Legacy Document 1 st draft: 4 th July 2011 Legacy Document_Worcestershire_v1 3_July 2011 (2) 1
Contents Introduction Worcestershire NHS Worcestershire/Worcestershire PCT Current Position Financial Management Information Performance Commissioning Primary Care Human Resources Quality Communications Community Engagement Governance Public Health Key Projects Transforming Community Services (TCS) The Elective Care Orthopaedic Project Practice-based Commissioning Flu GP Premises Developments Dental services Proposals for the Development of Evesham Community Health Services System Delivery Plan (QIPP Plan) Workforce Planning Challenges and Risks Key documents Directory of Services and Skills Legacy Document_Worcestershire_v1 3_July 2011 (2) 2
Introduction This document has been produced in response to the National Quality Board s publication, Maintaining and improving quality during the transition: safety, effectiveness, experience. Part One 2011-12 (March 2011). Each Directorate is preparing a Current Position statement detailing key information likely to be required by successor organisations, together with high level outlines of major projects. A repository of documents supporting both these elements, and providing a more detailed overview of the PCT will be created within a file sharing facility, the exact format of which is to be agreed. The document will be maintained until the abolition of PCTs in March 2013, and will form part of the handover process to Clinical Commissioning Groups together with a detailed brief on further soft intelligence and information. Worcestershire Our vision for Worcestershire is: of a county where people live longer and live better, have the support they need to adopt healthy lifestyles and have the choice of high quality services which are delivered as close to home as possible. Worcestershire has a population of just over 550,000, of whom 47,000 (8.5%) are aged over 75 and 98,500 (18%) are aged 65+, greater than the regional and national averages. Only about 2.5% of the population are from minority ethnic groups, lower than the national average. The area is some 670 square miles, most of it being rural. The principal urban areas are Worcester, more or less central to the county; Kidderminster in the north of the county and Redditch in the north east. The northern edge of the county borders the Birmingham and Black Country urban conurbation. The county is divided into six district council areas, Worcester City, Redditch and Wyre Forest (containing Kidderminster) cover the main urban areas, Bromsgrove is a mix of urban and rural areas, whereas Malvern Hills and Wychavon are largely rural, with smaller towns. Health outcomes in the county are generally better than average when compared to regional and national figures. Mortality rates for all the major killers are lower than nationally and hospital admission rates are lower than national averages for most causes. However admission rates for hip fracture are above the national average. NHS Worcestershire/Worcestershire PCT Since 1 st July 2011 Worcestershire PCT has been a commissioning only NHS body, following the transfer of its provider services to the newly established Worcestershire Health and Care NHS Trust. The Board structure, membership and functions are detailed in Standing Orders as published on our website. (http://www.worcestershire.nhs.uk/publications/policies-andprocedures/corporate.aspx) These were revised in March 2011 and are due for review by March 2013. Legacy Document_Worcestershire_v1 3_July 2011 (2) 3
Current Position Financial Management Area: Finance Current Position Statement Worcestershire PCT is in a financially sound position delivering planned surpluses since its inception. The last 3 years show: 2008/9: 4.862m 2009/10: 3.517m 2010/11: 3.47m 2011/12: planning on 3m surplus Key Committees Monthly finance reports produced and distributed to Board members. Annual Accounts produced as prescribed by the Department of Health. Two committees operate as sub committees of the Board, the Finance and Performance Committee and the Audit Committee. Both committees operate bi monthly. Is it a statutory requirement? Audit Committee statutory Finance and Performance Committee not statutory but always recommended for good financial stewardship. Any risks that have been highlighted: In terms of the health economy the major risk is around Worcestershire Acute Hospitals Trust. At this stage the Trust are still planning to break-even, however this requires delivery of a 15 million CIP programme (revised from 23m). Currently, there are 16.2m of planned schemes identified against this 15m target, albeit that 6.5m are amber or red rated. The Trust s position also includes a final loan repayment to the SHA of 5m, and options are currently being explored on how this will be achieved. This information is based on the June 2011 position. Ongoing discussion with WAHT regarding their cost improvement plan. All information is contained within the following directories: M:\PCT\Finance\Commissioning and Primary Care M:\PCT\Finance\Worcestershire\Financial Accounting Brian Hanford, West Mercia Cluster Director of Finance Simon Hairsnape, West Mercia Cluster Managing Director - Worcestershire Mary Walters, Chief Finance Officer Legacy Document_Worcestershire_v1 3_July 2011 (2) 4
Jan Clossick, Russell Davies, Toni Slater Commissioning Accountants Sue Johnson, Mark Darby, Financial Accountants Information Area: Information Current Position Statement The PCT Information Services team maintains and develops the data warehouse to support all aspects of performance, contract monitoring and commissioning support. This includes provision of information for PCT board reports, GP Commissioners, contract management boards, Finance and Performance Committee. The team comprises a core data analysis function, a Business Intelligence development function and a Clinical Commissioning support function (with named liaison information specialists supporting each of the 3 Clinical commissioning areas). The team provides activity and PbR data to Finance colleagues to support the provision of GP Practice budgets and to provide baseline contract activity plans for our contracted providers. The team also provide information to Public Health, Primary Care, Clinical Development, Commissioning and Performance teams to enable monitoring and reporting of key performance areas. Key Committees (including how it is managed, who manages it and how often? 