Warrington Clinical Commissioning Group 2. What we want to - - PowerPoint PPT Presentation

Warrington Clinical Commissioning Group ‘

• 2. What we want to achieve

2.1 Core mission and values

This core mission is underpinned by our core values: Patients, service users, carers and their families will see:

• a difference in service provision with holistic management of care;
• models of care based on service user led pathways with no organisational

boundaries and systems that work;

• more care delivered closer to home;
• individuals supported to better manage their own conditions;
• an increased use of technology;
• more appropriate signposting to services, particularly in moments of crisis;
• increased use of education by all agencies to help people; and
• more use of existing support networks such as the family.

These values drive our strategic objectives: To support this we will:

• narrow the gap in health needs between the wards of the town.
• be driven by a desire to continually improve service quality and outcomes
• use evidence based practice to effect whole system change
• use sustained patient and public engagement and involvement in review,

development and implementation of pathway and service redesign.

• use sustained clinical and provider engagement and collaboration to

redesign and implement pathway and service redesign.

• deliver a whole system information strategy will ensure a single care

patient care record with patient access to their information

• Improve availability of information to support informed choices
• reflect service changes in quality contracts
• improve information to target services more effectively

Our Core Values Excellence Valuing patients and partners Accountability Partnerships in everything Honest and Integrity Open and transparent Courage

Our Strategic Objectives Improve healthy life expectancy for all Reduce inequalities All Commissioned Services support delivery of the NHS Constitution for

• ur population

Continually improve quality of commissioned services Achieve sustained financial balance Maintain a highly effective and motivated workforce Ensure sound governance arrangements are in place Promote appropriate integration of commissioned services

Our core purpose is to turn £250 million of resources into the best possible health outcomes for the people of Warrington.

Our Whole System Vision

Self-sufficient communities enjoying improved health and wellbeing and better life experiences, who and when they need them have access to high quality and efficient services.

Transforming Services

Primary Care End of Life Frail Older people Children Planned Care Medicines Management Preventing Premature Death Long Term Conditions Urgent Care Mental health

Reframing our Vision Event - 2013

The graphic represents the whole system event we hosted in June 2013. All partners explored the model of support required into 2014 and beyond to reflect the profile of our population. People considered the whole system transformational programmes of work to ensure they are developing appropriately to provide the right models of support for our population as they age, requiring effective inter-professional care co-ordination and navigation through complex health & social care systems

Transformation Programme

In 2014/15 incorporates previous work programmes for Long Term Conditions, Older People and End

• f Life Care.

What do we want to achieve?

• People living as long and as well as

possible in their own environment and communities (NOF 13/14 2.1)( ASCOF 1A)

• Integrated, co-ordinated services which

support people to maintain health and independence in their place of residence (NOF 13/14 -2.1, 2.3a, 3.6) (PHOF 4.11)

• Care which is proactively planned and

managed and has moved away from a reactive model of care

• Recognising where complexity exists

and co-ordinating multi- agency care where required

How will we do it?

• By working with partner organisations to

develop integrated, co-ordinated, inter- disciplinary services across health, social care and the voluntary sector using contract levers and service specifications

• By clustering inter-disciplinary services

around the ‘primary care home’ model

• By increasing awareness around the needs
• f people with dementia. A Dementia

Action Alliance will be established.

• By reducing unscheduled admissions in

areas which we believe should be markers

• f strong community management such as

UTIs, pneumonia, cancer and for people on End of Life care pathways

• By embedding comprehensive,

standardised assessment and care planning processes

Transformation Programme

Continued:

• By working with all of our provider organisations to reshape commissioned

service provision to provide inter-disciplinary, systematic access to case management and care co-ordination, using service redesign models, service specifications and contracts to facilitate change

• By establishing strong quality markers for care home health provision and by

providing a supportive system to manage those with complex needs in a safe way

• By ensuring that the flow of care from secondary providers into community and

primary care management is timely and seamless

• By ensuring that people have the understanding and knowledge to become

equal partners in their care management

• By recognising the impact of lifestyle choices, social well-being and environment
• n health outcomes through collaboration with Public Health, NHS England and

Public Health England colleagues

End of Life Care

What did we want to achieve?

• Improve the experience of care for people

at the end of their lives (NOF 13/14 - 4.6)

• Increase the number of people achieving

their preferred place to die.

• Reduce the number of people dying in

hospital

• Improve quality of service offered (NOF 13/14-

4b)

• Improve reported patient experience

(NOF13/14 -4b)

• Enhance the quality of life for carers (ASCOF

1D)

How did we say we would do it?

