NHS Kernow Disclosure log Freedom of Information requests July 2015

Transcription

1 NHS Kernow Disclosure log Freedom of Information requests July 2015

2 Contents FOI Contracts - Continence service... 3 FOI Prescribing & pharmacies - Non-NICE drugs... 5 FOI Contracts - Eye care services... 5 FOI Referral management - GP referrals and prescribing... 7 FOI Organisation - Integration plans domiciliary care... 7 FOI Children s health - CAMHS... 8 FOI Urgent care - QUIPP plans for emergency care... 9 FOI Finance & budgets - Finance and activity plans FOI Contracts - INR testing / analysis services FOI Urgent care - Out of hours service FOI Finance & budgets - Agency and interim staff spend FOI Prescribing & pharmacies - NICE guidelines on anticoagulation FOI Individual funding requests - Wig policies FOI Contracts - Wet AMD services FOI Continuing healthcare - Personal health budgets FOI Organisation - Service eligibility FOI Individual funding requests - IVF treatments FOI Contracts - Podiatry services FOI Contracts - Patient transport FOI Prescribing & pharmacies - Prescribing committee FOI Finance & budgets - Agency spend FOI Long term conditions - Pallative services Appendix - FOI Appendix - FOI Appendix - FOI The information supplied to you continues to be protected by the Copyright, Designs and Patents Act You are free to use it for your own purposes, including any non-commercial research you are doing and for the purposes of news reporting. Any other re-use, for example commercial publication, would require the permission of the copyright holder. Most documents supplied by NHS Kernow Clinical Commissioning Group will have been produced by local officials and will be our copyright. Information you receive which is not subject to our copyright continues to be protected by the copyright of the person, or organisation, from which the information originated. You must ensure that you gain their permission before reproducing any third party information.

3 FOI Contracts - Continence service Date received: 31/07/ What is the population size covered by your community continence service provider? A. NHS Kernow serves a resident population of 534,000, across Cornwall and Isles of Scilly. 2. Please provide a copy of your community provider continence service specification. A. NHS Kernow commissions Peninsula Community Health to provide an integrated children, young people and adult service that receives referrals for all of these conditions. Please find attached a copy of the service specification between NHS Kernow and Peninsula Community Health to provide this service. 3. Does your provider provide incontinence pads to patients, or do they assess patients and advise which products the patient needs to purchase? A. NHS Kernow does not have the information you have requested and the provider is not required to share this information with the commissioner under the terms of the contract. Please contact the provider, Peninsula Community Health, to request this information: pch.foi@pch-cic.nhs.uk. 4. If your provider does provide incontinence pads, is there a limit to how many they are prescribed? If so how many are they allocated? A. NHS Kernow does not have the information you have requested and the provider is not required to share this information with the commissioner under the terms of the contract. Please contact the provider, Peninsula Community Health, to request this information: pch.foi@pch-cic.nhs.uk. 5. How many weeks supply of pads do patients get at a time? A. NHS Kernow does not have the information you have requested and the provider is not required to share this information with the commissioner under the terms of the contract. Please contact the provider, Peninsula Community Health, to request this information: pch.foi@pch-cic.nhs.uk. 6. What is the average number of pads prescribed to each patient per day? A. NHS Kernow does not have the information you have requested and the provider is not required to share this information with the commissioner under the terms of the contract. contact the provider, Peninsula Community Health, to request this information: pch.foi@pch-cic.nhs.uk. 3

4 7. How often are patient s continence requirements reviewed? A. NHS Kernow does not have the information you have requested and the provider is not required to share this information with the commissioner under the terms of the contract. Please contact the provider, Peninsula Community Health, to request this information: pch.foi@pch-cic.nhs.uk. 8. How many pads does your provider prescribe a year, for the last full year of data that is available? A. NHS Kernow does not have the information you have requested and the provider is not required to share this information with the commissioner under the terms of the contract. Please contact the provider, Peninsula Community Health, to request this information: pch.foi@pch-cic.nhs.uk. 9. What is the average daily cost of a patient within the continence service? A. NHS Kernow is unable to provide this information as we commission Peninsula Community Health to provide this contract as part of a block contract arrangement to provide community health services. It is not required to provide these details under the terms of the contract. The provider may be able to provide this information: pch.foi@pch-cic.nhs.uk. 10. Please confirm the percentage of the continence patient case load that are prescribed pads due to mobility issues rather than incontinence? A. NHS Kernow does not have the information you have requested and the provider is not required to share this information with the commissioner under the terms of the contract. Please contact the provider, Peninsula Community Health, to request this information: pch.foi@pch-cic.nhs.uk. 11. Do you provide products for CHC patients in nursing homes, or would this be included in their CHC package of care? A. Yes, products for CHC patients are provided in nursing homes. 12. Could you please share any prices of products that you may have available? A. NHS Kernow does not have the information you have requested and the provider is not required to share this information with the commissioner under the terms of the contract. Please contact the provider, Peninsula Community Health, to request this information: pch.foi@pch-cic.nhs.uk. 13. What is the overall cost of your community continence service for the last year available? Please then split this into the amount spent on products, and the amount spent on service delivery. 4

5 A. NHS Kernow is unable to provide this information as we commission Peninsula Community Health to provide this contract as part of a block contract arrangement to provide community health services. The provider is not required to provide this information to the commissioner under the terms of the contract. The provider may be able to provide this information: pch.foi@pch-cic.nhs.uk. FOI Prescribing & pharmacies - Non-NICE drugs Date received: 31/07/ How many applications have you had for funding for high cost drugs for non-nice indications in the last year? A. Since April 2015, NHS Kernow has received two applications for drugs as special cases by its Individual Funding Request panel. 2. How many of these applications were successful? A. Both applications were approved. 3. How much funding has been allocated to high costs drugs for non- NICE indications in the last year? A. None; NHS Kernow does not commission non-nice drugs. 4. Please indicate the number of applications and funding in the last year for the specified indications below. Indications Hidradenitis Suppurativa Juvenile Idiopathic Arthritis Non-Radiographic Axial Spondyloarthritis Ulcerative Colitis Total Applications None None None None Successful Applications Total Funding FOI Contracts - Eye care services Date received: 30/07/ What is the total population of the area covered by your CCG? A. We serve a resident population of around 534,000, across Cornwall and Isles of Scilly. 2. What percentage of the population is over the age of 60 in the area covered by your CCG? 5

