General Practice Forward View Plan Sutton CCG 1) Extended Access What are we doing across London? London is an outlier on satisfaction for making an appointment, patients perspectives on the convenience of appointments has got worse since 2014, whilst in the rest of the country this is getting marginally better. In 2016, the % difference between wanting a same day appointment and being able to get one was more than twice that of the rest of the country. This is mirrored with satisfaction in General Practice overall, and affects A&E departments, when patients cannot get an appointment the same day, (3%) more that the rest of the country have to wait over a week, this also impacts attendance at A&E; with over double the percentage (7% versus 3% in 2016) reporting attending A&E as a result. London have agreed with National an approach to share their allocation from the areas who received Prime Minister's Challenge Funding, across London. This means a share of 26m in 2016, and the same again in 2017. This will provide London with the opportunity to increase access across the capital, providing greater equality of access to General Practice - London has committed to delivering extended access across the city by Q4 2017 to 97% of patients. In addition, the offer will enable London to have the flexibility to address in hours challenges as well as extended hours, with some primary care hubs providing an additional 12 hours of access every day, seven days a week - stand alone hubs, and other areas opting to providing extended hours from 6.30-8pm on weekdays and 12 hours per day on weekends - top up hubs. London has a minimum specification for the extended access hubs (unless evidence is provided for an alternative local approach), which include: - Appointments must be pre-bookable in advance - Open to all registered population in the area - Has access to medical records - Accessible via multiple routes including 111, online and via the practice London has also committed to measuring and monitoring appointments and utilisation as required nationally, and regularly reviewing utilisation to ensure capacity is appropriately used, and innovative solutions are found to underutilisation or capacity challenges. As part of the re-procurement of 111 services across SW London there will be a phased approach to Directory Of Services development and this will enable direct electronic booking and referral to all parts of UEC system between 2016 & 2019. The procurement of an integrated 111/GPOOH provider will allow warm transfers from 111 and direct electronic bookings into GPOOH for advice and face to face consultations. This may be extended to include direct electronic bookings into GP hubs, depending on their operational model i.e. whether they accept booked appointments or run as a drop in service. What are the CCG's plans for delivering extended access, and when will this be delivered? (summary) Sutton are proposing to use top up hubs with 1 fully compliant site and 1 partially compliant site. Site 1 (Wrythe Green surgery) will deliver 6.30pm- 8.00pm Monday to Friday and 8am-8pm Saturday and Sundays and Site 2 (Jubilee Health Centre) will deliver 6.30pm-8.00om Monday to Friday and 8am-12 noon on Saturdays. A third site may be added following evaluation of demand. Sites 1 and 2 will both be 75% complete by end of Q4 2016-17 and fully implemented by Q2 2017-18. Site 3 will be implemented by Q2 17-18. Sutton will use Integrated Digital Health Record to share medical records and online booking (all practices on EMIS Web). What are the CCG's plans for improving access (wider than delivering extended access?) Patient online has been implemented in all practices across Sutton giving access to patients for booking 80% + of all GP pre-bookable appointments - target is for 20% of patients to have an active online account by end of March 2017. Patients are also able to order repeat prescriptions and access their detailed coded medical records. Heath Help Now App and website is now available to all patients registered with the Sutton CCG GP practices enabling access to local health advice and information about appropriate services. A pilot is running in Sutton in 3 practices using the AskmyGP software which allows patients to access a GP consultation electronically to ask for health advice. This is due to be evaluated in the next few months for consideration of rolling out to all practices in Sutton. A pilot is being considered to employ Clinical Pharmacists in practices in Sutton to relieve GPs' time for prescribing which will allow more time for patient How do you plan to improve access with additional investment in 18/19 & 19/20? (GPFV funding calculations have an indicative increase in funding from 19/20) The model of 8-8 access which is currently being developed by the GP Federation must be sustainable, along with the various other innovations that will be rolled out over the next 2 years to improve access. At present, funding for these initiatives has been committed for 2016/17 and 2017/18. Additional investment in 2018/19 and 2019/20 will be used to maintain these schemes and continue to increase uptake. Total Investment