Minutes: Transformational Redesign Group

Transcription

1 : Transformational Redesign Group Date Wednesday 9 th July 2014 Time Venue 15 Marylebone Road, 5 th Floor, Room 5.3 Present Dominique Kleyn DK Patient User Panel Eva Hrobonova EH Public Health, WCC Jacqueline Glasser JG Patient User Panel Jessica Brittin JB NWL CSU Matthew Bazeley MB CLCCG Neville Purssell NP Chair, GP, CL CCG In attendance Cariad Gurden (minutes) CG CL CCG Alison Miller AM CL CCG Alison O Grady AOG CL CCG Alyson Hope AH CLCCG Emma Coore EC GP, CLCCG Gordon Hunting GH CLCCG Helena Stokes HS CLCCG Jason Nash JN CLCCG Kiran Chauhan KC CL CCG Lily Megaw LM CL CCG Louise Maille LM NWL CSU Marina Muirhead MM CL CCG Mark Jarvis MJ CLCCG Mona Hayat MH CLCCG Nancy Maduakoh NMa CLCCG Noel Marrow NM Joint Commissioner,Vulnerable Adults, NWL CSU Rosalyn King RK CL CCG Sheila Neogi SN GP, CLCCG Siobhan Herron SH CL CCG 1

2 Apologies Andy Goodstone AG GP,CLCCG Denise Johnson DJ Practice Nurse, CLCCG Maher Shakarchi MS GP,CLCCG Mona Vaidya MV GP,CLCCG Minutes 1.0 Apologies for absence The apologies were made for absentees (see above). 2.0 Declarations of interest NP declared his interest in the meeting as a provider of GP services including PRS, A Community interest company. 3.0 Agree Minutes from the Previous Meeting The minutes from the previous meeting were agreed, with 2 amendments: 4.0 Action 0269: FMP should read F&P 4.0 Action 0315 : Complimentary should read Complementary CG 4.0 Action Log 4.1 to close: 0247, 0268, 0314, 0315, 0316, to amend: 0246 RK would also like to be involved in the work plan LS to give update on Children s Care at next TRG. Children s update next month. RK LS /RK 5.0 PRS/PCP Re procurement 5.1 MH introduced the paper which outlined the re-procurement options for the PRS. AOG/MH were seeking: Confirmation that the options presented were correct Amendments or additions that the TRG felt were needed. The process following this would be submission to the Investment committee who would advise on the preferred option before submission to the Governing Body. AOG stated that the current patient referral service was out of contract and needed to be reprocured. She reminded the group of the objectives in setting up the PRS: To support in booking referrals To influence GP behaviour in referral process To reduce inappropriate referrals The current system was costing 800,000 overall with 40,000 referrals processed. This was a 20 per unit cost. 2

3 Minutes The options for reprocurement currently under discussion were: 1. Decommission. GP s would revert to arrangements in place prior to This would give savings but not support GPs around making appointments. The current view of service usage data would be lost (but could improve community service info) 2. Re-commission service similar to the current service. This would have the same approach to triage. Would not deliver savings or meet evolving context of health system, could disengage those GPs who were already bypassing the system. It would facilitate service continuity with minimum disruption, and real time data would still be available. 3. A revised model. Support and feedback provided to GPs through clinical audit and increased feedback with reduced clinical triage (this would offer some real time data and divert some referrals). This would be more cost effective and meet needs of evolving health landscape as there would be capacity to provide the latest information on pathways and services to GPs. Has capacity to tackle non referring practices. Additionally aligns with best practice report (Kings College) May cause disruption in implementation period. 4. A Revised model option 2 This would be similar to option 3 but without any clinical triage element. Large cost savings but with potential risk. Discussion SN felt that PRS had standardised where GPs referred to, but that the service would now need to develop due to the changes WSIC would bring about. The PRS would need to adapt to new and increased referral pathways. The PRS must have the capacity to direct to the correct service. The system needed to reduce delay to the referral process and ensure the correct information was being used in the booking process. SN proposed that further work was done to refine Option 3 to align with CCG strategy around patient needs. EH asked if there was any patient expression of current services or feedback regarding what improvements/changes? GH felt it was important that the patient/ GP discussion was thorough so that the correct decision was reached. Option 3 could present opportunity for this dialogue if managed correctly. GH also highlighted the lack of sound evaluation in relation to PRS. He felt the independent evaluation undertaken did not provide costs or outcomes and did not give sound guidance for further actions. RK stated that the CCG should be ambitious in its plans of how PRS could work with WSIC to provide strong redirection support and clever triaging. She felt if the PRS could be cost neutral it would still be worth having. Addressing non use of PRS JB suggested that a way to tackle non users of PRS may be to require only PRS referrals within community contracts. Another way to tackle could be to adopt a model similar to ChelWest to stop consultant to consultant referrals. PCP It was felt by the group that the link between PCP and PRS needed re-evaluation. Some of the 3