6 A. The total percentage of people older in Cornwall older than 60 is 29 per cent. 3. What is your predicted spend on eye care services this year? A. During 2015/16, NHS Kernow s predicted total expenditure for eye care services is 10.1 million. This excludes high cost drugs and only covers CCG commissioned services, such as the retinal screening programme. Please note the planned spend for 2015/16 includes a deflator, but NHS Kernow is commissioning additional activity to support people who need eye care services. This figure is likely to change and an accurate figure can be provided at the end of the financial year. 4. What was your total spend on eye care services in the (a) 2014/15 financial year, (b) 2013/14 financial year and (c) 2012/13 financial year? Please supply the figure in British Pound Sterling (GBP) and as a percentage of your total budget. A. NHS Kernow was established on 1 April 2013 and cannot provide any information about the former primary care trust. For spend during 2012/13, please contact the Department of Health s legacy team, which will be able to answer your questions. Please informationteam@dh.gsi.gov.uk. During 2013/14 NHS Kernow spent million on eye care services. This is 1.48 per cent of the total budget. During 2014/15, NHS Kernow spent million on eye care services. This is 1.52 per cent of the total budget. This excludes high cost drugs and only covers CCG-commissioned services, such as the retinal screening programme. 5. Are you planning to commission any new eye care services over the next 24 months? If yes, which services and when? A. Yes, a post-operative cataract pathway (LES) in autumn Are you planning to make any changes to the commissioning arrangements of eye care services that are currently being delivered? If yes, what changes and by when? A. NEW Devon Clinical Commissioning Group is leading a procurement of glaucoma surveillance services, to be in place for April This will apply to NHS Kernow patients that choose Plymouth Hospital NHS Trust as a provider of their ophthalmology care. New service to be in place April Who is the named lead with responsibility for eye care within your CCG? A. NHS Kernow s Chief Finance Officer Simon Bell has responsibility for contracting and procurement. His is simonbell@nhs.net. 6

7 FOI Referral management - GP referrals and prescribing Date received: 30/07/ Does the CCG currently operate any schemes for GPs which include a maximum number of referrals as a target? Please list all relevant, including schemes to be implemented in the next year. A. NHS Kernow does not operate any schemes which include a maximum number of referrals target for GPs. 2. Which procedures does this scheme target? Please list all relevant. A. Not applicable. 3. Are there any incentives or sanctions linked to achieving these targets? Please give details. This could include a payment per patient for achieving targets, or loss of payments for exceeding them, but does not have to be financial A. Not applicable 4. Does the CCG have similar targets for prescribing, excluding schemes to switch from branded drugs to generics? Please list all relevant, including schemes to be implemented in the next year. Which conditions or medicines does this scheme target? Please list all relevant. Are there any incentives or sanctions linked to achieving these targets? Please give details. This could include a payment per patient for achieving targets, or loss of payments for exceeding them, but does not have to be financial. Please include documents or details of these schemes that would be sent to GPs. A. Please find attached details of NHS Kernow s GP Prescribing Quality Scheme FOI Organisation - Integration plans domiciliary care Date received: 29/07/ Does your CCG commission domiciliary care? A. Yes. 2. How many patients do you provide health-funded domiciliary care for? 7

8 A. NHS Kernow does not collect the information in a format you have requested. We can confirm that at the end of June 2015, NHS Kernow funded 598 people for all categories of domiciliary care, but we are currently unable to split this in a format you have requested. This is something we are investigating and may be able to provide this information later in the year. 3. How many hours per week are commissioned? A. NHS Kernow is unable to provide this information as it is not collected in a format you have requested. 4. How many service users / patients do you care for under this agreement? A. NHS Kernow operates a spot-purchase arrangement and does not have the information you have requested. 5. What is the average hourly rate of services provided? A. Providers state the rate for the care provision through a mini tender type process. The rates vary across the county from to 18, giving an average of approx. 16 per hour. 6. Do you provide simple homecare or complex clinical care in the community? A. NHS Kernow commissions both simple homecare and complex clinical care in the community. 7. What is the name of the person who is responsible for commissioning these services? A. NHS Kernow s Chief Finance Officer Simon Bell has overall responsibility for contracting and procurement. 8. Could you please confirm the population base for this CCG area? A. NHS Kernow serves a resident population of 534,000, across Cornwall and Isles of Scilly. FOI Children s health - CAMHS Date received: 28/07/ Please can you provide an account of the amount of money spent on Child and Adolescent Mental Health (CAMHS) services by your CCG in 2014/15? A. During 2014/15, NHS Kernow spent 3, 980, 296 on CAMHS (excluding children in care psychology service, and 558, 725 on the CAMHS primary mental health worker service. 8

9 2. Please can you provide the amount spent by your CCG on Child and Adolescent Mental Health services for eating disorders in 2014/15? A. During 2014/15, NHS Kernow spent 220, 711 on the children s eating disorder service. 3. Please can you provide the number of referrals to Child and Adolescent Mental Health Services in your CCG area in and the number who received treatment for 2014/15? A. During 2014/15, there were 2,900 referrals to CAMHS in Cornwall and the Isles of Scilly, and 2,389 people received treatment for CMAHS Tier 2 and Tier 3 services. FOI Urgent care - QUIPP plans for emergency care Date received: 28/07/ Please send me details of all initiatives in NHS Kernow CCG s QIPP plan that are intended to produce a reduction in acute emergency activity. Please include the projected net savings attached to these initiatives. A. The following initiatives are outlined in NHS Kernow s 2015/16 QIPP (Delivering Better Value) plan, with the aim of reducing acute emergency activity. Alcohol care team: It is estimated that close to a quarter (102,000 people) of the population in Cornwall and the Isles of Scilly aged 16 or older are regularly drinking above the recommended safe levels. Of these, 16,200 of these are estimated to be alcohol dependent. An estimated 66,500 people are drinking more than double the daily unit guidelines in one session (source: Cornwall and Isles of Scilly alcohol strategy). This has led to levels of non-elective hospital attendances and admissions in relation to alcohol, and frequent admissions for people living with the consequence of long-term alcohol use, including gastro and liver-related disease. During 2013/14, Royal Cornwall Hospitals NHS Trust data show in excess of 3,000 alcohol-related emergency department attendances and 3,400 admissions and 5,700 outpatient alcohol-related attendances. The total cost of this activity was 5.3 million. The opportunity exists to remodel existing resources and to map the required gaps to provide a comprehensive, redesigned acute and community alcohol care pathway. The three main objectives of the alcohol care team are: Reduce acute alcohol related hospital attendances, admissions, outpatient appointments and readmissions; 9