• Commission services that deliver integrated

approaches to providing care at the end of life

• Develop services to ensure clinicians have

24/7 access to specialist palliative care advice,

• Implement ‘whole system’ use of

Community Care Plan (CCP) to incorporate

• Targeted Care Home support
• Work with partners to enhance peoples

understanding of issues related to death and dying using ‘Dying Matters’ philosophy

• Top 10 quality markers from the End of Life

Care Strategy 2009 in all provider contracts (quality markers for each sector as appropriate from the strategy)

End of Life Care

How we know we are succeeding:

• Significant improvement in the number of people having care plans, particularly in the

nursing and residential home environment and community.

• Care of the Dying Pathway (also called LCP) is still used and continues to give patients

and their families comfort in the dying phase. All patients and their families/carers receive information and able to discuss their wishes. National guidance is awaited and we will implement the system that replaces the Liverpool Care Pathway

• The number of people dying in their preferred place of choice across all settings

continues to increase

• The end of life work across all settings has helped contribute to the number of

unplanned admissions in conjunction with all other programmes.

• Successful introduction of a community-wide Do Not Attempt Resuscitation (DNACPR)

policy that will help families/clinicians/professionals and patients to stay in their preferred place of care at the end of life.

• Anticipatory prescribing for people at the end of life will be launched across Warrington

in March 2014

End of Life Care

What we also want to achieve in 2014/15:

• Audit the number of hospital admissions of 8 days or more which

end in death with the aim of reducing this further, developed through links with the ‘Primary Care Home Model’

• Continue to work towards developing 24/7 specialist palliative care

advice for health professionals

• Work with McMillan and St Rocco’s Hospice to develop a local

information service to support cancer / end of life patients and their carers

Preventing Premature Death

• What did we want to achieve?
• In accordance with domain 1 of the

National Outcome Framework prevent people from dying prematurely and increase life expectancy at 75 (NOF 13/14 –

1b, 1.1, 1.2, 1.3, 1.4,) (POF 4.4, 4.5, 4.6, 4.7)

• Earlier detection of cancer (NOF 13/14 1.4 (i)

(ii) )(POF 4.5)

• Consistent reporting of cancer staging

data

• Decrease in mortality from cancer (NOF

13/14 1.4 (i) (ii) )(POF 4.5)

• Closing of inequalities gap
• Decrease in alcohol related morbidity
• How did we say we would do it?

(Public Health lead)

• Local Enhanced Service for ‘Health

Checks’ to identify and manage risk factors

• Promote participation in cultural and

sporting activities as a means of promoting health and wellbeing

• Improve uptake of screening

programmes for early intervention and better outcomes

• Tackling health inequalities / targeting

areas of greatest need

• Commissioning ‘Lifestyle’ programmes

to promote positive life choice that impact on health

Preventing Premature Death

How we know we are succeeding – long term outcomes

• Increased uptake of national CVD screening programmes
• Reduction in mortality from cardiovascular disease
• Positive reporting from cancer staging data confirming earlier

diagnosis

• Decrease in mortality from cancer
• Reduction year on year of inequalities gap
• Decrease in real terms in alcohol related morbidity
• Improvement in life expectancy for the population of Warrington

Measurements used:

i. Under 75 mortality rate from cardiovascular disease ii. Under 75 mortality rate from respiratory disease iii. Under 75 mortality from cancer

Preventing Premature Death

Progress and next steps 2014/15

Delivery of the large scale prevention plan through a range

• f Lifestyle Services Commissioned;

(alcohol, healthy weight, smoking in deprived wards, reducing health inequalities)

(NOF 13/14 – 1a/b, 1.1 – 1.7), (POF 4..4. – 4.7)

• Prison population health improvement (including health

checks programme)

• Health Checks across general population
• Cancer Early Detection
• Falls Prevention Programme
• Healthy Ageing Volunteers
• Healthy Ageing Top Tips Guide
• Children and Young People Plan
• New alcohol service commissioned through CRI

Preventing Premature Death

Progress and next steps - Cancer prevention and early detection

• Healthy Lives Healthy People Team focussed upon inequalities
• Skin Cancer Campaign Summer 13 implemented and stage 1 of the

evaluation positive

• Be Clear on Cancer Campaigns (Blood in Pee, etc) locally
• Screening: Campaign targeted towards 20% most deprived localities

(planned Jan 14)

Reducing Health Inequalities

Next steps 2014/15

Priorities outlined in the Lifestyle Survey 2013:

• Alcohol misuse reduction – Harmful drinking on the

increase

• Healthy Weight (focus on overweight & obesity across

the town)

• Activity, exercise and poor diet behaviours
• Emotional Wellbeing

(Delivery through the Healthy Lives Healthy People Team and Neighbourhoods Team in Public Health)

• Lifestyle Services (all services have a KPI for addressing

the needs of our deprived communities)

• Develop Health and Housing Strategy and action plan

Public Health Integrated Commissioning

Next steps 2014/15

What we also want to achieve in 2014/15;

• Continued delivery of the overall Public Health Plan ensuring

reflection of Lifestyle Survey 2013 findings

• Develop Integrated Wellness Services & ensure delivery of the

health inequalities KPI targets within contracts

(smoking cessation in deprived wards, alcohol, healthy weight, reducing health inequalities)

• Evaluation of the impact of the health checks programme with

regards to lifestyle changes and behaviours

• Commission Health Checks Training for practitioners
• Alcohol misuse reduction
• Healthy Weight Strategy and action plan
• Cardio-Vascular Disease Plan - development & implementation
• 0 to 19 years public health service; With NHSE Public Health jointly

commission a service during 2013/14, with NHS England, with a view to have new arrangements in place by April 2014.

