Contents 1.0 Foreword Introduction Strategic Drivers and Context Our Strategy... 10

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Transcription:

Contents 1.0 Foreword...4 2.0 Introduction...5 3.0 Strategic Drivers and Context...6 3.1 Policy Environment... 6 3.2 Connecting for Health... 7 3.3 GP Systems of Choice (GPSoC)... 7 3.4 Local Drivers and Strategies... 8 4.0 Our Strategy... 10 4.1 Vision... 10 4.2 Values... 10 4.3 Minimum Standards... 11 4.4 Education and Training... 11 4.5 Information Governance (IG)... 11 5.0 Delivery of the CCG Strategic Commissioning Plan... 12 5.1 Planned Care... 12 5.1.1 Efficient services... 12 5.1.2 Value... 13 5.1.3 Effective Outcomes... 13 5.1.4 Patient Experience... 13 5.2 Urgent Care... 14 5.2.1 Access to Primary Care Information from ED, Urgent Care and OOH Settings... 14 5.2.2 Urgent Care Dashboard... 14 5.3 Reablement... 15 5.3.1 Delayed discharges... 15 5.4 Preventative Care/Integration... 15 5.4.1 Risk Stratification... 16 5.4.2 Improved Data Quality... 17 5.4.3 Summary Care Record... 17 5.4.4 Electronic Shared/Single Care Record... 18 2 P age

5.4.5 Tracking Patients through the System... 18 5.4.6 Telehealth/Telecare... 18 5.4.7 Membership Database... 18 6.0 Health Economy Interoperability/Strategies... 21 7.0 General Practice IT... 23 7.1 GP Architecture... 23 7.2 GP Clinical Systems... 24 7.3 Electronic Document Management (EDM):... 24 7.4 Text Messaging to Patients... 24 7.5 Patient Self-Check in Screens... 24 7.6 GP2GP Messaging... 25 7.7 Electronic Prescription Service... 25 7.8 Patient Access to Electronic Records... 25 7.9 Mobile devices... 26 7.10 Non-GMS Applications... 26 7.11 GP Imaging... 26 7.12 Intranet... 26 7.12 Interactive Screens... 26 8.0 Corporate Services... 29 8.1 Organisational Intelligence... 29 8.2 Financial/Corporate Systems... 29 8.3 Mobile Devices... 29 8.4 Remote Working... 30 8.5 Smart Phone Applications... 30 8.6 Networking/hosted servers... 30 8.7 Email... 30 8.8 Contractual Clauses: Healthcare and Commissioning Support Providers... 30 9.0 Delivery Arrangements... 33 10.0 Funding and Finance... 34 11.0 Risks... 35 12.0 Implementation Plan and timescales... 36 13.0 Conclusion... 38 3 P age

1.0 Foreword I have been working in general practice for over 25 years, and now, more than ever before, do I believe that IT and Information is fundamental to shaping and improving healthcare services for the future. Healthcare workers cannot function effectively without appropriate IT support. And IT without robust, upto date information, is not appropriate. This strategy sets a three-year vision for information and IT across Dudley CCG and reflects local requirements driven by improvements in the quality of care, patient health and care outcomes, the reduction of inequalities and increasing productivity and efficiency. The ambition is bold, but the aim is to deliver the whole of this strategy within 3 years in times of reducing resources in the NHS. However, information and information technology is a critical tool which successful CCGs will use to deliver the necessary improvements within such diminished resources. The success of this strategy depends as much on a culture shift in the way patients and professionals think, work and interact as it does on data or IT systems. It depends on making the shift to give patients more control of their health and care and on recognising that professionals collecting and sharing good information is pivotal. I believe this is vital for success for both the CCG, our member practices, our partner organisations and more importantly our population. Dr Richard Johnson Clinical Lead IT December 2013 4 P age

2.0 Introduction Information, and the infrastructure upon which it is built and applied, is one of the CCG s key assets. The CCG requires accurate, timely and relevant information to enable it to both commission and deliver the highest quality health care and to operate effectively as a modern and efficient public sector organisation responsible for health and social care of individuals requiring support. Having accurate relevant information available at the time and place where it is needed, is critical in all areas of the CCG s business and plays a key part in corporate and clinical governance, strategic risk, service planning, commissioning and performance management. We are also aware that our members, practices within our CCG and the patients they care for, require 21 st century infrastructure to enable them to provide the best possible care. This Strategy describes the CCG s vision and strategic direction for information management and technology developments for the period 2013 2016. It describes the strategic drivers and context within which it must operate, considers the impact of national initiatives and strategies, the data required, the information systems needed to deliver the data and the technical infrastructure, governance arrangements and the delivery model required. The document describes how the CCG will utilise IT and information to best deliver in four areas:- 1. Delivery of the CCG s Strategic Plan. 2. Ensuring the business of the CCG operates effectively. 3. Working with partner organisations. 4. Supporting our members in having effective IT provision in primary care The Strategy will be updated annually to reflect changes in priorities. 5 P age