10 To reduce acute length of stay for appropriate patients and ensure adequate community based resources; To systemise and mainstream the use of Brief Intervention Advice for appropriate patients in ED settings and across wards where indicated The anticipated gross saving is: 479,000. Living Well East: During 2014/15, emergency admissions at Plymouth Hospital NHS Trust increased by 6.3 per cent. The development of the Integrated Care Community for east Cornwall will transform adult care and support within the community leading to reduced emergency admissions and lengths of stay at the Trust. As part of NHS Kernow s move to integrate health and care services to ensure people receive bespoke services closer to where they live, and evidenced in its work in Newquay and Penwith, the development of an Integrated Care Team for adult care and support in east Cornwall will have the following three main objectives: To improve experience of adult care and support by providing holistic care, including guided conversations so that a person s goals for their wellbeing can be understood and achieved wherever possible; To improve adult care and support by creating an integrated team between primary care; community services; social care and the voluntary sector. This will reduce duplication and improve efficiencies for the services as well as providing more coordinated care for patients. To reduce the overall cost of adult care and support by reducing the hospital trust s contract value through a reduction in emergency admissions, a reduction in excess bed days, a shift of some normal stay tariffs to short stay tariffs and a reduction in emergency department attendances. The anticipated saving is gross 290,000. Paediatric service redesign: NHS Kernow has undertaken a review of the flow of children in and out of hospital as well as the Big Six children s conditions that result in children being admitted to secondary care. These are bronchiolitis/coup; fever; gastroenteritis; head injury; asthma and abdominal pain.. We have worked across the region with the South West Strategic Clinical Network and identified pathway improvements to reduce inappropriate and avoid unplanned hospital admissions (AUHA).The Big Six are the six most common reasons that children are admitted to hospital and can result in circa 50 per cent of paediatric admissions. We are working with the Royal Cornwall Hospitals NHS Trust to implement Big Six pathways and we have invested in an additional consultant paediatrician and enhance the flow of children in and out of the department, enabling more children to remain at home or to be discharged sooner. These changes will allow increased paediatrician cover up until 9.30pm on weekdays, as well as mornings of weekends and bank holidays. 10

11 An acute clinic will be developed to prevent admissions and direct telephone support from consultant to GP for acutely unwell children in primary care. NHS Kernow is also working with its partners to embed the planned assessments of acutely unwell children by the new GP out of hours provider and will disseminate training to GP practices on Big Six pathways, and provide an education based pod casts to support each pathway. We are also working with colleagues to embed the consistent discharge advice for the Big Six across acute and primary care, including health visiting and school nursing. The three main objectives of the scheme are: To ensure a movement from unplanned secondary admission to planned primary case management where appropriate; To provide better outcomes for children and young people in the community and secondary care settings as appropriate to their needs and within the scope of this project; To develop and trial Pod Casts for knowledge support in the primary care community regarding children and young people case management, commencing with those conditions in scope in this project. The anticipated saving is 422,000. FOI Finance & budgets - Finance and activity plans Date received: 28/07/ Please send me the latest version of NHS Kernow CCG s finance and activity plan for All CCGs have been required to submit data to NHS England via this template: I am asking for the most recent version of this report. A. NHS Kernow can confirm it has submitted its 2015/16 finance plan to NHS England. This information will be published on NHS England s website later this year and we therefore exempt the release of this information under Section 22 of the Freedom of Information Act, information intended for future publication. FOI Contracts - INR testing / analysis services Date received: 27/07/ For the financial year April to March and April to March , the number of providers commissioned to deliver INR testing/ blood coagulation analysis in nonhospital settings: A. There are five providers commissioned to provide INR testing / blood coagulation analysis. This may be in hospital and non-hospital settings. 11

12 2. For the financial year April to March and April to March , the number of patients managed for INR testing I blood coagulation analysis in non-hospital settings: A. NHS Kernow does not have the information you have requested. We have also contacted our providers and have been advised they are also unable to provide this level of detail. 3. For the financial year April to March and April to March , the number of patients managed for INR testing /blood coagulation analysis in hospital settings. A. NHS Kernow does not have the information you have requested. We have also contacted our providers and have been advised they are also unable to provide this level of detail. 4. For the financial year April to March and April to March , the total number of unique patients managed for INR testing I blood coagulation analysis A. NHS Kernow does not have the information you have requested. We have also contacted our providers and have been advised they are also unable to provide this level of detail. 5. Please list all providers currently commissioned to deliver INR testing I blood coagulation analysis. A. Royal Cornwall Hospital Trust. Plymouth Hospital NHS Trust. Torbay and South Devon Hospital. North Devon District Hospital. Royal Devon and Exeter Hospital. 6. Please provide contact details of current INR testing I blood coagulation providers, ideally to include: name, site location, site postcode NHS code, phone and A. Pathology department, Royal Cornwall Hospital Trust. Pathology department, Plymouth Hospital NHS Trust. Pathology department, Torbay and South Devon Hospital. Pathology department, North Devon District Hospital. Pathology department, Royal Devon and Exeter Hospital. 7. Details of any new and/or additional IiNR testing/ blood coagulation services planned from April, 2015 and March A. NHS Kernow does not have details of any new or additional IiNR testing/ blood coagulation services planned from April, 2015 and March

13 8. Contact details of the INR testing/ blood coagulation commissioning lead(s) at NHS Kernow. A. NHS Kernow s Chief Finance Officer Simon Bell has overall responsibility for contracting and procurement. His is simonbell@nhs.net. FOI Urgent care - Out of hours service Date received: 27/07/ Is your GP OOH service required or recommended to meet a minimum staffing level? A. Yes, NHS Kernow does recommend its GP out of hours service provider meets a minimum staffing level. 2. If so, what is the requirement or recommendation? A. There is a requirement that at no time during the out of hours period, there will be fewer than three GPs available and that, as a minimum, these three GPs would have a responsibility for oversight of clinical workforce deployment during their shift, for a geographically defined area 3. Is this staffing level a contractual requirement? A. Yes. 4. On how many occasions per month for the past 6 months has your GP OOH provider failed to meet that minimum staffing requirement/recommendation? A. None. 5. Please detail for each occasion how far below the required/recommended staffing level the service was? A. Not applicable. 6. What sanctions have been applied to the GP OOH provider in the past 6 months due to failure to meet a minimum staffing level? A. Not applicable. 13

14 FOI Finance & budgets - Agency and interim staff spend Date received: 23/07/ The total amount spent by your organisation on non-medical / non-clinical interim staff (i.e staff that may work within contract management, human resources, IT, finance, procurement, business development, administration, et cetera). I request this information for the financial years of 2013/14 and 2014/15. When responding, please confirm if the value given is inclusive of agency fees and VAT. A. During 2013/14, NHS Kernow spent 1.0 million on non-medical / non-clinical interim staff. During 2014/15, NHS Kernow spent 1.1 million on non-medical / non-clinical interim staff. These costs are inclusive of irrecoverable VAT and agency fees, where applicable. FOI Prescribing & pharmacies - NICE guidelines on anticoagulation Date received: 20/07/ Following the NICE recommendations for the use of NOACs in anticoagulation please could I request any guidance/protocols/pathways looking at their place in therapy in: 1) Cardiology (atrial fibrillation) 2) Hematology (DvT & other venous thrombotic events) 3) Respiratory (treatment of pulmonary embolism) Could you please also include any documentation provided by the CCG to support primary care in implementing the guidance and confirm if there is a rebate scheme in place for any of the NOAC treatments. A. Details of NHS Kernow-approved guidelines and protocols for NOACs are published on our formulary website, The details are available under the following categories: CIOS Dabigatran Factsheet Rivaroxaban in DVT Management - Factsheet Rivaroxaban and Dabigatran, Off-Label use - Factsheet KCCG Prescribing Pathway: Rivaroxaban for DVT We therefore exempt this information under section 21 of the Freedom of Information Act, information accessible by other means. 14

