Plan to Improve Working Relationships with General Practitioners Action Plan Approved October 2009 Domain Action Responsibility Timescale Assurance Progress (Feb 10) 1. Communications 1.1 This plan to be circulated for comment to all PCT medical directors, PEC chairs, DPHs; interested GPs; and mental health lead commissioners. Medical Director 3 ms (Jan 2010) Comments received and incorporated The GP survey has been completed with results collated. This has been discussed initially at the reputation management board in August. A further communication to GP practices is now planned. 1.2 Joint primary & secondary care forums /educational events to be set up in each locality to meet at least annually, in which the Trust can showcase developments, and seek the views of general practitioners on how things could be improved further. Led by the Network Director Adult Services with input from the other. Network AMDs to assist in organising events. 12 ms (Nov 2010) Schedule and minutes of forums received by medical director (and ultimately included on GP relationship database). Evidence that any action points from forums discussed at Network Governance Groups All Networks are joining resources to allocate GP practices to a key manager and consultants so that a programme of practice meetings can develop. A planning meeting is arranged for 2-09-10 to develop this work. JK updated the reputation management board on 5-08-10. JK is meeting SJ to agree what support the communication team can offer to support staff in meeting GPs. 1.3 GPs should have up to date information about LCFT services and care pathways in electronic form via practice managers. Communications and Corporate Affairs 12 ms (Nov 2010) to implement Evaluate at 20ms (Jul 2011) 1 GP extranet set up and publicised, and provides contact details of local consultants, local managers and complaints process. Quarterly Primary care e bulletin distributed Evidence that practices have The GP survey bulletin provided some initial information to GPs and until the portal is ready, we will continue to issue to issue bulletins timescale to be discussed with Max The GP portal pilot, if successful, will be the mechanism for the dissemination of information to GP Practices.
received and used e bulletin Evidence of effectiveness from GP survey SJ and DH will link to Network visits to ensure we have a positive and clearly articulated message concerning services and care pathways 1.4 LCFT to set up a Primary care relationship management database of GPs to track and record interactions with GPs Communications and Corporate Affairs / IM&T /Network Director Older Adult Services (pilot) 12ms (Nov 2010) pilot project established and evaluated 24ms (Nov 2011) roll out all practices Report on pilot project Evidence that database in place Customer Relationships Management (CRM) database is in development. Proof of concept for the CRM database has been developed. This is currently awaiting testing from GPs before being trialled for c3-4 weeks. The GP portal proof of concept site has been set up. Pilot practices in East Lancashire and a GP Liaison Officer have been identified Chris Anderton is planning meetings regarding CRM proof of concept. This will need input from max Marshall, Sarah Jones & Ian Huitson 1.5 GPs to have more information about the proposed new inpatient facilities Project Director Capital Programme 6ms (April 2010) begins and continues to end of capital programme Communication with GPs part of programme communication plan Information on progress distributed to GPs via the proposed e bulletin All GP surgeries in Lancashire receive a copy of Insight on a quarterly basis, which includes a supplement about the Capital Programme. (Please also see below) Achieved 2 New build items will are included in the quarterly bulletin. The first bulletin has an item on the planning application and the
possibility of a dedicated event for GPs Achieved GPs have been invited to express their interest in attending an engagement event detailing of the outline planning application for Whyndyke Farm. Achieved & ongoing GPs receive the supplement on an ongoing basis. PEC Chairs are now included in the distribution list and are also alerted of key project milestones/information (such as engagement events, service model info and progress reports.) Achieved & ongoing 1.6 LCFT to carry out yearly GP satisfaction survey to be coordinated through practice managers. 1.7 Internal Marketing Campaign to ensure all LCFT staff understand importance good relationships with primary Medical Director/ Communications and Corporate Affairs Communications and Corporate Affairs Draft survey 3ms (Jan 2010) Amended with GP comment 6ms (Apr 2010) Initial survey conducted 8ms (Jun 2010) Annual surveys at 20 (Jul 2011) and 32 ms Jul 2012) Presented to EMT 6ms (April 2010) Implemented 18ms 3 Findings of surveys reported to Trust Board Internal Marketing Plan to Improve Customer Care presented to EMT The GP survey has been completed with results collated. This has been discussed initially at the reputation management board in August. A further communication to GP practices is now planned. The first set of visits are to identify those practices who have responded to the survey. JW we are intending to develop plans through network governance to develop scheme of visits to GP practices. The Associate Director for Training & Communications and Corporate Affairs are meeting to discuss