Frail Older people

• What did we want to achieve?
• Help older people to recover their

independence after illness or injury

(NOF 13/14 – 3.3, 3.4, 3.5 (i) (ii), 3.6(i) (ii) )

• Pro-active management of frail older

people wherever resident (NOF 2013/14 – 4.9

in development, ASCOF 3E)

• Rapid assessment for acute illness (NOF

13/14 – 4.3, 4.4 (i))

• Supported hospital discharge and

continuity of care; ((NOF 2013/14 – 4.9 in

development, ASCOF 3E)

• Increased social awareness of the

signs & symptoms of frailty

• Shift the focus from disease based to

holistic coordination of care

• Develop & promote patient self

management

• How did we say we would do it?
• Commission continuous improvement in

co-ordinated hospital discharge and continuity of care

• Integrated Neighbourhood Teams as

part of Long Term Conditions programme will provide care co-ordination and support

• Commission a Geriatrician led ‘Care

Homes Support’ initiative to better support frail older residents - includes 5 Borough’s development re Dementia support

• AED Front End / Urgent Care re-design

to reduce avoidable admissions

• Commissioning a Falls Service
• Implementation Telehealth / Telecare
• Commission integrated ‘wrap around’

services for older people to support them to maintain independence (NOF 2013/14 – 4.9 in

development, ASCOF 3E)

• Use of ‘Community Care Plan’

Frail Older People

How do we know we are succeeding?

• Fewer attendances and admissions of frail older people
• Rapid assessment for those experiencing acute illness / deterioration;
• Fewer delayed hospital discharges and transfers of care
• Increased use of anticipatory care tools e.g. Anticipatory Care Calendar
• Increased social awareness of the signs & symptoms of frailty
• Through the Long Term Conditions Programme evidence that we have

achieved a change in the focus of care - on-going

• Through the Long Term Conditions Programme demonstrate an increase in

effective patient self management - on-going

Measurements used

i. Unplanned hospitalisation for chronic ambulatory care sensitive conditions (adults) ii. Emergency admissions for acute conditions that should not usually require hospital admission

• iii. Emergency readmissions within 30 days of discharge from hospital

Frail Older People

What we also want to achieve in 2014/15:

• HCS acute risk-assessment programme will enhance discharge planning, scheduled ‘go live’ date

December 2013

• Telephone follow-up check post-discharge - CQUIN with WHHFT aims for re-admission reduction
• Collaborative care teams phased roll out through 2014/15 (see LTC work stream update)
• Focus on supporting care homes providers and residents - 2 extensive pilot projects completed

2013/14 – Care Home Enhancement Project & 5BP Dementia – Care Homes. Learning from these will be used in next PDSA cycle for the overarching ‘Transformational programme’

• Falls service in place via Bridgewater Community Health Services; Falls group being re-

established with a focus on prevention; NICE guidance162 has been reviewed by provider

• rganisations to establish compliance levels
• Tele-care is delivered by Warrington Borough Council. Simple Tele-health pilot using text

messaging reminders has been implemented using CQUIN funding. This will have synergy with the planned DES for primary care in 2014/15.

• Community care plans – patient held / uptake increased through End of Life and Frequent

Attenders work streams / roll out continues in 2014/15 using contract levers and KPI’s in 2014/15 this work stream will be incorporated into ‘Transformation Programme – Frail Older People, End of Life & Long Term Conditions’

Children

• What did we want to achieve?
• Deliver safe care to children in acute

settings (NOF 13/14 – 1.6 (i) (ii) (iii), 4.8 in development,

5.5)

• Improve the safety of maternity

services and the experience of maternity services (NOF 13/14 – 4.5, 5.5)

• Reduce unplanned hospitalisation (NOF

13/14 – 2.3 (ii), 3.2)

• Reduce deaths in babies and young

children (NOF 13/14 - 1.6 (i) (ii) (iii))

• Develop community based & self-

managed care

• Integrated children’s community

services

• Increased post natal support with

respect to breast feeding

• How did we say we would do it?
• Commission services that safeguard and

promote the welfare of children

• Develop pathways based on best

practice evidence

• Commission integrated children’s

services

• Reduce unplanned acute paediatric

admissions

• Shift more provision into community

settings

• With Public Health, work to reduce

childhood obesity and promote exercise and healthy lifestyle choices for children

• With the Borough Council and Public

Health partners, work to increase educational attainment and commission services to promote health and wellbeing for children and adolescents

• Develop integrated systems pathway with

Borough council

Children

How do we know are succeeding?