15 FOI Individual funding requests - Wig policies Date received: 17/07/ Please provide details of your CCG s NHS wig provision policy for dermatology patients, including those with alopecia and other dermatology conditions which cause hair loss. I would assume that a wig policy would include such information as: 2. Details of the number of wigs that dermatology patients can obtain via a NHS wig prescription including details of the type of wig allowed, whether a monetary value is placed on allowance, any limitations/timescales. 3. Can people with all types of alopecia obtain a wig via a prescription? i.e can androgenetic and scarring alopecia patients obtain a prescription or is one offered just to those with alopecia areata? 4. If wig prescriptions are only offered to those with a certain severity of hair loss, what extent of the head needs to be affected for a prescription to be offered? 5. Are prescriptions for human hair wigs ever offered? 6. What is the annual CCG budget for wigs? 7. Does the annual CCG budget for wigs include wigs for oncology patients as well as dermatology patients? Or are there separate budgets? If so, please provide details of both. 8. Do patients have a choice as to a supplier to take their wig prescription? 9. If a choice of supplier is provided, please confirm the number of choices patients receive and the names and addresses of the NHS approved suppliers. A. NHS Kernow does not have the information you have requested. The information you have requested may be held by Royal Cornwall Hospitals NHS Trust, which provides the dermatology service. NHS Kernow would not know details about costs incurred by the hospital s oncology service either. Please foi.rcht@cornwall.nhs.uk. FOI Contracts - Wet AMD services Date received: 13/07/ Does the CCG commission NHS funded services for the assessment and treatment of Wet Age Related Macular Degeneration? A. Yes. 2. If the CCG does commission such services, please provide a list of providers commissioned for the following periods: A. From 1 April 2014 to 31 March 2015, NHS Kernow commissioned Royal Cornwall Hospitals; Plymouth Hospitals; Royal Devon and Exeter; and Northern Devon Healthcare to provide services for the assessment and treatment of Wet Agerelated Macular Degeneration 15

16 From 1 April 2015 to 31 March 2016, NHS Kernow has commissioned Royal Cornwall Hospitals; Plymouth Hospitals; Royal Devon & Exeter, and Northern Devon Healthcare to provide services for the assessment and treatment of Wet Age Related Macular Degeneration 3. For each provider listed, please provide a copy of the pricing scheme agreed for the financial year 2015/16 A. NHS Kernow commissions Royal Cornwall Hospitals NHS Trust to provide a Wet Age-related Macular Degeneration service under a locally-negotiated tariff. This tariff is unique to the CCG and the Trust and providing this information would prejudice the CCG s commercial interests. We therefore exempt the release of this information under section 43 (2) of the Freedom of Information Act, commercial interests. In reaching this conclusion we have carried out a public interest test and, whilst recognising the need for being open and transparent, we believe this is outweighed by concerns that, as the commissioner of this service in Cornwall, the release of this tariff would prejudice NHS Kernow s ability to negotiate and secure a competitive tariff in the future and commission a service that provides value for money for the population of Cornwall. Plymouth Health NHS Trust; Northern Devon Healthcare and Royal Devon and Exeter Hospitals Trust are paid the national tariff to provide the service. Details of the outpatient procedure cost is available online at _OPATT_model_ xlsx We therefore exempt the release of this information under section 21 of the Freedom of Information Act, information accessible by other means. 4. Please provide a copy of the contract or extract from contract and/or any variation thereof, or any service level agreement that covers the period 2015/16 A. This service is one of many included in the contract between NHS Kernow and Royal Cornwall Hospitals NHS Trust to provide services, but is not specifically referenced in the contract. NEW Devon Clinical Commissioning Group leads the ophthalmology contract for Plymouth Health and will be able to provide details of this service level agreement. Please d-ccg.foi@nhs.net to request this information. FOI Continuing healthcare - Personal health budgets Date received: 13/07/ How many patients have applied to the CCG for a personal health budget since April 2015? 16

17 A. 17 people have applied to NHS Kernow for a personal health budget since April How many patients in the CCG area who applied since April 2015 now hold a personal health budget? A. Three people. 3. How many requests made since April 2015 for personal health budgets were not approved by the CCG? A. None. 4. How many patients have applied to the CCG for a personal health budget in total? A. Since NHS Kernow was established on 1 April 2013, 24 people have applied for a personal health budget. 5. How many patients are there in total in the CCG area who now hold a personal health budget? A. Seven people. 6. How many requests made in total to the CCG for personal health budgets were not approved by the CCG? A. None. 7. How many patients in the CCG area are eligible for personal health budgets? A. NHS Kernow commissions health services for a resident population of 534,000. Anyone in Cornwall and the Isles of Scilly who is eligible for adult continuing healthcare and children s continuing healthcare may benefit from a personal health budget. NHS Kernow is looking at how people with long-term conditions or mental health needs may benefit from a personal health budget to meet their assessed health needs. FOI Organisation - Service eligibility Date received: 09/07/ Has NHS Kernow CCG introduced, or is it planning to introduce, new limits to access/eligibility for services during , for financial/efficiency/value reasons? A. Yes. 17

18 2. Is your CCG planning to introduce new limits to access/eligibility for services during , for financial/efficiency/value reasons? If you responded yes to either of the previous questions, please state your plans for limiting access/eligibility. If you responded yes to either of the first two questions, how much money do you estimate this will save? A. No, NHS Kernow does not have any plans to introduce new limits to access/eligibility for services during 2016/17 for financial/efficiency or value reasons. This decision may change as NHS Kernow s plans to reconfigure services as part of our work to integrate services and improve access is developed. NHS Kernow is currently looking at introducing new limits to access/eligibility for vasectomy services during This service will only be commissioned in secondary care for those patients who require general anaesthesia for clinical reasons. NHS Kernow is also looking at introducing new limits to access joint injection services. This service will only be commissioned in secondary care for those patients where two landmark sited injections have been attempted in primary care first. These plans are in the development stage and the full financial impact is still being assessed. FOI Individual funding requests - IVF treatments Date received: 09/07/ Please can you tell me how many cycles of IVF treatment the CCG offers to women under the age of 40 and how many cycles to women over the age of 40. A. NHS Kernow provides one cycle for women under the age of 40. NHS Kernow do not offer IVF treatment to women over the age of 40. You can find details of our IVF policy here: grequests/policies/assistedconceptionrevisedoct2010.pdf 2. Please can you also tell me how many individual funding requests the CCG has received since April 2013 for IVF treatment and how many have been granted funding. 3. Please list the number of applications and those which were successful on an annual basis since April

