GP/GB/20140925-9 Governing Body Meeting 25 September 2014 Report Title: Written By: Presented By: Urgent Care Transformation Programme Update Nicola Walsh, Interim Transformation Programme Manager Iain Crossley, Chief Finance and Contracting Officer Purpose of the paper: The Central Lancashire health and social care economy has invested in a number of schemes and clinical developments which will improve the patient experience of urgent care services, ensure patients are treated in the most appropriate settings and consequently reduce inappropriate admissions and subsequent readmissions into hospital. This paper provides an update from the Urgent Care Board for all the partners involved in the Urgent Care Transformation programme on the progress of the projects over the first 6 months of mobilisation. Key Issues: Background The programme is overseen by the Urgent Care Board on behalf of the Clinical Senate. Regular reports have been made available for all partners over the last few months; including a world cafe event which showcased the work streams and a more intensive review of the work streams which was discussed at the joint CCG Governing Body development session in July. The programme has already attracted national interest; as the partners are aware, the 7 day access work stream received a national award and the full programme has been submitted to the NHS Leadership Academy as an example of excellence in partnership working. The attached report has been developed by the Urgent Care Board to show the progress against the seven key work streams at the end of the first 6 months of mobilisation. Impact to Date At this early stage of a 2-3 year journey it is difficult to directly attribute success to the individual work streams; however, progress against the project deliverables is already favourable when benchmarked against the performance of similar health economies. Nationally there has been an increase in Emergency Department attendances of 3% over last year whilst in Lancashire the pressures are even higher; 7.6% in total. However, in Central Lancashire the trend has been slowed as the economy is only experiencing a Urgent Care Transformation Programme Update NHS Greater Preston CCG Governing Body Meeting 25 September 2014
1.7% increase. The level of admissions has risen, however, there are no indications that this has not been the appropriate response. Alongside this, Lancashire Teaching Hospitals FT has delivered the A&E 4 hour target for the last four consecutive quarters and is on target to deliver it again in Q2 2014/15. This provides a degree of reassurance that the changes in the system are having an impact on the service experience for patients. Transformation Programme Project Work Streams: The programme is divided into 7 work streams: Step Up Step Down Community bed occupancy in the rehabilitation unit has increased by 20% since 2012/13 and domiciliary rehabilitation usage has increased by over 25% with the contract running continually at over 95%. However, at present this is having limited impact on length of stay at the hospital. An enhanced bed based model with Lancashire Care FT is being scoped to increase the impact and relieve system pressures. Ambulatory Care The COPD pathway is fully operational with early reports showing positive impacts. However, the redesign of the heart failure pathway has been slightly delayed. Main Access Point The service specification drafted and ready for wider consideration by partners. Self-Care/Self-Management All links have been made across all of the other projects now and impact measures have been identified to Self-Care/Self-Management and Connect 4 Life. Core Personal Profile A patient information leaflet is currently being reviewed by the Patient Advisory Group and once GP practices Information Governance agreements are in place an informed decision can be made on how the Core Personal Profile is hosted. Redesign Emergency Department Front Door The Urgent Care Service model has been determined and phase 1 of the implementation is underway. Construction at Chorley Hospital of the enhanced facilities has started. The Governing body is currently considering the appropriate procurement options for commissioning this service Integrated Neighbourhood Teams The Senate has considered the progress to date and further enhancements to the mobilisation timetable have been agreed. The roll out of MDT s continues and the project plan is being redefined to ensure there is enhanced support for each locality based on the need on each locality/peer group. Regular updates have been provided to the GP Peer groups and CCG Membership Council to ensure all GP practices are aware of the implementation plans. Urgent Care Transformation Programme Update NHS Greater Preston CCG Governing Body Meeting 25 September 2014