4 options discussed for PRS would support PCP more than others. An additional option could be to include PCP PRS within WSIC rather than procuring out to new providers. This would involve an interim maintenance of the service with the current provider followed by transference to the new PRS service with the WSIC provider in future. This would give parity of esteem with physical health to the PCP service. 5.6 There was discussion from EC and SN regarding how effective this would be. EC felt that as PCP had many external parties to deal with it needed to be a strongly coherent service and was best dealt with under one mental health team. PCP was moving to SystmOne and this was a different IT system to the PRS booking service. SN added that the PCP service needed to crystallise and be recognised as a system that effectively referred patients on and responded quickly. In the past there had been issues using CRM. As SystmOne came online the process would become more fluid and speedy. There was a risk that WSIC would not complete. If this occurred it was felt the original option 3 could be returned to with PRS being re-procured to a provider. NP felt that it was not possible to recommend such a large decision For Mental health at this point but that he would support EC to raise these issues further and seek solutions. Action 0351 Option 3 work to be done to link more to WSIC. Non users of PRS to be addressed. The PRS needed to be clear in its clinical triage elements and not undermine original referrals. The system needed to evolve and be more interactive with GP / Patient. The financial model must be correct to lower unit cost as it was unaffordable at present. NP warned that removing all clinical triage runs a large risk. AOG Action 0352 PCP to be readdressed as to how it sits within PRS as currently not working well. Evidence of patient view on holistic health must be considered in relation to this also. 6.0 Planned Care Procurement 6.1 MH provided an update to the planned care procurement regarding current developments, governance, patient engagement and key issues arising. KC /EC Planned Care Procurement was on track for timescales in most cases. There was a delay to PRS implementation (as per item 5.0) Dermatology had also been delayed. The CLCCG was now the host body for all 9 areas of planned care procurements. The governance structure was in place for all 9 procurements which all had steering groups in place that feed into the tri borough board. This in turn would feed into the FPC and Governing body. Patient engagement advances had been the recent Your Say Consultation document. There was a delay to process mapping for the integrated impact assessment. The key issues currently effecting the Planned Care Procurement were: The Procurement model currently at PAG: a compressed model to be discussed with joint procurement CCGs 4

5 6.2 Dermatology delays as cited in paper. South borough MSK contract cessation. The provider did not want to continue and had been refused a tariff increase. A contingency was being set in place: the provider for the north area would oversee the south until the contract was re awarded. Wheelchairs: A project review was underway. The project would be paused for 4 weeks and would reopen with the appropriate structures and systems in place. There were currently no patient representatives for the upcoming bidder event, however this would be arranged for the following event. 7.0 Homeless Intermediate Care 7.1 SH gave background on two services currently involved in the provision for Homeless Health. These had received funding from the Department of Health to run services. She was providing an update on them and seeking a recommendation on how to proceed with Intermediate Care. Service1: The Passage The Passage project to provide service began in Nov 2013 and was establishing pathways and training with Acute services. The Passage had funding to continue until the end of November. Service 2: St. Mungo s. This provider had had more issues. It had recently completed refurbishment for care beds but had no clinical provision in place. Finance issues had developed from the overrun of the refurbishment and St Mungo s were looking to the CCG for shortfall funding. St Mungo s are planning to charge for the care beds and the legality of this was felt to be questionable. There was no agreed start date for clinical provision. 7.2 There was a long term plan to embed the specialist nurses required for homeless health into planned care, but an interim was also required. An option discussed was to extend The Passage funding to bring it in line with the expiration of the St Mungo s contract. This would mean there was some coverage for this care at this time. The CCG could then procure its own service for the total area going forward. The funding for the Passage had been 178,000 for running costs for the year. This would be a rough estimate of the cost to re-fund. A cost model was needed to give more accurate information. The risk of not providing further funding would be that service users in the category would more frequently visit and spend longer in hospital. There may also be an increase in morbidity. There had been no service prior to this pilot so there would be no actual increase in risk but it would fail to tackle a long standing issue/gap in provision. Action Work to be undertaken to prepare recommendation to FPC on providing additional funding for The Passage service. 8.0 Wellwatch RK 5