19 Year Total received Total funded 2013/ / /to date 10 4 FOI Contracts - Podiatry services Date received: 06/07/ Do you commission podiatry services provided under AQP? 2. If you do commission podiatry services provided under AQP who do you commission these services from? 3. What is your tariff description and costs for AQP podiatry services? 4. Please indicate your tariff type and volume for AQP podiatry services? 5. Please indicate activity type by tariff, by provider for AQP podiatry services for , , and 2014 to current date? 6. Does your AQP provider ensure decontamination of instruments in line with European standards? A. NHS Kernow does commission a podiatry service, but this is not commissioned under Any Qualified Provider. We are therefore unable to answer your questions. FOI Contracts - Patient transport Date received: 03/07/ Please can you send me PTS contract monthly performance reports for April 2014-March 2015 including: Performance against contracted Key Performance Indicators by the provider Performance against any additional non-contracted performance measures A. Please find attached documents containing the information you have requested. 2. Please can you tell me the number of complaints received by the provider relating to Patient Transport Services per month from April 2014-March 2015? A. NHS Kernow does not receive copies of complaints that have been received by the provider, unless it relates specifically to the commissioning of this service. We are therefore unable to provide the information you have requested. 3. For each month (April 2014-March 2015) we would also like a breakdown of the nature of complaints by category A. NHS Kernow does not have the information you have requested. 19

20 FOI Prescribing & pharmacies - Prescribing committee Date received: 03/07/ Below is a list of the current members of the Cornwall Area Prescribing Committee. Would it be possible to see if these details are up to date. If they are not can you please provide an update. A. Please find below an update contact list for the Cornwall Area Prescribing Committee. Please note NHS Kernow can only confirm details of its employees. Please contact the other contacts listed to confirm their details. Forname Surname Job Title Additional Information Public Health Consultant Public Health England Nick Gibson GP Clinical Lead NHS Kernow, Bodriggy Surgery nickgibson1@nhs.net Jonathan Katz APC Chair, GP NHS Kernow, Penrun Surgery j.katz@nhs.net Prescribing Clinical Lead Margaret Abban Lay Member Healthwatch Michael Wilcock Head of Prescribing Royal Cornwall Hospitals Trust Support Phillip Yelling Pharmacist LPC Representative Georgina Praed Head of Prescribing and Medicines Optimisation NHS Kernow georgina.praed@nhs.net Martin Ronchetti GP Clinical Prescribing NHS Kernow, Pensilva Surgery Martin.Ronchetti@nhs.net Lead Ros Palmer Pharmaceutical Advisor Peninsula Community Health Sarah Williams PA to the Chief Pharmacist Royal Cornwall Hospitals Trust Tabinda Dugal Consultant Endocrinologist Royal Cornwall Hospitals Trust Phil Trevail GP & LMC Representative Pool Health Centre Jonathan White GP Prescribing Locality Lead NHS Kernow, Stillmore Surgery jonathan.white9@nhs.net Amanda Pell Senior Pharmaceutical NHS Kernow amanda.pell@nhs.net Advisor Peter Short GP Prescribing Locality Lead NHS Kernow, Three Spires Medical Practice peter.short1@nhs.net FOI Finance & budgets - Agency spend Date received: 03/07/ Please provide details relating to the supply of Agency Allied Health and Health Science Professions for : Spend on Agency Dieticians for the April 2014 March 2015 Financial Year Spend on Agency Podiatrists for the April 2014 March 2015 Financial Year Spend on Agency Arts Therapists for the April 2014 March 2015 Financial Year Spend on Agency Chaplains for the April 2014 March 2015 Financial Year Spend on Agency Clinical Psychologists, Counsellors or Psychotherapists for the April 2014 March 2015 Financial Year 20

21 Spend on Agency Orthoptists for the April 2014 March 2015 Financial Year Spend on Agency Play Specialists for the April 2014 March 2015 Financial Year Spend on Agency Sexual Health Advisors for the April 2014 March 2015 Financial Year Spend on Agency Diagnostic Radiographers and Sonographers for the April 2014 March 2015 Financial Year Spend on Agency Therapy Radiographers / Radiotherapists for the April 2014 March 2015 Financial Year Spend on Agency Physiotherapists for the April 2014 March 2015 Financial Year Spend on Agency Speech & Language Therapists for the April 2014 March 2015 Financial Year Spend on Agency Occupational Therapists for the April 2014 March 2015 Financial Year Spend on Agency staff within Pharmacy (Pharmacists, Technicians & ATO s) for the April 2014 March 2015 Financial Year Spend on Agency Audiologists for the April 2014 March 2015 Financial Year Spend on Agency Mortuary Technicians/Anatomical Pathology Technicians for the April 2014 March 2015 Financial Year Spend on Agency Cancer Screeners for the April 2014 March 2015 Financial Year Spend on Agency Cytology Screeners for the April 2014 March 2015 Financial Year Spend on Agency Healthcare Scientists for the April 2014 March 2015 Financial Year Spend on Agency Dental Staff for the April 2014 March 2015 Financial Year Spend on Agency Optometry Staff for the April 2014 March 2015 Financial Year Spend on Agency Phlebotomists for the April 2014 March 2015 Financial Year Spend on Agency Biomedical Scientists & Medical Lab Assistants for the April 2014 March 2015 Financial Year Spend on Agency Genetic Counsellors for the April 2014 March 2015 Financial Year Spend on Agency Clinical Physiologists (Including Cardiac) for the April 2014 March 2015 Financial Year Spend on Agency Medical Physicists for the April 2014 March 2015 Financial Year A. As a commissioner and not a provider of services, NHS Kernow can confirm it has not spent any money on the professions staff listed. 21

22 FOI Long term conditions - Pallative services Date received: 02/07/ What is the population covered by your Clinical Commissioning Group? A. 534,000 people. 2. For the most recent full year you have data for, what is the number of: a) Adult deaths (18 and over) b) Child deaths (under 18) c) Neo-natal deaths? A. From 1 January 2014 to 1 January 2015, there were the following number of deaths in Cornwall and the Isles of Scilly there were: 5,674 Adult deaths (18 and older) Seven child deaths (28 days to 18 years) neo-natal deaths (under 28 days) 3. How many patients have Palliative Care needs? A. NHS Kernow does not have the information you have requested as it does not hold patient-identifiable data and people may be seen across many settings and providers. 4. What services do you commission for Specialist Palliative Care? Acute hospitals Community hospitals Care homes Hospices Continuing Care At Home EOLC facilitator Specialist Palliative Care Nurses (Macmillan) Specialist palliative care. Outpatient support to oncology services at Royal Cornwall Hospitals NHS Trust and Plymouth Hospital NHS Trust. Care for dying people when a community hospital is deemed to be the appropriate environment People often reside in care homes for 24-hour nursing care. Inpatient and outpatient specialist palliative care. 24/7advice line. People often cared for at home funded through CHC or other mechanism at the ends of their lives. Delivered by care agencies throughout Cornwall and the Isles of Scilly. Dedicated end of life care service in Carrick and Restormel provided by Peninsula Community Health Guidance and support with GSF and ACP, training and education across health services Face-to-face visits to all patients older than 18 years every day between 0900 and Telephone advice line to professionals 24/7. 22