An updated service specification has been drafted to more closely define the requirements of all service providers involved in Integrated Neighbourhood Teams and will be available shortly for wider consideration by partners. Operational Resilience The CCG Governing Body is considering a separate paper on the urgent care system enhancements required to deliver services over the winter period; many of these short term changes are supporting the transformational work streams. Actions Required by Governing Body Members: The Governing Body is asked to note the current progress in the mobilisation of the Urgent Care Transformation Programme. Urgent Care Transformation Programme Update NHS Greater Preston CCG Governing Body Meeting 25 September 2014
Central Lancashire Health Economy Whole system Urgent Care Transformation programme Urgent Care Board Report for Partner Governing Bodies/Boards September 2014
Projects Ambulatory Care Redesign Emergency Department Front Door Step Up, Step Down Core Personal Profile Integrated Neighbourhood Teams Main Access Point Self Care, Self Management Governance and work streams Partner Organisations Lancashire County Council Lancashire Teaching Hospitals NHSFT Lancashire Care NHSFT Chorley & South Ribble CCG Greater Preston CCG Clinical Senate Urgent Care Board UC Transformation working group Governance Forums Governing Body Monthly Clinical Senate Monthly Urgent Care Board Fortnightly Joint Executive Committee Weekly Urgent Care Transformation Group Whole System Urgent Care Transformation Programme Enabling Workstreams Information Technology Communications & Engagement Finance & Benefits Seven Day Access
Exec Lead: Iain Crossley (CCG) Programme Lead: Nicola Walsh (CCG) Programme Management Support: Sharron Livesey (CCG) Programme management Programme Aim Local people who need access care should receive support which is fit for purpose in a timely fashion. The system will need to achieve a balance between patient experience, quality outcomes, access and cost. To achieve this we will develop a simplified, proactive, robust system for patients that will promote health and well being, and redirect current levels of urgent care into planned or managed care within the whole health and social care system 24/7. People first, partners will have joint ownership and accountability for enabling people, families and communities to have a good life of their choice, within the resources they have Everyone has a bed it is in their own home, People expect to receive care and support close to their home No person will need to make a decision about long term care and support in a hospital bed Discharge to Assess not Assess to Discharge People will receive seamless care and support, regardless of the number of clinicians or practitioners involved in their life People will be supported to stay connected with local family and community networks and resources that keep them safe and well Resources, including voluntary community faith sector and community assets will be wrapped round local GP surgeries and coordinated through integrated neighborhood team arrangements We will pro-actively manage capacity and demand as one community of partners, utilising combined resources to ensure right support in the right place at the right time, 7 days a week, 365 days a year Update from previous month SRO meetings recommenced from 2 nd September Update paper to JEC and Senate completed Issues raised regarding attendance and delivery of milestones Next Steps of KPI dashboard report to Governing Body in September Update to Clinical Senate in September
Redesign Emergency Department Front Door SRO: Andrea Trafford (CCG) Project Lead: Richard Audley Project Aim Redesigning the Emergency Department (ED) front doors at both Chorley and Preston to improve streaming of patients to the most appropriate care pathway. This will include developing Urgent Care Centres at both sites to provide primary care 24/7 in addition to the existing care streams in the ED. Improving access to primary care for patients who attend ED: This will minimise the number of minors ED attendances and inappropriate ED attendances treated within existing ED streams that can otherwise effectively treated in primary care Appropriate streaming of patients when they present at the ED front door: This will ensure that patients have the quickest possible access to the most appropriate care for their condition Reduce the number of patients treated within the existing ED streams: This will increase the likelihood of LTH achieving the 4 hour access target in ED Diversion of patients to more appropriate health care services Colocate urgent primary care provision with ED 24 hours a day: This will promote models of care that optimise the ways that staff work in OOH and ED This will promote cooperation and integration between OOH and ED Achievements during previous month Deliverables planned up to the end of September 2014 Chorley Medics and Preston Primary Care are forming a new joint venture company to deliver Urgent Care Services which is in the process of being formalised legally Discussions are on-going between LTHTR and Chorley Medics/Preston Primary Care (CMPPC) in relation to delivery of a Pilot UCC service at both CDH and RPH by CMPPC. Next meeting between CMPPC and LTHTR ED staff and management is planned for 4 th September. Confirmation of implementation plan to get to pilot phase 1 commencement by mid September due on Thursday 4 September Confirm procurement option with Governing Body in September
