails 7. Continual Service Improvement/Innovation Plan Description of Scheme Move services from secondary care to the community Milestones Expected Benefit Timescales Frequency of Monitoring To be agreed Cost reduction and To be agreed care closer to home 8. Baseline Performance Targets Quality, Performance & Productivity Performance Indicator Indicator Threshold Method of Measurement Frequency Monitoring of Podiatry 95% of patients whose referral to first definitive treatment time is within the 18 week national referral to treatment waiting time 95% Score Card

6 95% of patients accessing the homeless service, assessed and treated within 2 weeks 95% Score Card Podiatric Surgery 90% of patients whose referral to first definitive treatment time iswithin the 18 week national referral to treatment waiting time. Additional Measures for Block Contracts:- Staff turnover rates Sickness levels Agency and bank spend Contacts per FTE 90% Score Card 9. Activity 9.1 Activity Activity Performance Indicators Podiatry First attendances Follow up attendances Method of measurement Activity Report Baseline Target 6,300 56,700 Threshold Frequency of Monitoring Reporting split by Bournemouth and Poole / Dorset. Podiatric Surgery Activity Report First attendances 352 Follow up attendances 1516 Reporting split by Bournemouth and Poole / Dorset for June 2011 data onwards.

7 9.2 Activity Plan / Activity Management Plan activity reports as set out in section 2.1 of the main contract Capacity Review 10. Currency and Prices 10.1 Currency and Price Basis of Contract Currency Price Thresholds Expected Annual Contract Value Block/cost &volume/cost per case/other * *delete as appropriate 10.2 Cost of Service by Commissioner Cost of Service Co-ordinating Commissioner Associate Associate Associate Annual Expected Cost Note: Podiatry holds a 5 year contract for decontamination of the instruments, signed in 2010