23 5. How many Palliative Care Specialists are provided by these services you commission? 6. If possible, please specify numbers of Palliative Care Specialists broken down by: a) Consultants in Palliative Medicine b) Specialists Nurses employed as a clinical nurse specialist or a consultant nurse in palliative care c) Allied health Professionals, please specify? A. NHS Kernow does not have the information you have requested for question five and six. You may wish to contact our providers to request this information: Royal Cornwall Hospitals NHS Trust: foi.rcht@cornwall.nhs.uk Plymouth Hospital NHS Trust: plhtr.foirequests@nhs.net Peninsula Community Health: pch.foi@pch-cic.nhs.uk Macmillan Cancer: Please call Do you commission Specialist Palliative Care Services in a community setting? A. Yes, NHS Kernow does commission specialist palliative care services in community settings. Details are provided in answer four. 8. What is your annual budget dedicated to Specialist Palliative Care Services commissioned for the current financial year, ? A. NHS Kernow s budget for specialist palliative care services in acute hospitals during 2015/16 is million. The annual budget for hospices during 2015/16 is million. 9. What is your annual budget for other Palliative Care or End of Life Care Services commissioned for the current financial year, ? A. NHS Kernow does not have a separate budget for palliative care or end of life services and spend is included in different budgets. As of 30 June, 2015, NHS Kernow plans to spend million on end of life or palliative care services during 2015/16. The budget for fast track (end of life) expenditure is million for 2015/16. Please note this spend will change during the year as people are either moved to, or removed from the NHS Continuing Healthcare budget. 10. How many beds are there specifically dedicated to Specialist Palliative Care Services. If possible please break down by: a) Hospices: Number of beds in each hospice inpatient unit, please specify each unit by name. b) Other Providers: Number of beds in each provider inpatient unit, please specify each unit by name. 23

24 c) Hospital: Number of beds in each hospital inpatient unit, please specify each unit by name. A. NHS Kernow does not commission a specific number of beds for Specialist Palliative Care. 11. Do you commission for seven day admissions to Specialist Palliative Care Beds? If yes, please provide further information on whether these admissions are available in: a) All hospice beds you commission b) Some hospice beds, and if so how many? c) NHS funded Specialist Palliative Care beds in hospitals, and if so how many? d) NHS funded Specialist Palliative Care beds in another facility, and if so how many? e) Any other facility, please specify. A. NHS Kernow does not commission services from a hospice. Acute providers work on a 24 hour/seven day bases. 12. Do you commission seven day Specialist Palliative Care Services? If yes, please give their hours of operations and the specific services available. A. Yes, NHS Kernow commissions the following seven day specialist palliative care services: A 24 hour delivery for end of life care equipment, including beds and mattresses A specialist care advice line 13. Do you commission seven day Specialist Palliative Care Services for patients in their own homes? If yes, please specify. A. Yes, NHS Kernow commissions the following seven day specialist palliative care services for people in their homes: A 24 hour delivery for EOLC equipment including beds and mattresses. A Specialist care advice line. Macmillan nurses and district nurses (depending on needs). 14. Do you commission 24 hour/seven day Specialist Palliative Care advice? If yes, a) Is this advice from a consultant to all other out of hour s healthcare professionals in your area? b) Is this direct advice to patients and their carers? c) If by another means, please specify what type of advice is available and how this advice is given. A. Yes, NHS Kernow does commission 24-hour/seven day specialist palliative care advice. This does include advice from a consultant and direct advice to patients and their carers. 24

25 15. In hospitals, do you commission Hospital Specialist Palliative Care Support Teams? If yes, please give details of which hospitals. A. Yes, NHS Kernow commissions Royal Cornwall Hospitals NHS Trust and Plymouth Hospital NHS Trust. 16. Do you commission seven-day hospital acute pain control team services? Yes/No A. Yes, NHS Kernow does commission seven day hospital acute pain control team services for in-patients. 17. Do you commission education support for Specialist Palliative Care Services? If yes, please specify. 18. Does this education support require Palliative Care Specialists to educate other healthcare professionals? If yes, please specify. A. NHS Kernow does not specifically commission education support for services. 19. Do you have any future plans for new Specialist Palliative Care Services? If yes, please specify. A. NHS Kernow continuously review the services required for the population of Cornwall and the Isles of Scilly. 25

26 Appendix - FOI

27 Care Pathway/Service Improving Bladder & Bowel Health (2 Pathways: Child & Young People; Adult including Urodynamic Investigations for females) Commissioner Lead Provider Lead Period 1 st October st March 2016 Date of Review April 2013 Applicability of Module E (Acute Services Requirements) NA Key Service Outcomes The following are expected outcomes of the service: Patients will have an understanding of their condition(s), how to comply with treatment, how to recognise signs of exacerbation or deterioration and action to take in these circumstances A named key worker for each patient Improved quality of life and well being Enhanced awareness and understanding of factors influencing continence and how to prevent reoccurrence of symptoms 1. Purpose 1.1 Aims and objectives To provide leadership and deliver evidence based bladder and bowel continence care for children, young people and adults, with the aim of resolving symptoms or improving quality of life where symptoms are irresolvable. It is recognised that some continence issues arise due to the specific condition or range of conditions that the individual is living with. For example an older person may experience incontinence after having a stroke, this may be a temporary situation that resolves as recovery takes place or may be a longer term consequence. Other examples include people who may have complex physical needs such as a person with dementia. People with ongoing, complex care needs, which may include living with one or more long term condition(s), tell us that they want the same fundamental care: early diagnosis, support and information to live as independently as possible, and easy access to services when they are needed. This specification sets out the outcomes expected for this care group and should be read in conjunction with Services for People with on going Complex Care Needs (including Personalised Care Planning). Personalised care planning underpins care for people with complex needs. It is a process whereby people are supported to develop confidence and competence in managing the challenges of living with their long term condition(s), so that they have an improved quality of life, improved clinical outcomes and make more appropriate use of health and social care resources. The majority of the referrals to the service are for incontinence. However, other lower urinary tract and bowel symptoms are included. Incontinence increases with age for both men and women. Urinary incontinence (UI) affects 1 in 3 women aged 18+ (35,000:100,000 women), but less

