Primary Care and Community Services Delivery Unit Hilary Dover, Director, Primary Care and Community Services Vicky Warner, Nurse Director, Primary Care and Community Services Debra Rees, Quality Safety and Improvement Manager, Primary Care and Community Services HD
Our Portfolio Clusters (x5) GMS (Inc Primary Care Estates) Clusters (x6) GMS(Inc Primary Care Estates) District Nursing Long Term Care/ Continuing Health Care Community Resource Services District Nursing Long Term Care/ Continuing Health Care Community Resource Services District Nursing Long Term Care Continuing Health Care Community Resource Services Community Hospital & Clinics Community Hospital & Clinics Prison Prison GP Out Of Hours Eye Healthcare Community Pharmacy Oral Healthcare (including Restorative Dentistry in the process of transferring over) Public Health Nursing Sexual Health Audiology Speech and Language Therapy Podiatry Orthotics Musculoskeletal Clinical Assessment Service Chronic Pain Cardiac Rehabilitation, Cardiology and Heart Failure HD
Governance and Assurance Primary Care & Community Services Board Quality and Safety Primary Care Workforce Children & Young People Primary Care and Community Services Healthcare Standards Assurance Mechanisms Management Board & Quality and Safety Group Performance Scorecard Primary Care Visiting Programme Primary Care Clinical Governance Self Assessment Post payment verification audit programme HIW inspections Community Health Council Access Surveys Complaints and Incidents Risk Register Out of Hours Performance Scorecard Dental Dashboard Regional Quality Framework for Care Homes Friends and Family/SNAP 11 Fundamentals of Care Audit HD
Health and Care Standards Quality, Safety, Improvement and Patient Experience Group - culture and structure Ongoing self assessment integral to governance Dynamic improvement plan Board papers aligned to Health and Care Standards Team Brief HD
Staying Healthy: Healthier Communities Information from 1 st quarter 20 Uptake of Vaccinations & Immunisations (Childhood) Target 95% 4 in 1 pre school booster (at age 4) 89.4% 2 nd MMR dose (at age 4) 91.2% % uptake Hib/Meningitis C booster (at age 4) 94.2% 94.2% % of children who received scheduled vaccinations 86.6% Next report due November 20 Information from October 20 statement Uptake of Influenza Vaccinations Target 75% Uptake of Influenza vaccine 65 & over 64.3% Uptake of Influenza vaccination- under 65 in at risk groups 43.3% HD
Staying Healthy Healthy Communities Reducing Smoking Rates ABMU/national smoking cessation target = 5%; with 40% quitting at 4 weeks Stop Smoking Wales aims to achieve 2.2% of target; 1.8% from hospitals and level 3 pharmacy Achievement to Sept 20 = 1.3% (improved from 0.5% Sept 2015) But 4 week quit rate target met and exceeded: 44% Smoking Cessation Target Recovery Plan in development for presentation to Board in January HD
Safe Care Risks and Incidents Risk Register Red Risks GP sustainability Whole System Fragility Demand and Capacity for Speech and Language (paediatric service) Local development plans & population growth Finance Supervisory Body Function for Deprivation of Liberty Safeguards Top 5 themes for Incidents of harm Pressure ulcers Not Health Board Acquired Health Board Acquired Medication Behaviour (including violence and aggression) Patient Falls Communication VW
Safe Care Preventing Pressure Damage 35 30 Pressure Ulcers Not Health Board Acquired Gorseinon Hospital joined Primary Care and Community Services 25 Datix codes 20 15 Negligible Minor Moderate Major 10 5 0 Oct 2015 Nov 2015 Dec 2015 Jan 20 Feb 20 Mar 20 Apr 20 May 20 Jun 20 Jul 20 Aug 20 Sep 20 Oct 20 VW
Safer Care Preventing Pressure Damage 50 Pressure Ulcers Developed in Health Board Care Gorseinon Hospital joined Primary Care and Community Services 45 40 35 30 25 20 15 Negligible Minor Moderate Major 10 5 0 Oct 2015 Nov 2015 Dec 2015 Jan 20 Feb 20 Mar 20 Apr 20 May 20 Jun 20 Jul 20 Aug 20 Sep 20 Oct 20 VW
Safe Care Preventing Pressure Damage Standardised reports across the Delivery Unit including Action Plans for identified themes/issues App developed to support staff in the prevention and management of pressure ulcers Development of a Nursing and Community Services Quality and Safety Group to share and learn from best practice Pressure Ulcer scrutiny with teams 3000 leaflets on pressure ulcer prevention/awareness delivered to Swansea District Nursing Service to provide pressure ulcer advise leaflet to patients with the skin bundle to promote independence and management VW