3 x Clinical Commissioning Group boards - provision of strategic and local information at county, locality and practice level (via Business Intelligence and ad hoc reporting). Monthly Finance and Performance Committee provision of information to monitor monthly review of internal and external performance measures (e.g. contract performance and QIPP). Monthly Commissioning Executive - provision of activity information for specific project and programme areas. Weekly Contract Management Boards provision of a suite of monitoring reports for our main acute and community providers. Monthly Joint Information Group for main 2 providers. Monthly Is it a statutory requirements if not explain why this is done? Some information provided is to meet statutory requirements (e.g. QIPP, CQUIN). Purpose of other committees is to ensure robust monitoring of contract performance and performance against key targets (e.g. commissioning intentions) at PCT and Clinical Commissioning Group level. Any risks that have been highlighted: Risks identified in year as a result of regular monitoring. N/A Committee minutes as detailed above, Clinical Commissioners, GP practices, PCT Directors and Senior staff. Business Intelligence reports available to designated PCT and GP Practice Legacy Document_Worcestershire_v1 3_July 2011 (2) 5
staff. Marion Burrows Head of Information Services, NHS Worcestershire marion.burrows@worcestershire.nhs.uk Mathew Jack Information Services Manager, NHS Worcestershire Mathew.jack@worcestershire.nhs.uk Performance Area: Performance Management Current Position Statement Currently have two staff, acting Head of Performance and Performance Analyst. No confirmed news on cluster performance management arrangements but SHA are continuing their role in analysing NHSW and the rest of the health economy. Key Committees Finance and Performance Committee NHS PCT Board CCG Boards Commissioning Executive Any risks that have been highlighted: Achievement of targets set related to A&E, Referral To Treatment, Stroke, Mixed Sex Accommodation, Health Care Associated Infections, Cancer 62 day time to treatment Commissioning Managers are challenged to ensure action plans are in place to bring any service back in line with expected outcome level. These are in-built to the NHS contracts to ensure a contractual compliance is required. Apart from the committees listed above the data is available on the Performance Management Intranet web page where our Performance Management Framework and other reports are loaded. http://nww.worcestershire.nhs.uk/directorates/delivery/performance-management.aspx Alex Hill: Acting Head of Performance Management Tel: 01905 760127 Email: alex.hill@worcestershire.nhs.uk Simon Hairsnape, West Mercia Cluster Managing Director Worcestershire simon.hairsnape@worcestershire.nhs.uk David Williams, Performance manager at SHA 01212131978 david.williams@westmidlands.nhs.uk Lesley Cable at SHA - Tel. 0121 695 2372 E-mail: lesley.cable@westmidlands.nhs.uk Legacy Document_Worcestershire_v1 3_July 2011 (2) 6
Commissioning Area: Worcestershire Acute Hospitals NHS Trust Contract Current Position Statement 1.1. The 2011/12 recurrent contract value agreed by NHS Worcestershire and Worcestershire Acute Hospitals NHS Trust is 235,564,707. It includes all cost per case arrangements, block funding, a variety of other elements of the contract and CQUIN. The detail behind this financial value is set out in the final Contract Offer which also includes non recurrent allocations bringing the total financial package to 250,364,707. 2.1 The financial value of the Maternity and Paediatric plan, above which marginal costs will be set at 0%, has been reset for 2011/12 at 27,316,114. (This excludes maternity matters funding). Key Committees (including how it is managed, who manages it and how often? Committee Owner Frequency Contract Management Board (CMB) which incorporates representation from associate commissioners) Clinical Services Review Group (CSRG) NHSW Commissioning NHSW Quality and Patient Safety Monthly Monthly Service issues Group (SIG) NHSW Commissioning Monthly Joint Information group (JIG) NHSW Information Services Monthly Is it a statutory requirements if not explain why this is done? Contractual Obligation Any risks that have been highlighted: Risk Committee through which actions are reviewed and monitored Action Plan Stroke Services CMB/CSRG Yes Eliminating Mixed Sex Accommodation CSRG Yes A Compliance with CQC Outcome 5, Nutrition CMB/CSRG Yes Re-provision of intermediate care services and the closure of Aconbury wards CSRG Yes Transfer of suite of services to Malvern Hospital CMB Yes T t Legacy Document_Worcestershire_v1 3_July 2011 (2) 7
Transfer of Cancer services CMB Cancer Strategy Transfer of Ca Contract over performance CMB Continual monitoring and corrective action as required. Contractual terms will provide for elective over performance to be payable at agreed marginal rates up to an agreed threshold. Contract over A&E Performance failing to meet 4hour Standard target of 95% CMB Performance Notice issued 04/07/11. Action Plan received and being monitored through CMB A&E Performa meet 4hour St of 95% 62 day performance for Colorectal cancer services CMB Formal letter issued May 2011 requesting action plan. 62 day perform Colorectal can M:/PCT/Commissioning/All-Three-PCTs/Contracts2010-11/WHAT/Risk Register March 11.xls See Above M:/PCT/Commissioning/All-Three-PCTs/Contracts2011-12/WAHT M:/PCT/Commissioning/All-Three-PCTs/Contracts2010-11/WAHT Paper File in Commissioning cabinet Name Position Organisation E-Mail Simon Hairsnape West Mercia Cluster Managing Director: Worcestershire NHSW Simon.Hairsnape@worcestershire.n hs.uk Chris Emerson Deputy Director of Delivery NHSW Chris.Emerson@worcestershire.nhs. uk Brian Hanford West Mercia Cluster Director of Finance: Worcestershire NHSW Brian.Hanford@worcestershire.nhs.u k Karen Hunter Head of Quality and Patient Safety NHSW Karen.Hunter@worcestershire.nhs.u k Chris Tidman Director of Finance WAHT chris.tidman@worcsacute.nhs.uk Legacy Document_Worcestershire_v1 3_July 2011 (2) 8