3.0 Strategic Drivers and Context 3.1 Policy Environment The most recent reforms in the NHS commenced with the publication of a Government white paper Equity and Excellence: Liberating the NHS, published in June 2010. This recommended changes to the NHS encompassing the following domains: Putting patients and public first Improving healthcare outcomes Autonomy, accountability and democratic legitimacy Cutting bureaucracy and improving efficiency The Health and Social Care Bill was developed in response to this and was initially published in January 2011 and following further revision was finally published in March 2012. The Health and Social Care Act details the current commissioning model whereby Clinical Commissioning Groups have the responsibility for commissioning the healthcare services listed on page one. In addition to core changes in commissioning arrangements the Act placed an emphasis on a number of other areas including huge improvements in efficiency and the way in which the NHS both manages and uses information. It is anticipated that increasingly patients will have a far greater say in making informed decisions about their care. The Department of Health sought to add further clarity around Information Management and published The Power of Information. In June 2013 the Department of Health has published the information strategy, The Power of Information, which set a ten year framework for transforming information for the NHS, public health and social care. Unlike previous information strategies, The Power of Information does not reinvent large scale information systems or set down detailed mechanisms for delivery. Rather, it provides a framework and a route map to lead a transformation in the way information is collected and used. It takes the needs of patients, carers, users of care services and citizens as the key driver for change. It provides the infrastructure to support the things that need to be done system wide, but recognising that information technology is always advancing, it promotes flexibility and local innovation. The Strategy focuses on information in its broadest sense, including the support people need to navigate and understand the information available. This is about ensuring that information reduces, not increases, inequalities and benefits all. The Power of Information strategy s main ambitions:- Information used to drive integrated care across the entire health and social care sector, both within and between organisations Information regarded as a health and care service in its own right for us all with appropriate support in using information available for those who need it, so that information benefits everyone and helps reduce inequalities Change in culture and mind set, in which our health and care professionals, organisations and systems recognise that information in our own care records is fundamentally about us so that it becomes normal for us to access our own records easily Information recorded once, at our first contact with professional staff, and shared securely between those providing our care supported by consistent use of information standards that enable data to flow (interoperability) between systems whilst keeping our confidential information safe and secure 6 P age

Our electronic care records progressively become the source for core information used to improve our care, improve services and to inform research, etc. reducing bureaucratic data collections and enabling us to measure quality A culture of transparency, where access to high quality, evidence based information about services and the quality of care held by Government and health and care services is openly and easily available to us all An information led culture where all health and care professionals and local bodies whose policies influence our health, such as local councils, take responsibility for recording, sharing and using information to improve our care The widespread use of modern technology to make health and care services more convenient, accessible and efficient An information system built on innovative and integrated solutions and local decision making, within a framework of national standards that ensure information can move freely, safely, and securely around the system The intention is for clinical staff to access, contribute to and choose to share health and care records, supporting a culture of no decision about me without me for the patient. Better use of information and innovative technology can help professional teams to prioritise more face-to-face support where that is needed, and can also enable local areas to design integrated health and care services, and improvement strategies that reflect local need. The Power of Information states an expectation for all general practices within England to offer Patient Online by 2015. This has also been mandated by NHS England. Patient Online includes transactional services such as booking and cancelling appointments, requesting online prescriptions, online access to the medical record and secure online communication. Implicit within these service enhancements is an aspiration to ensure communications between the NHS and its patients is Digital by default. The success of The Power of Information depends as much on a culture shift in the way patients, users of services and professionals think, work and interact as it does on data or IT systems. It depends on making the shift to give patients more control of our health and care and on recognising that collecting and sharing of good information is pivotal to improving the quality, safety and effectiveness of patient care, as well as patient experiences of care. 3.2 Connecting for Health In March 2013 Connecting for Health was disbanded and the majority of its former functions amalgamated within the Health and Social Care Information Centre (HSCIC). This included the transfer of responsibility for the contract management of nationally defined contracts including those formerly commissioned to support GP Primary Care under GP Systems of Choice (GPSoC). In addition, NHS England has set out new national arrangements for the management, support and commissioning of GP IT services. In Securing excellence in GP IT Services Operating Model NHS England has established the commissioning and accountability processes encompassing information technology for general practices. The model sets out a number of core or mandatory services (which must be funded and provided to GP practices) together with a number of additional or discretionary funded items which are subject to local strategic direction and choice. 3.3 GP Systems of Choice (GPSoC) The GPSoC framework still exists; however as of September 2013 the GPSoC framework governing procurement of GP clinical systems is being both redesigned and re-negotiated with a range of national 7 P age

