NHS Standard Contract - Service Specification Service Specification Service Commissioner Lead Lead Final Primary Care Based 12-Lead Electrocardiogram Service Andrew McMylor / Dr Nicola Jones Jeremy Fenwick, Battersea Healthcare CIC Period 1 st April 2016 31 st March 2018 Date of Review June 2017 1. Population Needs 1.1 National/local context and evidence base National Context The 12-lead ECG is a non-invasive tool in the management of confirmed or suspected cardiovascular disease which involves correctly placing 12 adhesive electrode leads on the patient s chest and limbs and recording the results for interpretation. It can be performed safely by healthcare professions with appropriate training (see 3.5). Local Context Wandsworth Clinical Commissioning Group (formerly Wandsworth Primary Care Trust) began commissioning general practices to perform ECGs in primary care with the objective of transferring a proportion of 12-lead ECGs from acute hospitals into a primary care setting thus delivering care in a more convenient location for patients. Over a five year period between 2007/08 and 2012/13 the number of 12-lead ECGs performed for all CCGs at St George s Hospital has steadily declined by 41% and it is estimated that a similar percentage decrease applies to Wandsworth practices. Queen Mary s Hospital has reported a decline of around 33% in 12-lead ECGs performed at the trust. Historically, uptake of the 12-lead ECG service by general practices has been good with 37/42 practices in Wandsworth signing up to deliver the service. In 2015/16 there is full coverage in Battersea with all 12 practices signed up, in West Wandsworth 8/9 practices are signed up and in Wandle 17/21 practices have signed up to deliver the service. The new provider must be able to improve on this current coverage, providing care close to home and continuity of care for patients. 2. Outcomes 2.1 NHS Outcomes Framework Domains & Indicators Domain 1 Preventing people from dying prematurely X Domain 2 Enhancing quality of life for people with long-term X conditions Domain 3 Helping people to recover from episodes of ill-health or following injury Domain 4 Ensuring people have a positive experience of care X Domain 5 Treating and caring for people in safe environment and protecting them from avoidable harm 2.2 Local defined outcomes To offer a service which is convenient for patients; To minimise the level of anxiety experienced by the patient by providing a primary care based service rather than going to hospital for a diagnosis where appropriate see acceptance and exclusion criteria. 1 X
3. Scope The purpose of this Service is to provide 12-lead ECG as a diagnostic tool in the management of confirmed or suspected cardiovascular disease within a primary care setting close to the patient s home. The Service will provide recording and interpretation of routine ECGs which is automatically generated though ECG machine s computer. Where an abnormal ECG is recorded this will be referred on for expert analysis to the ECG Reporting Service. Patients with suspected Acute Coronary Syndrome should be referred immediately to secondary care. All new cases of suspected exertional angina should be referred to a Rapid Access Chest Pain Clinic. 3.1 Aims and objectives of service To ensure the accuracy of ECG tracing through a quality assured service; To offer an appointment within 2 weeks of referral; To keep waiting times within the clinic to a minimum and to inform patients of the reasons for any delays experienced; To offer a service which is accessible and convenient for patients; To actively and continually seek feedback from patients on the Service they have received and to use this to shape service delivery. 3.2 Service description/care pathway In the delivery of this service, the will adhere to standards set out in the Society for Cardiological Science and Technology s Approve Methodology for Recording a Standard 12-lead Electrocardiogram. As part of their business as usual, referring GPs will identify patients who require an ECG using the criteria detailed under 3.3 and 3.4. The referring GP will undertake an assessment which includes history and clinical examination. Following a consultation, the referring GP recommends an ECG and a referral is made to the ECG Service. The will have in place a written procedure which will be agreed with the Commissioner prior to the contract being issued. The s written procedure will form an appendix to this Contract and must as a minimum detail how the will: Manage referrals into the Service including assessment against eligibility criteria and the process for rejecting and promptly notifying the referring GP of inappropriate referrals; Contact patients to arrange an appointment for their test; Provide the patient with confirmation of their appointment; Check that any pre-visit requirements have been adhered to by the patient before performing the test; To perform 12-lead ECG testing in accordance with the Society for Cardiological Science and Technology s Approve Methodology for Recording a Standard 12-lead Electrocardiogram; Each ECG tracing along with the message generated from the ECG machine stating whether the tracing is normal or abnormal should be shown to a GP following which the GP will determine whether an expert analysis is required, in the case of the latter, to upload the ECG tracing into Cardioview or similar system and attaching the tracing in an email to the Wandsworth ECG Reporting Service provided by St George s Hospital ecg.gp.report@nhs.net copying in the referring GP. The report will be provided within 72 hours; Promptly reporting back the results of the test (including providing the feedback of the ECG Reporting Service where relevant) to the referring GP securely (see IM&T requirements); Recording the results of the test onto EMIS; Capture the data fields required under sections 3.8 and 5. 3.3 Population covered The service is available to patients who are over 18 years old, registered with a GP in Wandsworth and fall within the acceptance criteria (see 3.4) 2