Katie Osmond Assistant Director of Finance WAHT katie.osmond@worcsacute.nhs.uk Harrison Riley Commissioning Manager NHSW Harrison.Riley@worcestershire.nhs. uk Mary Walters Chief Finance Officer NHSW Mary.Walters@worcestershire.nhs.u k Mat Jack Information Services NHSW Matthew.Jack@worcestershire.nhs.u k Phil Graham Business Information manager WAHT Phil.Graham@worcsacute.nhs.uk Paul Hanson Senior Account manager HCS paul.hanson@hcs.nhs.uk N.B. Correct as at 4th July 2011 Area: Community services (adults and children s community services, prison health) Contract Current Position Statement 2011-12 contract value 88,321,899 (..\..\..\Contracts 2011-12\Worcestershire PCT (provider arm)\2011-12 Contract\Financial Plans\WPCT Contract Summary - Final Version 31.03.2011.xls) 2010-11 Performance: Slight under-performance against the contracted financial values for 2010-11 (PbR activity slightly above (6.8%) financial plans); Achievements evidenced in 2010-11: Achievement of 18-weeks Referral to Treatment Targets (RTT) (admitted (90%) and non-admitted (95%) care); Achievement of target (90%) for routine breast screening of women aged 53 70 years; Achievement of access targets (100%) to Genitourinary Medicine (GUM) Services. Key Committees Worcestershire Community Services Contract Management Board (monthly, managed by Wyre Forest Clinical Commissioning Group on behalf of the three Worcestershire Clinical Commissioning Groups Worcestershire Community Services Clinical Quality Review Group (monthly, managed through NHS Worcestershire Quality and Patient Safety team); Worcestershire Community Services Joint Information Group (monthly, managed by NHS Worcestershire Information Services). Is it a statutory requirements if not explain why this is done? Not a statutory requirement but essential for good contractual management of performance Legacy Document_Worcestershire_v1 3_July 2011 (2) 9
and quality, including patient safety. Any risks that have been highlighted: No significant risks identified. Minor issues with the contract being recorded and picked up through a service issues log, which includes evidence of action plans agreed with the service leads to rectify/reduce any risks associated with the issue. This is regularly reviewed by the commissioner and progress reported to CMB on a monthly basis with details of the actions being taken to rectify/resolve the issue(s) raised. As above Available on the Commissioning Shared Drive (M) under Contracts 2010-11 and Contracts 2011-12. File name Worcestershire PCT (provider arm). (..\..\..\Contracts 2010-11\Worcestershire PCT (provider arm);..\..\..\contracts 2011-12\Worcestershire PCT (provider arm)) Lead Commissioner for Community Services Anita Roberts Ext 37169 (01905 760057) anita.roberts@worcestershire.nhs.uk Commissioning Support Manager for Community Services Rachael Blundell Ext 37162 (01905 760050) rachael.blundell@worcestershire.nhs.uk Wyre Forest GPCC Board Secretary (administrative support for CMB) Julie Bishop Ext 37176 (01905 760104) julie.bishop@worcestershire.nhs.uk Children s Joint Commissioning Unit Manager - Zoë Cookson 01905 766989 zcookson@worcestershire.gov.uk Prison Health Commissioning Helen Cochrane 07595 023190 helen.cochrane@worcestershire.nhs.uk Chief Executive of Worcestershire Health and Care NHS Trust - Sarah Dugan sarah.dugan@hacw.nhs.uk Director of Finance, Worcestershire Health and Care NHS Trust Robert Mackie Robert.mackie@hacw.nhs.uk Director of Service Delivery, Worcestershire Health and Care NHS Trust Jan Ditheridge jan.ditheridge@hacw.nhs.uk Head of Information Services, NHS Worcestershire Marion Burrows, Ext 37324 (01905 733676) marion.burrows@worcestershire.nhs.uk Charlie Windsor, Head of Information and Contracting, Worcestershire Health and Care NHS Trust 01905 681536 Charlotte.Windsor@hacw.nhs.uk Head of Performance, NHS Worcestershire Alex Hill, Ext 37179 (01905 760127) alex.hill@worcestershire.nhs.uk Head of Quality and Patient Safety, NHS Worcestershire Karen Hunter, Ext 37168 (01905 733818) karen.hunter@worcestershire.nhs.uk Area: Contract Monitoring (Mental Health contract) Legacy Document_Worcestershire_v1 3_July 2011 (2) 10
Current Position Statement It is expected that there will be continued developments on reporting across 2011/12 in line with new performance frameworks. These will continue to include mandatory mental health measures (National Operating Framework cites Early Intervention, Crisis Resolution/Home Treatment [CRHT], Care Programme Approach, Improving Access to Psychological Therapies [IAPT]) the introduction of QIPP indicators and metrics and expectations of the following outcome frameworks as they develop: MH Strategy NHS Outcomes Framework Adult Social Care Outcomes Framework Public Health Outcomes Framework Other NHS providers Monthly returns, quarterly/bi annual contract reviews as required. Key Committees Contact Management Board: to hold Worcestershire Health and Care NHS Trust to account for the mental health service elements of their contract. Provider produces monthly activity and performance monitoring reports in a format and timescale agreed with the Joint Commissioning Unit (JCU). The JCU coordinates the meetings ensuring all performance data is collated and circulated with agenda papers at least 5 working days before the meeting date. Given the cluster arrangements and staff changes this meeting is being chaired by Susan Harris, MH Commissioning Lead in the JCU. Agenda items are to be presented to the Chair in a timely fashion The JCU will provide Worcestershire Health and Care NHS Trust with a written review record of the Contract Management Meeting for both parties' signature. These will contain without limitation a summary of all the matters raised during the review, actions taken, agreements reached, disputes referred to, dispute resolution and the outcome of such referrals and any variations agreed. Contract Management Board takes exceptions from both the Clinical Quality Review and the Joint Information Group meetings. A member of the JCU is represented in both of these meetings. Is it a statutory requirements if not explain why this is done? While 2011 12 Standard NHS Contract and any subsequent contract remains in force both parties shall monitor all relevant schedules and review any matters considered necessary including without limitation: Service activity Financial activity The performance of the parties including any Performance Notices and Warning Notice issues. Capacity reviews Compliance with clinical quality and performance indicators CQUIN Performance Improvement Programme/PbR (Payment by Results) Legacy Document_Worcestershire_v1 3_July 2011 (2) 11
