Project Initiation Document Purpose: This document is intended to capture the necessary information required to describe the work stream progress from Concept to Proposal. Programme/Project name: Director Sponsor Lead Clinician Programme/Project Lead Document Control Document Status Version Date 29.7.13 Review Status Reviewed By Final Draft for Programme Board Review and Approval Final Draft V6 Organisation Version Date Sukhi Mahil & Helen Rose NHS Erewash CCG V2 17.6.13 Helen Rose NHS Erewash CCG V3 28.6.13 Sukhi Mahil NHS Erewash CCG V4 2.7.13 Helen Rose NHS Erewash CCG V5 29.7.13 Document History Improving the Quality of Primary Care Helen Rose Dr Neerunjun Jootun May Giordano Version Document Status Summary of Changes Date Version 1 Draft for review 6.6.13 Version 2 Returned to Director Lead for review and refinement PMO amendments to structure and feedback on additional information required 10.6.13 Version 3 Returned to Lead for review and refinement Updated following review of V2 to strengthen document and reflect cross over with over Strategic Priorities 17.3.13 Version 4 Draft for review Updated to reflect QIPP and baseline 28.6.13 figures Version 5 Draft Consistency check and review 2.7.13 Version 6 Final Draft Dependencies and Governance 29.7.13 arrangements updated Version 7 Draft for review Included patient experience and Flu data in baseline file 21.11.13 Approval Status Role Name Signature Date Director Sponsor Programme/ Project Lead Page 1 of 6
Finance Lead Clinical Lead Programme Board Approval 1. Background & Context NHS Erewash CCG s Integrated Plan for 2012-15 set out a long term vision for healthcare that focuses on prevention, better co-ordinated care, improved quality, and more efficient use of NHS resources. Access to primary care services were raised as a concern by members of the public at a consultation event, and on comparative data Erewash CCG are below both the Derbyshire and National averages for patients reporting a positive experience of primary care (88.9%). Over 90% of all patient contacts with the health service occur in primary care, and Erewash CCG sees primary care as the foundation for high quality health care for the population of Erewash. GPs have generally provided a first point of contact or gateway to the NHS, referring patients on for further investigations and specialist care. GPs have a key role in ensuring that patients receive the right care, in the right place and right time. Comparative data shows that there is a wide variation amongst practices in referral rates to outpatients, admission rates to hospital, prescribing costs, and other quality markers and outcomes. It is planned that by improving quality in primary care and providing education and support to Practices along with alternative care pathways this will reduce the level of variation and inefficiencies. The ageing population and increasing number of people with long term conditions means that there is increasing pressure upon secondary care services. There is therefore a need to focus on prevention to reduce future ill health, and identifying pathways and services that can be delivered in primary care to ensure efficient use of resources. This programme links strongly with other Strategic Priority Programmes of work, especially Integration of Care for Frail Elderly, Improving Care for People with Long Term Conditions, and Improving End of Life Care; but will also be an enabler to the other 3 programmes. There is also significant cross over with the Strategic Priorities; Improving Outcomes for Children and Reducing Inequalities. The initiatives around increasing the range of services in primary care and reducing clinical variation are expected to contribute towards QIPP savings. 2. Aims This programme of Improving the Quality of Primary Care focuses on a number of initiatives to achieve the following overall aims:- Improving the patients experience of primary care (Improving quality) Reducing clinical variation between practices with regard to both clinical practice and clinical outcomes (Better co-ordination of care) Increasing the range of services available for patients in primary care (Prevention) 3. Objectives The Programme aims will be delivered by: Roll out of local system to measure patient experience based upon electronic survey; machines in practices on a regular basis. Questions would be locally derived and increased number of patients would be asked for an opinion; Page 2 of 6
Implementation of the local CQUIN scheme to include review of Practice access arrangements; encourage use of the Single Point of Access (SPA), Care Coordinators; Care Plans to manage Long Term Conditions; Roll out and continuation of Local Enhanced Services for AF and Care Homes; Implementation of new pathways to support transfer of cardiology and diabetes patients from secondary care into the community or primary care (delivered through inclusion as QP indicators); Evaluation of 7 day working pilot to contribute to review and development of urgent care model; Continued QUEST education sessions to focus on use of clinical pathways; Work with NHS England and Public Health as the responsible commissioners for the Vaccination and Immunisation Programmes, and Practices to encourage improved uptake of Vaccinations and Immunisations and Health Checks; Alignment of Care Homes to GP Practices to prevent unnecessary emergency admissions; Introduction of an Innovation Fund for Practices to apply for funds to support improvements and delivery of the Strategic Priorities, demonstrating a Return on Investment; Continued OD programme for primary care to develop General Practice. 