in Extended and Improved Access Evening Hours 6:30-8:00 at Hubs. Improved Patient Access to Primary care - increase in number of appointments outside of core hours. Reduced A&E activity. Improved Patient Access to Primary care - over 1,350,000 Weekend Hours at Hubs the weekend 462,000 636,000. Reduced A&E activity Project implementation costs including set up costs and programme management delivery of the project in time, on budget within the allocated resources 17/18 GPAF Allocation Planned population coverage of 8-8, 7 day a week extended access (%) Additional appointments available during core hours (8am - 6.30pm Mon - Fri) - please note for some areas this will be blank Additional appointments available Mon - Fri (6.30 onwards) Additional appointments available Sat & Sun Total additional capacity available (on top of core General Practice) 18/19 GPAF Allocation
2) Online consultations What are the priorities for online consultation rollout? South West London ETTF schemes for video consultations and two way SMS communication between patients and GP practices. Further roll out of AskMyGP, subject to successful evaluation of pilot. A collaborative project across SWL has been agreed to introduce Skype for Business to all 175 SWLCCG GP practices in Croydon, Kingston, Merton, Sutton and Wandsworth CCGs in order to enable the primary purpose of patient consultations via a secure video service. The cloud-based infrastructure of the solution and compatibility across multiple platforms and devices facilitates quick deployment across all sites. The solution will enable GPs to provide a better service to suit their most vulnerable patients by offering them the possibility of a secure and controlled video consultation at an agreed appointment time pre-arranged via a unique email invitation sent to patients for e-consultation from anywhere using a device of their choice. The proposed technology scheme facilitates better care delivery through proactive locality-based MDTs, enables individuals to take a more active role in managing their own health and wellbeing, and improves productivity. What is the timeline for delivery of the priorities? Date procurement will commence On confirmation of central ETTF funds. By end of March 2017 Planned start of works The work will begin in Q1 of 2017 and will last for approximately 6 months. Estimated completion date The project resulting in the deployment of Skype for Business in all 175 GP practices and 21 MDT hubs should conclude in Q3 of 2017. Total Investment in Online Consultations 0 SWLCC to procure Skype for business licenses and associated devices on behalf of all 5 CCGs CCGs to identify local project management staff to undertake deployment Start of works 50,469 67,724 Further engagement with the MDTs, GP community and practice staff The IT support providers for the 5 CCGs to be informed of any potential network topology requirements Online consultation GPFV allocation (17/18) Online consultation GPFV allocation (18/19) Planned number of online consultation systems in place: 3) Provider Development (e.g. Vulnerable Practice, Practice resilience, Time to Care) What are the priorities for delivery in 16/17? NHS Sutton CCG's general practice resilience plan outlines how national resources will be utilised to support general practice, the plan covers these areas: 1) Recruitment and retention that promote SWL London as a good place to work 2) Collaborative Working: Collaboration on policies and procedures and better communication 3) Development of social prescribing pathway from primary care into local authority and third sector services 4) Merger and dispersal support 5) List closure resilience 6) Significant support provided through quality improvement programme; support for practices in special measures or rated requires improvement by CQC. CQC readiness training and development. 7) CCG funded "working at scale" programme for practices What are the objectives (and timeline) of the CCG 3p/h investment (overall - detail to be included in column I) Draft proposals - subject to internal governance and engagement - 1.50 per head investment in 2017/18 and 2018/19. Schemes as shown in column I. What are the priorities and use of funding in 17/18? See columns I and J - collaboration, social prescribing and transformational support What activities (and investment) has the CCG already invested in providers in 16/17? 