care (May 2011) Evidence that plan has been implemented to EMT 1.8 Improving relationships with primary care will be included in the Trust s Annual Plan. Chief Executive Achieved 12 ms (Nov 2010) Annual Plan 2009-10 Annual Plan 2010-11 this Annual plan 2010-11 is being developed 2. Care Pathways 2.1 LCFT to provide access to services via a single contact number. IM&T/ 12ms (Nov 2010) 18ms (May 2011) Evidence that contact numbers in place and being used. Evidence from GP survey that aware of contact number The development of a single Trust-wide telephone contact number and the associated call handling technology has not been progressed. The development of a GP portal and GP Liaison Officers has been developed instead. These Liaison Officers will have published contact numbers. This exists in some areas of the EIS/SMS/CAMHS Network where access to signposting and crisis are required. EIS pathways in place are effective. Discussed at the LEAN feedback event on18/08/10. Both Adult and Older Adults Network Director advised that this should be included as one of next 3 LEAN projects and to use Lancaster and Morecambe as the area to have a single access. 4 Where the Adult Network are PCMHT / IAPT providers then local single point of access and contact numbers are in place. Additional work is needed on
CMHT and CRHT, contact details this will be taken forward by the Step 2/3 leads Adult Network is now planning to develop a SPoA concept in each locality to receive referrals and guide GPs and users into services. This work commenced in August 2010. 2.2 Process in place to resolve internal allocation disputes quickly without involving GPs Director of Nursing, Adult/Older People/Young People Complaints procedure within 6 ms (April 2010) 20 ms (Jul 2011) to show evidence of improvement Complaints procedure in place for GPs GP survey shows allocation issues no longer a problem for GPs Complaints procedure being developed. All allocation disputes for the Adult Network are escalated and decided at team level or by local senior manager. Escalation guidance is incorporated into CRHTT Operating procedures. Completed This occurs in EIS where necessary, and is not an issue in other areas of the Network. Completed Transitional protocol between Older Adult and Adults which includes escalation plan to avoid disputes between services. Complaints are also monitored. In in place. Completed Single point of access development to identify problems in this area and to create an SPoA that eradicates disputes or system blocks. Completed 2.3 Care pathways to be agreed Network Director Older 12ms (Nov 2010) LIT forums set up in 1 st 20 care pathways approved 5
for admission, discharge, crisis and detox, with GP involvement 2.4 Effectiveness of MoM care pathways to be audited with GP involvement People Network Director for Older People for LIT forums and agreement 16ms to ( March 2011) communicate pathways 24 (Nov 2011) ms to place on MoM 36ms (Nov 2012) each PCT and Relevant care pathways agreed GP survey shows GPs aware of pathways Care Pathways placed on Map of Medicine Audit completed for all relevant Map of Medicine (MoM) pathways across LCFT footprint by Trust. Funding agreed for ongoing support of pathway development and include engagement of GPs/Primary Care and managed part of STP process for the next 12 months. Appointment made in June due to commence in September. Linked to regional network on MoM. issues which prevent the deployment of MoM in the initial care pathway project. The 2 nd Phase of the Care pathway Project is ongoing and the MoM deployment will continue to be progressed. Delayed due to recruitment to vacant post. Interviews scheduled for early June.(as per 2.1) 3. Relationships 3.1 Networks to develop a communication plan for GPs that should involve one yearly meeting to each practice from a local senior LCFT clinician Adult/Older People/Young People & Associate Medical Directors 6 ms (April 2010) 12ms (Nov 2010) Visit Plan available Evidence that visits are taking place begins to be logged on relationship database Adult Network to develop on back of step care structure. Work has commenced to put together a programme of meaningful meetings. This will be developed in collaboration with other Networks 12-08-10 Updated in 1.2 and 1.6 Further meeting taking place on 03/09/10 Local senior LCFT Clinicians to give an update regarding meetings in June 2010. 3.2 GPs should have direct Associate Medical 6ms (April 2010) Clear process Process to be designed and 6
access to consultant psychiatrists to discuss prescribing and risk issues, and more complex patients. Directors Adult/Older People/Young People 8ms (Jun 2010) 20ms (Jul 2011) established for GPs to access consultant opinion Evidence that process communicated to GPs & that consultants mobile numbers provided to GPs Evidence from the GP survey that the process is effective agreed across Networks. Currently work underway to identify psychiatry role on step 2/3. Single points of access exist which guide referrals to correct service including psychiatrists. This exists across the EIS/SMS/CAHMS Network. Local senior LCFT Clinicians to give an update June 2010. This work will be progressed in detail once GP requirements are understood after the initial clinician manager visits We are also planning via SPoA concept to allocate a Consultant on a rota basis to be part of the daily SPoA MDT. 3.3 Practice-based commissioning groups to have regular (yearly) meetings with key local clinicians and managers to discuss service performance and improvement. Communications and Corporate Affairs; Adult/Older People/Young People 6ms (April 2010) 18ms (May 2011) Comms team to obtain a list of PBC groups and to work with networks to develop a with comms plan for each group Minutes from meetings are available and reported to network governance groups. Recording begins on relationship database. The list of GP PBC leads has been compiled Sarah Jones John Keaveny are meeting mid September to discuss the networks marketing plans to GPs and how we link in network communications with corporate communications Adult Network has built in leadership and engagement role in step care leader roles. Completed 7 There would be a value in doing this exercise plan with networks to ensure a coherent picture of the organisation was conveyed