• Pilot implementation of integrated community paediatric teams
• Changing from acute setting to community setting for delivery of services
• Started to reduce planned and unplanned paediatric admissions to hospital
• Worked with 3rd Sector organisations to improve safeguarding procedures
• Piloted an integrated community based paediatric nursing team
• Started to reduce planned and unplanned paediatric admissions to hospital
• Working with Public Health on reducing obesity in pregnancy
• Established a refreshed ‘Emotional Health & Wellbeing Board’ and produced a draft

pathway for commissioning services.

• Agreed a governance and delivery structure with Warrington BC for children & young

people with ‘Additional Needs

• Revised and implemented a new Continuing Care Policy

Children

Measures used i. Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s (NOF 13/14 -

2.3ii)

ii. Emergency paediatric admissions for acute conditions that should not usually require hospital admission (NOF 13/14- 3a, 3.2) iii. Emergency admissions for children with lower respiratory tract infections (LRTI) (NOF 3.2) iv. Infant mortality and Neonatal mortality and stillbirths (NOF 13/14 - 1a (ii), 1.6 (i) (ii) (iii), 5c) v. Reduction in length of stay by condition (NOF 13/14 – 4.8 under development) vi. Increase in breastfeeding initiation rates (current target 72%)

• vii. Increase in percentage of women exclusively breastfeeding on transfer to health

visitor (current target 48%)

• viii. Patient recorded experience measures and ‘improving people’s experience of

integrated care’ (NOF 13/14 4.9) (ASCOF 3E)

Children

What we also want to achieve in 2014/15:

• Improved health outcomes for children & young people with additional needs
• Improved emotional health and wellbeing outcomes for children & young people
• Delivery of more services in the community closer to home
• Jointly commission ‘health’ training for services

Planned Care

• What did we want to achieve?
• Ensure Warrington patients have a

positive experience of care (NOF 13/14 - 4b /c,

4.1, 4.2, 4.3, 4.7, 4.8)

• Achieve 75% rate of day case activity in

25 procedure/ intervention areas

• Commission pre-operative assessment

clinics in community settings

• Improved outcomes from planned

procedures (NOF 13/14 - 3.1)

• Commission enhanced recovery models
• Improve patient experience of hospital

care (NOF13/14 - 4b/c, 4.1, 4.2, 4.3, 4.5, 4.8 under

development, 5c, 5.1- 5.4, 5.5)

• Standardised , evidence based service

specifications

• Reduce reportable patient safety

incidents (NOF 13/14 - 5a/5b/5c, 5.4, 5.5, 5.6)

• How did we say we would do it?
• Increase day case provision
• Clear pathways with specifications

and outcomes with an anticipated reduction in length of stay and emergency readmissions within 30 days of discharge

• Work with partners to develop

enhanced recovery models

• Work with partners to develop and

commission pre-operative assessment clinics in the community

• Explore commissioning delivery of

planned care ‘closer to home’

• Commission planned services that

appropriately meet the needs of all patients including those with dementia/learning disabilities & military veterans

Planned Care

How do we know we are succeeding?

• Service specifications are included in contracts
• Enhanced recovery models implemented – limited progress / for further review 2014/15
• Minority groups needs are equally met by main stream service delivery

Measures used;

i.Day case activity ii.Number of elective procedures weighted by effectiveness i Hip replacement ii Knee replacement iii Groin hernia iv Varicose veins (NOF 13/14 - 3.1,2,3,4) iii.Patient experience of hospital care (NOF 13/14 - 4b /c, 4.1, 4.2, 4.3, 4.7, 4.8) iv.Patient experience of outpatient services (NOF 13/14 - 4.1) v.Responsiveness to in-patients’ personal needs (NOF 13/14 - 4.2 ) vi.Incidence of hospital-related venous thromboembolism (VTE) (NOF 13/14 - 5.1 ) vii.Incidence of healthcare associated MRSA infection (NOF 13/14 - 5.2.i ) viii.Incidence of healthcare associated C. difficile infection (NOF 13/14 - 5.2.ii) ix.Patient safety incident reported (NOF 13/14 - 5a/b/c)

Urgent Care

• What did we want to achieve?
• Ensure patients have a positive

experience of care (NOF 13/14 - 4)

• Reduce unscheduled care activity and

associated length of stay (NOF 13/14-2.3.i/3a)

• A ‘whole system’ approach to

management of unscheduled care activity

• Support to Frequent Attenders into

Accident and Emergency Departments

• Improve recovery from injuries, major

trauma (NOF 13/14 - 3.3, 3.5(i) (ii) )

