S.U.C.C.E.S.S. Project Overview Project Initiation Document (PID) (Part 1) June Governing Body 2014
SUCCESS Project Project Initiation Document (PID) Part 1 Project Name Project Description The SUCCESS scheme (pilot) The SUCCESS scheme pilot is to develop a network of modern Urgent Care Centres of excellence throughout the Swindon community, accessed via patients respective primary care surgery. The project is focused on coping with on the day demand in primary care in order to allow General Practitioners to focus on the most vulnerable of their patients who need their input to remain in good health and stable. This is hoped to cope with demand and have an effect on the acute pathway Version control Version: Final 2.0 Reference number: SUCCESS 2.0 Title: Authors: Swindon Urgent Care Centre and Expedited Surgery Scheme (SUCCESS) Mary O Donohoe, Project Manager, NHS Swindon CCG, Dr Peter Crouch, Clinical Chair NHS Swindon CCG Thomas Kearney, Associate Director of Commissioning (Out of Hospital Care and Mental Health) Executive Lead SRO Dr Peter Crouch, Clinical Chair Thomas Kearney Date of origin: 6/04/14 Implementation Date: 12 th May 2014 Expiry Date: Date of formal review for project 31 st January 2015 Tuesday, 6 May 2014 Page 1 of 20
Document status: Distribution: Final Version following Review by Project Board /Clinical Chair and SRO NHS England Board Members Swindon CCG Board Members SEQOL Board Members Swindon Practices Action: Distribution Board Members including CCG& NHS England Area Team for approval Amendment History: Date: Amended by: Details: MOD / TK 12/2/2014 TK Creation MOD / TK 02/05/2014 MOD / TK Project plan updates PAC/TK 28/05/2014 PAC/TK/MOD Update following comments by first meeting of proposed Project Board members Document location: SUCCESS model/projects/commissioning/swindonccg/m files Purpose of this document The purpose of this PID is to define the project, to form a firm basis for governance, management and assessment of the overall implementation and success of the project. The PID includes information on: Project aims - What the project is aiming to achieve Project Resources Governance Who will be involved and their responsibilities How and when the project will happen Tuesday, 6 May 2014 Page 2 of 20
1. Background 1.1 A brief statement about the background to the project By way of response to the national Call To Action by NHS England, Swindon Practices fully recognise the pressing operational transformational and financial drive required to innovate and drive up productivity and efficiency through modernization and recalibration of primary care to deliver modern ways of working and efficient, cost effective care delivery. Swindon Practices feel that the proposed SUCCESS project could provide an opportunity to catalyse the transformation by seeking to provide increasing availability and responsiveness for primary care to respond to on the day requests for face to face or home assessment and treatment. Swindon Practices wish to take the opportunity to develop a network of three modern Urgent Care Centres of excellence throughout the Swindon community, each serving a local population of c 80,000 patients. The aim is to provide convenient access to requests for same day assessments both at dedicated centres and in the patient s own home by providing access to a geographically dispersed network of modernized local urgent care centres and, where needed, access to an expedited home visiting service. We anticipate that this is best designed and delivered provided and coordinated by a network of primary care providers working in collaboration a whole system approach to benefit every resident of our town and the surrounding area of Swindon & Shrivenham. To support the implementation of an innovative collaborative model of urgent primary care delivery, we propose a network of care delivery which will provide enhanced services and treatment options for patients at urgent care centres and in their own homes both during and outside of the hours that patients are normally able to access primary care services. We are quietly confident that this approach will also greatly enhance the routine services provided by participating practices by partially immunising the routine care environment from rising urgent care service delivery monopolization and disruption. We feel that this scheme has the potential to transform our whole healthcare system locally whilst improving both urgent and routine care provision. Tuesday, 6 May 2014 Page 3 of 20
