London Central & West Unscheduled Care Collaborative Annual Report
2 LCW Annual Report 2008/09 CONTENTS 3 About LCW 4 Overview of the year 5 Clinical Governance 5 Education 6 Performance 7 Finance 7 The year ahead
LCW Annual Report 2008/09 3 About LCW Fifteen years ago a group of local, enthusiastic family doctors set up the first doctors out of hours (OOH) co-operative in London. This evolved into the current membership-based organisation which operates as a not for profit Community Benefit Society. LCW has 430 GP members drawn from the 170 local GP Surgeries across Brent, Hammersmith & Fulham, Kensington & Chelsea and Westminster. The same qualities have underpinned LCW s work from the beginning - a highly professional, cost effective service delivered by experienced local staff working in a family-friendly environment. These qualities combined with a can do mentality have meant that LCW is innovative, reliable, and continues to be a real benefit to the local community. One of the secrets of LCW s success is the close-knit team work from everyone ranging from managers, to frontline operational, support and clinical teams and the clinical governance, training and business support staff. LCW provides out of hours primary care services to 800,000 patients across 4 PCTs (Brent, Hammersmith & Fulham, Kensington & Chelsea, and Westminster) offering GP telephone advice, GP surgery consultations and GP home visits. It also provides 24/7 clinical support, infrastructure and organisational support during normal office hours. These include: primary care A&E streaming/re-design models, two NHS led Walk in Centres and the developing polyclinics at Hammersmith and Charing Cross Hospitals. Over the years LCW has worked in partnership with local commissioners and providers contributing to a number of local health initiatives and developments. It has successfully developed key strategic partnerships with a variety of organisations including: PCT commissioners and provider services, practice based commissioning groups, acute trusts, pharmacists, London Ambulance Service, mental health trusts and social services. Our Council Dr Michael Cornell Dr Munir Datoo Dr Jens Ludders Dr Sarah Talbot Dr Hilary King Dr Asma Siddiqi (Chairman, Westminster Rep) (Company Secretary, Brent Rep) (Westminster Rep) (Hammersmith & Fulham Rep) (Kensington & Chelsea Rep) (Member Rep)
4 LCW Annual Report 2008/09 Overview The last year has been one of further organisational development with key successes being due to our preparedness for competitive tendering and formation of key strategic partnerships. Significant events and developments of the year include: Formation of Partnership for Health (PfH) local NHS partners Imperial College Healthcare NHS Trust (ICHT), Central London Community Healthcare (CLCH) and LCW PfH success in winning the Hammersmith and Fulham unscheduled care tender. LCW continues to be recognised as an integral part of the local health community and remains a member of the Integrated Service Improvement Programme (ISIP) for Inner West London Health Care Community. This has included: Ongoing participation in the ISIP at a strategic level The practical development and delivery of services to support integrated healthcare Contributing to the better integration of all the elements of OOH care including: rapid response and community nursing, London Ambulance, pharmacy, mental health and social care Supporting other ISIP streams to help develop innovative solutions to improve care pathways for the management of chronic diseases, in particular COPD, Diabetes and Palliative and End of Life Care Support implementation of the Darzi recommendations by developing the OOH Single Access Hub to a 24/7 Single Point of Access (SPA) Continuing to invest in the most up to date technology to support integrated healthcare. LCW has formed important key relationships with the NHS London team and is: Working with NHS London Groups to scope and input into the outline of what is required of a 24/7 SPA Reviewing its flu pandemic plan, developed in partnership with NHS Westminster Continuing to support local NHS in emergency and contingency planning Supporting the local NHS From left to right: Daniel Iatras - Call Handler; Samantha Calver - RMC Officer; Catherine Girvan - Call Handler Tonia Culpin Chief Executive through severe winter pressures by increasing OOH provision and supporting the increased demand on services LCW is developing additional strategic partnerships with local Practice Cluster Provider Units and other GP-led organisations to add value to local tender opportunities in relation to GP extended hours and GP-led unscheduled care services. Our financial position remains strong and we maintain our reputation for providing a quality service at a reasonable cost. In keeping with our not for profit status, we continue to re-invest any surplus into the local health care community including: Maintaining the ongoing work of the Clinical Governance Committee and Educational Club Maintaining our record for providing quality services to patients and commissioning organisations Continually reviewing IM&T to ensure systems are up to date and delivering quality patient care Supporting local commissioners to ensure effective flu pandemic planning.
LCW Annual Report 2008/09 5 Clinical Governance All our clinical governance activity is centred around service to patients and the focus for 2008/09 has been on consolidation - making sure that the systems put in place during 2007/08 are working effectively. The Clinical Governance Committee s work over the year has been constructive, lively and well guided by the chairman - Prof Paul Thomas. It meets quarterly to review all complaints, significant events and professional feedback. It has completed several audits including: attendance in A&E, prescribing emergency contraception, compliance with drug formulary and comparing night and evening GP referral rates to A&E. A consequence of these audits is an improvement in practice - for example: night time referrals rates to A&E have been reduced by three per cent. Looking forward to 2009/10 our challenge is to better understand and devise mechanisms for monitoring and maintaining service and care delivery standards as it becomes increasingly involved in partnership working with other organisations. Steve Kemp has joined LCW as the Integrated Governance Lead and will use the framework of Standards for Better Health to improve governance and risk management systems. Dr Tim Ladbrooke Medical Director We continue to progress our audit of doctors and call handlers performance using the RCGP toolkit. This provides individual GP feedback on referral rates, productivity and other performance data including compliments and complaints. Education This year has consolidated the systems for clinical governance, clinical supervision and registrar supervision. The number of compliments LCW receives is matched by the number of complaints and all are scrutinised by the Clinical Governance Group for lessons to be learned. Lessons are posted on the Education Board and discussed at the Education Club. Lessons often include reminders about the need to be systematic in history taking and examination, keep good records, speak to people kindly, and remain calm. Audits for this year have helped to develop protocols to collaborate with others. The manual that provides decision support for doctors has been built systematically over the past few years and is reviewed and updated annually. The Education Club has delivered excellent presentations by top speakers and lively discussion. For example, Michael Pelly gave a wonderful presentation on stroke and transient ischaemic attack that informed us about clinical management and how local services are developing. Our annual accreditation with the London Deanery was successful with our continuity and mutual support for doctors in training being commended. Prof Paul Thomas Education Lead In the coming year we will: maintain robust systems deliver our annual audit and education programme develop our education curriculum to support core and new services.
