CCG Clinical Commissioning Forum. Thursday 3 rd September 2015

Transcription

1 CCG Clinical Commissioning Forum Thursday 3 rd September 2015

2 LUNG SCREEN UPTAKE TRIAL Hackney CCG forum meeting September 2015 Professor Jane Wardle, Professor Samuel Janes, Dr Angshu Bhowmik Mamta Ruparel, Samantha Quaife Karen Sennett (Islington), Lucia Grunn (Camden), Eleanor Hitchman (Hackney & City)

3

4 PARADOX IN UPTAKE: FEWER HIGH RISK Positive response rate (%) UKLS Trial 40 Current smokers Former smokers All approached Q1: Most deprived Q2: Above average deprivation Q3: Average Q4: Below average deprivation Q5: Least deprived IMD rank McRonald et al (2014)

5 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)

6 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

7 WHAT WE ASK OF YOU SITE INITIATION Researcher visits practice- study explained & contracts signed Practice administrator runs pre-developed search GP screens patient list (one week) RANDOMISATION Administrator removes personal information; Researcher randomises and allocates appointments 1 st MAILINGS Researcher visits practice Administrator uploads patient details and specifies mail packs to be sent by Docmail (secure 3 rd party) 2 nd MAILINGS Administrator removes attenders & cancellations from list Repeat of 1 st mailings process (to send reminder letters) REIMBURSEMENT & TIME Service support costs to practices are in the region of 260 Administrator time 5-6 hours GP time 1-2 hours Practice manager time 1 hour

8 ELIGIBILITY Age Inclusion Criteria Current Smoker (recorded anytime since 2010) Exclusion Criteria Inability to consent (eg dementia) On palliative care register Metastatic cancer Lung Cancer CT thorax in past year GP deems unsuitable

9 Multiple health intervention: Lung health check Informed consent to study/ screening Spirometry OPPORTUNITY FOR QOF POINTS Smoking cessation Data collection Proceed to LDCT scan Management and follow up in secondary care

10 CREENING 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.

11 F INTERESTED. Mamta Ruparel / Samantha Quaife Lungs for Living Research Centre, UCL Respiratory Health Behaviour Research Centre, UCL lungscreen@ucl.ac.uk

12 1 2 End

13 Urgent Care Programme Board Crisis Response and Effective Admissions Follow-up from the 1st July 2015 workshop

14 1 4 What were we trying to resolve? How do we ensure services are joined up? How can they be accessed in a crisis? How do we ensure the crisis care plan is followed? Monitoring and assuring the quality of each intervention This is the tricky bit and coordinating th is and ensuring we simplify things for p atients, carers and clinicians WILL TAKE TIME!

15 1 5 Who was involved? Care Homes Housing with care Nursing Homes

16 1 6 Outcomes and headline action plan Primary Care First There was consensus that primary care should be the first port of call for patients in and out of hours. Crisis Response Via The 999 System and a Single Point Of Access Providing a local access point and contact number in City and Hackney for the London Ambulance Service is pivotal for developing whole-system crisis pathways. Maximising The Potential Of Existing Community-Based Crisis Response Services There are ways to maximise the uptake and potential of existing services. Acute-Based Services The commissioners and the Homerton clinicians and managers should work to further define the range of acute-based services which support ambulatory care (eg OMU) and model the scope for further developing these services. Staff in A&E need to be able to access crisis and community services to prevent onward admissions. Care Plans And The Crisis Plan An interim paper-based/manual solution needs to be found to ensure care plans are available in peoples homes and a local IT solution for at least passive viewing of care plans should be prioritized in the medium term. Care Homes, Housing With Care And Carers staff in these areas need to receive clear information about the numbers to call in crisis situations and bespoke training for particular crises.. Developing Clinical Pathways Across The Whole System There was consensus that patients and the wider system would benefit from agreed whole-system crisis pathways to support out of hospital care and effective admissions.

17 What s there now and how can we make it simpler? New Models and New Ways of Working Example of new out of hospital services New Intermediate Care Service (IIT) Oct One Hackney live since Apr ParaDoc live since April New out of hours service (CHUHSE) live since Dec Overnight Nurse live Jan 15 All of these new services are available now or will be by the end of the summer

18 Next steps Community Based Crisis Pathways Defining and clarifying crisis services Clarity on referral criteria, access points, opening hours, Targeted communications with GPs, patients and carers Care Homes, Housing with Care and Homecare Tailored communications plan, Education and training plan 1 8 System-wide health and social care pathways Catheter Falls Back Pain COPD Chest Infection Social Issues Crisis

19 1 9 End

20 City & Hackney Mental Health Crisis Line Bailey Mitchell C&H Crisis Team Co-Manager Andrew Horobin Associate Clinical Director for Community and Specialist Teams

21 Crisis Care Concordat The crisis line addresses one of the Concordat s 4 key areas Access to Support Before Crisis Point. By providing residents of the City of London and Hackney access to a crisis professional with knowledge of local services 24 hours a day, 7 days a week we hope to intervene with advice and support before a crisis point is reached. When I need urgent help to avert a crisis I, and people close to me, know who to contact at any time, 24 hours a day, seven days a week. People take me seriously and trust my judgement when I say I am close to crisis, and I get fast access to people who help me get better.

