Rural Locality Network Meeting

Rural Locality Network Meeting 2-5pm on Tuesday 10 th February 2015 at Cheshire View, Chester Attendants: [Attachment] In attendance Jenny Dodd Colin McGuffie Assistant Chief Officer West Cheshire CCG Locality Support Manager, Rural Apologies Linda Duffin Trevor Ferigno Debbie Bailey Rajesh Rajan Chris Ashbrooke Phillip Milner Louise Davies Sarah Murray Rob Nolan GP, Farndon Health Centre Practice Manager, Farndon Health Centre Practice Manager, Bunbury Medical Practice GP, Frodsham Medical Practice Practice Manager, Frodsham Medical Practice GP, Rookery Surgery, Tattenhall GP, Laurel Bank Surgery, Malpas Primary Care Programme Lead West Cheshire CCG Director of Contracts and Performance Practices not represented by a GP: Frodsham Medical Practice, The Rookery Key Points to Communicate to your Practice The two week wait referral process is being reviewed. The aim is to improve the quality of care for patients by improving earlier diagnosis and therefore improve survival rates. The changes will also see an improvement in compliance with 62 day targets Practices are urged to work together when formulating proposals for capital bids. A working party has been formed to discuss the changes in approach for the Primary care CQUIN for 2015/16. Any questions can be addressed to Tanya Jefcoate-Malam. Ian Butterworth to investigate the tenancy arrangements for rooms within the Tarporley, Princeway and Helsby practices. Actions: Jamaila Tausif to ask East Cheshire Trust to set up a series of meetings with Rural GPs. Jamaila Tausif to forward details about the Turning Point communication plan to be published through the ebulletin. Jamaila Tausif to send electronic versions of referral form and contact details to Colin Colin McGuffie to get a group email list of GPs to provide to Turning Point. Paula Taylor to look in to DNA rates for two week wait referrals. 1

1 Welcome and Introductions Jenny Dodd in place of Rob Nolan; Richard Henney representing Laurel Bank Surgery; Melissa Siddorn representing Farndon Health Centre The group expressed their disappointment at the cancellation of the January meeting due to pressure on the wider system. As the Ellesmere Port and Neston and the City network meetings went ahead it was felt that the group had missed out to some degree. 2. Apologies for absence Linda Duffin Trevor Ferrigno Debbie Bailey Rajesh Rajan Chris Ashbrooke Phillip Milner Louise Davies Sarah Murray Rob Nolan 3. Declarations of interest No new interests were declared. 4. Cancer Update Paula Taylor, commissioning manager for cancer gave Dr Rachel Warner s apologies. Paula then gave an update on current work around improving cancer diagnosis. Paula said that there are on average 580 two week wait referrals per month across West Cheshire. Around 10% of these will be diagnosed with cancer. This makes up around half of the cancer diagnoses with the remaining half either being diagnosed as a result of screening, via another managed referral route or via emergency presentation. Paula Taylor, commissioning manager, West Cheshire CCG The CCG rate of new cancer cases has risen over the last 5 years to 573 per 100, 000 population. The number of cancer survivors is also increasing, leading to increasing pressures on the system. The Countess of Chester Hospital has seen increased pressure around the 62 day target over the last year, citing amongst others, increasing demand and quality of referrals as some of the difficulties they are facing. As a result, Paula and Rachel are reviewing the two week wait referral process. The aim is to improve the quality of care for patients by improving earlier diagnosis and therefore improve survival rates. The changes will also see an improvement in compliance with 62 day targets. The key changes are: New paragraph at the top of all forms for the GP to make the patient aware of: what s going to happen next and that the patient may go straight for a diagnostic test. Assurance of appropriate counselling: the GPs has made the patient aware of why they are being referred and that it is to rule out cancer, 2

that they have given the patient the information leaflet and patient availability is checked. Some additional tumour site specific information requested to enable quicker diagnosis and so secondary care have all the information they need. A discussion followed around the review and more wider issues on cancer. The main points are summarised below. Steve Pomfret said that there needs to be a balance between the benefits of increasing the early diagnosis of cancer and need to simply refer more patients to meet guidelines. Paula said that the new guidance suggests that more patients will be referred under the new pathway. Alistair Adey asked if the did not attend (DNA) rates for two week wait referrals were different than rates for general appointments. The group agreed that they would be happy to support the hospital by chasing patients on the day if required. ACTION: Paula Taylor to look in to DNA rates for two week wait referrals. Steve Pomfret suggested that the form needed some way to highlight that a patient has a cancer and be seen, even though they may not fulfil the strict criteria for the two week wait referral. Helen Black raised an issue around the new Be Clear on Cancer Campaign. She said that the new campaign was likely to produce a significant increase in the number of patients presenting with cancer related symptoms. Paula agreed and said that the hospital had added an extra two gastroscopy clinics each week to respond to any increased demand. Steve Pomfret thanked Paula for her presentation. 5. NHS Property Services Steve Pomfret welcomed Ian Butterworth to the meeting and explained the context to the invitation. He said that practices have suffered in recent years in terms of local housing developments not building in health improvements to their bid. As a result practices have seen increased patient lists and further pressure on their premises to meet that demand. Steve asked if Ian could provide advice on how practices can influence or inform planning decisions, or get support from the local authority and developers. Ian Butterworth, Regional Programme Manager, NHS Property Services Ltd Ian gave some background to NHS Property Services and the role that they play. Part of that role is to support NHS England on section 106 applications. These agreements are legal agreements between a planning authority and a developer, which ensure that certain extra works related to a development are undertaken. This could include building work to extend practices, or financial support to recruit additional GP capacity. 3