Ambulatory Care sensitive conditions SRO: Emma Foster (LCFT) Project Lead: Elizabeth Fleming (CCG) Project Aim Develop clear pathways and models of care for conditions included in the Directory of Ambulatory Care Sensitive Conditions (ACSC) to minimise the risk of admission to hospital for these conditions. Achievements during previous month Heart Failure pathway re-design commenced Patients identified with COPD have now been loaded onto the Quadramed system enabling Community Teams the ability to directly access patients presenting on wards with COPD. The view will show patients in an Acute setting and will allow them to plan interventions in hospital as appropriate. Deliverables planned up to the end of September 2014 COPD: Interim evaluation of Qtr 1 of admission avoidance pilot pathway by Sep-14 COPD: Agree model for spirometry and pulmonary rehab by Sep-14 Proactive case management of ACSC by multidisciplinary teams This will enable primary, community and secondary care teams to work in an integrated manner and proactively manage patients with ACSC This will minimise the risk of acute events, thereby reducing 999 calls, ED attendances and non-elective admissions Implementation of new pathways of care for ACSC: These new pathways will be supported through community-based services which will provide alternatives to hospital admission and where appropriate, will provide early supported discharge services Improve outcomes for people with an ACSCs: Patient outcomes will be at the centre of the pathway redesign, and all new pathways will be monitored to ensure effectiveness, experience and safety Deliverables planned up to the end of September 2014 continued Heart Failure: Agree current and future state at Director Level meeting - ACHIEVED Gastroenterology and Dehydration: Agree through Ambulatory Care Clinical Pathways meeting (Interdependency UCC) to roll out upper GI bleed ambulatory care pathway to UCC by Sep-14 ENT (pediatrics): Undertake stakeholder workshop and agree current state and desired future state. At workshop scope possibility of ambulatory care pathway for Feverish Child by Sep-14 ENT (pediatrics): Agree draft ambulatory care pathway for Feverish Child by Sep-14 Diabetes: Agree future service model for diabetes foot screening by Sept- 14
Step up, Step down SRO: Terry Mears (LCC) Project Lead: Kate Burgess (LCC) and Jane Kitchen (CCG) Project Aim This project will develop discharge and admission avoidance pathways that enabling people to leave hospital in a timely and appropriate way, with the opportunity to access appropriate rehabilitative services. The project will support admission avoidance and ensure that people have the opportunity for thorough assessment and informed decision making away from an acute setting. The service will offer person centred support, wherever possible it will be delivered in a persons usual place of residence. At the end of a period of rehabilitation people will be re-connected to their communities and feel more able to manage their own condition. Implement discharge to assess model throughout Lancashire Teaching Hospitals: Implement an integrated discharge and admission avoidance team Develop service to ensure it can meet demand in terms of volume and acuity Understand the role for medical rehabilitation within an acute setting Reduce number of delayed transfers of care within acute setting Develop the use of step up service to support admission avoidance: Clear defined pathways for health and social care professionals to access the service Widely communicate the service offer The service will offer, a period of assessment, recuperative care and or rehabilitation Achievements during previous month Deliverables planned up to the end of September 2014 Lancashire Teaching Hospitals NHS Foundation Trust have agreed to develop an Integrated Discharge Team with key partners to achieve better patient flows 10% increase in the Domiciliary rehabilitation/ crisis contract The Step Up, Step Down (SUSD) electronic referral form has been updated, this will be passed to the Quadramed and EMiS team for inclusion in their software, reducing the need for the manual telephone referral from LTHTR. It will also ensure that the referral indicates it relates to SUSD. The community minimum dataset will provide a view of SUSD activity and cross reference to admissions and admissions avoidance which is key for winter pressures INT support wrapped around residential bed provision implemented by Sep-14 10% Increase number of people stepping up from community by Sep-14 LCFT to prepare an improved proposal on the SUSD model for Clinical Senate Sept 14