• Formalise Multi Disciplinary Team

support to care homes

• Improve recovery from stroke (NOF 13/14 -

3.4, 3.6 (i) (ii) 4.9 under development) (ASCOF 2B / 3E)

• Work with primary care to address

access issues

• How did we say we would do it?
• Implementation of a Primary Care led

“front door” to A&E at the Warrington Hospital site (PCUCU implemented)

• Review and update in line with

published outcome based evidence of current service specification

• Reduce admissions for acute

conditions that should not normally require hospital admission (NOF 13/14 - 3a)

• Improve people’s experience of A&E

services (NOF 13/14 - 4.3)

• Use contractual levers and penalties to

ensure providers meet the minimum standards for stroke and TIA care

• Improve access to Primary Care

Services

Urgent Care

How do we know we are succeeding?

Reduction from 2012/13 baseline for AED attendances and unscheduled admissions has been achieved in 2013/14

Measures used:

i.Through contract monitoring of key performance indicators within the 2013/14>contracts (and application of contractual penalties) ii.Improved access to GP and Primary Care Commissioned services iii.Unplanned hospitalisation for chronic ambulatory care sensitive conditions (adults) (NOF

13/14 - 2.3.i)

iv.Emergency admissions for acute conditions that should not usually require hospital admission (NOF 13/14 - 3a ) v.Emergency readmissions within 30 days of discharge from hospital (NOF 13/14 - 3b ) – requires

further improvement

vi.Patient experience of A&E services (NOF 13/14 - 4.3, 4.8 under development) vii.An indicator on the proportion of stroke patients reporting an improvement in activity/lifestyle on the Modified Rankin Scale at 6 months (NOF 13/14 - 3.4 )

Urgent Care

What we also want to achieve in 2014/15;

• Following good evaluation of PCUCU (now ‘Urgent Care GP’) extend pilot to

include Ambulatory Care Sensitive Conditions management to reduce admissions and improve patient experience

• Revise PCUCU (Urgent Care GP) service specification to reflect on-going

development and integration of this service and include in acute and community contracts

• Continue reduction in unscheduled care activity, reduced to date by 8% by

piloting an AMU and GP Urgent Care.

• A ‘whole system’ refreshed vision to manage unscheduled care activity

including care co-ordination & key worker model

• Support to Frequent Attenders into Accident and Emergency Departments –

early MDT implemented / risk stratification builds on this

• Care Homes Enhancement Project implemented winter 2013/14 – learning

feeds into initiatives for the current winter

• Ten practices are undertaking NHIi Productive GP / 4 practices

implementing ‘Dr First’ to address access issues

Urgent Care

How will we know we have succeeded in 2014/15?

• Continue to reduce unscheduled care activity and associated length of stay

(NOF 13/14-2.3.i/3a)

• A ‘whole system’ approach to management of unscheduled care activity will

be implemented through collaborative care teams model / overarching transformational programme

• Provision of effective support to Frequent Attenders into Accident and

Emergency Departments to reduce attendances

• Improved recovery from injuries, major trauma (NOF 13/14 - 3.3, 3.5(i) (ii) )
• Implementation of optimum model of support to care homes providers &

residents to reduce avoidable AED attendances and acute admissions

• Improved recovery from stroke (NOF 13/14 - 3.4, 3.6 (i) (ii) 4.9 under development) (ASCOF 2B / 3E)
• Improved primary care access successfully managing unscheduled care as

appropriate

• Development of Warrington ‘brand’ primary care – reduce variation in

delivery and achieve equitable access for all localities (Plus continued use of specific measures detailed above)

Primary Care

• What did we want to achieve?
• Ensure patients have a positive

experience of primary care (NOF 13/14 - 4a)

• Reduce variations in primary care

practice.

• Reduce avoidable secondary care

activity

• Ensuring people feel supported to

manage their condition (NOF 13/14 - 2.1)

• Enhancing quality of life for carers (NOF

13/14 - 2.4) (ASCOF 1D)

• Facilitate positive experiences of care

for patients by enhancing access to primary care (NOF 4.4 (i) )

• Commission support for GP Practices

covering the most deprived 20% of the population to improve uptake rates for cervical, breast and bowel screening

• Enhance efficiency and effectiveness

to improve patient experience

• How did we say we would do it?
• Identifying people with long term

conditions and supporting them to manage their condition

• Promote peer review and adherence to

agreed pathways

• By engaging in and informing service

redesign and development of service pathways in relation to the Integrated Programmes including acute

• Identify and support carers to improve

health related quality of life

• Review secondary care activity
• With Medicines Management work to

reduce variations in prescribing

• With Medicines Management work to

reduce waste

Primary Care

How do we know we are succeeding?