North Centre South Geographical deployment of Urgent Care Centres within the SUCCESS scheme each model supporting a population of c.50,000 patients Appropriate preservation of continuity of care for patients requiring on the day urgent referrals or home visiting within our collaborative SUCCESS model is maintained by the patient s own GP surgery who continue to provide first line contact and triage for all urgent on the day requests from their registered population. The S.U.C.C.E.S.S. model is an acronym for Swindon Urgent care Collaborative Emergency Surgeries Services. Based on their knowledge of and in discussion with the patient, each practice should decide on a case-bycase basis whether it would be most appropriate to treat the patient within their own urgent appointment slots /within their own home visiting service or on-line book an assessment shortly the same day in one of the geographically convenient urgent care centres (based on patient choice) or an expedited same day home visit. This geographical spread of dedicated urgent care centres throughout the Swindon community promotes patient choice and convenience enhances accessibility for the whole of the Swindon population by operating between 10am 6.30pm every day (including weekends). By providing a responsive collaborative model of on the day / urgent home visiting services, the local primary care and acute hospital provider(s) will benefit from being able to re-focus released time to deliver routine, preventative and elective aspects of primary healthcare. The sustainability of this proposal is underpinned by the realistic expectation that this element of urgent care system will allow the recalibration of primary care resources to focus on routine evidence based care and the minimization of unpredictability and disruption that is associated by attempting to provide both urgent and routine care from the same location. Tuesday, 6 May 2014 Page 4 of 20
We propose that the services provided by Swindon s Urgent Care Centre SUCCESS network will be complimented by improved access to an expanded range of near-patient diagnostic capabilities and a responsive and supportive peripatetic urgent home visiting service reaching out to patients at times when GPs are normally busy in routine & emergency surgeries. Swindon practices worked with The Primary Care Foundation to establish when expediting home visits could be helpful in terms of avoiding unnecessary admissions to hospital however, although the appetite is well established, this has been largely difficult to implement in isolation because of the rising tide of urgent care. We remain convinced that successful implementation of the scheme will help prove the positive impact of expediting urgent home visit times so that patients are assessed and treated earlier hopefully leading to less deterioration whilst waiting for a home assessment to occur and wider exploration of alternatives to admission and faster recovery times due to lower probability of deterioration prior to admission. We anticipate that the scheme may lower the risk of inappropriate emergency admission whilst at the same time helping to smooth out phased demand on urgent transport and other urgent care services and by helping to stagger arrivals at secondary care emergency departments (helping to eliminate the post surgery deluge of admissions). We have been working with primary care IT system suppliers in recognition that real time access to clinical information will be essential to support clinicians providing assessments at the urgent care centres and whilst delivering urgent home visit assessments. We are now confident that our planned IT infrastructure will ensure rapid secure access to information held on primary care medical systems and that clinicians will be able to document clinical observations, assessments, outcomes and treatments directly back into the patient s lifetime primary healthcare record at the practice so that the patient s own practice is kept fully informed. Directly entering information into the participating surgery s clinical medical system will deliver real time communication for all participating parties. A simple review of the patient s medical record will provide the host surgery with details within seconds of the assessment and or the home visit is completed. Summary The aim of this pilot project is to create an environment in which recalibration of primary urgent and routine care can occur in line with national drives for primary care innovation to meet elevated patient expectation whilst preserving the role of host GP surgeries at the heart of decision making and coordination of registered patient care. By managing and evenly distributing unplanned on the day demand and allowing primary care surgeries to treat and assess those patients who most benefit from continuity of care it is expected that this innovative whole system model of transformation will promote sustainability and increase patient satisfaction with the services offered and received whilst increasing capacity within the local health economy. This should in turn reduce waiting times for routine appointments throughout the primary care system and increase the available consultation time for those patients who will most benefit from the expertise and experience of their GP coordinating multidisciplinary assessments and interventions. We therefore see SUCCESS as a system wide enabler for primary care (including risk stratification) and significant elements of our Service Redesign and system wide QIPP schemes. By reducing the unpredictable impact of Tuesday, 6 May 2014 Page 5 of 20
