Elective Hub Steering Group 16 th May 2018 0
Agenda Agenda: 1. Welcome and Introductions Janet Butterworth 2. Elective Hub Launch Video Governance: 3. Journey so far ToR and Membership Stakeholder management Elective Hub Standards Janet Butterworth Cath Briggs 4. Website Janet Butterworth Work plan: 5. Programme plan Case for change Update on the priority areas:- Data Quality Pathway Development/ Specifications Janet Butterworth Cath Briggs Planned Care Leads: 6. Priorities and support 7. Date of next meeting Janet Butterworth 1
Journey so far Funding to create a GM Elective Hub from NHSE Elective Programme Priorities identified through Directors of Commissioning and Planned Care Leads Papers prepared for governance process Sign off from Partnership Executive in February Reporting to PFB and AAG Launch March Work programmes underway 2
Elective Hub Launch Video 3
Terms of Reference & Membership What is the Elective Hub? The Elective Hub in Greater Manchester (GM) is a programme of work focused on demand management for planned services in GM. The Hub is part of and has received funding from the National Elective Programme run by NHSE, but has negotiated freedoms to develop a programme of work which supports the priorities of devolution in GM. The Hub runs until March 2019 but due to a late start is likely to run until the summer of 2019. Priorities have been agreed for transformation and identifying good practice in the following areas: Pressure areas in high volume specialties across GM which contribute to increasing activity in hospital services Data quality and transparency to support operations in a devolved health and social care system Opportunities to develop a community of practice supporting GM commissioning and sharing good practice from across England 4
Terms of Reference & Membership Governance arrangements The Elective Hub has been through the governance process of the Greater Manchester Health and Social Care Partnership, receiving sign off by the Partnership Executive in February 2018. Partnership Executive requested that oversight of the Hub be from Provider Federation Board (PFB) and AGG, with final oversight from the Partnership Executive. Key forums/groups for engagement and information sharing are: GM Performance and Delivery Board, The GM Commissioning Hub, Directors of Operations, Directors Commissioning and their Planned Care Subgroup, Directors of Adult Social Care, LCO Networks, Directors of Public Health, Patient focused working groups. Formal papers will not routinely be shared with these groups unless requested but it is expected regular updates will be received at forums associated with these groups. The Elective Hub works outside the scope of the GM programme Theme 3 5
Terms of Reference & Membership Membership of the group The Steering Group is made up of representatives from the key forums outlined above. In addition the Steering Group welcomes subject matter experts from the areas of current focus Purpose of the Steering Group To provide first level oversight of the work of the Elective Hub To contribute to the development of the work and ensure priorities for the different focus areas are met and delivered To ensure full engagement of the work of the Hub across GM and to support the adoption of products and methods which are delivered by the Hub 6
Stakeholder Map DoCs AGG PFB Partnership Exec Provider Orgs NHS & Non- NHS Performance & Delivery Board NHSE & Elective Programme Elective Hub Stakeholders Social Services Public Healthwatch STP Areas Across England LCOs Commissioning Hub Elective Hub 7
Elective Hub Standards Proposition to develop a set of common standards rationale aligned with direction of travel across GM e.g. Commissioning Hub, Dementia Standards, Primary Care... Embedded within the specifications Reduce variation in provision and commissioning of elective care across GM Part of a sustainability framework? Facilitates a Locality self assessment approach Supporting dashboard Key interventions across the pathway associated with each standard Staged trajectory of improvements (depending on starting point) Co-design stakeholder engagement 8
Draft Standards Shared Decision Making/Self-support The public should have access to wellpublicised key resources to enable self-care Alternative mechanisms for obtaining advice should be made available e.g. first contact practitioner, social prescribing/ community All patients should be involved in decision making throughout the pathway selfmanagement Rethinking Referrals All referral options should be explored prior to release of referral from practice, including opportunities to have discussions with secondary care (Advice and Guidance; telephone contact with clinicians referrals should be sent on agreed templates (with minimum dataset) Referrals should be triaged in secondary care Transforming Outpatients Wherever possible, patients should be seen in one stop settings Follow up should be virtual wherever possible, and undertaken by the right level of staff Commissioning Good practice should be reflected in whole system patient pathways and service provision Outpatient discharge information should include high quality discharge letters which follow SAIL criteria 9
Website 10
Programme Plan Refer to handout 11
Case for Change Challenged RTT in GM Significant number of patients referred for hospital based specialist opinion when other options available This results in patients waiting lengthy periods for review Ø may result in multiple trips to hospital and repeated time off work for patients and carers Delays in patients reaching definitive diagnosis and treatment Ø this may lead to presentation in urgent care system in some cases or reduced likelihood of recovery to full health Current medicalised system need to explore all options including selfsupport and community offer Elective Care Transformation should place more people with the right person first time, improve access into secondary care services, increase likelihood of earlier diagnosis and treatment and offer patients maximal opportunity to self-manage where feasible 12
Elective Demand value proposition 1. Leadership System-wide reset of electives to establish transparency and confidence across GM Agree priorities Potential to support cancer pathways 2. Tableau Data Flows Step 1: NHSE data library Step 2: Open data flows from trusts following data quality check GP, commissioner and patient transparency & tracking ability 3. Demand Mgt Standardise GM approach LCO models outside hospital Understand the issues Prioritise investiment/ improvement work 4. Specialty Reviews Long wait specialties Do once for GM Workforce constrained specialties Using whole system diagnosis through Tableau 5. Data Quality DQ assurance tests for Providers Assurance of PTL construction and RTT compliance standard view across GM Reduce risk of harm Reduce GP contacts Literacy, awareness & foundation for further tools Shared capacity 2018-19 13