Information supplied pursuant to agreed information requirements Contract variations Service developments / commissioning intentions The Contract Management Board will receive and ratify the minutes of the Clinical Review Group, noting any non-compliances and remedial actions proposed. Any risks that have been highlighted: Place of Safety (PoS) we are working to ensure compliance with Regional Protocol. The challenge has been multi agency sign off (namely WAHT and the Police) regarding specific aspects of the protocol. IAPT roll out lower than expected investment in IAPT meant that the roll out of psychological therapy services has been limited. Future investment will need to come from cost shifts in the block contract, namely Community Mental Health Team (CMHT) redesign and this is yet to be determined. Redditch and Bromsgrove Clinical Commissioning Group is considering options around retender and long term position of independent counsellors. Secure services changes there are potential changes to the criteria to and from secure services which could impact on the Out of Area Placements Budget and the use of Psychiatric Intensive Care Unit (PICU) beds in county. Dementia lack of data means that planning for future provision has limitations. The demographic pressures in this area means that we need to quantify current resources to maximise investment. There are also risks with short term funding for some services. Young onset Dementia is also poorly supported in the existing portfolio of services PbR moving to tariffs with limited guidance/standardisation is resource intensive and the team capacity to undertake detailed analysis is limited QIPP work around CMHT capacity and Adult Bed numbers still underway. The evidence base around CMHT capacity is limited nationally and locally. Place of Safety action plans owned by PoS working group with updates to Commissioning Executive IAPT continued work re: CMHT redesign through Trust Modernisation Programme Board. Initial action plan scoped out re: re-tender Secure services changes awaiting further guidance on criteria to understand numbers and impact Dementia modelling group with Project Initiation Document (PID) in place. The Dementia Programme has a number of working groups, inc Young onset Dementia, with action plans reporting into Dementia Care Planning Partnership PbR PID in draft and working group in place QIPP action plans discussed at Strategic Modernisation Programme and monthly CMBs Worcestershire Health and Care Trust Senior Management Team Worcestershire JCU Contract Monitoring Board meeting Worcestershire JCU Joint Information Group Clinical Quality Review Group, NHS Worcestershire Appropriate sub groups including Care Planning Partnerships, Clinical Commissioning Legacy Document_Worcestershire_v1 3_July 2011 (2) 12
Groups, multi agency MH Act working group, modelling groups etc Sue Harris Lead Joint Commissioner, JCU SHarris2@worcestershire.gov.uk Andrea Payne Mental Health Contracts Officer, JCU APayne@worcestershire.gov.uk David Hitchen Commissioning Officer, JCU dhitchen@worcestershire.gov.uk Tony Leak Karen Hunter Alex Hill Mike Harris Jan Ditheridge Robert Mackie Charlie Windsor Information and Performance Manager, Worcestershire County Council Head of Quality and Patient Safety, NHS Worcestershire Acting Head of Performance Management, NHS Worcestershire Financial Controller, NHS Worcestershire Director of Service Delivery, Worcestershire Health and Care NHS Trust Director of Finance and Resources, Worcestershire Health and Care NHS Trust Head of Information and Contracting, Worcestershire Health and Care NHS Trust tleak@worcestershire.gov.uk Karen.hunter@worcestershire.nhs.uk Alex.hill@worcestershire.nhs.uk Mike.harris@worcestershire.nhs.uk Jan.ditheridge@hacw.nhs.uk Robert.mackie@hacw.nhs.uk Charlie.windsor@hacw.nhs.uk Area: Joint Commissioning Unit (JCU) - Adults Current Position Statement The JCU Adults was established in 2008 under Section 75 of the 2006 National Health Service Act which allows for joint commissioning and the pooling of funds. The Partnership Agreement runs until 2013 and describes the joint commissioning and pooled budget arrangements. Key Committees (including how it is managed, who manages it and how often? The arrangements are overseen by the Adults Joint Commissioning Group (JCG) made up of the Chief Executive, West Mercia Cluster Managing Director: Worcestershire, Chief Finance Officer, and Director of Public Health of the PCT and the Director, Head of Social Care and Head of Finance of the County Council's Adult and Community Services. The JCG meets 4 times a year. From June 2011 the Health and Well-being Board will oversee joint commissioning and Legacy Document_Worcestershire_v1 3_July 2011 (2) 13
pooled budgets. Is it a statutory requirements if not explain why this is done? Both the PCT and the local authority have duties and powers to co-operate in order to secure the health and welfare of the local population Any risks that have been highlighted: No risks have been highlighted specifically in relation to the JCU itself. Kathryn Downton Interim Head of Joint Commissioning, kdownton@worcestershire.gov.uk Area: Children's Joint Commissioning Unit (JCU) Specialist CAMHS Current Position Statement Specialist CAMHS is jointly commissioned by the CJCU under a S75 agreement. The service provides Tier 2 and 3 specialist support and treatment for children and young people with mental health problems and their families. The service is delivered from three localities and the provider has an action plan to achieve county-wide consistency in service provision to correct historical inequities. A needs assessment and review of the service are underway. The 2010 Ofsted/CQC inspection found deficiencies in the service. There is an Improvement Plan in place for each inspection report, with targets to improve timely access to CAMHS for Looked After Children, to provide a CAMHS Out of Hours Service for urgent cases and also to develop care pathways for children with ASD and ADHD. Key Committees (including how it is managed, who manages it and how often? Children's JCU governance arrangements: Monthly Joint Commissioning Executive (JCE) Membership includes: Simon Hairsnape (Chair) Richard Harling Gail Quinton Brain Hanford Richard Keble NHS West Mercia Cluster Managing Director, Worcestershire Director of Public Health NHS Worcestershire/Worcestershire County Council (WCC) Director of Children's Services, WCC NHS West Mercia Cluster Director of Finance, Worcestershire Head of Commissioning and Partnerships, WCC Bi-monthly CAMHS Joint Commissioning Sub-group (CAMHS JCG) Membership includes: Richard Keble Head of Commissioning and Partnerships, WCC Legacy Document_Worcestershire_v1 3_July 2011 (2) 14
