LOCAL DELIVERY PLAN PRIMARY CARE STRATEGIC AIMS LEADERSHIP & WORKFORCE The key focus for 2015-16 is the development of a clinical strategy for NHS Fife which has a major strand of work in relation to primary care. It seeks to set out potential new models of primary care which are in line with the emerging thinking on the new GP contract for 2017. This is linked to the Health & Social Care Partnership work on integration and we will be seeking to develop services at locality level around a core of general practices. Work will continue to strengthen intermediate care models building on the Integrated Discharge Hub. Developing joint clinical priorities across the boundaries of Primary and Secondary Care continues to gain momentum in line with: Reducing emergency hospital admissions Reviewing variations in hospital outpatient referrals Reviewing A & E attendances We aim to see more emphasis on supporting practices with options to develop community based services e.g. phlebotomy services, to increase working across the interface of primary and secondary care with more consultant outreach, particularly from the Care of Older People s team. We aim to pilot new clinical fellowships working in both general and hospital medicine to test out our approach to integrated care in Queen Margaret Hospital and Glenrothes Hospital this year. Each locality s commissioning framework will be based on locally agreed care plans, tailored to the population demographics, and delivered in partnership with local non statutory providers in care and local communities. A key element of work to support this is our strategic approach with Community Planning Partners to develop local microproviders of care within local communities. We are seeing early evidence of practices coming together to share services and infrastructure and this will increase given the GP recruitment challenges and which may lead to some practice mergers. Fife Optometric community has long had a strong leadership with strong ties with Ophthalmology. The Area Optometric Committee meets regularly and is always interested in developing local initiatives or being involved in helping with national strategies. Fife also has a well established range of High Street Practices covering all areas across the Health Board. This ensures that no member of the public in Fife should have trouble accessing Optometry Services.
PLANNING & INTERFACES NHS Fife has been engaging with GP Practices to discuss the challenges of mutli-morbidity and increasing numbers of elderly patients. The difficulties of recruiting GPs into General Practice are also impacting on the delivery of care. NHS Fife has held two development sessions (January and June 2015) and further engagement is planned to develop local clusters of practices as part of the Health and Social Care Partnership. Practices are a key part of the plans for integration and further work to develop health and social care teams based around the patient are planned. The focus will be around clinically relevant topics where issues can be identified, solutions sought and actions developed and implemented. One of the first topics for focus will be on how integration can support ill or vulnerable elderly at home. The discussions are starting with clusters of GPs in the Dunfermline and West Fife area and will be rolled out across Fife. Other areas for the involvement of primary care in the Health and Social Care integration agenda are being planned as a result of the feedback from the initial development sessions. Primary Care was also consulted on the development of the NHS Fife Clinical Strategy at these sessions. A Prescribing Action Plan has been approved and alongside it plans have been developed and submitted to substantially increase the pharmacy workforce working directly with GP practices to facilitate the most clinically and cost-effective used of medicines in primary and secondary care. The support to practices will focus on outlier practices but also significantly increase the input directly into each GP practice to focus on the delivery of the Prescribing Action Plan. Optometry Services continue to change and develop under the new regulations in Scotland (2006 & 2010). Independent Prescribing Optometrists are beginning to use their new qualifications to treat and monitor conditions that would have previously been dealt with by GPs or in Secondary Care. This will lead to reduced pressure on GP Practices and the HES. The new SIGN 144 mentioned above, will also lead to better use of Optometric Services. The use of SCI Gateway by Optometrists will continue to develop and the soon to start electronic submission of Optometrists payment forms to PSD should lead to a much more efficient system. Saving NHS funds through a paperless system and also helping to ensure the appropriate use of GOS. TECHNOLOGY & DATA The following initiatives are being developed:- Windows 7 Upgrade 100% of the general practice PC estate, 1400 units, to be upgraded from Windows XP to Windows 7 by EOFY 15/16. Project resourced by ehealth, Primary Care.