22

23 FAQs Who is the crisis line for? When does it operate? Who is staffing it? Can I refer patients to mental health services through this line? Will I get feedback that my patient or client has called? What s the difference between this and the Samaritans? How does this link in with other mental health services? Should I call the crisis line to discuss a person s needs or should I advise them to contact the line directly?

24 2 4 End

25 Macmillan Social Prescribing Service Laura Westwick Macmillan Social Prescribing Manager

26 Why refer to the Macmillan Social Prescribing Service Increased diagnoses and longer survival for cancer patients rates show us that long term management is becoming more important 15 months after diagnosis, people with cancer had 60% more A&E attendances, 97% more emergency admissions and 50% more primary care contacts compared to a population of the same age/gender* 64% of people living with cancer have practical or personal support needs, and 78% have emotional support needs; the majority (75%) of which say that these needs are caused by their cancer or cancer treatment* City and Hackney CCG scored below the England average in the 2013 National Cancer Patient Experience Survey (CPES) on key items relating to satisfaction with support from health and social services *Nuffield Trust Evaluation (2014)

27 Patient concerns insights and research Anxiety about reoccurrence It s so difficult dealing with uncertainty Low confidence I m not as confident now. I can't do things I used to do Concerned family I needed time away from my worrying family Low energy/fatigue I feel exhausted all the time Living with and beyond cancer psychosocial concerns Lacking emotional support I need to get things off my mind Depression I was really depressed once all the attention had gone Social isolation I live on my own I need company 1 in 5 suffer from loneliness as a result of their cancer (Macmillan) Feeling lost The hospital was my world...now what? 1 in 4 feel abandoned by the health system when they are no longer receiving treatment in hospital (Macmillan) East London patient quotes obtained during interviews conducted by Mac SP team at the Bromley by Bow Centre between March and June 2015

28 Macmillan Social Prescribing Model Support on offer Different levels of support, from initial signposting over the phone to up to six 1-2-1, face to face sessions at a community location Eliciting needs and interests, making personalised plans to improve patients sense of control and wellbeing (motivational interviewing and coaching techniques) Team - training/knowledge in the needs and issues faced and local services available (both cancer specific and more generally) Support patients to connect with appropriate services (e.g. physical activity sessions, welfare advice, volunteering opportunities, employment projects)

29 Macmillan Social Prescribing Model Connecting patients to relevant services Financial/practical I needed help filling out DLA form. Help at home Tower Hamlets Friends and Neighbours help with shopping and housework. Physical activity/healthy eating community based exercise beyond the short term programme. Peer support Having the support group has been important. Getting to chat and speak about things that you can't with peoples husbands or family Complimentary/pampering Acupuncture, reflexology, homeopath - it lifts my spirits, makes me brighter. Counselling/emotional support I had counselling for 10 weeks - they listened, they didn't talk. That was nice. Giving back I volunteer at St Josephs hospice. It feels good to give back. I feel better. Social activity It s a bit of movement but more it is meeting up with people and having a laugh. East London patient quotes obtained during interviews conducted by Mac SP team between March and June 2015

30 Macmillan Social Prescribing Making a referral WHO Open to all patients over 18 with any cancer type Patients don t have to be newly diagnosed can be many years in remission Patient can be referred after needs are highlighted during a Cancer Care Review HOW Referral to be made via the Family Action Hackney Social Prescribing referral form Under the Relevant Medical Conditions list the cancer diagnosis The Family Action wellbeing coordinators these on directly to the Macmillan Social Prescribing team who make contact with the patient Patient can be referred after needs are highlighted during a Cancer Care Review Patients can self refer

31 3 1 End

32 IRIS Identification of Referrals to Improve Safety

33 DOMESTIC ABUSE = HEALTH ISSUE

34 3 YEAR TRIAL 80% OF WOMEN IN VIOLENT RELATIONSHIPS SEEK HELP FROM A HEALTH SERVICE AS THE FIRST OR ONLY POINT OF CONTACT WOMEN REPORTED TRUSTING IN THEIR GP AND BELIEVING THE GP COULD HELP THEM OVERALL ANNUAL COSTS TO HEALTH IS 1.7 BILLION

35 HACKNEY 3 HOMICIDES IN % INCREASE IN CRIMES OF VIOLENCE AND ABUSE 6.5% INCREASE IN DOMESTIC ABUSE THE HIGHEST RATE OF DOMESTIC ABUSE FROM ALL THE BOROUGHS IN LONDON

36 WORKING TOGETHER TRAINING UPDATES DIRECT REFERRAL PATHWAYS SUPPORT AND ADVICE REFERAL UPDATES SAVING TIME SAVING COSTS