trying to deliver traditionally hybrid models (by separating hot urgent and cold routine services) we will be able to test the impact of implementation of similar systems on similarly geographically compact predominantly (though not exclusively) urban populations i.e. a full scale average southern England town feasibility test. 2.1 Outcomes of the Project The SUCCESS project will underpin and deliver an extensive range of key outputs for patients who are registered with practices who are members of Swindon Clinical Commissioning Group and who reside in the Swindon and Shrivenham area. These are outlined below; 1. Extending access to on the day assessments within general practice by improving access for patients to on the day assessments of their urgent medical needs. 2. Greater flexibility for patients choosing a time and location that is convenient from a network of urgent care centres across Swindon. 3. Facilitated real-time access to pertinent patient information for treating clinicians where the patient receiving clearly documented treatments delivered elsewhere other than their practice 4. Greater integration of urgent and out of hours care by introducing the facility for the OOH service to offer appointments in the early part of the next day (where clinically appropriate) and an expedited home visiting service during the daytime for when I ll pop out after surgery isn t soon enough. 5. Working closely with NHS England to test and pilot innovative new approaches to commissioning primary care services 6. Better management of Long Term Conditions by releasing more time back to practices to focus on those issues which benefit from continuity and longer more reliably uninterrupted appointment times. 7. Integrated approach to providing general practice and wider out-of-hospital services, such as community nursing and pharmacy, diagnostic services and voluntary sector provision 8. Expanded diagnostic ability in community setting (near patient testing) Facilitation of the provision of expanded care options in the community e.g. Paediatric Hot Tots observation facility Tuesday, 6 May 2014 Page 6 of 20
2. Project Definition 2.1 Relationship to Strategic Objectives 1. Extending the access within general practice by improving access for patients every day of the week Local patient engagement (One Swindon, One Voice Engagement PPI Strategy) Improving general practice A Call To Action (A Primary Care Strategy for BGSW NHS Area Team) Back to Basics (Our Strategy for Care) One Swindon : One Vision (Five Year Strategic Plan 2014-2019) 2. Promotion of innovative ways for professional networks to refer patients appropriately between services and communicate reason for referral and outcome of assessment and any treatment provided (system operability) Communications and Information Technology Strategy (2014) Tuesday, 6 May 2014 Page 7 of 20
2.2 Project Objectives The main objective is to create an environment in which recalibration of primary urgent and routine care can occur in line with national drives from primary care innovation to meet elevated patient expectation whilst preserving the role of host GP surgeries at the heart of decision making and coordination of registered patient care. By managing and evenly distributing unplanned on the day demand and allowing primary care surgeries to treat and assess those patients who most benefit from continuity of care, it is expected that this innovative whole system model of transformation will:- Promote sustainability and increase patient satisfaction with the services offered through increasing on the day capacity within the local health economy Reduce waiting times for routine appointments throughout the primary care system Increase the available consultation time for those patients who will most benefit from the expertise, continuity and experience provided by their own practice Reduce pressure on primary care improving retention and recruitment Reduce pressure on and risk of overload of acute primary care pathways of care. The project will be seen as a system wide enabler to support demand within primary care and support elements of our acute care service re-design and inform future acute pathway development. 