3.4 Any acceptance and exclusion criteria and thresholds Acceptance Criteria: Patients who are referred to the service by the GP where an ECG is clinically indicated. Exclusion Criteria Patients under 18 years of age (see above); Patients registered with a GP outside of Wandsworth; Patients who have not been referred by a Wandsworth GP; ECGs required for routine medicals and medical certificates; ECGs are not to be performed as part of pre-operative assessment. Patients with any of the following conditions must be sent to hospital by ambulance: Suspected acute MI; Acute or unstable angina; Suspected complete heart block; Tachyarrhythmia in an unwell patient such as AF with a rate over 150. 3.5 Training, Skills and Experience The Service will be provided by a nurse or healthcare assistant who is competent in the use and recording of an ECG. Ideally this will be in the form of a recognised qualification awarded by the Society for Cardiological Science and Technology (certificate or associate membership) following the successful completion of the appropriate examination. As a minimum the nurse or healthcare assistant will be able to provide evidence of having undertaken a practical assessment which was overseen by a competent practitioner holding the above award. The must ensure that there is appropriate support and supervision available for those providing the service. 3.6 Equipment The will purchase its own equipment to enable it to deliver the Service. This includes replacing equipment that has reached the end of its lifespan; The ECG equipment must meet or exceed the requirements of IEC 60601-2-25 (2011); It is the s responsibility to calibrate and arrange for serving of the device in line with the manufacturer s guidance; It is the s responsibility to purchase all consumables such as replacement cuffs and batteries, these costs are included within the service price; It is the s responsibility to monitor the life span of the device and to purchase a new device as required. Again this cost will be borne by the as it is built into the service price. 3.7 Interdependence with other services/providers The will develop relationships with other providers in order to become an integral member of the Health and Social Care Community. Wandsworth Clinical Commissioning Group (CCG) All Wandsworth general practices including GPs, practice nurses and healthcare assistants Cardiology units at acute hospitals Third sector organisations Wandsworth Borough Council Service users as key stakeholders Healthwatch 3.8 Finance and Activity The will be paid 16 per ECG performed. Payment will be made only for activity which is coded using the EMIS codes stated below monthly in arrears. Test performed Read code ECG performed 321B 12 lead ECG or 3212 Standard ECG The is required to have a system to identify a) which practice patients have been referred 3
from and b) where the ECG was performed and will be required to report this to the CCG on a monthly basis. 4. Applicable Service Standards 4.1 Applicable national standards (eg NICE) GC127: NICE Clinical Guideline on Clinical Management of Primary Hypertension in Adults CG95 Chest Pain of Recent Onset: Assessment and Diagnosis of Recent Onset Chest Pain or Discomfort of Suspected Cardiac Origin (March 2010). www.nice.org.uk/guidnce/cg95 CG108 Chronic heart failure. (August 2010) www.guidance.nice.org.uk/cg108 Clinical Guideline GC180 Atrial Fibrillation: The Management of Atrial Fibrillation (June 2014) http://www.nice.org.uk/guidance/cg180 CG127 Hypertension; Clinical management of primary hypertension in adults. (August 2011) http://www.nice.org.uk/guidance/cg127 4.2 Applicable standards set out in Guidance and/or issued by a competent body (eg Royal Colleges) Society for Cardiological Science and Technology s Approve Methodology for Recording a Standard 12-lead Electrocardiogram. 4.3 Applicable local standards See section 3.2 above. 5. Applicable quality requirements and CQUIN goals 5.1 Applicable Quality Requirements (See Schedule 4 Parts [A-D]) The will submit the following quality information to the Commissioner. Data line Source Frequency What does this tell us? The provider has in place an The s operational operational procedure which QR1 procedure covering the meets the requirements of the requirements of 3.2 service specification QR2 QR3 QR4 QR5 QR6 Provide copy of staff management / supervision policy Names of staff providing the service and confirmation that their training meets the requirements set out in section 3.5.1 Declaration that equipment used in delivery of the service meets the requirements of 3.6 Number of complaints relevant to service and actions taken to address complaints Reporting on any significant untoward events in line with NHS England framework, including action taken by the. then annually then annually Quarterly By Exception The has a system of support in place for staff and ensuring standard operating procedures are adhered to. Assures the CCG that staff have the right qualifications and skills to perform the test properly, so that the results are reliable therefore minimises patient risk That the equipment used by the provider in delivery of the service meets with the relevant requirements. Demonstrates that the provider has systems for patients to complain and that the acts on the feedback received. Ensures that the CCG is aware of any events as they happen and that the has followed the NHS England framework 4
6. Premises The provider must be able to improve on this current coverage, providing care close to home and continuity of care for patients. All premises and equipment to be used must be subject to proper maintenance, the responsibility for the provision of suitable premises and equipment will be with the provider and must be relevant to the service, including as a minimum: 1. Premises must be DDA compliant either ground floor or with lift access if not; 2. Premises to enable safe and convenient patient access in relation to transport links; 3. Adequate seating to enable all patients to sit while waiting, including chairs for patients who have difficulty sitting low down. 4. WC facilities should be provided; 5. Have access to interpretation and translation services; 6. Ensure that all premises and equipment to be used is subject to proper maintenance; 7. Decontamination and clinical waste disposal as appropriate; 8. Toilet access (DDA compliant); 9. Hand-washing facilities for provider/patients; 10. Non-slip flooring; 11. Patient changing facilities/curtain area; 12. Storage facilities for consumables. 5