6 LCW Annual Report 2008/09 Performance Patients remain central to our service delivery and LCW is pleased to report continued high performance across the out of hours quality standards during the year. All exceptions are fully investigated and undergo a quarterly joint review with commissioners. Every 1:25 patients are randomly selected and asked to complete and return a patient satisfaction QTR 4 QTR 3 QTR 2 QTR 1 QTR 4 QTR 3 QTR 2 QTR 1 Calls to LCW 0.0% 20.0% 40.0% 60.0% 80.0% 100.0% Primary Care Centre - Time from Telephone Triage to Clinical Assessment 80% 82% 84% 86% 88% 90% 92% 94% 96% 98% 100% Abandoned Calls Answered Within 60 Sec Emergency < 1 Hour Urgent < 2 Hours Less Urgent < 6 Hours questionnaire. LCW is delighted to report over 93% patient satisfaction with the out of hours service. The number of complaints that LCW receives is matched by the number of compliments. All complaints, professional feedback and unsatisfactory patient questionnaire responses are fully investigated by our Medical Director and Clinical Governance Committee and along with compliments are used as shared learning across the organisation, linking to our full educational curriculum. LCW continues to self monitor against Standards for Better Health and undertakes regular reviews with an action plan to support continuous development and improvement. Compliments and Complaints Dr Munir M Datoo Company Secretary and Council Member Home Visit - Time from Telephone Triage to Visit 10 Complaints QTR 4 8 Compliments QTR 3 QTR 2 Emergency < 1 Hour Urgent < 2 Hours Less Urgent < 6 Hours 6 4 2 QTR 1 0 QTR 1 QTR 2 QTR 3 QTR 4 80.0% 85.0% 90.0% 95.0% 100.0% Telephone Assessment Patient Satisfaction Survey 100% QTR 4 QTR 3 Urgent < 20 Mins 90% 80% 70% 60% Satisfied Unsatisfied Less Urgent < 60 Mins 50% QTR 2 40% 30% 20% QTR 1 10% 90.0% 91.0% 92.0% 93.0% 94.0% 95.0% 96.0% 97.0% 98.0% 0% QTR 1 QTR 2 QTR 3 QTR 4
LCW Annual Report 2008/09 7 Finances Our current capitation fee remains competitive and we continue to perform well against our cash flow projections. The appointed auditors - Pannell Kerr Forster - confirmed an operating surplus, which has enabled LCW to meet its strategic plan for continuous infrastructure review and development as well as re-investment of funds to improve services to patients. As a social enterprise, LCW has re-invested 166,343.32 from April 2008 to March 2009 across the four PCTs we cover. During the week of the heavy snow a further 5,540.12 was allocated for additional GPs and support staff to ensure service delivery was maintained. Overall our re-investments have meant: More GPs to support local primary care provision alongside A&E Extended opening times for OOH Primary Care Centres to improve patient access thereby: ɶɶ Enabling A&E to stream appropriate patients to a primary care GP on site ɶɶ Further supporting our PCTs to meet A&E 4hour waiting time targets Investment in developing infrastructure so that LCW IM&T systems can help NHS IT systems exchange information in particular health alerts such as pandemic flu Development of home working solutions, plans for new telephony and contingency IM&T. The Year Ahead Implement planned infrastructure and organisational plans including: ɶɶ Appointment of Chairman to Council ɶɶ Appointment of Chief Operating Officer ɶɶ Appointment of Assistant Medical Directors ɶɶ Appointment/source - Information Analyst ɶɶ Recruit operational supervisor team Work with partners to ensure successful mobilisation of new H&F contract: ɶɶ Board and strategic responsibilities ɶɶ Overall responsibility for day to day service delivery ɶɶ Joint responsibility for key performance to minimise financial risk ɶɶ Satisfy and exceed contractual obligations Support Commissioners to implement and deliver local integrated service initiatives: ɶɶ 24/7 SPA for health care professionals and patients ɶɶ Integrated pathways to support patient care ɶɶ Readiness to compete; NHS London pilot for Single Point of Access Hub Developing further strategic partnerships to support changing NHS Policy and local - Priorities for 2009/10 plans to enable readiness for competitive tender: ɶɶ St Charles Hospital Urgent Care Centre ɶɶ Service re-design St Mary s Hospital ɶɶ Service re-design Chelsea and Westminster Hospital ɶɶ Other GP-led Health Centres & Polysystems Continue to review plans for re-siting LCW in line with NHS Kensington & Chelsea redevelopment of St Charles Hospital site.
From left to right: Conan O Neill - Senior Operations Coordinator; Roz Irvine - K&C Night Community Nurse Manager; Sharonn Grayling - PCT Service Coordinator; Adam Duncan - Chief Operating Officer; Leeanne Austin - Deputy Manager LCW UCC NHS Tower St Charles Hospital Exmoor Street London W10 6DZ Tel: 020 8969 0808 Fax: 020 8962 4401 Tedros Tzegai Statistics Officer Virna Kelly-Barrett Finance Officer Kerry Jeffs Operational Supervisor