Core Personal Profile SRO: Terry Mears (LCC) Project Lead: Kate Burgess (LCC) and John Mercer(LCFT) Project Aim Develop a single summary assessment form that can be used by a range of hospital and community health and social care professionals to undertake a baseline assessment of patient s health and social care needs to simplify and speed up the assessment process. This will be stored in a central, web-based system that all health and social care providers can access, together with the patient s end of life care plan and safeguarding assessment, where appropriate. Rationalising the assessment process will minimise duplication: This will provide an improved patient experience and will minimise the amount of time that care professionals spend undertaking assessments This will minimise Delayed Transfer of Cares caused by patients awaiting assessments either for social care or other non-acute NHS care A single assessment process will ensure that all health and social care professionals providing care to an individual patient will have a consistent understanding of the patients care needs: This will ensure improved continuity with care planning and provision for an improved patient experience Ensuring that all health and social care professionals have 24/7 access to end of life care plan and safeguarding assessment: This will minimise the risk of patients being inappropriately taken to hospital and will therefore reduce the proportion of patients conveyed to hospital by ambulance Achievements during previous month Deliverables planned up to the end of September 2014 Partnership agreement now in place between developers. The demo of the CPP will be available to view on the Patient Knows Best portal by Oct 14 An options appraisal of all available Core Personal Profile opportunities to be undertaken by Aug-14 - ACHIEVED A pilot to be undertaken with two GP practices once IG agreements are in place and a CPP has been agreed by Sep-14 DECISION MADE TO ROLL OUT ACROSS ALL PRACTICES AWAITING FEEDBACK FROM PATIENT ADVISORY GROUP GP IT strategy links made with the UC programme, to be presented to JEC Sept 14
Self Care, Self Management SRO: Terry Mears (LCC) Project Lead: Jacqui Sutton (LCC) and Kim Haworth (LCC) Project Aim Self-care will be a function that threads through the new 'Better Care, Better Value' models of care in Central Lancashire. It will focus on empowering individuals to take responsibility for their own health and well-being by understanding what makes sense to each individual. It will encourage them to self-manage their own condition including symptom management, adapting to their conditions, and dealing with the emotions arising from having the condition such as anxiety and depression. Current service provision does not have a structure or clear guidelines for patient education - the experience is varied across the services and pathways and can be disease specific. There are also no defined linkages or pathways to the social care offer which will prove to be decisive if the project is to be sustainable. Review of CCG and LCC contracts with a view to aligning to support self care, self management (SCSM) Key recommendations paper to inform redesign of contracts for SCSM Assist with early implementation of COPD pathway Identify measures to track impact of SCSM activity Develop focus groups with clinicians and citizens, family carers to understand what works/doesn't work re SCSM Achievements during previous month Deliverables planned up to the end of September 2014 Four new staff members took up post on the 26th August enabling additional capacity to manage the volume of referrals Increased numbers of referrals have been received since the start of the project equating to an increase of approximately 40% Bi-monthly newsletters that dovetail with the activity of the stakeholder groups to ensure the progress of the Connect 4 Life project is communicated to a wide range of stakeholders including all GP surgeries was circulated in August. To request a copy contact Rebecca.Addey@lancashire.gov.uk A Community Connectors event was held in the Fulwood area during August to promote neighbourly connections Understand the measurements and impact assessment of SCSM Align and embed the values within COPD with the self assessment tool Joint work with Ian Roberts to investigate the potential to jointly commission suitable community 2015-16 contracts by Aug-14 Complete draft paper with key recommendations to inform redesign of contracts for SCSM by Sep-14 Joint work with Lynne Bax (PhD student) on promoting How Are You Today tool and to explore opportunities for evidencing the effectiveness of the tool and how to develop joint evidence base and promotion by Aug-14 - ACHIEVED Align and embed the values within COPD with the self-assessment tool by joint working with Sarah Hurst Lead Physiotherapist Respiratory Service COPD Pathway by Sep-14 Identify measures through partnership work to track impact of SCSM activity by Sep-14 Undertake first focus group (COPD) to understand what works/does not work for SCSM, learning from this will inform future focus groups by Sep- 14