2.3 Project Scope / Exclusions/Assumptions In-scope All 26 practices in the Swindon and Shrivenham area The model will operate from three Urgent Care Centres in North, Central and South Swindon throughout the Swindon community. An expanded Hot Tots observation service is also incorporated within the pilot at each centre is planned. Currently limited access to this service is provided in one central location from 4.30-7.30 pm Monday-Friday The Expedited Urgent Home Visiting Service and Children s clinic will be incorporated as part of the model All Urgent care centres will be direct bookable on-line by all Swindon practices A proof of concept for an IT interface which draws clinical information from the host GP system and allows entry of notes into the host system to enhance clinical treatment and communication Expanded near-patient testing facilities for urgent care centres and expedited home visiting services Exclusions Ability to access scheme without prior triage by the patients own surgery or the out of hours service Emergency expedited home visiting services i.e. this service will not replace 999 provision. Increased operating hours for GP surgeries (this service will assist by smoothing unpredicted variable demand but will not increase operating hours for host surgeries. The model will not include increased remote access to host GPs such as Skype or email consultations. Tuesday, 6 May 2014 Page 8 of 20
Assumptions The generated capacity, from the model s implementation, for all surgeries will generate increased capacity/ability to work with patients vulnerable to rapid deterioration and those who would benefit most from being treated by their own GP i.e. patient with established Long Term Conditions / the vulnerable elderly population and those with multiple co-morbidities Increased capacity to provide additional attention to these patient groups will reduce unnecessary admissions and pressure on the acute pathway 2.4 Project Deliverables and/or Desired Outcomes The project will be managed by a Programme Board and Project Team drawn from CCG elected representation from primary care (The CCG), NHS England, Community Providers and incorporate the views of patients and the public through patient and public engagement. The project will be supported with robust corporate governance arrangement to ensure the objectives are achieved as well as clearly stated Terms of Reference. Progress will be reported and monitored by the Executive Management Team, Clinical Leadership Group and Governing Body of Swindon CCG and NHS England. The pilot will be independently evaluated with the benefits and lessons learnt to be shared with other health economies who may be interested in the findings and outcomes of the pilot. An agreed and detailed communication and engagement plan will be developed and shared with all key stakeholders, audiences including public/patient and will be evaluated and reviewed after 3/6 months. 3. Initial Business Case 3.1 Proposed Operational and business considerations aspects submitted to CCG governing body Tuesday, 6 May 2014 Page 9 of 20
3.2 Costs Proposed Financial aspects submitted to CCG governing body 4. Project Organisation Structure Role Nominated Person Project Board Clinical Commissioning Group Accountable Officer Clinical Chair Director of Finance Associate Director for Primary Care Development & Engagement (Appointed May 2014 commencing August 2014) Executive Director of Commissioning NHS England Area Team Director of Commissioning Head of Primary Care Head of Primary Care Finance Primary Care Development Manager Project Sponsors Dr Peter Crouch, Clinical Chair, Swindon CCG Debra Elliott, Director of Commissioning, NHS England AGSW Area Team SRO Clinical leads Thomas Kearney, Associate Director of Community Care/Mental Health, Swindon CCG Dr Paul Dryden & Helen Greenwood (SEQOL) Project Manager Thomas Kearney, Associate Director of Community Care/Mental Health Wider project team: Heather Mitchell Jan Trethewey Tuesday, 6 May 2014 Page 10 of 20
Helen Greenwood Dr Peter Mack Dr Paul Dryden Mary O Donohoe Commissioning Leads Information/Data analysis leads Patient & Public Engagement Lead Communications Lead Finance Lead Swindon CCG & NHS England Area Team Tracy Iles / Giles Parker Robin Butcher, Patient and Public Engagement Manager, Swindon CCG Ruth Atkins, Communications Lead Swindon CCG Matthew Hawkins, Deputy Finance Officer, Swindon CCG 5. Initial Project Plan 5.1 Milestone Plan Milestone Reference Responsibility Estimated Completion Date Outcome expected 1. Secure staff and IT infra-structure 2. Training of staff and test-bed centres for evolution of IT interoperability model TK, HM, PC, HG 15/4/2014 TK, PC, PM, HG 12/5/2014 30/5/2014 Proof of concept for IT solution using Black Pear IT interoperability model. Clinical IT system secured for SUCCESS Centres with creation of patient demographic database for Swindon patients. Training underway for SEQOL staff at 2 EMIS WEB enabled locations 12/5/2014 in preparation for two SUCCESS Centres operating to provide a training environment for SEQOL Staff and a live test bed environment to promote the creation and evolution of the IT interoperability functionality with effect from Monday 2 nd June, 2014 Home Visiting Service to go live for all practices on 19/5/2014 supported by faxed clinical information prior to the IT Operability solution implementation 3. Creation of online appointment system and real time population of SUCCESS clinical database with pertinent patient TK, PC, BP, MOD 10/6/2014-23/6/2014 Initial API (Advance Programme Interface) design and build will occur with EMIS Web progressing to EMIS PCS and LV and then INPS Vision and TPP Practices. Stage 1 Demographic import and access Stage 2 Appointment Access Tuesday, 6 May 2014 Page 11 of 20