suppliers. The revised arrangements for the framework will include a number of tiers, some setting out centrally funded components and others where items have been tested and certified with a centrally negotiated approach to procurement. The outcome of these negotiations and the introduction of the new arrangements is some months away from being understood in detail nevertheless a revised approach, implementing a number of changes is being developed which will bring about: An improved alignment between primary care IT and the national strategy for primary care Improved levels of engagement between all parties in designing and continually improving the procurement framework Incentives for use of systems as opposed to remuneration linked to deployment targets Commoditisation, e.g. national procure certain line items at least one provider for national infrastructure Achievement of equity (whilst ensuring that people operate within governance standards and meet minimum specifications) Delivering value for money Determining a maturity index to help identify areas of greatest need Ensuring the GMS contract obligations are fulfilled Local CCG level responsibility for the management of GP primary care IT budgets through a yet to be determined process of delegation from NHS England It is widely recognised there are some significant national challenges with the current arrangements for supporting GMS IT in general practices. These include an inequitable distribution of budgets, a separation between budget holders and service commissioners which causes confusion, a lack of clarity on responsibility for some items, capacity and capability issues at a locality level, confusion around complimentary items and legal ownership of assets and depreciation. These issues all currently affect Dudley CCG and its general practices to a greater or lesser extent. The new GPSoC framework will provide a tiered procurement solution. Core (mandatory) services will be included in a tier one offering. Two subsequent tiers will include system enhancements from GP clinical system suppliers and other suppliers which will be subject to accreditation and testing arrangements. Locally Dudley CCG will need to develop and adopt a policy in respect of GPSoC to ensure a fair and consistent approach to the implementation of these systems is enabled. It is understood future arrangements for funding could mean a re-baselining of local GP IT budgets. The effect of this combined with a suggested real terms increase on overall funding for GP IT is unknown, but given the increased expectations around Primary Care IT and particularly the delivery of Patient Online will inevitably mean the pressures around managing Primary Care IT budgets will not subside. 3.4 Local Drivers and Strategies At the time of writing this Strategy the CCG has been in operation for six months and during this time there have been a number of strategic documents approved by the CCG Board which will be dependent on the utilisation or implementation of robust IT and informatics systems. These include the CCG s: Strategic Plan describes the overarching aims and objectives of the organisation, including the commissioning and service change priorities Primary Care Strategy defines how the CCG will develop our membership and improve the quality of primary Care provision in Dudley 8 P age

Quality and Safety Strategy defines the CCG s approach to measuring and improving the quality and safety of commissioned services from our providers Communications and Engagement Strategy describes how the CCG will engage with our members, patients and public, and our communication systems Social Media Strategy defines the intent of the CCG to embrace social media as a form of communication with the public Financial Plan describes the financial context of the CCG for the next 3 years The IT and informatics requirements of each are described in this Strategy. 9 P age

4.0 Our Strategy This strategy provides a strategic framework for IT and informatics developments within the CCG. This strategy is compatible with the recently announced NHS information strategy The Power of Information: putting us in control of the health and care information we need. The Strategy aims to link IT developments into the CCG s overall objectives and details the governance arrangements underpinning further investment in IT. The Strategy argues that the implementation of the IT systems it describes is a critical factor in improving efficiency and patient safety and underpins the overall strategy of the CCG. 4.1 Vision IT is a key strategic enabler to delivering what we as a CCG have been established to deliver. It is fundamental to the effective and efficient delivery of health services, both in a hospital setting, but increasingly community and primary care services. As a membership organisation we aim to ensure that services provided by and commissioned by our members are of the highest quality and a progressive IT strategic platform is key to achieving this. Dudley CCG wishes to increase the use of digital technology in the delivery of healthcare services to patients in order to bring about improvements in the quality, safety and the efficiency of the NHS services it commissions on behalf of the population we serve. More specifically we will ensure that: high quality clinical information is accessible in an integrated, shared clinical record, in real time, at the point of care; IM&T programmes are fully aligned to enable the clinical business needs of Clinical Commissioning Group; the CCG is able to fully implement Patient Online and the unnecessary duplication of the capture and dissemination of patient information for the management and care of patients is kept of a minimum. 4.2 Values We have identified a number of core values against which we have assessed priorities for investment in Information technology solutions. In no order of importance or priority they are: We will commission effective, safe and efficient healthcare We will provide of high quality timely information We will record information once and sharing it through the interoperability of systems A patient s medical data is to be shared with clinicians in other settings on an individual basis where a legitimate relationship exists, at the point of care, with the consent of the patient Information will be used for secondary purposes such as establishing the health needs of a population and shared with all relevant parties We will ensure appropriate disclosure of information to fellow professionals and patients Clinicians and carers to predict which patients will need enhanced or tailored care We will enable the CCG to better understand the diversity of our patient population. By gaining a deeper and more accurate understanding of the diversity of our patients we can ensure equity of access to healthcare and its provision We will predict how needs will change at a population level to be able to plan for the future needs of our population we need to understand how the demographics and health profile We will share knowledge about best practice 10 P age