4. Anticipated Outcomes By delivering each of the objectives set out it is expected that there will be: o Reduced clinical variation in access to secondary care services o Better co-ordinated care for people in care homes and reduction in avoidable hospital admissions o Improved uptake of immunisation and vaccinations o By March 2014-150 more patients with diabetes and 60 more cardiology patients will receive their care in the Community, instead of going to hospital o By 2015 there will a 2% increase (based on a local survey) in patient experience of Primary Care 5. Project Scope Included Improving the patients experience of primary care Increasing the range of services available for patients in primary care, including:- o Organisationally developing primary care to meet the needs of the population in the future Reducing clinical variation between practices with regard to both clinical practice and clinical outcomes Not Included (state if nothing) QIPP Plans and/or other Strategic Priorities Issues relating to Primary Care services commissioned by NHS England Area Team (although clearly joint working important on Improving Quality of Primary Care); Individual Practitioner Performance Outline which( if any) QIPP plans/ Strategic Priorities this programme/project will support delivery of (in part or fully) Page 3 of 6
Scheme/ Area of Work QIPP Saving Strategic Priority Atrial Fibrillation Screening 194000 Reducing Inequalities Programme Community CQUIN (use of 250,000 Integration of Care SPA, Care Coordinators, Integrated Care Model Non elective activity) Supporting People with Long Term Conditions Primary Care QOF QP - Reduction in Clinical Variation (planned Care reduction in referrals and elective care) GP Alignment Scheme (Care homes) Increased uptake of Vaccinations & Immunisations 500,000 Improving End of Life Care 50,000 Integration of Care Supporting People with Long Term Conditions Improving End of Life Care Improving outcomes for Children 6. Baseline Position/ Key Performance Indicators Describe your KPI s. These will measure progress towards the achievement of your objectives. Include a baseline & planned trajectory for improvement. Where there is cross over between areas of work the overall KPI should be agreed between the Programme Leads and reported once. Baseline.xlsx In addition to the baseline figures inserted above, the KPIs below will also be reported through this Programme: Reduction in Clinical Variation to be reported Monthly (through this Programme but supports delivery of outcomes in Strategic Priorities: 3 Improving Outcomes for Children (in relation to A&E attendances); 5 Integration of Care, 6 - Supporting People with Long Term Conditions, 7 - Improving End of Life Care) o Reduction in Outpatient referrals Baseline 2012/13 out-turn o Reduction in avoidable admissions Baseline 2012/13 out-turn o Reduction in admissions from Care Homes Baseline 429, target reduction: -25%, therefore 107 fewer admissions from Care Homes o Reduction in A&E Attendances Baseline 2012/13 NB: as the 2012/13l out-turn position (excluding the changes to specialised commissioning) in in the process of being finalised, the KIPs will also need to be reflected and agreed across the relevant strategic priorities. Diabetes and Cardiology care in the community (based on QIPP Plans to transfer patients from NUH) o Baseline to be identified Patient Experience o Local baseline to be determined in Q2 2013/14 to enable measure to be put in place to achieve 2015 2% increase. Page 4 of 6
Other KPI s (counterbalance measures) 7. Benefits Quality, Financial, Operational, Workforce Estimated savings 3 yrs 2013/14 PYE k 2013/14 FYE - 994 k 2014/15 - k 2015/16 - k Benefit Description/ Summary The savings identified above reflect the gross savings and do not take any investments required into account (e.g. incentive schemes, LES ). It is also important to note that the savings accounted for and reporting through this programme will also support other Strategic Priorities as set out in section 5 above. Saving_investment.x ls Benefits Realisation.xlsx Erewash QIA tool July 2013.doc 8. Assumptions - Recruitment to Primary Care Commissioning Officer Role - Recruitment to Urgent Care Service Development Manager Role - Primary Care Engagement 9. Critical Success Factors - Agreement and implementation of Primary Care CQUIN scheme to incentivise engagement 10. Major Milestones (with timescales by month) Full implementation plan will be developed once Project manager in post (1 st July) Workplan.xlsx 11. Key Risks Impact (1 5) Prob (1 5) Mitigating Actions Impact (1-5) Prob (1-5) This risk log should only be populated by risks assessed as being extreme or high as these require to be visible at Trust level and managed accordingly Identify mitigating actions and rescore the risk if the actions are completed fully Risks.xlsx Page 5 of 6
What risks is there that equality of access, experience or opportunity for protected characteristics will be affected by the PID proposal? This relates to the EIA/QIA that needs to be done on all PIDs. Demonstrate how this will be undertaken (in the interdependencies identify GEM Support required and what will be done) Equality Impact Assessments have been undertaken in relation to: The Atrial Fibrillation Screening Programme Care Homes Alignment CQUIN 13. Patient & Public Engagement Define plans to undertaken patient engagement in process of agreeing plans and progress Annual programme of Public Involvement through PPGs, PPG Networks, and Stakeholder Forum. Stakeholder forum on the 11 th July 14. Resources required to progress to next stage Identify resources needed (and secured??) for the delivery of the programme e.g. Project manager, Clinical Lead, Analyst, Improvement Lead, Finance input. Detail by role, grade, WTE. Resources.xls 15. Key dependencies Identify key dependencies external and internal to help identify any potential opportunities or risks which will need to be managed Interdependencies.xl s 16. Governance arrangements Meeting structure (i.e. for performance & risk management / escalation) Programme Board Frequency Monthly Purpose Page 6 of 6