Zoë Cookson Sue Harris Angela Kirton Liz Altay Iona Payne Anne Scarsbrook Marie McCurry Joint Commissioning Unit Manager, WCC Adult Mental Health Commissioner Commissioning Manager, CAMHS Public Health Consultant Service Manager, Specialist and Transitions Services, WCC Service Manager, Early Intervention and Targeted Support, WCC Associate Director, Worcestershire Health and Care NHS Trust Monthly CAMHS Commissioner/Provider (contract monitoring) meetings These are attended by: Richard Keble, Head of Commissioning and Partnerships, WCC Zoë Cookson, Joint Commissioning Unit Manager, WCC Marie McCurry, Associate Director, Worcestershire Health and Care NHS Trust Su Cuerden, Clinical Service Manager, Worcestershire Health and Care NHS Trust Angela Kirton, Commissioning Manager, CAMHS, WCC Ursula Doerry, Clinical Director, CAMHS, Worcestershire Health and Care NHS Trust Is it a statutory requirement if not explain why this is done? Yes Any risks that have been highlighted: A recent increase in waiting times and numbers, particularly of long waiters, has been reported. The provider has also reported increased pressures on staff and these factors have triggered a focused examination of risk in the service. An extraordinary meeting of the JCE met on May 20 th with a 'Risk Summit' agenda. This found that risks are being managed and there is no evidence to suggest that the service is currently unsafe. However, there were actions to be taken. These are currently being worked on by commissioners and providers. 1. The CAMHS Risk Summit action plan 2. Ofsted and CQC action plans Children's JCU governance arrangements (see above) Ofsted and CQC Improvement Plans governance arrangements. Key Contacts: Legacy Document_Worcestershire_v1 3_July 2011 (2) 15
Angela Kirton, Commissioning Manager, CAMHS 01905 766295 Zoe Cookson, Joint Commissioning Unit Manager, WCC 01905 766989 Area: GP Out of Hours (OOH) Contract Current Position Statement Harmoni provide monthly reports on activity and performance approximately 2 weeks after the end of each month. The report covers a range of national specified indicators covering response times, plus some local derived performance indicators covering workforce in particular. An annual contract review took place in October 2010. The current contract runs until 30 th Sept 2013. From April 2011, Harmoni took over responsibility for OOH service to prisons. Primary Care Foundation manages a comprehensive benchmarking service for primary care out of hours. All West Midlands PCTs were required to participate by the SHA. Limited information had previously been obtained for Worcestershire due to the difficulty in extracting data from HMS, the computer based system used by the previous provider, TCN. Key Committees Reports are received at the monthly Contract Management Board (CMB) and incorporate quality and patient safety. This is currently chaired by Trevor Neatherway. Other key PCT representation is Simon Hairsnape, Cluster MD, Dr Jonathan Leach (clinical lead) and Lynn Takavarasha (Quality lead). Currently (June 2011) we are trying to gain GP representation from each of the commissioning consortia to join this Board. There is a LINK representative on CMB (Ann Montagu-Smith). GP OOH Management Board meets bi-monthly chaired by Dr de Cothi, GP lead for unscheduled care. Includes representation from each GP commissioning cluster, LMC, Harmoni and NHSW. Involved in some performance monitoring, defining local performance indicators and discussion of clinical protocols and potential service improvements. OOH and clinical staff meeting irregular intervals, led by clinical development staff to facilitate communication, joint working and problem solving primarily between OOH primary care and district nursing. SHA OOH leads meeting ad hoc networking, SHA undertook review of all PCTs in autumn 2010 following CQC report. OOH Project Board to develop single point of access for all OOH health and social care services. Project leads Ruth Davoll NHSW and Elaine Carolan, JCU Worcs County Council. Is it a statutory requirement if not explain why this is done? GP out of hours has a high political profile, both nationally with significant media and political interest, and locally with GPs scrutinising performance. The in-house OOH primary care service was put out to tender by the PCT in 2008. After a robust procurement process, the contract was awarded to Take Care Now (TCN). They took over management of the service in July 2008 and then full scale implementation of the new service model and IT systems in Oct 2008. There were some early teething problems but contract monitoring and performance reporting were successfully established. GPs and others began expressing concern about TCN service standards in spring 2009. The PCT undertook an independent review which made recommendations to improve staffing levels and increase use of local GPs which TCN implemented. In June 2009, CQC initiated an investigation of TCN following the Urbani case, which reported in June 2010. Interim national guidance was published in Oct 2009 during the investigation. NHS Legacy Document_Worcestershire_v1 3_July 2011 (2) 16