Data Quality Tableau demonstration 14
Specialty Reviews and Specification Development 1. Giving visibility of the approach 2. Assurance of engagement process and key milestones 3. Feedback on the outline specification templates 4. Views on: the development of an EC standard for GM longer term view/positioning 15
What the Ask Is Develop commissioning specifications and toolkits (MSK, Dermatology, Gastric) for commissioning round Autumn 2018. Quick wins - sharing of baseline data and existing learning materials in the meantime Assumptions Alignment with GM Commissioning Hub Positioning with SCF and LCOs Co-design with nominated leads Testing may be required 16
Design Principles 1. Specifications will set a consistent level of standards/outcomes and outline good practice and approaches for elective care across GM for MSK, Gastro and Dermatology services. 2. Specifications will be based on known evidence based interventions from national/local information, good practice and impact data emerging from pilots and/or actual integrated service offers. 3. Co-design with commissioning and provider colleagues underpins the development of the specifications. 4. The specifications will support a drive to whole pathway commissioning within each Locality. 5. Current models of commissioning, and plans for the future direction of commissioning across GM (SCF and LCO), have been taken into account. 17
Impact Supports GPs to make the right decisions in referral management Aligns health. public health and social care offer Helps reduce demand in a way that does best in each locality Aids shared discussions with patients putting them at the heart of the decision making process Supports localities in targeting appropriate investment and resources in elective care 18
April - May Approach May - June Rapid stakeholder engagement exercise Review existing documents and guidance Develop supporting materials Draft generic template Co-design content of specifications Additional Key recommendations Dashboard Providers Commissioners GM Commissioning Hub National colleagues National GM Locality Case studies Key metrics CBA impact opportunity cost Toolkits EUR policy Sign off by SG One off design workshops e.g. Tariff, commissioning at GM level 19
Phased Development & Implementation The priority to driving a whole pathway approach to commissioning will be: PHASE 1 The development of elective care pathway based specifications that enable a reduction on demand, along with consistent interventions within the primary and community settings. Directors of Commissioning/Planned Care Leads will be key to supporting implementation of the specifications from Autumn 2018. Local engagement with clinicians and managers. Standards and outcomes for elective care will need to be embedded within provider contracts. The longer term view will be to support commissioners in ensuring the right capacity and services are in place to respond to the demand across the pathway and supporting operational planning investment agreement ambition Enablers in place Managing demand for elective care has to be aligned with plans for Acute Care across GM 20
Assurance & Engagement Date Assurance Engagement April National team, NHSE 100 day test workshop, GM Locality commissioners/providers, GM Commissioning Hub May Elective Hub Steering Group Design workshops x 3, Transformation Unit June Provider Federation Directors of Commissioning, Planned Care Leads July AGG August GM LCO Network 21
Draft Template Details 22
Levels of Specification Overarching Generic Elective Care Three levels of specification will be developed Specialty & Pathway Specific Advice & Guidance Self support Shared Decision Making Dermatology, Gastro, MSK, Ophthalmology Will be generic to all (for common elements, and then specific advice per specialty) Shared decision making helps control activity of elective care at the front end 23
How specifications support a possible future commissioning model Overarching Generic Elective Care Strategic Commissioning Function responsible for commissioning for a whole pathway of elective care Specialty & Pathway Specific Primary care education and training Public health Locality Care Organisation (LCO) ensures the elements of the specification are met by providers in supply chain Primary/ Community Secondary Primary/ Community Advice & Guidance Self support and Shared Decision Making Shared Decision Making 24
Overarching Generic Elective Care National and local targets: National GM Standard for Elective Care Generic Outcomes for Elective Care across GM Draft Template Case for Change: Clinical Existing provision and variation Public (feedback from Taking charge together). Social care perspective (PSR) Commissioning Coterminous theme 3 Population health Purpose & Usage: (See following slide) Pathways: It applies to Supporting resources: Case Studies Data pack (tableau GM position and local variation) Website National resource Enablers for Elective care: Workforce development Capacity planning Referral management Data and date cleansing OPD & virtual FU IT Payment mechanisms 25
Specialty & Pathway Specific Evidence Base Draft Template Pathways included: Common Standards & Outcomes Overall Measurement & Impact Supporting resource: Case Studies Data pack (tableau GM position and local variation) Website National resource Core enablers for.. Workforce development including education and development Capacity planning Data and date cleansing IT Payment 26
Specialty & Pathway Specific Primary care education and training Public health Eg Dermatology Primary/ Community Secondary Primary/ Community Undergraduate training Working with primary care to upskill Shared decision making training motivational interview training Campaigns?? Self support Patient Webinars Shared Decision Making Rethinking referrals Clarity on specialist service provision across GM Capacity planning Transforming outpatient appointments e.g. flexible follow up options Neighbourhood working approaches Dermatoscope and telederm Advice & Guidance Dermatoscope Telederm Standarised referral template Transforming outpatient appointments 27 Tracking referrals
Benefits 28
Toolkits & Further Opportunities PHASE 2 Toolkits to support Specifications Dashboard Case studies ERS Policy Workforce development & Education & Training Support Implementation Advice & Guidance (Tariff) GM Level IT Specification 29
Planned Care Leads Jen Riley update 30
Next Meeting Dates Tuesday 17 th July 10.00 12.00 Lostock A & B, PP3 Wednesday 20 th September 10.00 12.00 Ribble, PP3 31