6 Minutes SH updated the group regarding Wellwatch with particular regard to the recent evaluation of this service. She sought a recommendation from the TRG in regards to the future of this service and whether further procurement would be sought. WW Evaluation Issues SH informed the group that Wellwatch was contracted to March Ww had been tailored and amended to create a suitable service but data had been difficult to capture and use for evaluation of the service. This was due to a transition from the CRM system, where the categorisation of patient data by Ww intervention start date had been lost so that the data was currently of little use for analysing patient hospital activity pre and post Ww intervention. Ww are trying to work back and get info for DMIC. Changes to data laws had also prevented the use of risk stratification tool and, thereby, limited the data we have available. Survey responses had been low and so was not robust/statistically relevant. There was not a consistent management of the service and a Care Plan definition had not been in place from the inception of the project so data regarding care plans was not correctly accounted. The Evaluation process had been difficult, therefore, however a decision was required at this point to allow time for a procurement window, if needed. GH emphasised the importance of learning around the Evaluation, so that this process would be improved. Evaluations needed to look clearly at finances, to be external and independent. Findings must be meaningful. A definition of a Care plan was needed. The future of Ww was questioned, given that WSIC will be managing LTC patients going forward. Ww Care Plans A positive from Ww was that care plans for complex patients were now generally in place and could fit with the development of WSIC which would also create care plans as part of its system of working. As a first stage of roll out, WSIC could potentially take over the work and care plans from Ww using SystmOne as the IT support system. This would create a standardised, embedded system for care planning. There was an April deadline for WSIC to take over care for the most vulnerable section of patients. RK felt that the DES could be used as a vehicle to pre-empt WSIC prior to April. If WSIC did not come to fruition there would still be the DES and the village-based system in place. EH was to inquire after H & F data. Recommendation NP Recommended that Ww be decommissioned and work for care planning be absorbed into WSIC via DES whilst funding was still available over this year. Additionally he felt it would be beneficial to look at the positive aspects of Ww from evaluation and ensure that these were being transferred into the WSIC system. EH 8.5 Action 0353 RK to take recommendation not to commission to Governing Body in Sept. 9.0 Community Independence Service 9.1 AM briefly updated the group on this fast moving programme: CCG Chairs have confirmed in principle that the single integrated specification should be agreed across commissioning organisations by 31 August It is intended that CCG Governing Bodies and Local Authorities will authorise the business case in September, along with detailed commissioning intentions The period from September 2013 March 2014 will then be used for transition and implementation follow through RK 6