Worcestershire had already implemented the recommendations in the CQC report prior to publication. http://www.cqc.org.uk/_db/_documents/20100714_tcn_summary.pdf In the spring of 2010 TCN was taken over by Harmoni and following a due diligence process the Worcestershire contract was novated from TCN to Harmoni on 1 st April 2010. National quality indicators, governance and local relationships have all improved since. Problems were experienced with the HMS IT system and subsequently, in October 2010, a new Adastra system was implemented in Worcestershire with further improvement in data reporting. Any risks that have been highlighted: Performance over the Christmas 2010 holiday period was acknowledged by all sides to have been below what was acceptable. There was pressure on all areas of the urgent care system (e.g. 999, A&E) at the same time and the OOH service was unable to ease pressure elsewhere. Access to historical patient records on HMS is problematic following a system failure just prior to transfer of the service from TCN to Harmoni. Old Adastra OOH patient records pre TCN are held by NHS Worcestershire with access via Paul Newell (paul.newell@worcestershire.nhs.uk). Focus in 2010/11 was on the handover of the contract from TCN to Harmoni and then responding to the CQC investigation into out of hours services. Consideration is now been given to address service development opportunities. A first wave of additional local Key Performance Indicators have been agreed with the provider and the intention is to introduce a further set in the second half of the year to address enhancements to service quality. Information can be found filed in M:\PCT\Commissioning\All-Three-PCTs\OUT OF HOURS - HARMONI\Out of Hours current file Clinical Commissioning Group urgent care leads are:- Wyre Forest Dr Tony de Cothi, tonydecothi@nhs.net Redditch and Bromsgrove Dr Richard Davies, richard.davies2@nhs.net South Worcestershire Dr Felix Blaine, felixblaine@nhs.net, Dr Jonathan Thorn, jthorn@nhs.net, Dr Nikki Burger, nicole.burger@nhs.net NHS Worcestershire contacts: Trevor Neatherway, Commissioning Lead for OOH: trevor.neatherway@worcestershire.nhs.uk Jonathan Leach, Medical Director: jonathan.leach@worcestershire.nhs.uk Lynn Takavarasha, Quality assurance lead for OOH: lynn.takavarasha@worcestershire.nhs.uk Harmoni contacts are: Steve Donald Director of Development, steve.donald@harmoni.co.uk, 07974 923819 Dr Russell Kelsey Regional Medical Director, russell.kelsey@harmoni.co.uk Legacy Document_Worcestershire_v1 3_July 2011 (2) 17
Diane Spreadborough General Manager, diane.spreadborough@harmoni.co.uk, 01905-28248 Ann Smith Regional Director, ann.smith@harmoni.co.uk Debra Bruton - Lead Nurse, debra.bruton@harmoni.co.uk Area: Continuing Healthcare Current Position Statement The Continuing healthcare department manages the commissioning and case management of placements that relates to NHS funding via eligibility against the National Framework for NHS Continuing Healthcare, covering all client groups, including Learning Disabilities, Physical Disabilities, Mental Health. Key Committees Ratification meets twice weekly, with a Local Authority representative, managed by the continuing healthcare team. Learning Disabilities Panel meets monthly with other health professionals and is managed by the Continuing Healthcare team. Local Review Panel meets twice monthly, with an Independent Chair, Local Authority representative and PCT Senior Manager. Managed by the Continuing Healthcare Team. SHA Independent Review Panels held monthly and is managed by the SHA. SHA Leads Meetings held bi-monthly and managed by the SHA. Transitional Care Steering Group held weekly and is managed by Joint Commissioning Unit. Safeguarding Board held monthly and is managed by the Local Authority. Is it a statutory requirements if not explain why this is done? It is a statutory requirement to identify when an individual has a primary need for healthcare. Any risks that have been highlighted: Financial risk to the Primary Care Trust High level media interest Regular reporting to the PCT Board, monthly financial meetings with the Director of Finance. Regular meetings with a Senior Director in relation to complex case issues. It is shared SHA wide and also nationally through Benchmarking data. Hilary Green, Countywide NHS Continuing Healthcare Manager Hilary.green@worcestershire.nhs.uk Tel: 01905 733848 Corinne Taylor, SHA Lead Tel: 0121 695 2488 Legacy Document_Worcestershire_v1 3_July 2011 (2) 18
Stephanie Kenney, Assistant Commissioning Manager (contracting) Stephanie.kenney@worcestershire.nhs.uk Tel: 01905 760113 Primary Care Area: GMS\PMS Commissioning Framework 2010-13 Current Position Statement Benchmarking of all practices using 09\10 data complete across a range of indicators (including QOF) All practices visited to renegotiate PMS Contracts (39) Nov 2010-Jan 2011 GMS practices visited (26) to agree QIPP Enhanced Service Jan-March 2011 Objectives agreed at GMS\PMS Commissioning Group 8 June 2011 Lead Lynda Dando, Head of Primary Care with Primary Care Commissioners aligned to Clinical Commissioning Group geographical areas Jo Hall, Nigel Higenbottam, Jeanette Giles Key Committees (including how it is managed, who manages it and how often? GMS\PMS Commissioning Group chaired by Lynda Dando meets monthly Commissioning Executive to agree annual priorities for negotiation into contracts and ES Is it a statutory requirements if not explain why this is done? Process and requirement for annual reviews is a statutory requirement. The Worcestershire approach, as articulated in its Framework, is a local initiative Any risks that have been highlighted: Capacity to analyse data for benchmarking an annual requirement Manpower to share information, discuss with practices and agree areas for improvement Ability to measure whether progress has been made\objectives achieved DH sponsored analysis tool for benchmarking practices to be re-launched shortly but this only addresses this particular risk. Primary Care Folder: GPs\Performance Management\GP Benchmarking\Segmentation and sub folders within this Lynda Dando, Head of Primary Care\Deputy Director Nigel Higenbottam, Deputy Head of Primary Care Jo Hall, Primary Care Commissioning Manager Jeanette Giles, Primary Care Commissioning Manager Legacy Document_Worcestershire_v1 3_July 2011 (2) 19