28 than 20% are actively treated Lower urinary tract symptoms (LUTS) affect 2.7% of men aged 18+ and 35% of men aged 60+ UI and / or faecal incontinence affect 50-80% of care home residents The actual number depends on the help-seeking rate of the population, and how proactive clinicians are at identifying UI in their female patients. Provision for female lower urinary tract dysfunction is supported by a clinical pathway via the Map of Medicine. This will provide one point of referral for women who present with urinary incontinence from primary care through to secondary care. The aims are to : Provide a single clinical care pathway for women with urinary incontinence which promotes conservative management in accordance with NICE guidance. To provide a consistent, comprehensive, effective accessible, legal and appropriate continence service to service users. To provide a quality service consistent with national frameworks and NICE guidance To maximise the use of skilled professionals To maximise the use of conservative treatments for common bladder conditions and reduce secondary care admissions. Men are just as likely as women to develop a bowel control problem. Prevalence of faecal incontinence is less well documented in both sexes, but best estimates suggest that the prevalence in adults at home is about 1%, with 17% of the elderly reporting symptoms. In institutions the prevalence of faecal incontinence is about 25%. For children, it is estimated that persistent bedwetting affects approximately 1 in 6 five year olds, 1 in 7 seven year olds, 1 in 11 nine year olds and 1 in 15 eleven year olds. Day-time wetting affects about 1 in 25 five year olds, 1 in 50 seven year olds and 1 in 100 eleven to eighteen year olds. Faecal incontinence affects about 1 in 30 five year olds, 1 in 75 six to ten year olds and 1 in 100 eleven to eighteen year olds. For anyone of any age faecal and/or urinary incontinence is distressing, unpleasant and frequently socially disruptive. As a health issue incontinence may: cause skin breakdown which may lead to pressure sores; be indicative of other problems in children, such as emotional problems rather than physical disorders. As a social issue, failure to manage faecal and urinary incontinence may: lead to bullying of children at school, adults in the workplace and older people in residential care and nursing homes; in children, cause emotional and behavioural problems; restrict employment, educational and leisure opportunities; lead to social embarrassment and social exclusion; result in people moving to residential and nursing homes incontinence is second only to dementia as an initiating factor for such moves; cause conflict between the individual and their carer; cause soiling and ruin clothes and bedding, leading to extra laundry costs and increased expense for these items. For carers, incontinence is sometimes the last straw and is often a major reason for the breakdown of the caring relationship which can lead to admission to residential or nursing home care 1. The Bladder and Bowel Specialist Service in Cornwall will provide support and leadership on a countywide basis. The objectives of the service are to:

29 Provide advanced second level assessment to patients in the treatment and management of faecal and/or urinary incontinence; constipation and other lower urinary tract symptoms Act as a resource for healthcare professionals in the pursuit of therapeutic continence care delivery Develop clinical practice guidelines using evidence based practices and pathways of care; ensuring that they are implemented, regularly updated and available to relevant staff Monitor quality through clinical audit, taking into account comments and complaints Work in partnership with other organizations (NHS and other statutory and voluntary organisations) Provide educational support and training programmes to multidisciplinary teams Deliver HEAC348 Effective Continence Promotion and Management of Incontinence Degree Level Partnership Course Deliver high quality and cost effective services. Provide educational forums to healthcare professionals (including the independent sector) that facilitates a network of interest and resource Hold current literature on the promotion of continence and management of incontinence Contribute to research methodology that aims to improve clinical and service delivery. Gain increased recognition/awareness of bladder and bowel continence problems across all disciplines Develop cross-boundary evidence based care pathways Facilitate the Continence Service User Group Improve access to services Improve equity of service Improve patient satisfaction Reduce hospital admissions Reduce healthcare-acquired infections 1.2 National/local context and evidence base National Audit of Continence Care Robert Francis Inquiry report into Mid-Staffordshire NHS Foundation Trust Privacy and Dignity in Continence Care National service frameworks: - Older people - Long-term conditions - Child health and maternity - Stroke Good practice in continence services The Expert Patients Programme NICE clinical and public health guidelines NICE quality standards Essence of Care Cost-effective Commissioning for Continence Care (2011) All Party Parliamentary Group for Continence Care Report 2. Scope 2.1 Service Description The Bladder and Bowel Specialist Service serves the population of Cornwall & Isles of Scilly, it will provide leadership and direct care (as described above) and: Provide timely access to assessment, treatment and evaluation for a range of bladder and

30 bowel continence problems Ensure that patients/carers and families feel that they are listened to and that we are responsive to their needs Promote dignity at every opportunity Deliver quality care that is safe and effective People have a right to be continent, whenever this is achievable and to the highest standards of available health care, social care and management to ensure an optimum quality of life, independence and personal dignity. The Bladder and Bowel Specialist Service provides leadership and guidance across Cornwall and Isles of Scilly to facilitate and support this ethos. 2.2 Any exclusion criteria The Directory of Services on Choose & Book sets out the exclusion criteria e.g. no referral for products or sheath fitting; or red flags where patients need to be seen by secondary care. All referrals are vetted by a member of the clinical team. If the referral is not accepted it will be returned to the referrer with a written explanation of why it is not appropriate. 2.3 Geographic coverage/boundaries The service covers Cornwall and the Isles of Scilly 2.4 Whole system relationships Continence issues cuts across a majority of health conditions so the service does not work in isolation. The strong relationships with a network of partners locally, regionally and nationally should be maintained. These include; Continence Service User Group Education Social Care Primary Care Voluntary and Charitable Organisations/Committees Quality, Innovation, Productivity and Prevention (QIPP) Groups 2.5 Interdependencies and other services Stakeholders and interdependencies will vary as identified above and the interface with universal services cannot be over stated. Access to and support from universal services should always be accessible as circumstances allow. 2.6 Relevant networks and screening programmes The commissioner may wish to discuss the introduction of Chlamydia Screening for the woman over 50 during the term of this contract. The commissioner may wish to discuss the recruitment of a Nurse Specialist for Children s Continence (the current service healthcare professionals don t hold a paediatric qualification). The commissioner may wish to discuss a review of the service to identify if the capacity will meet the future public health needs of incontinence across all age groups. Networks: The Bladder and Bowel Foundation ERIC (Education and Resources for Improving Childhood Continence PromoCon Royal College of Nursing Continence Care Forum The ACA (Association for Continence Advice) All Party Parliamentary Group on Incontinence National Clinical Supervision Group International Continence Society Research Institutions