7 Work is in progress to: Develop the business case Continue to develop the depth of understanding of current services and also examples outside Triborough Extend stakeholder engagement, particularly to broaden clinical input Continue to understand and integrate with the wider context of other programmes, particularly Whole Systems and Customer Journey Define the programme of work through to service transformation, particularly the important period from August to October that will require iterative development and preparation for service change in April AM welcomed feedback from stakeholders on the emerging CIS model Whole Systems 10.1 MM discussed updates to the WSIC project. Since the WSIC panel the WSIC team had started to focus in on the detail of how the system would run (looking at the who, what, where, when) and to look at capitation and costing. Mental health was being more strongly included within the model. They were looking at community capital and how this could be used. In terms of governance, the steering group remained and five task groups had been set up to convene weekly until September, with the intent to commission by October This would be prior to a full business case being ready due to data warehouse delay issues, so there would be no large scale costing available. The business case would be available in December 2014, with contracting beginning in January Not all CCG s were anticipated to be ready to commission in October but it was felt that the CLCCG would be ready and that a strong engagement process was continuing with this project. MM appealed for the group to identify useful contacts for this project to MM. DK asked for clarification of contingency. What would happen if the model from Mackenzies / data warehouse did not become available after they had already put out an intention to commission? MM told the group that the service would roll out as a shadow service for the 1 st year, where costs were tracked in shadow form and this would act as a safety net should such a situation arise Action 0356 MM would present back to the group with more detail on structures, risk benefits etc. at the next TRG. She could produce a written report for this and would bring commissioning intentions to the TRG prior to October EOLC NM and LM introduced the paper which discussed the current provision and options for future design of services and pathways for EOLC. The Paper gave a broad view of the current providers and commissioning and three options for the future of the service. The presenters sought guidance/recommendations regarding how the service would be developed going forwards. Current provision Currently the CLCCG were contracting and commissioning 4 hospices and specialist community arrangements. Although there was no change in overall mortality trends, there was growing demand on community/hospice providers. The CLCCG was unique in its commissioning of 4 hospices, which was high, but it did use less care homes service. It had 6 contracts for palliative care. An archaic commissioning system was in place due to a continued use of old geographical location boundaries. The service would therefore benefit from analysis and potential change. 7 MM

8 11.3 There were 3 options set out in the paper: 1. No change to service. This was not recommended as it would not meet ongoing need. A Joint strategy needs assessment and Capacity plan were needed to look at more detail at what service was needed going forward 2. Interim measures. A reduction to the two main hospice providers, as the other two providers have contracts for a very small number of beds. To look at capacity planning going forwards. Other small changes could be made to streamline the service. For example Market testing small areas of provision for savingswhich could then be reinvested into additional palliative care services. 3. Complete re-tender process. This would involve a full palliative care report, to create a model and test out within the market place. It could prove more expensive to go to tender in the long term as Hospice treatment was often heavily subsidised by charitable means and the total cost of the care was not currently known / declared by providers. Discussion NP highlighted the need for further cost analysis before any work to make major changes to the system could take place DK felt that from a patient perspective to have more hospices / locations available was preferable to reducing to two sites. She felt more cover of the patient view was needed in this work. RK highlighted a recent report by Marie which identified the CLCCG EOLC as a good service. The main issue currently identified was that hospital admissions in this area do not tend to be released and end up dying in hospital rather than their preferred location. RK did feel that the service was somewhat disjointed / fragmented and would not meet future demands. She felt that, currently, work in this area needed to address service gaps / issues such as above. NP questioned whether this was a major issue/ failing in provision. It was agreed that greater provision for a rapid response palliative service may be required and that there was an issue with identifying patients in hospital who were suitable for this service and getting them onto wait lists for palliative beds. Was this a gap in provision or an issue with transfer? LM felt that perhaps such patients could be diverted from A&E pathways to hospices and could receive the medical interventions they needed there? There was an increased demand from Hospices to care for patients with complex conditions. It would therefore be beneficial to look at all care pathways into this service. Care planning in this period was also crucial. It should be thorough and be monitored for changes with input from all parties including the GP etc. Action 0354 NP recommended that further work was undertaken on cost risks before suggesting large changes. Work to streamline pathways from acute to community / hospice should occur to ensure these pathways take place and that care planning is thorough. EOLC should evolve towards an Overhaul of provision. He did not feel it necessary, currently to move to 2 hospice providers, as capacity was still need. A timescale of 3 months was suggested RK 8

9 12.0 Right Choice First Time Due to time constraints HS agreed to send a written update by regarding this item Any Other Business It was suggested that the issue of being Quorate should be addressed, through inviting new GP members or changing requirement levels for the group Meeting Closed The meeting was declared closed. 9