We will support evidence based decision making 4.3 Minimum Standards As a CCG we strive to achieve and deliver to the highest standards possible. Therefore, in order to ensure proper arrangements are in place to support project implementations and business as usual support activities the following standards will apply:- Project Management activities will adhere to Prince II project management methodology Where necessary relevant ITIL standards will be required to be adhered support all activities relating to changes of the IT infrastructure owned or maintained by the CCG Information systems integration will be based upon the good practices and standards laid down by the NHS IT toolkit All proposals will be compliant with the IOC standards with regard to information governance. 4.4 Education and Training Dudley CCG recognises the need to ensure users of IT systems are appropriately trained in order to ensure the systems can be used safely and appropriately and that the CCG is able to extract the maximum return for its investment for the benefit of patients. This strategy requires the introduction of new systems and processes covering a range of areas from Summary Care Records to Electronic Prescribing, from Patient Online to changes in GP clinical information systems. For the introduction of new systems to be a success it is imperative that our users are appropriately skilled and trained in their usage. As the project to develop and implement each new system commences an appropriate training needs analysis will be undertaken to ensure the necessary resources to support the training required are available. 4.5 Information Governance (IG) IG provides a framework to bring together all the legal rules, guidance and best practice that apply to the handling of information. Due to the range and complexity of the standards and legal rules, the Department of Health has developed sets of information governance requirements which enable NHS and partner organisations to measure their compliance. In order for the CCG and our member practices within Dudley to comply, with NHS IG requirements the CCG will provide training and support in the following areas: General awareness training Information sharing management protocols Caldicott requirements guidance End to end data protection compliance Freedom of Information Act compliance IG audits and Toolkit completion support Development of yearly IG improvement plans Incident management support All developments proposed within this strategy will meet IG standards and be implemented to ensure maximum IG Toolkit ratings. However, we are currently restricted in the delivery of key objectives by the inability to access Patient Identifiable Data (PID) as a consequence of the implementation of the Health and Social Care Act 2012. This is not acceptable to us as an organisation and we will work with the Health and Social Care Information Centre to identify and source alternative networks to access such data where appropriate. 11 P age

5.0 Delivery of the CCG Strategic Commissioning Plan The strategic plan of the CCG has been constructed to describe the 4 main commissioning priorities of the organisation, namely Planned/Elective Care, Urgent Care, Reablement and Preventative/Integrated Care. Each has differing IT and Informatics requirements, as described below: 5.1 Planned Care Planned care services relate to the delivery of short term, reliable, value added interventions at a time and place of the patient s choice. Planned care services are our largest area of spend. However there is also a significant variation both between services and between providers in the number of steps that a person may go through during the course of their treatment. As a commissioner we have very little direct input to the delivery of these services, but we will expect our providers to be able to articulate and publish the value of their services to patients and carers. We will develop a publicly available provider dashboard which will set out how we evaluate and benchmark the quality of services from every one of our providers with whom we hold a contact based upon these measures and the feedback from patients. We intend to deliver our priorities on Planned Care by focussing on the efficiency of services; value of services; effective outcomes and Patient experience. 5.1.1 Efficient services Planned care services are our largest area of spend. However there is also a significant variation both between services and between providers in the number of steps that a person may go through during the course of their treatment. Therefore, we will commission by working with providers to determine how they will improve the efficiency of the services that they provide. In April 2015 we will use this information to publish an efficiency index for all planned care services and will use this with our GP members as one criterion when advising on managing referrals and on setting commissioning priorities. Methods to achieve this will include:- 5.1.1.1 Patient Pathways Patient care pathways are structured multi-disciplinary care plans which detail essential steps in the care of patients with a specific clinical problem. They have been proposed as a way of encouraging the translation of national and local guidelines into local protocols and their subsequent application to clinical practice. They are also a means of improving systematic collection and abstraction of clinical data for audit and of promoting change in practice. We will review care pathways as a contributing means to defining efficient providers. 5.1.1.2 Map of Medicine/Referral Management System Map of Medicine is a methodology for creating care maps and keeping them up to date with emerging evidence, informed by practice-based knowledge, and, where appropriate, cognisant of healthcare policy. It enables GPs to offer comprehensive, evidence-based local guidance and clinical decision support at the point of care and aids CCGs in achieving their quality and productivity targets. The system includes: GP system integration Locally relevant information Standardised referral forms 12 P age