31 2.7 Training/ education/ research activities N/a 3. Service Delivery 3.1 Service model and 3.2 Care Pathway The table below maps how all patients access the service from the point of a screening question and moving to level 1, 2 or 3 depending on clinical need. Complimentary to this model, is the development of specific children & young people s pathways. Clinical leadership of the service will be provided by a Nurse Consultant Continence problems will largely be identified and assessed in primary and community care settings. The following table maps a stepwise approach to accessing assessment, treatment and management. Assessment, treatment and management for the patient will be offered at four levels of care: Screening Level First Level Second Level Third Level This level is about improving access to continence care, which involves frontline professionals encouraging discussion of the problem with patients and screen for it by asking: Does your bladder or bowel ever/sometimes cause you problems? (Essence of Care 2001) Referral onto the first-level will be determined by a positive response to the question. This level involves the front-line professional who is competent at offering a first-level assessment using a locally approved continence assessment tool. Failure of treatment, doubtful diagnosis or complexity will determine referral to the second level. This level includes specialists such as the Continence Promotion Service, Physiotherapists specialising in continence, Urologists and Gynaecologists. Referral onto the third level will be for complex cases not resolved at this level. This level is a further step for highly specialised care, usually provided in centres of excellence. Provision for female lower urinary tract dysfunction is supported by a clinical pathway via the Map of Medicine, providing a one point of referral for women who present with urinary incontinence from primary care through to secondary care. Children and Young People Continence Assessment and Management Guidelines: Toilet training Daytime urinary incontinence Nocturnal enuresis Idiopathic constipation Encopresis These guidelines are at the implementation stage and being reviewed periodically. 3.3 Location(s) of service delivery The service is provided via out patient clinics and on a domiciliary basis. Clinics are delivered across the county in Community Hospitals and Health Centres either monthly or twice monthly: Bodmin Hospital

32 Camborne & Redruth Community Hospital Launceston Hospital Liskeard Hospital Stratton Hospital St Barnabus Hospital Edward Hain Hospital Camborne Health Office Helston Hospital St Austell Hospital Poltair Hospital Truro Health Park Newquay Hospital Falmouth Hospital St Mary s, Isles of Scilly Urodynamics Investigations are provided in Camborne & Redruth Community Hospital. Clinics for children at Doubletrees, Curnow and Nansallon Special Schools are provided on by appointment basis according to need (per school term as required). Details of the clinics including when they are held, contact details, how to book an appointment etc should be available on the provider s website and in other appropriate published information. Details of the clinics including when they are held, contact details, how to book an appointment etc should be available on the provider s website and in other appropriate published information. 3.4 Days/hours of operation Details of the clinics including when they are held, contact details, how to book an appointment etc should be available on the provider s website and in other appropriate published information. 3.5 Referral criteria and sources Children, young people and adults experiencing complex bladder and bowel continence problems, irrespective of disability or diagnosis, have access to the service. All new patients are offered up to 45 minutes consultation and follow-up consultations are up to 30 minutes. The urodynamic element of the service will ensure that all patients are seen within 6 weeks from referral (national target for diagnostics). Referrals must be in written format and may be made by health and social care professionals. Selfreferrals are accepted if second level assessment is required. Details of how the service can be accessed including referral criteria and contact details should be available on the provider s website and in other appropriate published information. 3.6 Referral processes Choose & Book is not available for directly bookable clinics via the Referral Management Centre. Referrals continue to be sent to the Bladder and Bowel Specialist Service office based in St Austell Community Hospital. Details of how the service can be accessed including referral routes should be available on the provider s website and in other appropriate published information. 3.7 Discharge processes Once active intervention is complete the patient will be discharged from the service. At this time:

33 The patient will be given advice regarding where and how they can seek further advice and/or help. A letter will be sent to the GP within one week of discharge from the service detailing any assessments carried out, the outcome of these, the care/treatment/advice given and ongoing management of their condition/guidance regarding future advice to the patient and criteria for re-referral if appropriate. Patients will be offered the opportunity to be sent a copy of this letter. Following discharge each patient will be sent a satisfaction questionnaire. The feedback received via the return of these questionnaires will be captured and used to inform future service improvement. 3.8 Response time and prioritisation The maximum time from referral to treatment for the continence services will be 18 weeks, with the exception of Urodynamics Investigations, which as a diagnostic test must be complete within 6 weeks of referral. Details of how the long the waiting time is likely to be should be available on the provider s website and in other appropriate published information. 4. Other The Bladder and Bowel Specialist Service will take all appropriate opportunities to provide information and advice to service users and their carers regarding prevention of incontinence and living well with continence problems. The provider s website should include or provide links to appropriate information for the public. The service should act as a resource for health and social care staff to access information and advice to assist with holistic care planning for service users. Nurse consultants employed by the provider in respect of this service will be made available to the commissioner, via a separate service agreement, to provide clinical and specialist advice on service improvement and commissioning issues 5. Quality Requirements Performance Indicator Indicator Threshold Method of Measurement Service User experience Service User Experience Measurement As part of the to be provider undertaken as programme to part of the be agreed provider with the programme to commissioner. be agreed with Survey the commissioner. Access Access New patients seen and treated within 18 weeks of referral Urodynamic Testing completed within 6 weeks of referral 95% 95% Monthly Routine service data system Routine service data system Consequence Breach of

34 If required, relevant Quality Requirements from Section 3 Part 1 of Module B can be inserted here although these will apply to the Services even if not listed here. 6. Activity See activity plan 7. Prices and Costs 7.1 Price If required, relevant Prices may be inserted below Basis of Contract Total Unit of Measurement Price Thresholds Expected Annual Contract Value (for this service)

35 Appendix - FOI

36 Objectives: GP Prescribing Quality Scheme To support delivery of the identified Medicines Optimisation initiatives, and drive costeffective prescribing. 2. To balance the requirement to deliver savings with a requirement to recognise the quality of prescribing. 3. To offer achievable incentives to all practices, and be as transparent and as easy to understand as possible. Prescribing Quality and Savings Action Savings Achievement: Practices to implement a savings plan to achieve a savings target based on potential switches and projects (Eclipse) discussed at Practice Visits Antibiotic Prescribing for Upper Respiratory Tract Infections (URTIs) Diabetes and Frailty Polypharmacy strategy- implementation of one focus project e.g. HARMs Anticholinergic load Benzodiazepine review Bisphosphonate Review PPI review URTI toolkit docx Managing Type 2 Diabetes in Frailty Polypharmacy Strategy Final version Polypharmacy Strategy Review Repo GPPQS Payment Up to 25p per registered patient 10p per registered patient 15p per registered patient 10p per registered patient Practice Elements- Prescribing Budget 2015/16 Prescribing Outturn v Budget GPPQS Payment 0 2% Underspent 10p per registered patient 2 4% Underspent 20p per registered patient 4 6% Underspent 30p per registered patient 6 8% Underspent 40p per registered patient 8 10% Underspent 50p per registered patient 10 12% Underspent 60p per registered patient 12 14% Underspent 70p per registered patient 14 16% Underspent 80p per registered patient 16 18% Underspent 90p per registered patient >18% Underspent 100p per registered patient Locality Element - Prescribing Cost Growth Growth Rate (year to Mar 16) GPPQS Payment % Below England Rate 10p per registered patient % Below England Rate 20p per registered patient % Below England Rate 30p per registered patient % Below England Rate 40p per registered patient % Below England Rate 50p per registered patient % Below England Rate 60p per registered patient Kernow Clinical Commissioning Group