150k invested in GP practices to work at scale; 87k (provisional allocation for 2016/17 resilience) to fund transformational support and engagement, social prescribing and list dispersal support Practice Resilience Investment CCG Investment Total Provider Development Investment Collaboration on policies and procedures and better communication Reduced workload in practices; standardised policies and procedures across the CCG footprint; better communication within and across practices Development of social prescribing pathway from primary care into Reduction of non-medical clinical contacts in local authority and third sector services primary care; improved patient experience 54,006 26,917 27,090 through accessing the most appropriate services more quickly; improved integrated working across the health and care economy 548,770 (over 17/18 and 18/19) Establish a proactive team that can provide practices facing transformational contractual changes with project management, patient engagement and support eg closure, list dispersal, merger Practices are supported, processes are streamlined, patients are actively engaged with plans for changes and services are maintained throughout Improved communication within and between practices and the CCG - Reduced workload in practices,better IT solution to be implemented communication will increase productivity (High Impact Action 5 & 7) Social prescribing - comms and engagement to ensure optimal use of new service; further development and evaluation, ensuring patient feedback is central to decision making Clinical pharmacists in practices to reduce workload of prescribers by managing repeat prescription services; undertake medicine optimisation reviews and alignment of medication Patient education programme - targetted education for specific cohorts of patients eg COPD, diabetes, older people, children and families, etc Reduction of non-medical clinical contacts in primary care; improved patient experience through accessing the most appropriate services more quickly; improved integrated working across the health and care economy (High Impact Actions 1 & 8) Improved safety of prescribing, improved patient experience through better prescribing processes, reduced workload for prescribers in practices (High Impact Action 4) Patients will have better understanding of their health needs and conditions to better selfmanage and reduce unnecessary contacts with primary and secondary services; patients will be introduced to a full range of health, social care and third sector services which can support them to better manage their health and care needs. (High Impact Action 9) Provider Development Investment (17/18) Please note: Based on an assumption of 1.5 p/h investment p.a. could also be 3p/h in 17/18 or 18/19 Provider Development Investment (18/19) Please note: Based on an assumption of 1.5 p/h investment p.a. could also be 3p/h in 17/18 or 18/19 Help Yourself to Health - six week education and support programme Targeted patient groups will have better for non-english speaking communities, to encourage appropriate use understanding of the health system and most of health services and avoid unnecessary use of urgent care services appropriate routes for accessing primary care services; health advocates to be identified through the programme to further spread education into hard to reach groups and communities (High Impact Action 9) Identification of patients and referral to National Diabetic Prevention Programme Working at scale to provide access to extended primary care services, 8-8, 7 days per week Prevention of diabetes or early diagnosis to reduce complications; promotes self care (High Impact Action 9) Improved patient experience and partnership working across general practice (High Impact Action 7) 4) Training care navigators & medical assistants What are the CCG's plans for training care navigators and medical assistants? The CCG has recruited two care navigators to work alongside MDTs across our locality networks. We are working with our CEPN and our Education and Training Subgroup to put training in place for signposting and workflow optimisation across the entire admin and receptionist workforce. We are also bidding for funding from HEE to pilot an apprenticeship framework for practice administrators to gain skills as medical assistants. As part of this we envisage working closely with practices to identify and develop our current workforce to be able to fulfill this new role and with GPs and Practice Managers to ensure that the role is embedded within practice operations. High level training for all practice admin & reception staff in signposting and workflow optimisation will take place over 2017/18 during term time and this will involve all Sutton practices. We will also seek at least one practice per locality to undertake the year long apprenticeship and detailed work with practices to develop and implement these new roles. Our priority will be to ensure that these roles are sustainable and make a demonstrable outcome to improving the efficiency of clinical staff. We will also be participating in the SWL collaborative plan to which we have pooled our allocated resource of 17k for 2016/17 and 34k for 2017/18. Activities to include: *Recruitment of candidates *Form working group with clinical leadership & practice management representation *Run PLT event(s) for non-clinical staff *Briefing session for pilot practices and mentors *Support learners through apprenticeship *Support practices to operationalise new role *Evaluate impact Total Investment in Training Care navigators & Medical Assistants SWL: Project scoping and proposal development. Engage with CEPNs and identify all stakeholders involved. Review best practice and innovations from elsewhere December 2016 January 2017 0 SWL: Needs Assessment with general practice December 2016 January 2017 SWL: Presentation of initial proposal to TPC DG. Further refinement of proposal, including discussion/consultation CEPNs, SWL workforce SWL: Identify early adopter/pilot sites March - April 2017 33,646 33,862 SWL: Identify provider From April 2017 SWL: Roll out of pilot practices TBC Training care navigators & medical assistants (17/18) Training care navigators & medical assistants (18/19)