Area: GP Appraisal and Revalidation Current Position Statement There is a well managed and inclusive GP Appraisal system for all GPs on the NHS Worcestershire Medical Performers List. The appraisal process includes all doctors irrespective of type i.e. Principal, Salaried, Sessional etc. At the present time there are 457 doctors who require an annual appraisal and 28 fully trained and operational Appraisers (one currently on sabbatical so 27 working). The process and management of GP Appraisal is as laid out in the GP Appraisal Policy which is published on NHSW website. Key Committees The GP Appraisal process is managed by the GP Appraisal Co-ordinator. A GP Appraisal Lead is contracted to work 2 sessions per week. The Director of Primary Care is the Medical Director/Responsible Officer. An annual report is presented to the Quality and Patient Safety Assurance Committee, a sub-committee to Trust Board. Is it a statutory requirements if not explain why this is done? It is a statutory requirement that every doctor on the Medical Performers List is offered and undertakes an appraisal each year. Any exceptions are recorded and managed under the terms of the GP Appraisal Policy. Any risks that have been highlighted: The additional requirements that will be necessary under Revalidation are being considered and action plans will be put in place to meet these, in particular with regard to any remediation that may be required. Transition from NHSW to a new body who will manage GP Appraisals will be managed as and when further detail becomes available. None at present but these will be developed to ensure a smooth transition from the current appraisal into Revalidation process and also the move to a new responsible body. Internally between GP Appraisal Co-ordinator and the Medical Director/Responsible Officer. Externally a report of successfully completed appraisal is shared with other employing organisations. This information is restricted to date of appraisal and name of appraiser only. Yvonne Buttery, GP Appraisal Co-ordinator (01905) 733819 Yvonne.buttery@worcestershire.nhs.uk Dr Jonathan Leach, Medical Director/Responsible Officer (01905) 733853 Jonathan.leach@worcestershire.nhs.uk Legacy Document_Worcestershire_v1 3_July 2011 (2) 20
Area: Medical Performers Lists Current Position Statement: General Medical Practitioners included in PCT's Medical Performers List: 503 General Dental Practitioners included in PCT's Dental Performers List: 303 General Ophthalmic Practitioners included in PCT's Ophthalmic Performers List: 136 Pharmaceutical Services and Appliance Contracts: 96 Key Committees Performance Decision Making Group Performers List Panel Membership is detailed in Performance Decision Making and Performers List Policies and have to be quorate for decisions to be authorised/legal Meetings are held as and when necessary. Deal with applications to the Performers Lists and any subsequent poor performance which may result in conditions being placed upon a practitioners performance, onward referral to regulatory or other bodies, suspension or ultimately removal. Is it a statutory requirement if not explain why this is done? Performance Decision Making Group is held to deal with performance issues at a less formal level than the Performers List Panel which operates in accordance with the NHS (Performers Lists) Regulations 2004 and the NHS (Pharmaceutical Services) Regulations 2005 Any risks that have been highlighted: None identified at present Not at present A report summarising all cases considered is reported confidentially on an annual basis to the PCT Board. Serious cases are reported confidentially to the Board as they occur. Jo Hall, Primary Care Contracts Manager: Jo.Hall@worcestershire.nhs.uk Jonathan Leach, Medical Director: Jonathan.Leach@worcestershire.nhs.uk Area: Optometry Current Position Statement: General Ophthalmic Mandatory Services Contract: 82 General Ophthalmic Additional Services Contract: 31 Legacy Document_Worcestershire_v1 3_July 2011 (2) 21
Key Committees Ophthalmology Commissioning Group (bi-monthly) Lynda Dando, Head of Primary Care Is it a statutory requirements if not explain why this is done? The Ophthalmology Commissioning Group ensures a commissioning and performance management focus for the ophthalmic community, e.g. Ophthalmologists, optometrists, medical practitioners, etc. develops and implements service specifications in line with PCT commissioning intentions to include enhanced eye care services. develops and implements a framework for ensuring governance and quality in the commissioning of community based eye care services. Any risks that have been highlighted: Generic risks associated with abolition of PCT in 2013 Enhanced services commissioned on behalf of South Worcestershire and Wyre Forest in relation to Intra-ocular pressure (IOP) referral refinement scheme Post operative cataract Primary Eyecare Acute Referral Scheme (PEARS) pilot Shared Drive and archived filing on site Lynda.Dando@worcestershire.nhs.uk Head of Primary Care Ashif.Dhanani@worcestershire.nhs.uk Optometric Adviser Jeanette.Giles@worcestershire.nhs.uk Primary Care Contracting and Commissioning Manager Sue.Huxley@worcestershire.nhs.uk Primary Care Contracts Officer (Performers List and POL Administrator) Deborah.Dennis@worcestershire.nhs.uk Primary Care Contracts Officer (POL administrator) Area: Dentistry Current Position Statement: GDS Contracts 74 PDS Plus contracts 13 (5 +5 year contracts) PDS Contracts - 10 (Orthodontic), expiry 2013 Dental Helpline in operation Key Committees Legacy Document_Worcestershire_v1 3_July 2011 (2) 22
Commissioning Executive, NHS Worcestershire (weekly) Salaried Dental Contract and Performance Monitoring Group Lynda Dando, Head of Primary Care Dental Commissioning Group (quarterly) Lynda Dando, Head of Primary Care Dental Contracts and Performance Group Chair, Alan McMichael Dental Public Health Consultant, MCN (in development) Is it a statutory requirements if not explain why this is done? Any risks that have been highlighted: Risks associated with abolition of PCT in 2013 None at present Shared Drive and archived filing on and off site Lynda Dando, Head of Primary Care: Lynda.Dando@worcestershire.nhs.uk Alan McMichael, Dental Public Health Consultant Alan.McMichael@worcestershire.nhs.uk Nigel Crew, Dental Commissioning Manager: Nigel.Crew@worcestershire.nhs.uk Sally Everton, Dental Contracts Manager: Sally.Everton@worcestershire.nhs.uk Sue Huxley, Primary Care Contracts Officer (Performers List and POL Administrator) Sue.Huxley@worcestershire.nhs.uk Deborah Dennis, Primary Care Contracts Officer (POL administrator): Deborah.Dennis@worcestershire.nhs.uk Jan Clossick, Dental Lead Commissioning Accountant Jan.Clossick@worcestershire.nhs.uk Area: Pharmacy Contracts Current Position Statement: General Pharmaceutical Services Contracts: 94 Essential Small Pharmacy Local Pharmaceutical Services Contracts: 1 Appliance Contracts: 1 Key Committees Dispensing and Pharmacy Practices Committee Is it a statutory requirement if not explain why this is done? Committee with delegated powers to consider and approve/not approve applications for inclusion in the PCT's Pharmaceutical List complies with the NHS (Pharmaceutical Services) Regulations 2005 Legacy Document_Worcestershire_v1 3_July 2011 (2) 23