The ability to monitor local performance Pre-populated referral forms It is the intention of Dudley CCG to implement Map of Medicine to improve the efficiency and effectiveness of its referral management of patients for further support and packages of care. 5.1.2 Value It is important for us as a commissioner that we can establish with our providers a shared understanding of how our services deliver value. We will work with our providers to identify how to evaluate and monitor, both individually and collectively, levels of dependency, patient improvement and the social value of services. 5.1.3 Effective Outcomes Planned care services are value added treatment services, i.e. their purpose is to enhance a patient s health and wellness. The basic premise for the intervention of planned care is to undertake it knowing what is required to return the patient to their home following the maximised potential resolution of their condition through the correct intervention. Providers will be expected to demonstrate the effectiveness of the services that they provide. We will work with providers to define expectations, but we expect them to offer solutions on how to measure outcomes that matter to patients. It is important that we develop a shared understanding of the value that these services offer, their effectiveness, and their rates of success. Services which demonstrate effective outcomes will be positively promoted and ultimately any service where the outcome value cannot be demonstrated will ultimately be decommissioned. 5.1.4 Patient Experience A key test of the effectiveness of services is whether or not patients report a good experience on the care they ve received. The experience of the service is therefore the fourth key measure of care alongside the effectiveness, efficiency and value. We will work with our commissioning support providers, covering IT, patient experience and health intelligence to develop a system to record, monitor and evaluate patient experiences. We will then work with providers to develop a smart dashboard for planned care which illustrates the performance of services against each of these four measures and so inform patient choice and GP referrals; and in addition inform future CCG prioritisation decisions. Where possible we will collate existing publicly available information to populate this dashboard but we anticipate that providers will need to consider how they will promote their own information that demonstrates the value of the services that they provide. 13 P age

Benefit analysis: Description Benefit Type Beneficiary Efficiency index - Financial Savings Patient, CCG, GP Practice Demonstration of value - Added value of service demonstrated - Assurance Value for money is being delivered Patient experience - Efficient delivery of services - Better adherence to treatment plans - Reduction in complaints Planned case dashboard - Financial Savings - Efficient delivery of services - Better adherence to treatment plans - Reduction in complaints CCG Patient Patient, NHS Trust, CCG, GP Practice Patient, CCG 5.2 Urgent Care Urgent care services are designed to deliver value added interventions in a crisis, where the capacity available is appropriate to the presenting need and each part of the system has a clear, distinct and exclusive role. For the urgent care system to operate effectively, there are some fundamental IT/information requirements as described below: 5.2.1 Access to Primary Care Information from ED, Urgent Care and OOH Settings It has been demonstrated that the efficiency of patient flows and effective clinical decision making would be increased if clinicians in the A&E Department had access to, and utilised, primary care systems. It will be a prerequisite of providers in the new urgent care model in Dudley that the preferred system for primary care is used at the front-desk of the Urgent Care Centre, the A&E Department and by Out of Hours providers. 5.2.2 Urgent Care Dashboard A key determinant of a provider s, and CCG s, success is the performance of the urgent care system. A robust, real-time performance management and tracking system will be developed to ensure all partners, including Dudley Group Foundation Trust (DGFT), West Midlands Ambulance Service, Dudley and Walsall Mental Health Partnership Trust (DWMHPT) and Dudley Social Services have access to valid information to enable better management of the system. 14 P age

Benefit analysis: Description Type Beneficiary Primary Care system in A&E - Complete medical history when patient attends urgent care centre - Reduction in medical tests carried out - Reduction in duplication of medications prescribed - Reduction in administration time for medicines reconciliation requests - Avoidance of emergency admissions - Quicker discharge from hospital Urgent Care Dashboard - Reduction in capacity issues - Quicker identification of system bottlenecks - Improved throughput of patients - Quicker discharge from hospital - More joined up delivery of healthcare services - Improved patient experience Patient, NHS Provider Trust, CCG, GP Practice Patient, NHS Provider Trust, CCG, GP Practice 5.3 Reablement Reablement services are designed to deliver an integrated system, where people regain independence in the least restrictive setting possible. They are intended to reduce dependence. To facilitate this, the following developments are proposed: 5.3.1 Delayed discharges Effective patient flows from hospital into residential and nursing homes are key to the effectiveness of DGFT. We will work with Dudley MBC and DGFT to construct an effective system to aid such flows this reducing the number of delayed discharges Benefit analysis: Description Type Beneficiary Delayed discharges - Quicker identification of system bottlenecks - Improved throughput of patients - Quicker discharge from hospital - More joined up delivery of healthcare services - Improved patient experience Patient, NHS Provider Trust, CCG, GP Practice 5.4 Preventative Care/Integration Our key strategic priority is to support and invest in services deliver what the CCG terms preventative care. Privileging these services is not just about prioritising these services, it is about making these services the preferred, default activity in the way health and social care is delivered. 15 P age