information from referring surgeries 4. All three SUCCESS sites operational receiving referrals from Practices using EMIS & Vision Clinical Systems 5. First evaluation board after full implementation 6. 3 month evaluation, quantitative and qualitative measures TK, PC, BP, MOD Project Board Stage 3 Pertinent Clinical Information Import Stage 4 Pertinent Clinical Information Export Stage 5 Reporting and KPI Measurement 15/07/2014 Two SUCCESS Centres live and implementation of Paediatric Hot Tots observation service at North and South locations with expansion of current Paediatric Hot Tots service at Central Location By 31/08/2014 Project Board 30/11/2014 7. Full pilot evaluation Project Board 28/02/2015 For full Gantt chart for project milestones please see Appendix Two. Tuesday, 6 May 2014 Page 12 of 20
Appendix One: Project Milestones and high level Gantt chart Summary Tuesday, 6 May 2014 Page 1 of 20
Appendix Two: Agreed Terms of Reference for Sustainable Primary Care Change Programme Board SUSTAINABLE PRIMARY CARE CHANGE PROGRAMME BOARD Draft TERMS OF REFERENCE 1. Membership 1.1 The Programme Board shall comprise of the following members:- Clinical Commissioning Group Accountable Officer Clinical Chair Director of Finance Associate Director for Primary Care Development & Engagement (TBA May 2014) Executive Director of Commissioning NHS England Area Team Director of Commissioning Head of Primary Care Head of Primary Care Finance Primary Care Development Manager 1.2 The CCG Accountable Officer will be the Chairman of the Board and the Director of Commissioning for NHS England Area Team will act as Vice- Chair Tuesday, 6 May 2014 Page 1 of 20
2. Quorum 2.1 The quorum necessary for the transaction of the business shall be four comprising at least one member each of the CCG and NHS England Area Team. A duly convened meeting of the Programme Board at which a quorum is present shall be competent to exercise all or any of the authorities, powers and discretions vested in or exercisable by the Programme Board. 3. Frequency of meetings 3.1 The Programme Board shall meet at least bi-monthly and at such other times as required. Agendas and papers will be available to each member of the Programme Board in advance and preferably at least 2 working days prior to any meeting. 4. Venue of meetings 4.1 Unless otherwise agreed each meeting will take place at the NHS Swindon CCG Offices and any changes will be advised as required. 5. Minutes of meetings 5.1 Minutes will be taken of the discussions, agreements and actions and a record kept of those present and in attendance. 5.2 Minutes of meetings shall be made available electronically to all members and presented and agreed at the next available meeting. 6. Duties 6.1 The duties of the Programme Board shall be: 6.1.1 Programme Plan Agree overall programme of work and supporting projects Approve project resources Agree programme risk and issues logs and dependency maps Ensure the programme and supporting projects are delivering on key milestones and receive exception reports to identify variances Tuesday, 6 May 2014 Page 2 of 20
Ensure action plans are implemented to address any variances Report progress and exceptions to the CCG Board on a monthly basis 6.1.2 Risk and Issue Management Receive and agree programme risk and issue logs and take action accordingly to mitigate risks and resolve issues that have been elevated from Project leads. Risks will be managed in line with the CCG s and NHS England s Risk Management procedures, adopting the same scoring system, and those assessed as significant will be transferred to the CCG/NHS England Risk Register and Board Assurance Framework as required. 6.1.3 Communications Approve supporting communications plan to ensure information on the progress of the programme is widely available across the organisation, to patients and the public and other external organisations. Celebrate success. 6.1.4 Link to operations Ensure programme fit with Trust operations and joined up decision-making with Management Executive Group and CCG Trust Board. 7. Relationships 7.1 The Programme Board reports to the CCG Board and to NHS England s Executive Group. The Project Leads will meet outside of the Programme Board to review key milestones and risk logs, discuss and resolve issues Tuesday, 6 May 2014 Page 3 of 20
where appropriate and elevate those that cannot be resolved to the Programme Board. Tuesday, 6 May 2014 Page 4 of 20
Attach map of geographic area covered Tuesday, 6 May 2014 Page 1 of 20
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