Integrated Neighborhood Teams SRO: Terry Mears (LCC) Project Lead: Nicola Walsh Project Aim To establish eleven multi-disciplinary integrated neighborhood teams (INTs) serving central Lancashire. These will be arranged around naturally forming community populations aligned with GP practices. Each integrated team will relate to a total population of around 30-45,000. These have grouped a number of communities with similar demography/ geography together. Public health information will further inform our understanding of the needs and characteristics of these populations and thereby shape the longer term workforce & service development. The teams will work closely with GP practices to provide care to people with longterm condition and including those with complex health and social care needs, to help them live independently in the community. Each INT will manage a cohort of patients at high risk of admission/ readmission to hospital because of complex medical and social needs. They are likely to represent 0.5-1% of the total neighbourhood population served by the team- A cohort of 25-30 patients per integrated team. These patients will have been identified through the Risk stratification tool in GP surgeries (which also has a predictive risk of readmission) or through clinical decision making. End of Life patients will also be managed within the Community Admission Prevention function offered by the INT. This group of patients will receive multidisciplinary case management and close regular review by GP and INT. The approach will be broad to ensure the teams meet the needs of adults of all ages, with a wide range of long-term conditions. The teams will include a wider social care offer from Voluntary, Community and Faith Sectors and community assets, facilitated through local area co-ordination. Implement the introduction of a risk stratification model within GP practices Ensure processes are in place to support the utilisation of the risk stratification tool by GPs and integrated teams Plan and oversee the development and implementation of integrated health and social care teams Enable the teams to be co-located where possible incorporating physical and mental health nursing and therapy staff and social care Ensure these team members have the skills to ensure better management of multiple long term conditions Incorporate the voluntary/ third sector where possible Enable integrated teams and their patients to access specialist services as appropriate, in a timely manner Achievements during previous month Deliverables planned up to the end of September 2014 Paper circulated to Senate awaiting feedback from recommendations Service specification agreed SENATE 18-SEP Have full view of staffing within the INT AWAITING CONFIRMATION Scope the requirements to build a local focus for each INT DUE SEPTEMBER
Main Access Point SRO: Terry Mears (LCC) Project Lead: Nicola Walsh Project Aim Main Access Point (MAP) project is a clinically driven and patient focused change project which aims to develop and implement a 24/7 single point of referral service for community services within Central Lancashire. The MAP service will support the referring clinician by providing straight forward and simple telephone/electronic/email/fax referrals that would allow the clinician to maximise the amount of time with patients and to match the patient s needs to an appropriate service in the locality nearest to the patient s own home. This service will support integration by being one point of contact into all community services and will be supported by a comprehensive directory of services, which will identify all community services capacity and availability by time of day. This new service will offer GPs and other healthcare professionals a single point of contact into community services which will help to avoid admissions and support discharge processes. Main Access Point in the interim stage would be the single point of referral contact centre for District Nurses, Community Matrons and Therapy Teams for GPs. Design, Develop and Implement Single Electronic Referral form, Telephone Number, Fax Number and Electronic Referral pathways for all community services. Develop and Implement the referral pathways for community services covered by MAP. Achievements during previous month Deliverables planned up to the end of September 2014 Paper circulated to Senate awaiting feedback from recommendations Virgin Media have installed an additional 20 telephone lines into the Main Access Point which will come on-stream by the end of August. This will provide increased telephone capacity reducing the likelihood of getting an engaged tone. Standard operating procedure to be agreed Referral process agreed All IG issues to be resolved