Technology Refresh 63% of the general practice PC estate, 850 units, to be replaced with new PCs by EOF Y15/16. In conjunction with Windows 7, ensures current and future PC service demands (system and user) can be met. Project resourced by ehealth, Primary Care. SWAN Migration 86% of general practices successfully migrated from N3 to SWAN, remainder scheduled for completion Q2. Project resourced by NSS, ehealth. Patient Portal / Online Services 40% EMIS practices utilise Patient Access (PA), 60% INPS practices utilise Vision Online Services (VOS). Both systems offer patients online appointments and repeats. Work towards 100% PA and VOS utilisation by OEFY 15/16. Project resourced by Primary Care. Remote Access 12 general practices configured with a further 9 pending. Provided practitioners and practice management with secure real time access to practice IT systems from a remote location. Project resourced by ehealth, Primary Care, participating practices. Scottish Primary Care Information Resource (SPIRE) Two general practice pathfinders identified, 1 x EMIS, 1 x INPS. Technical scoping underway. 11 Fife practices have expressed interest in SPIRE participation. Project resourced by NSS, Primary Care. Docman 75200 Fife pilot 16/06 30/06 subject to product version availability. General release early July. Project resourced by NSS, Primary Care. National GP IT System Re-Procurement Exercise Fife engagement via ehealth Leads and National Service Board. Main deliverable will be a new GP IT system framework. Contract award 06/2017 with transition activities thereafter. Project resourced by NSS, Boards. Cyberlab Order Comms All practices will be ordering laboratory tests electronically by mid 2015. Clinical Portal All practices will have access to clinical portal by mid 2015.
Chronic Medication Service Work ongoing during 2015/16 to encourage practices to provide suitable patients with a serial prescription. Dental All general dental practices will be sending referrals via SCI Gateway mid 2015. They will also be receiving electronic schedules and prior approval by end of 2015. Paper Communication All paper communication from primary care has ceased and is being sent electronically. Orthodontic Practices Orthodontic practices have NHS Mail and will be brought into the SCI Gateway project mid 2015. Optometry SCI Gateway / NHS Mail rolled out to all Optometry practices during 2015. Optometry Practices continue to use increasingly sophisticated equipment on a day to day basis. The widespread use of Digital Retinal Photography has been in place since 2010. Some practices have now moved on to optical Coherence Tomography (OCT) which allows an even greater imaging of all the tissues of an eye. Unfortunately their use is not currently part of the NHS system and patients may have to pay privately for the service. One area that the new SIGN 144 recommends is a measurement of corneal thickness on patients with Ocular Hypertension or suspect Glaucoma, not all Optometric Practices have the equipment that is needed to take this measurement. Optometry Scotland is in negotiation to see if Pachymeters can be put into all Optometry Practices. Some of the Practices in Fife already have this type of equipment and are currently taking theses measures. Immediate Discharge Letter / EDT Piloting the electronic transmission of the IDL from secondary care during March, if successful it will be rolled out in phases during 2015. Informal feedback from GPs has been very positive and the plan is to move to all wards in VHK, QMH and community hospitals using the eidl. CONTRACT AND RESOURCES We are exploring a new contractual relationship by awarding a single-handed GP Contract to a GP based in a practice 13 miles away. He will offer clinical support and supervision to salaried GPs remotely. In practices where GP recruitment is providing problematic we are introducing additional support from Practice Pharmacists. The will be a welcome addition to the
practice based multidisciplinary team both saving money for NHS Fife by improving rational prescribing and reducing workload for GPs by undertaking medication reviews for patients on several medication e.g. care home patients, initiating chronic medication service, carrying out prescribing projects, reviewing acute prescriptions, carrying out chronic disease clinics, e.g. hypertension clinics etc. One practice has employed two advanced nurse practitioners, replacing 10 GP sessions with 12 NP sessions. To date they have had no complaints from patients. Staff are happy with the new system and have managed to maintain good access to appointments. The NP s have taken on medication reviews and are about to commence on home visits to the nursing homes, which they estimate is about 1/5 of all house calls. They want to run with the current model through the summer to see what, if any, issues arise. The GP s have a more demanding surgery so will review the amount of patients they see in a surgery. We have established a GP Sustainability Group to support practices unable to continue delivering GMS under a Section 17J contract. We are designing a new model of primary care in Fife which aims to provide better, more holistic, person-centred and high quality care to people with chronic physical, emotional and/or mental health problems associated with adverse events in their childhood (whether disclosed or undisclosed). This is part of a wider endeavour to make health and care services trauma-informed and a longer term aim to eliminate childhood abuse in Fife in this generation. The project is called Better than Well because once people overcome challenges in terms of trauma and loss, addiction, chronic disease etc. they are often able to live life more fully than before they encountered these difficulties. The project is based on the principle that people can take greater responsibility for their health, become more involved in the design of services and act as equal partners with providers. The Developing Clinical Capacity aspect of Prescription for Excellence has progressed well in Fife and Pharmacist Independent Prescribers are now holding polypharmacy review clinics in 7 practices with the plan to improve this over the next year bringing more Pharmacist Independent Prescribers on board. This is being shown already to be creating clinical capacity within these practices allowing the GPs to focus on other work but be available to clinically support the pharmacist. h:\joyce\local delivery plan - primary care strategic aims.doc