Any risks that have been highlighted: Membership of Committee is precarious and Chairman and Lay Member will only participate as long as the Committee is administered by the Primary Care Contracts Manager. Chairman is legally qualified and fully conversant with the Regulations. Lay Member has many years of experience. Can be difficult to organise meetings of the Committee as all 3 members have to attend to be quorate. There are no deputies for the Chairman and Lay Member. All decisions are open to Appeal. None at present To be confirmed Jo Hall, Primary Care Contracts Manager: Jo Hall@worcestershire.nhs.uk Human Resources Area: Human Resources and related services Current Position Statement: Following establishment of new Trust and transfer of HR team to that new Trust (Worcestershire Health and Care Trust) there is a requirement to develop and agree an SLA between NHS Worcestershire and the new Trust. Key Committees To be determined, based on the SLA Is it a statutory requirement if not explain why this is done? Yes Any risks that have been highlighted: Potential lack of robust HR support at a time of change if SLA is delayed SLA being developed To be determined, based on SLA and future Cluster and PCT arrangements To be advised Quality Area: Quality Assurance Legacy Document_Worcestershire_v1 3_July 2011 (2) 24
Current Position Statement Quality and patient safety standards and KPIs are incorporated into all contracts, including national and local priorities, covering the quality domains of patient safety, patient experience and clinical effectiveness. Monitoring/quality assurance against the standards is undertaken regularly for the majority of contracts Overall the quality of services provided is good although some concerns have arisen which have been pursued with individual providers. WAHT: Challenges in meeting compliance with Eliminating Mixed Sex Accommodation requirements. Still require to complete capital building works in Observation Unit at WRH. Stroke Peer Review poor overall performance against suite of quality indicators which are being reviewed Cancer Peer Review recent review indicated some risks for which the Trust has responded with an action plan which is being monitored. CQC compliance with Outcomes 1 and 5 moderate concerns against Outcome 1 and major concern against Outcome 5. Action plans in place which are being closely monitored. Follow-up unannounced visit by CQC at end of June 2011 indicated from verbal feedback that the Trust was now compliant. WMHPT: Some concerns regarding submission of evidence for some of the quality standards, particularly around lessons learnt related to incidents WPCT (Provider Services) Issues related to provision of 24 hour District Nursing Service CAMHS service under scrutiny: need to manage referrals and waiting lists more effectively. Some delays/breaches in access to physiotherapy services OOH Service Subject to CQC review and report in 2010. Change to provider implemented from April 2010. Local KPIs in place. Some challenges in meeting full range of NQRs over Christmas and other BH periods. Close scrutiny in place for contract. GP OOH Management Board in addition to standard CMB process. NHS Worcestershire Quality and Patient Safety Team has a responsibility, through the Clinical Quality Review meetings, to monitor the quality and safety of all commissioned services and to ensure compliance with all obligations under the clause of the Contract, Schedule 3 part 4 (Quality requirements). This includes the main NHS providers (Worcestershire Acute Hospitals Trust, Worcestershire Health and Care NHS Trust), Harmoni Out of Hours service, locally contracted services, Independent providers (Spire and BMI) and 3rd sector providers, e.g. St Richard s Hospice. NHSW Quality and Patient Safety Team are accountable for coordinating and monitoring the quality and safety outcomes within the contracts, focusing on the domains of quality, patient safety, patient experience and clinical effectiveness. NHSW Quality and Patient Safety team is also responsible for the following: Accreditation of practitioners with special interests delivering services within Worcestershire Legacy Document_Worcestershire_v1 3_July 2011 (2) 25
Assuring the Board that all commissioned/contracted services are delivered to high standards of quality and safety Key Committees Joint Clinical Service Review meetings Monthly meetings with reports from providers against agreed reporting schedule to cover all quality domains and individual quality standards within the contract. Reports from CQR meetings submitted to Contract Management Boards for relevant provider Managed by Quality and Patient Safety Team Clinical service review meetings for some independent providers are combined with contract management board, for e.g. Harmoni and may be held less frequently, e.g. Spire Southbank Quality and Patient Safety Assurance Committee meetings Formal sub-committee of the PCT Board with aim to review/scrutinise reports related to the quality of services commissioned by NHS Worcestershire Meetings held bi-monthly Report to each Board meeting Managed by Quality and Patient Safety Team Chaired by NED Is it a statutory requirements if not explain why this is done? Clinical Quality Review meetings: part of contract monitoring requirements. Not statutory but essential Quality and Patient Safety Assurance Committee: not statutory but good practice and maintains focus on quality for the Board Any risks that have been highlighted: 1. Failure of providers to meet all quality requirements 2. Limited engagement with Clinical Commissioning Groups on quality assurance processes 3. Limited capacity to provide robust quality assurance against all contracts. 1. Maintain/enhance quality assurance processes 2. Discuss with Clinical Commissioning Groups their expectations of quality assurance 3. Identify ways in which engagement can be developed 4. Appointment of Executive Lead Nurse (Quality) to act as point of liaison with on Clinical Commissioning Groups matters of quality and patient safety 5. Review capacity and consider requirements of the Clinical Commissioning Groups to meet their responsibilities in this area Information shared with respective providers, NHSW Quality and Patient Safety Assurance Committee, NHSW Board, with a dashboard to the Provider Contract Board on a monthly Legacy Document_Worcestershire_v1 3_July 2011 (2) 26