This includes both services which empower people to take as much care of themselves as possible (i.e. be autonomous), in partnership with appropriate professionals, so that their overall health and wellbeing is enhanced and their level of clinical risk is reduced. This also includes those services which are designed to reduce people s levels of dependency or support people with long-term care and often includes the voluntary sector as well as NHS services. Our strategy is for all primary and community based services to integrate in order to deliver better coordinated and seamless care, through a single point of contact, in each of our five localities, thus developing five community hubs across the borough. The diagram on the right illustrates our locality model which is being developed together with Dudley MBC Social Services. We therefore expect all such providers which operate across a catchment area to organise their services in one of three ways:- Aligned to individual GP practices Operating on a locality basis, aligned to one or more of our five localities; Operating across the whole of Dudley, but with links to each locality. Services will be expected to deliver on a 7 day basis to ensure that patients needing prompt treatment are treated in a timely manner with no delays due to services not being available just because it is the weekend. We therefore intend to develop a model of delivery which provides a better response. We will redesign and invest in community and social care to provide rapid response service, 7 days a week, into people s homes (and care homes) either to provide home treatment or, if necessary, arrange an urgent planned transfer directly into the right service in the hospital (not via the A&E department). To enable the above to ambition to be realised, it is important that we progress on the following enablers: 5.4.1 Risk Stratification We will be developing our risk stratification tools as one means of evaluating and monitoring clinical risk. Dudley CCG has been selected as one of three pilot sites to test potential new risk stratification tools to be provided by the CSU. This piece of collaborative project work will involve experts from within the CSU working closely with both clinicians and commissioners from the CCG to understand their needs and test the use of risk stratification reports. The intention is to enable Dudley CCG to gain a granular understanding of the characteristics of their population at an individual patient level. This will in turn support locality based commissioning based on the characteristics of defined cohorts of patients within a local geography. Furthermore, when it comes to direct clinical care of patients, GPs, practice staff and other members of the community team who are providing direct clinical care will have direct access to the patients risk score and past health care resource utilisation across primary and secondary care. Initially the risk 16 P age

stratification reports are being targeted for use by case managers and GPs working in the context of a virtual ward. However the aim is to rapidly develop reports collaboratively with commissioners to support commissioning of services by locality teams. There is an ongoing feedback and evaluation programme in place designed to support the effective roll-out of the risk stratification tool across the CSU pilot sites. 5.4.2 Improved Data Quality We will develop a data quality programme for general practice to ensure Primis Data Quality principles are correctly applied and that general practices in Dudley are compliant with appropriate legal and NHS governance requirements. Dudley CCG GP Practices will work to Primis CARAT (Clear, Accurate, Relevant, Accessible and Timely) principles. The CCG will also provide a continual reminder to GP practices of the 8 principles of the data protection act:- 1. Fairly and lawfully processed 2. Processed for limited purposes 3. Adequate, relevant and not excessive 4. Accurate and up to date 5. Not kept longer than necessary 6. Processed in accordance with individual s rights 7. Secure 8. Not transferred to countries without adequate protection Whilst all General Practices use their clinical systems for the capturing of contemporaneous notes on patient consultations this Strategy will not only reinforce the importance of this work, but further enhance it. New developments including protocols to support the consistent recording and management of disease registers, templates for data capture, receipt of electronic clinical correspondence, guidance on clinical coding and developments to enhance the current scope of current clinical messaging arrangements will all help improve the depth and quality of the clinical record held in General Practices. The CCG will support its member practices by undertaking a baseline audit in each surgery and agree a number of actions which will form part of an overall development plan to be reviewed annually. 5.4.3 Summary Care Record The Summary Care Record (SCR) (GP extract of current medications, adverse reactions and allergies), continues to be deployed and utilised across the NHS in England. The Public Information Programme, informing patients of the service and giving them the opportunity to opt-out, has completed, and over half the population of registered patients have an SCR that can be viewed nationally by clinical staff in other settings when providing patient care. In addition, SCRs can be created for new patients and updated for existing patients at over half of GP practices in England. Demand for the service, in general practice (temporary and migratory residents, university students), secondary and community care settings, remains high and utilisation (record access and viewing) continues to increase as more records become available. The rollout of the SCR service is supported by NHS England and remains endorsed by leading healthcare, policy and governing bodies such as the British Medical Association, Royal College of General Practitioners and the General Medical Council. The future of improved healthcare provision has the safe and secure sharing of key patient information, combined with an increased interoperability of systems, as a key contributor to the NHS Outcomes Framework, which the creation and utilisation of patient summary care records supports. The purpose of the SCR is to provide safe and secure access to key elements of a patient s GP record within any appropriate healthcare setting, nationally, and without a dependence of any specific GP system. It is 17 P age