• Chronic disease registers, including mental health and substance misuse are

maintained

• Primary Care involved in service redesign
• Primary Care involved in developing revised outcome based service specifications

for inclusion in 2013/14> contracts

• Achieved reduction from the 2012/13 baseline in emergency attendances
• Achieved reduction from the 2012/13 baseline in emergency admissions
• Reduction in real terms of prescribing spend
• Reduction in the notional value of wasted medication

Measures that will continue to be used in 2014/15:

i. Patient experience of primary care through Out of hours GP services (NOF 13/14 - 4a (ii)) ii. Patient experience of GP services (NOF 13/14 - 4a (i))

Primary Care

What we also want to achieve in 2014/15;

• Enhanced primary care access (NOF 4.4 (i) )
• Primary care as the ‘home’ of care co-ordination and system integration
• Warrington ‘brand’ of primary care
• Maximise the number of existing services that can be provided to our communities

around primary care home clusters

• Reduce avoidable secondary care activity through maximising impact of integrated

primary and community care model

• Integration of local commissioning and NHS England commissioning

encompassing ten priority areas

• Develop ‘primary care home’ delivery model with CCG membership

How will we do it?

• Introduce enabling processes including shared IM&T resources and evidence

based risk stratification methods

• NHSI improvement programmes for primary care
• Access improvement programmes (Dr First/Patient Access etc)
• Innovation projects to test improved models of primary care to provide evidence of

effective outcomes and support service change and investment cases as appropriate

• Clearly specified service models delivered around the ‘Primary Care Home’

concept will be included in all of our contracts over a 3 year time frame, to include commitment to care coordination inter-disciplinary professionals (key working), ambulatory care models and diagnostics

Primary Care

How will we know we are succeeding in 2014/15?

• Agreed ‘Primary Care Home’ clusters are in place
• Risk stratification is in place and utilised within the ‘Primary Care Home’

to deliver planned person-centred primary care in collaboration with community care teams and MDT

• Increase in primary care appointments available
• Patients with complex conditions have a care plan
• Patients with complex conditions have care plans, have continuity of

care through a lead professional, and where indicated have a care coordinator (key worker) using inter-disciplinary team approach (Plus continued use of specific measures detailed above)

Long Term Conditions

In 2014/15 this work stream will be incorporated into inclusion ‘Transformation Programme – Frail Older People, End of Life & Long Term Conditions’

• What did we want to achieve?
• Enhanced quality of life for people with

Long Term Conditions (NOF 13/14 – 2.1)

(ASCOF 1A)

• To develop & implement a fully

integrated Long Term Condition model

• Long Term Condition pathways

delivered across all service delivery areas

• Increased social awareness of the

signs & symptoms of Long Term Conditions (LTC) including improving employment opportunities (NOF 13/14 -2.2)

(ASCOF 1E / PHOF 1.8)

• Improved early detection & LTC

diagnostics in all healthcare settings

• Reduced time spent in hospital by

people with Long Term Conditions (NOF

13/14 - 2.3 (i) )

• How did we say we would do it?
• Use a risk stratification tool to identify

where to focus specific interventions.

• Develop and agree pathways across

all service delivery areas

• Develop & promote patient self

management to support optimal self care & reduce exacerbations by use

• f Assisted Technology solutions
• Shift the focus of care from disease

based to integrated co-ordination of care for an individual

• Care delivered by integrated teams,

according to long term condition pathways & best evidence

• Evaluate Integrated Respiratory

Team’ pilot to inform mainstream service commissioning

Long Term Conditions

How do we know we are succeeding?

• Increase in reported health-related quality of life improvements for people with long term

conditions through using Quality of Life surveys undertaken in Warrington

• A reduction in the number of Warrington residents who are reported as Permanently

Sick/Disabled in the Warrington Working Together Survey

• Revised service specifications with outcome measures to reflect care pathway developments

varied into contractual agreements

• Reduction from the 2012/13 baseline in length of stay for unplanned hospitalisation of people

with long-term conditions

• Implementation of a range of Assisted Technology solutions / Telehealth – limited progress via

WBC / further development needed - see Frail Older People section

• Risk stratification reports will be available to all practices during Q3. This is liked to the

primary care DES for Risk Profiling and Case Management for 2013/14 and the introduction of Inter-disciplinary Collaborative Care Teams as a primary response.