Ian explained that there is a calculation that is used for section 106 applications. However, he felt that some NHS local area teams are not applying it properly because of the administrative work involved. NHS Property Service has agreed with the local authority that the NHS England calculation will be applied to any development over 100 houses. Therefore, as long as the work is done, practices should see some form of financial support. Ian suggested that if practices knew of any development plans that had been approved but that the practices had not been informed of the section106 implications, then they should feed back to him or Tom Britcliffe. Tom explained that Health can sometimes be a lower priority than schools, roads etc. in some developments. He said that It can be difficult to get financial support from the planners and the local authority. He also explained that any money only be drawn down from local authority, and then from NHS England once full planning is approved. Lynn Suckley told Ian that in relation to developments in Malpas, that the local authority offered money to support Health issues to NHS England, but that offer was declined. Lynn was concerned about why NHS England would not accept that money and build it in to funding for development of primary care in the affected areas. Ian agreed to discuss that specific issue with Glen Coleman and feed back to the group. Steve Pomfret expressed his concern that there seems to be no clear correlation between the demand from new developments and the ongoing funding for revenue funding, never mind capital funding for expansion to meet that demand. Ian explained that the local area team can apply for capital grants under certain criteria that practices can benefit from. There is a process for practices to apply under the 'premises direction' for expansion, for example. NHS England has written to all GP practices about the current capital infrastructure scheme. The scheme provides 1 billion over the next 4 years for funding primary care expansion. Around one third of it is for capital funding, the rest is revenue funding. The local Area teams are currently setting up panels to review the applications. Sam Jeffery asked whether there is a plan in place that projects will be assessed against, or will it be a first to apply basis? 4

Ian responded that NHS Property Services has provided technical support so that local area team can be strategic about the allocation of this funding. There is no primary care estates strategy at the minute, but Ian is helping some area teams develop theirs. If West Cheshire CCG opted for tier 3 cocommissioning, they would be responsible for the estates strategy. Otherwise the CCG and NHS England will need to discuss the CCG s commissioning needs and establish how estates fits in to that plan. NHS Property Services are capable of mapping the estates against what the services CCGs want to deliver. Ian explained that they would be able do this for West Cheshire. Glen Coleman chairs the Estates Group and should be the main contact for discussion, as funding grants are discussed at that group. Jenny Dodd said that the CCG would want to do this in conjunction with the local area team, developing a clear plan of what services we want to offer, where from. West Cheshire CCG want to be strategic and respond to need across the footprint rather than to each individual practice application for support. Lynn Suckley and Sam Jeffery supported the need to respond collectively. It is felt that individual practices are too small to be heard. Instead, they suggested responding as a locality to area team. This would highlight that there is work that needs to be done in the Rural area to map the services and identify what support practices need. The group then raised an issue that a number of practices had encountered with NHS England staff entering their premises to assess their viability to offer sexual health clinics there. There is an assumption that these buildings are NHS England properties, but they are owned by the GPs or at least occupied under head lease arrangements. Ian agreed to investigate what the status of tenant/sublet arrangements are for Tarporley, Princeway and Helsby and the feed back to the group. He also agreed to look in to the issue of East Cheshire Trust/NHS England acting unprofessionally on these visits and identify exactly who had visited the practices. ACTION: Ian Butterworth to investigate the tenancy arrangements for rooms within the Tarporley, Princeway and Helsby practices. 6. Primary Care CQUIN Update Tanya Jefcoate-Malam came to the meeting to give a progress update, to Tanya Jefcoate- Malam 5

get some feedback from the group and let practices know how they can continue to be part of the process. Feedback from practices and the Clinical Commissioning Group indicated the current process didn t essentially increase patient care, was bureaucratic and became a tick list in order to meet targets and receive incentives. The new process aims to achieve a more stream lined approach and pay out based on making a difference to patients and also aims to align with secondary and community CQUIN in full schemes. Last week a working party met to discuss the changes in approach and a hybrid scheme. The Clinical Commissioning Group are aware that it will take time to achieve these outcomes and an idea is to frontload in terms of financial incentives. For example in the first quarter frontload money for over 75 s. The outcomes and how these are measured are still to be confirmed. We would like practices to work together in clusters which will allow for better use of the money for meeting the demographic needs of the patients. Practices agreed they would like funding to be given to individual practices and an option to join and work at a cluster level but was not compulsory. The group wanted to make it clear that they wanted the funding streams to stay the same until there was an agreement for change. There will be a draft specification drawn up after consultation period, approved by the steering group and then circulated to practices for their feedback. In summary, the group welcome the funding streams and the front loading aspect. There remained a question about the nursing home LES being included. Funding would like to be at a practice level and there needs to be incentives to work as a cluster. Tanya will come back to the GP network meeting in March with the new process being launched from April 1st. In the meantime practices can email or call Tanya if you have any feedback or concerns, Tanya is more than happy to come out and visit practices. Helen Black thanked Tanya on behalf of the group for her hard work and effort to explain the process clearly. 7. Sexual Health Service Update Steve introduced Sarah and Jamaila and set the context for the presentation, highlighting the issues and concerns the group have around the change of provider. Sarah set out what the services are and who is now providing it. She Sarah Marshall (Commissioning Officer) Jamaila Tausif (Senior Manager Strategic 6