*Evaluate impact SWL: Wider roll out TBC SWL CCGs have agreed a series of priority areas to collaborate on relating to the GP Forward View, one of which is the training of care navigators and medical assistants. TPC leads in each CCG have agreed to explore pooled funds and undertake a collaborative approach to spending these funds from 17/18 onwards. Following collaborative working across SWL CCGs on transforming primary care, one TPC lead has been identified to provide some additional strategic leadership in the area of workforce across SWL, (the agreed first priority project to be training of care navigators and medical assistants) to bring together the views of all six CCGs and associated stakeholders and drive programmes forward. This will be supported by one of the 8B GP Forward View staff resources (with the aim to be in place by March 2017) and report in to the SWL Transforming Primary Care Delivery Group, as well as having close links to the SWL STP workforce board and London primary care workforce group. As of November 2016, a set of next steps have been agreed between SWL CCGs, largely to begin scoping a potential proposal while awaiting further details of the requirements of the programme (the specification referred to in the planning guidance). A session with the SWL community education provider networks (CEPNs) and Health Education South London (HESL) has been planned for January and it is anticipated that this group will be a key driver for moving the SWL interventions forward. This group will develop detailed plans to establish how new roles will be created in Primary Care and / or how staff within practices will be upskilled. Planned number of practices accessing training : Work carried out by HLP to identify potential workforce interventions has been used to inform possible future schemes of work that could be carried out across SWL. Any future initiatives will be taken forward via the group identified above, with work signed off by the Transforming Primary Care Delivery Group.
5) PMS plan What is your implementation timeline, key milestones, and governance processes to implementation? Draft offer will be presented to Primary Care Commissioning Committee in January 2017 for approval, following discussions at PMS Review Group, Primary Care Programme Board and Executive Committee in December 2016. This will then go out to practices for consultation in January, with negotiations in February and March for start date of 1st April 2017. How have and how will you be engaging with the local LMC? Local LMC have been involved in working up commissioning intentions and costing service proposals. LMC attend PMS Review Group, Primary Care Programme Board and Primary Care Commissioning Committee. What are you planning to commission with the PMS Premium? Includes: Improved immunisation rates (above national target) Increased uptake of cancer screening programmes Improved patient experience Improved access Reduced medicines waste Booking transport 24 hour BP Use of the most cost-effective gonadorelin analogue (Zoladex injections Improved End of Life Care Early diagnosis of dementia Improved Cancer Care Post Operative Wound Care Enhanced Safeguarding How does this support delivery of your STP/ GPFV plans? The PMS review and associated KPIs will look to support the delivery of the GP Forward View with a focus on the 10 High Impact Actions; that are referenced in the guidance Please describe how you are ensuring practices are not de-stabilised? What is your approach to transition & equalisation? Equalisation of funding has been undertaken in the past, so all PMS practices are equally funded. The 1 Sutton GMS practice will be offered PMS services for equal funding. PMS Premium Increased targets for cervical screening uptake Increased uptake of bowel screening through following up non-responders Increased uptake of cervical screening leading to early detection and Increased uptake of bowel screening leading to early detection and 760,000 760,000 Childhood immunisation 5 in 1 vaccine by 1 year To protect against childhood diseases Childhood immunisation aged 5 years and over To protect against childhood diseases Protection against flu and other Increased flu immunisations fo 65+ and under 65 at complications for the elderly and at risk risk groups Protection against pneumonia and Pneumoccocal immunisation 65+ other complications for the elderly and at Percentage risk groups of patients responding Patient Voice - Overall experience of your GP Surgery within the 'good' range' to this question based on national average Improved Access to include increased opening hours (over and above those stipulated in the Extended Hours DES), commitment to referring patients to the extended hours hubs (8-8, 7 days per week) commissioned for all patients in Sutton. Availability of a stated number of