Safe Care Medication Safety Never Events No HB Never Events regarding Medicines Management Allergy Status No incidents reported Missed/Omitted Dose Controlled drug incidents 41 Missed/Omitted Dose (12 month period) 79 involving Community Pharmacies (12 month period) VW
Safe Care Behaviour - Violence & Aggression to our staff 20 Behaviour (including violence & aggression) by Date of Incident (Month and year) and Severity 18 14 12 10 8 Negligible No Harm Minor Moderate 6 4 2 0 Oct 2015 Nov 2015 Dec 2015 Jan 20 Feb 20 Mar 20 Apr 20 May 20 Jun 20 Jul 20 Aug 20 Sep 20 Oct 20 VW
Safe Care Falls Community Hospitals 12 Patient Falls - Maesteg and Gorseinon Community Hospitals 10 No falls resulting in major harm over 12 months 8 6 4 Negligible No Harm Minor Moderate 2 0 Oct 2015 Nov 2015 Dec 2015 Jan 20 Feb 20 Mar 20 Apr 20 May 20 Jun 20 Jul 20 Aug 20 Sep 20 Oct 20 VW
Safe Care Infection Prevention and Control: Big Fight Campaign Antibiotic Prescribing in Primary care On track to deliver 2 Key Welsh Delivery Agreement targets: A reduction in variation of overall antibacterial prescribing in primary care across ABMU HB between December quarter 20 vs December quarter 2015 Variation in prescribing quarters ending June 15 versus June A reduction in overall antibacterial prescribing in primary care across ABMU HB by at least 1 percentage point better than the Welsh national average trend (December quarter 20 vs December quarter 2015) Percentage annual change in prescribing rates of antibacterials Round 2 Changing Social Norms Just in case to Only when needed Big Fight Event November 9th 20 European Antibiotic Awareness Day November 18 th Participation from 75% of GP practices 30 practices provided additional support from the Big Fight team member VW
Safe Care Infection Prevention and Control INFECTION CONTROL Number of healthcare attributed cases of Clostridium Difficile Number of healthcare attributed cases of Staph.Aueurs bacteraemia (MRSA & MSSA combined) Target 0 Oct- 15 Nov- 15 Dec- 15 Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- 9 3 4 2 2 6 3 3 6 7 5 6 4 2 8 4 7 7 9 5 2 3 11 9 10 9 Sep- Oct- Basis of Data Community Total Clean Hands Hand Hygiene Auditscompliance with WHO 5 moments INFECTION CONTROL Number of cases of Clostridium Difficile % Compliance with Infection Control Spot Audit Target Oct-15 Nov-15 Dec-15 Jan- Feb- 100% 92.31% 92.86% 100.0% 100.0% 100.0% Mar- 83.33 % Apr- 100.0 % May- Jun- Jul- Aug- Sep- Oct- 100.0% 47.8% 76.5% 85.7% 57.1% 93.8% 0 0 0 0 0 0 0 0 0 0 0 0 0 0 95% 91.76% 95.22% 95.44% 92.39% 95.52% 90.58 % 94.59 % VW 96.52% 90.50 % 93.19% 90.91% 86.36% 92.62% Basis of Data Maesteg and Gorseinon Hospitals Maesteg Hospital
Timely Care Primary Care Access Information from October Performance Report 88% of GP Practices open during daily core hours or within 1 hour of daily core hours target 88% (target met) 81% of GP practices offering daily appointments from 17.00-18.30 hours for 2 week days target 95%, but we have improved on last years position 62.3% of patients received care or treatment from NHS Dentist (once in the last 24months as a % of the population) - target 63% Referral to treatment waiting times Integrated Sexual Health RTT met consistently Pain management 100% RTT met since March Therapy and Health Science waiting times (>14 wks) Audiology Podiatry = 0 (Target met) = 0 (Target met) Speech & Language = 8 (Target not met) HD
Dignified Care Learning from Concerns and Compliments Improved dental out of hours model Reflection with teams regarding communication Documentation audit Review of case handover procedures Complaints workshop for Primary Care Patient Stories to Quality and Safety Process map for complaints handling HD
Patient Experience We have improved tools for gathering patient experience We are piloting Friends and Family test (SNAP 11) in one GP cluster and in District Nursing Our staff are being trained in taking patient stories We are implementing our plan to increase provision of services through the medium of Welsh Regional quality framework for Nursing Homes Testing friends and family in dental services Podiatry spot check in Podiatry and Orthotics Musculoskeletal Clinical Assessment Service HD
HD Our Community and Our Staff
Looking Forward Systematic use of data and information Analysis of trends and themes resulting in service improvement Consolidate and grow our Healthcare Standards Improvement Plan Develop new tools for outcome measurement to demonstrate improvement Patient experience and patient safety report Focus on primary care and nursing homes HD