explained that the new provider, Turning Point will communicate details around staff involved to practices. Any queries can be referred to Jason Car at Jason.Carr@turning-point.co.uk Several practices fed back their recent experience of having Turning Point staff arrive at their premises unannounced to view the site for delivery of Sexual Health services. The practices explained that here was no understanding of the fact that the property was owned by the GP practices, or had special noncompetition clauses in their lease. It all appeared a little unprofessional and uninformed. Apart from the issue of the behaviour and lack of understanding from those visiting the premises, the group were concerned about the possible impact on GP skill for sexual health procedures if services were set up in direct competition to the GP services. Jamaila responded by stressing the need to move forward and work together in partnership to improve services together. Sam Jeffery Expressed concern that the new providers seem unwilling to meet and work together to form those good relationships. Jamaila said that it is important that as commissioners, her team needed to meet with the practices and provider in the first instance to facilitate those good relationships. ACTION: Jamaila to ask East Cheshire Trust to set up a series of meetings with Rural GPs. ACTION: Jamaila to forward details about the Turning Point communication plan to be published through the ebulletin. ACTION: Jamaila to send electronic versions of referral form and contact details to Colin ACTION: Colin to get a group email list of GPs to provide to Turning Point. Helen Black asked how practices should raise any issues about the service. Jamaila stated that practices should contact the service in the first instance and then raise through the council complaints process if they did not get a satisfactory response. Commissioning, Cheshire West and Chester Council ) ACTION: Jenny Dodd agreed to check with Brain Green about whether practices should record concerns via the Datix system instead to avoid duplication. 7. North West Unified Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) Adult Policy Nial Casselden Vicky Oxford (Macmillan Clinical Commissioning Manager) attended the meeting to give an update on the North West Unified (DNACPR) Adult Policy. 7

Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) was identified by the Cheshire and Merseyside Strategic Clinical Network as a regional priority across the North West with agreement to have common principles around this area. A Unified Do Not Attempt Cardiopulmonary Resuscitation Policy, led by a North West Regional Steering Group was issued in April 2013. This was adopted across the North West with the exception of West Cheshire which continued to use its existing policy. Developments in the law and revised guidance of the policy has required review and revisions to incorporate necessary changes. As a result, there was a decision for West Cheshire to adopt the North West Unified Do Not Attempt cardiopulmonary Resuscitation Adult Policy. There is a colour change of the form from red to lilac. The lilac top copy is for the patient, the white copy is for practices to scan and put the notes on the patient notes and the 3 rd copy is for practice to store for audit purposes. GPs are required to manually write out the form, it was noted that there is not a lot of room to write notes. The ambulance service is still required to physically see the form in order to carry out the patient s wishes. The anticipated role out of the policy is Monday 2 nd March 2015. There will be a communication to practices as regards re-coding clinical notes. This information has been requested from the North West Project Lead for EPaCCS. As patients with current documents are reviewed, they are to be moved onto the new lilac form, red forms are still active. A new business process is required so new patient records are inputted onto ERIS. Practices fed back that because this will be an infrequent request, it would be more efficient to have one central place with the ambulance service inputting details. Vicky will feed this back to the North West Ambulance Service. Practices to look at the GP bulletin to book onto a training session. 10. Minutes of the last meeting No matters arising 11. Future s None 12. Any Other Business GP Federation Jonathan Gregson gave a progress update on the work that Primary Care 8

Cheshire have been involved in. The key points are: The new name has been agreed and adopted. The GP federation is now called Primary Care Cheshire. Data sharing forms now signed by members and returned to PCC PCC providing medical cover in Curzon House and Lightfoot Lodge DVT LES - Hubs set up through PCC for Tarporley, M56 cluster and the city - awaiting response from Ellesmere Port, Neston & Malpas Training - PCC have received funding from the CCG via Health Education North West to put towards management/admin staff training. This is non-recurrent funding and must be used by 31 st March. PCC currently working on a training package Chambers - several people now signed up, more welcome! EVS Chester - funded through vanguard, PCC facilitating the service with Lache and City Walls until 31 March 2015 Interface clinical services - this service is still available - Improving clinical outcomes and practice revenue through enhancement of QOF register prevalence. There is a possibility for increased revenue for members. Contact Lysa Morton/Nicola Daniels for further information. Close @ 17.15h Date and Time of Next Meeting: March 10 th 2015 9