to the PBC groups. This would be valuable in conjunction with adult network Older Adults require details of the practice based commissioning groups before can proceed. 3.4 GPs to receive information about the numbers of patient being seen from each surgery and the type of care they are receiving. These data will be updated and modified in line with feedback from GPs. Associate Director for Performance 6 ms basic data available (Apr 2010) LCFT will provide an annual webbased summary of the numbers of patients referred from each practice, and the type of care they are receiving (such as whether on CPA). The Trust has been looking at a number of ways of developing and providing this information. In the first instance, we have been developing an analysis of GP referral data within the Older Adult Network, so we can learn lessons that can be translated across the Trust. Provision of a separate web-based information system would be expensive and the Trust is therefore working with PCT s to see how we can jointly use existing systems (SUS, CDS) to make information available. The GP Portal software has been integrated with clinical systems to alert GPs of patient referrals, allocation of Care Coordinators and discharges via the portal. Completed Older Adult Network currently report on the number of referrals by GP Practice on a monthly basis per head of pop. This info will be used to feed back to GPs and commissioners. This is produced as a regular report see attached. Completed 8
Referrals East.xls 3.5 Medical Director of LCFT to have an annual meeting with each PCT Medical Director to Practice issues 4. Quality 4.1 Summary of all assessments by crisis teams to be conveyed to GPs verbally within one working day and in writing within three working days 4.2 All major changes made to treatment/care plan made by the care co-ordinator to be conveyed to GPs within five working days Medical Director 12ms (Nov 2010) Summary of meeting reported to EMT. Network Director Adult/Associate Director Healthcare Standards & Assurance Adult/Older People/Young People/ Associate Director Healthcare Standards & Assurance 8ms (Jun 2010) 8ms (Jun 2010) Audit of crisis communications provided to EMT Governance Audit of care coordinator communications provided to EMT Governance Standardised admission and discharge clinical letters agreed and operational. Completed & 24-08-10 Audit tool now developed and agreed by CRHTT managers and Team Consultants. Audit planned for September and results to be fed back at CRHTT managers meeting and Network Governance. Audit for EIS/SMS/CAHMS range of services would have to be complementary to other Networks, The detail will be discussed at the Senior Management Team Away Day. No further progress.. Working group set up to progress based on testing /proof of concept for CRM. GP practice manager involved in the working group (1.4) 4.3 A simple two stage complaints system should be Director of Nursing/ 6ms (April 2010) Evidence complaints Complaints procedure being developed. 9
put in place for GPs. This should consist of: (i) A senior LCFT manager in each locality whom GPs can contact directly if they have concerns; (ii) An escalation process via the Trust complaints department for GPs who receive an unsatisfactory response. The Director of Nursing will also receive green card reports from PCTs. Adult/Older People/Young People/Associate Director of Communications & Corporate Affairs 12ms (Nov 2010) 14ms (Jan 2011) procedure agreed and communicated Summary of complaints from Primary care to be included in complaints report to Trust Board (including response to any green cards received from PCTs) E Bulletin to GPs includes details of how to complain, and the Trust s response to common complaints. Will be placed on the agenda for EIS/SMS/CAMHS Network Governance and a system to achieve this action will be detailed. Agenda item for discussion / plan Testing out CRM as above. Include system for logging queries, etc, for GPs. linked to communication plan led by Communication & Corporate Affairs. Adult Network will implement the complaints system via the step2/3 managers and Adult 12-08-10 We are going to allocate a key local manager to each practice to act as an account holder Future e-bulletins will clarify the complaints process for GPs and the CRM will provide a single system for analysing themes of complaints 4.4 Risk assessment process in crisis teams to be audited and reviewed against best practice, including process for communication of risk Healthcare Standards & Assurance 18ms (May 2011) Audit of risk assessment of crisis teams presented to EMT Governance Has been done to a degree via the Network priority 09/10 - Out of Hours Admission Audit. A more specific audit questionnaire to be discussed further with Clinical Governance. 4.5 All Crisis team members to be given priority training in risk assessment in accordance with findings of Network Director Adult 18ms (May 2011) Evidence of completion of training 10 12-08-10 Team based educational development and case studies are used. SUIs are utilised and this will be
audit described above. developed further by the CRHT Managers. 11