appointments per 1000 registered Reduction in the number of patients with an appropriate clinician. Business inappropriate attendances to A&E. continuity plans. Patient experience - 'Overall how Full utilisation of appointments within would you describe your experience of making an primary care appointment'. Practice to achieve a minimum 75% score from the National Patient Survey. Maintain a DNA rate of 5% or less. Monitoring of referrals to and attendance of patients to walk-in centres, A&E and UCC during core hours Total Investment in initiatives (17/18) Total Investment in initiatives (18/19) 950,000 950,000 Reduce Medicines Waste Through Improved Compliance with Repeat Medicine that is currently within the local PMS Contract. This ensures Reduction in medicines waste, safe engagement with local pharmacists particularly cost effective prescribing and a around LTC patients and others with complex reduction in medicines related medicine regimes; patients at risk of medicines related admissons admissions, patients who are confused about their medication and patients who have recently been discharged from hospital 478,800 478,800 Information to be provided Booking transport, 24 hour BP, use of the most costeffective gonadorelin analogue (Zoladex injections)an audit has been carried out with our practices and the above services are provided to all our patients in general practice. These services are over and above the core PMS specification but contribute to the pro-active and co-ordinated care specifications as follows: Booking transport to ensure that patients are booked in a timely way for their hospital appointments to avoid unnecessary stress and cancelled appointments 24 hour BP this is another diagnostic service in primary care that helps with the diagnosis of hypertension and the optimisation of treatment to avoid emergency attendances at A & E Gonadorelin Analogue injections are given in primary care as part of the prostate cancer pathway See comments in previous box around pro-active and co-ordinated care specifications and avoidance of A&E attendances 448,400 448,400 Spirometry - necessary for the early detection and diagnosis of asthma and COPD. This allows for optimum treatment of these lung conditions in primary care to avoid admissions and multiple attendances to secondary care. See comments in previous box around detection, diagnosis and admission avoidance 190,000 190,000
End of Life Care - Better symptom control and carer support can be achieved by a multi-disciplinary (MDT) approach and improved anticipatory care, enabling all professionals involved in the care of the patient in the last stage of life to work together as a team and have access to the patient s care plan at all times. This includes patients with cancer and non-malignant conditions such as severe heart failure, COPD, long-term neurological conditions, severe frailty and dementia. Evidence shows that this approach (with access to CMC records and MDT working) reduces avoidable hospital admissions. The CMC electronic register further improves communication and supports improved outcomes for patients, helping them to be cared for, and to die, in their preferred place. Enhanced management of patients at the end of their lives to enable them to die at their preferred place. Recording of care plans on a centralised electronic register that is accessible to those agencies caring for the patient 114,000 114,000 GPs are encouraged to develop and maintain a register of all patients in the last 6-12 months of life (The London death rate is 0.6% which gives an indication of the numbers expected to be on a practice palliative care register). Dementia diagnosis to include opportunistic screening, in house dementia coding training, dementia screening questions as part of the care planning, medication reviews for patients diagnosed with dementia and regular audits To improve the dementia prevalence and ensure care plans are in place 95,000 95,000 Prostate Cancer - The service is to provide a follow up consultation for patients with established prostate cancer with stable PSA and who have no significant or at least stable treatment complications. The Consultation FU timeframe (ie 3,6 months/weeks) will vary according to the protocol used. The consultation is to include a review of the patient PSA test, symptoms and side effects of treatment. Two week rule referrals - To ensure that all cancer referrals are followed up and patients encouraged to attend their first offered appointment Transfer of service from secondary care to primary care Post Operative Wound Care - The service aims to provide practice-based, one off or on going follow up for wound care, post-operative suture/clip removal for Avoidance of patients attending patients and wound management, as appropriate. secondary care This includes minor dressings or more complex wound care if required. 