recognised that local data sharing solutions exist that utilise richer functionality of provider systems and make more data available to clinical staff providing care. With regard to patient consent, as a patient s medical data follows them through the local health system, general practice need to be sure that access to this data is controlled and that the appropriate laws and regulations are respected. Patients should have ultimate control over how their data is disclosed and to whom. We will ensure adequate protocols are followed with Dudley patients and conform to implement SCR. 5.4.4 Electronic Shared/Single Care Record Numerous organisations play key roles in the delivery of care and so effective communication between GP and provider is extremely important; as is the sharing of data and records so that we can support better and seamless delivery of care. We will therefore expect all providers to contribute to the development of a shared/single care record in Dudley. This will build on the nationally mandated summary care record, and will be a locally defined patient record with the ability to combine primary care, secondary care, community care and social care information. Better communication is at the heart of improving the care for our patients. A centralised electronic shared care record will help create a safer and more joined up NHS in Dudley helping make vital information more accessible at the time of need. 5.4.5 Tracking Patients through the System A key element of this priority to deliver integrated care is the ability to track patients through the system. The CCG needs to identify each intervention in a patient s journey through the health system and the associated cost. We will work with providers and commissioning support to ensure this is possible. To aid this, we will expect every organisation to use the NHS number and GP code as patient identifiers in all contract datasets and information requirements. The use of a common identifier will improve communication and data integration between services and practices. Any activity associated with data supplied without the NHS number will not be paid for. 5.4.6 Telehealth/Telecare Planning guidance for 2013 describes the requirement for the utilisation of telehealth and telecare to deliver improved care for patients. We have previously piloted teleheath for respiratory and heart failure patients and will develop a programme, in conjunction with DGFT, our main provider, to increase utilisation across Dudley. Initial discussions have targeted surgical specialities, to review how monitoring devices could be used to discharge patients into their homes with support from Community services. 5.4.7 Membership Database A unique feature of the NHS is that the public register with their GP. It is the GP who is at the central point in the NHS system that supports their patients throughout their life as the central co-ordinator of their care. The CCG is a membership organisation. This could be interpreted as the CCG s members being constituent practices, but we take the view that our members are also members of the public registered to our practices. We need to understand our registered members and their use of the health system so we intend to develop a membership database to record such information. 18 P age

Description Type Beneficiary Risk stratification - Greater understanding of dependency of individual patients - Reduced admissions - Reduced cost Improved Data Quality to enable data sharing for safety, quality and integrated care - Legal compliance - Enables streamlining and simplification of routine reporting - Easier identification of areas for improvement - Reduced administrative overheads Summary Care Record - Avoid harmful prescribing and treatment - Avoid duplicate or ineffective interventions - Reduce delays in diagnosis & treatment - Greater ownership by patients through access to their own SCR - Reduced administrative burden (repeated data entry) - Reduced errors of recorded information - Greater adherence to pathways and care plans Dudley Electronic Shared/Single Care Record - Avoid harmful prescribing and treatment - Avoid duplicate or ineffective interventions - Reduce delays in diagnosis & treatment - Greater ownership by patients through access to their own SCR - Reduced administrative burden (repeated data entry) - Reduced errors of recorded information - Greater adherence to pathways and care plans, eg end of life preference. NHS Number/Patient Identifiers - Ability to identify patients usage of health system. - Enables streamlining and simplification of routine reporting - Easier identification of areas for improvement - Reduced administrative overheads due to automation of record sharing Patient, NHS Provider, CCG, GP Practice Patient, NHS Provider Trust, CCG Commissioner, GP Practice Patient, NHS Provider Trust, CCG, GP Practice Patient, NHS Provider Trust, CCG, GP Practice 19 P age

Telehealth/Telecare - Improved patient experience - Reduction in emergency admissions - Reduced cost of unscheduled care services Membership database - Access to registered membership - Cost per patient in whole system Tracking patients through the system - More effective use of scarce resources - Adherence to NHS England targets - Improvements in care ownership Patient, CCG Patient, CCG, GP Practice Patient, NHS Trust, CCG, GP Practice 20 P age

6.0 Health Economy Interoperability/Strategies The vision for the CCG is that the health economy as a whole will have arrangements for ensuring Interoperability of each of its core systems. Dudley CCG commissions a number of parties to provide NHS care and treatment to the population it serves. Increasingly with developments in technology and increasingly complex needs of the patient population the packages of care will require delivery from a number of providers. In order to ensure a seamless package of care can be delivered to those in need it will be necessary to ensure all providers can share relevant information about those for whom they are providing services to other care providers with the GP Commissioner at the heart of the process. The diagram below outlines this: Within each provider there are various systems at different levels of operational performance and we intend to ensure that systems deployed meet the requirements to deliver the CCG s strategic plan. We aim to ensure that provider IT strategies are aligned to the CCG s IT and Informatics Strategy and will do this by co-production and implementation where appropriate. We support the model described by DGFT as identified below, and will support its delivery alongside ensuring it is appropriate for the needs of our member practices and CCG commissioning objectives. 21 P age

REAL TIME BUSINESS INTELLIGENCE MOBILITY TELE-CARE TELE- HEALTH PATIENT OPINION PATIENT CARE PLANNING PATIENT PORTAL ENTERPRISE SCHEDULING ORDER COMMS DECISION SUPPORT E-PRESCRIBING PATHOLOGY/PACS CARDIOLOGY EDM CLINICAL NOTING EPR/THEATRES PAS SOCIAL CARE VIEW AMBULANCE SERVICE VIEW PRIMARY CARE VIEW CLINICAL PORTAL Ambulance Service Social Care CUSTOMER RELATIONSHIP MANAGEMENT MESSAGING HUB FINANCE & PATIENT LEVEL COSTING Primary Care BIG DATA HR & ROSTERING SELF CARE ACUTE & COMMUNITY SOCIAL & PRIMARY CARE Extract: DGFT IT Strategy We will adopt the same approach for other providers, including DWMPHT, Black Country Partnership Trust, West Midlands Ambulance Service, Dudley MBC and private/voluntary sector. 22 P age