• Collaborative Care Teams model defined and this way of working will be specified in 2014/15

contracts

• Respiratory pilot will complete by end of 2013/14. Evaluation underway.
• Decrease in COPD admissions achieved
• Self-management group established. Development of support tool web-site commenced

Long Term Conditions

Measures used include:

• Under 75 mortality rate from cardiovascular disease; respiratory

disease and cancer (NOF 13/14 - 1.1, 1.2 and 1.4)

• Unplanned hospitalisation for chronic ambulatory care sensitive

conditions (adults) (NOF 13/14 - 2.3 (i) )

In 2014/15 this work stream will be incorporated into inclusion ‘Transformation Programme – Frail Older People, End of Life & Long Term Conditions’

Medicines Management

• What do we want to achieve?
• Improved quality and consistency of

prescribing and delivery of efficiencies

• Reduce the incidence of medication

errors and in particular those causing serious harm (NOF 13/14 - 5.4)

• Named medicines co-ordinators

working in each practice to support practice prescribing

• How will we do it?
• Work with Primary Care to reduce

variation in prescribing

• Utilising the Pan Mersey Area

Prescribing Committee to ensure a consistent and collaborative approach

• Commission the Medicines

Management Team (MMT) and clinical lead support to provide specialist advice and support to prescribers

• Commission the Medicines

Management Team to train medicines co-ordinators to support each practice

• With Primary Care work to reduce

waste

Medicines Management

How will we know we are succeeding?

• Deliver prescribing efficiency savings
• Reduction in the notional value of wasted medication
• Medicines Co-ordinators working in each practice within Warrington
• Reduction in variation in prescribing across the practices within Warrington
• Working with primary care on an enhanced service for near patient testing
• Input into the Pan Mersey Subgroups and Committee, present their recommendations to the

CCG for approval, advise practices and incorporate into work plan

• MM Team and clinical lead continue to support prescribers. Piloting intensive MM support in

some practices

• Medicines co-ordinators working in all but 3 practices delivering quality and cost-saving pieces
• f work
• MM Team have contributed to shared learning for the prescribing module of the NHS

improvement programme (covering 9 practices, 100,000 patients). The team has also provided individual support to practices as requested

Medicines Management

Measures used:

• Monitoring of prescribing spend using ePACT data
• Monitoring of prescribing variation using ePACT data and local/national benchmarking
• Monthly reports submitted by medicines co-ordinators

Progress to date;

• Monthly reports submitted by Medicines Management Team members and medicines

co-ordinators - delivered £478,425 of identifiable in year savings in 2013/14 so far (up to October 2013)

• Monitoring of prescribing variation using ePACT data and local/national benchmarking

– actual cost per Astro PU is £24.75, the second lowest in the Mersey and Warrington

• CCGs. In a basket of QIPP saving areas identified, spend for Warrington is -5.4%,

compared to the same 5 months in the previous year, and -4.5% for the Mersey and Warrington CCGs combined.

• Monitoring of prescribing spend using ePACT data – the prescribing budget is

currently predicting an overspend against the budget set (at month 5), however, actual annual cost growth is -1.41% compared previous year

Medicines Management

Emerging / new priorities for 2014/15

• Linking into ‘Primary Care Home’ strategy and supporting innovation bids

incorporating medicines optimisation themes

• Evaluate intensive support model for practices and continue if successful
• Explore specific areas where further prescribing efficiencies could be

delivered with partners e.g. stoma, continence prescribing

Mental Health

• What did we want to achieve?
• Enhanced quality of life for people with

mental illness and/or with dementia (NOF

13/14 – 1.5, 2.5 and 2.6) (PHOF 4.9)

• Improved experience of healthcare for

people with mental illness (NOF 13/14 - 4.7)

• Seamless integrated services for people

with mental health problems and substance misuse across all healthcare settings

• To ensure people with mental health

problems and dementia are identified and have their physical health needs addressed.

• To implement the National Dementia

Strategy

• Reduced premature death in people with

serious Mental Illness and Learning Disabilities (NOF 13.14 - 1.5 and 1.7) (PHOF 4.9)

• Appropriate support for Military Veterans
• How did we say we would do it?
• Promoting mental health wellbeing &

prevention in primary care

• Review and improve access to primary

care support for people with mental health problems including IAPT (NOF 3.1

v) and Military Veterans IAPT

• Providing integrated services to support

people with dementia in holistic way to meet the National Dementia Strategy

• Improved coverage of Dementia

Screening

• Develop substance misuse services to

ensure integrated service provision

• Work with partners to provide seamless

care and support in all settings including care homes

Mental Health

How do we know we are succeeding?

• Mental Health services that fully address the physical needs of patients – on-going work
• Acute Care Pathway, Home Treatment Team and Later Life and Memory Service are in place.
• Achieved expanded IAPT services including those for Military Veterans and incorporation into

commissioned services / shortened waiting times for IAPT access

• Pathways and information sharing protocols have been agreed to improve the experience of

healthcare for people with mental illness

• Implementation of a (RAID) – like Rapid Assessment, Intervention and Discharge service model

within available resources

• Increased percentage level of dementia screening across all sectors and subsequent appropriate

service responses - Registers are in place within Primary Care, offering annual physical health checks

• The Advancing Quality Alliance pilot is in place to reduce mortality rates by identifying and addressing

the physical health needs of patients with mental health problems and dementia

• Integrated services providing support to people with dementia holistically as recommended by the