152,000 152,000 95,000 95,000 95,000 95,000 Safeguarding this enhances the statutory requirement within the PMS Contract and supports good practice for CQC Inspections To ensure good quality and safe services are provided to patients 247,000 247,000 Total PMS Premium 3,625,200 3,625,200 6) Growth and un-committed headroom Based on the anticipated (it is noted that this is subject to expenditure budget confirmation once contract negotiations concluded) headroom and growth against the Primary Care allocations; what do you expect to invest in (if you have funding available over and above core commitments) 1% non-recurrent headroom. Anticipated headroom (total) Non-recurrent headroom Anticipated headroom Anticipated headroom 518,000 256,000 262,000 7) Workforce What is your local workforce strategy (excluding training outlined in provider development and care navigator sections above)? We have a local workforce strategy in collaboration with our CEPN which includes training, workforce development, leadership and workforce transformation across medical, clinical, and non-clinical staff groups. We have increased our capacity for undergraduate medics and nurses with three new nurse mentors and new teaching practices. Our GP training capacity was not fully utilised with this year's intake. We have a programme of GP training, protected learning time events, clinical development for the nursing and HCA workforce, and a non-clinical development programme and these are managed alongside their respective professional groups and with input from our CEPN steering group and CCG GP, nurse, and practice management leads. Within our primary care strategy and ETTF bid submissions, we are developing multi-professional training hubs in line with redevelopments and these will greatly improve our ability to maintain a pipeline of trainees within primary care and these are being developed in collaboration with St. George's University of London and Health Education England (South London). 8) ETTF plans Robin Hood Lane Health Centre Development The proposal provides for a 3,937 sqm (GIA) extension to the existing centre. This will provide accommodation for Relocation and expansion of the: Grove Road Practice, Mulgrave Road Surgery, Benhill Branch of the Benhill and Belmont Practice and Old Court House Surgery alongside the current Branch facility based at RHL. Additional capacity for Dr Seyan (already based at RHL) Total ETTF Investment ETTF Expected Funding in 17/18 ETTF Expected Funding in 18/19
Additional capacity for Dr Seyan (already based at RHL) Relocation of the SCILL facility to a new unit within the centre. This frees up the site for development whilst providing a purpose built facility for the service. Expansion of the Community Services to provide a new Elderly Care Hub for the CCG. A new Community Pharmacy. This proposal creates a new Health and Social Care Hub for Central Sutton, providing new fit for purpose accommodation for all GP Contractors in Sutton, who combined provide services to over 50,000 patients in Sutton Town Centre. This opportunity presents primary care commissioners with a valuable opportunity to deliver new purpose-built surgery facilities for the Practices in the town to co-locate at RHL, particularly since they are occupying old and unsuitable facilities that do not meet latest clinical and CQC requirements, as well as being too small for their expanding list sizes. LBS and PHP have held talks with Sutton Master-planners, who have included both the SCILL and RHL sites within the new Master plan for both site intensification and expanded use as a Healthcare centre. The new facilities can be developed with minimal disruption to existing services and can be delivered within 2-3 years if approvals can be provided quickly. Integrated Digital Care Record This project will: Provide patients and citizens with access to their own data. Enable citizens access to their clinical and care information held about them in their electronic records through an integrated view of care across multiple agencies Provide citizens with a means to record their care and manage their conditions and enable them to feel involved in, and in control of, their own care online Support Health and Social Care information sharing across providers and geographical boundaries with seven day access to critical clinical data. Support integrated operational functions across health and social care organisations. Extending data feeds to provide high percentage coverage of patients attending Kingston, Epsom and St Helier hospitals To reduce the demand in secondary care activity, Enable collaboration across services and organisations to deliver better outcomes for individuals, by building on existing technology used by the partner organisations Improve how clinicians are able to access and share information more easily across the NHS and other relevant health and care providers. Provide a solution that contributes to the improved effectiveness of the time that care professionals spend with individuals through reduction of duplication of tasks and data input Introduce Patient and Citizen Portal, Mobile Working and MDT Integrated Care Planning Develop additional data sharers and viewers in model currently available in Sutton and Kingston. To develop data sharers in Richmond in line with data sharers/viewers currently in place and planned for Sutton and Kingston. To develop a link with Coordinate My Care. TBC TBC TBC