7.0 General Practice IT Responsibility for the management of primary care IT services is delegated to the CCG from NHS England. Funding to support this has also been delegated, currently at 2012/13 levels. It is unclear at the time of writing this Strategy exactly how primary care IT will be commissioned and funded from 2014/15 onwards as national policy is awaited. The approach to be taken by the CCG is that we will invest in primary care IT if we foresee a demonstrable improvement in either the quality of service provided or commissioning outcomes. The level of investment in GPIT by the predecessor PCT was below regional average. A programme of investment in hardware has occurred over the last 12 months; however there are further steps that need to be taken to ensure that our members are provided with robust and effective infrastructure to deliver the high quality service to patients and support to improve the efficiency of internal working practices, such as backoffice functions. The following initiatives are proposed over the next 3 years: 7.1 GP Architecture Dudley CCG is responsible for the delivery of GP Systems and the technical architecture that underpins them. There are a number of significant risks and issues associated with these including but not limited to: Clinical systems software provider support is now end of life Windows 2003 and XP currently used by some practices There is limited resilience, recovery and maintenance arrangements in place Limited consistent security and user policies Limited integration with other services Challenges around the monitoring and management of backups There is a current GP Practice network that is nearing the end of its life and has some technical limitations around Wi-Fi, IP addressing and web filtering. Support for the current infrastructure will become increasingly costly. There is an urgent need to redesign the infrastructure and present GP practices with a virtual desktop environment. In addition, virtual domain controllers and file servers for each practice will help with more efficient security, user s authentication and file management arrangements. This will enable many of the current risks and issues to be mitigated for and the overall environment to be managed and maintained in a more cost effective way going forward. The key benefits will be: Consistent arrangements for user authentication with improved security Password self-service for users reducing support overhead Ease of implementation of new technologies Centralised monitoring and management of backups Enhanced capability to provide support and remote software deployment enabling a more cost effective and streamlined service to be provided to users The deployment of such a virtual environment will require both significant testing and piloting together with investment. It is recommended that a solution be developed and piloted prior to rolling out more widely across all General Practices in Dudley. 23 P age

7.2 GP Clinical Systems Over the past ten years there has been a national reduction in the number of both GP clinical system suppliers and numbers of systems. This has often meant a consolidation of systems, suppliers and functionality. The first version of the GPSoC framework under Connecting for Health set out a tiered approach to systems functionality and suppliers were encouraged to bring to the market Cloud or remotely hosted solutions which had a number of significant benefits for general practices. The decision of isoft to withdraw from the UK GP computing market has left Dudley CCG managing two suppliers (Emis and InPractice Systems) who currently supply five separate systems (Emis LV, Emis PCS, Emis Web, In Practice Vision 3 Hosted, In Practice Vision 3 Practice server based). The two hosted cloud solutions are EMIS Web and In Practice Vision 3 hosted. The majority of Emis users remain on locally hosted or practice based systems that are no longer being developed therefore, as a matter of priority each are being offered a fully funded migration to the replacement Emis Web product. Dudley CCG will continue to promote a choice of GP Clinical Systems but its preferred product is Emis Web, and we wish to see all practices migrate to this during 2013/14. We wish to see one system for a variety of reasons but including: The ability to have one clinical system to support all of general practice in Dudley, our Urgent Care centre (incorporating A&E triage), our Out of Hours provider and community services will be a significant step towards the delivery of a seamless, efficient, service to patients The CCG s Primary Care Strategy describes how the CCG will support member practices to work together to deliver primary care over the next 10 years. All practices on the same IT platform significantly improve interoperability and the sharing of data, thus increasing our potential to support practices to work in this manner. The streamlining and simplification of technical support. We believe it is in the interest of the patient to utilise scarce resources to develop and fund new technologies rather than fund technical and maintenance support to various system providers One clinical system in Dudley will drive, and simplify, innovation. We will fully fund, and provide operational support, to practices choosing to migrate to Emis Web. We will also prioritise the development of new products with practices using EMIS. 7.3 Electronic Document Management (EDM): EMD, incorporating Docman, enables GP practices to quickly process electronic documents and provides instant access to information. This enhancement of access for general practices to clinical information generated in DGFT and other providers is a high priority for the development of local system interoperability. This will improve the efficiency of GP practices and the quality of discharge letters from hospitals. We have implemented Docman to each of our practices and continue to ensure its operational effectiveness. We are working with DGFT on the introduction of the hub and the benefits improved two-way communication will bring to the health economy. 7.4 Text Messaging to Patients Automatically sending electronic appointment reminders to patient s mobile phones is known to reduce nonattendance in General Practice. We will explore the options available to Dudley practices. 7.5 Patient Self-Check in Screens Not all GP practices in Dudley use patient self-check in screens. We will perform an options appraisal of the most effective product and develop a plan for implementation. 24 P age