National Dementia Strategy - on-going work

• Awareness raising is in place and two pilot services supporting military veterans have been

commissioned

Measures used:

• Under 75 mortality rate in people with serious mental illness (NOF 13/14 - 1.5) (PHOF 4.9)
• Patient experience of community mental health services (NOF 13/14 - 4.7 )
• Number of elective procedures weighted by effectiveness - psychological therapies (NOF 3.1v )

Mental Health

What we want to achieve in 2014/15

• Improved integration of physical and

mental health care

• Continue the promotion of mental health

awareness

• Patients with mental health problems will

be seen in a timely way, staff are knowledgeable about the benefits of liaison psychiatry and there are improved

• utcomes for all involved in the pathway

How will we know we’ve achieved it?

• People with severe and enduring mental

health issues will have equitable access to physical health care

• There will be a reduction in morbidity for

people with mental health issues

• Early detection of mental health problems

will be encouraged and achieved across all sectors

• Earlier recognition and improved access to

mental health & social care support in primary care will be promoted and achieved

• Implementation of a Liaison Psychiatry

service

• Partners will work together to develop an

evidence-based, seamless care pathway

• Robust data systems will support the

evaluation of the service

Mental Health

What we want to achieve in 2014/15 Development of patient pathways to improve provision of care for people with complex and challenging behaviours. Improved experiences for people with dementia (NOF 13/14 – 2.6 (i) (ii) (ASCOF 2F / PHOF

4.16)

How will we do it ? Everyone who has been placed out of area will be reviewed and able to access local solutions sought By improving detection rates of people with dementia so people have the

• pportunity of timely assessment,

treatment and improved outcomes. By assessing the impact of the Later Life & Memory Service By undertaking on-going reviews of the prescribing of anti-psychotics in nursing homes

Mental Health

What we want to achieve in 2014/15

• Improved health outcomes for people

with Learning Disability (NOF 13/14 – 1.7)

• The CCG’s self-assessment rating for

the healthcare process of people with learning disability will improve

• The value of care-packages for people

with learning disability will improve

• A review of the inpatient bed base for

people with learning disability will be undertaken.

How we will achieve it?

• CCG will work with partners to ensure

that people with Learning Disability have the same access to and experience of health care as everyone else.

• CCG will work with partners to review

care packages, driving up quality, care and outcomes with care provided as close to home as possible.

• CCG will work with providers to review

current provision and agree future care pathway.

Mental Health

What we want to achieve in 2014/15 Access to services for Veterans and their families which recognise the requirements of the Operating Framework How we will we achieve it?

• Awareness raising amongst GPs and

partners

• Supporting the North West Armed

Forces Network

• Supporting the pledges of the

Community Covenant

• Supporting the recommendations of

the Murisson Report (via MVIAPT)

• Supporting staff who are members of

the Reserve Forces

Enabling intentions – I.T . Strategy

• Warrington's joint IT Strategy will support the Transformation Programme,

designed to drive integrated care across care settings enabling clinicians to move from unconnected silos of care to a seamless health and social care economy that supports the patient journey.

• Implementing a single integrated patient record across our health and social

care economy is key to improvements in care and efficiency and

• rganisations will reflect benefits of this in care models and IT investments.
• It is our intention to ensure information flows through the pathway by

ensuring 4 items are addressed

• Capture - Capture information efficiently and first time to provide an

effective service

• Share - Share responsibly and legally to make the most of the

captured information

• Mobile - Use mobile technology to share more effectively
• Use - all the other elements to enable more effective ways of

working

General Principles (1)

Warrington Clinical Commissioning Group will:

• Work collaboratively in its commissioning approach with partner CCG’s across

Merseyside and Cheshire, the CWW Area Team / Specialised Commissioning and Warrington Borough Council / Public Health to;

• ensure commissioned services meet the needs of our population
• review and implement commissioning policies to ensure consistency and outcomes /

evidence based approach e.g. Procedures of Limited Clinical Priority / Fertility Policy and criteria for provision of IVF

• With partner CCG’s across Merseyside and Cheshire, commission an ‘end to end’

needs assessment to inform future commissioning plans and service provision configurations

• Work with other partners who provide commissioned services for the population of

Warrington including but not limited to Warrington & Halton Hospitals NHS Foundation Trust, Bridgewater Community NHS Trust and the Five Boroughs NHS Foundation Trust

• Use CQUIN funding as an enabler to ensure demonstrable innovation and quality

improvement across all of our contracts to improve the quality of services and outcomes for the patients of Warrington

• Develop outcome based commissioning and contracting approaches in the next 12

months to 3 years, to ensure services produce the best outcomes for patients and move away from activity / output based focus

General Principles (2)

Warrington Clinical Commissioning Group will:

• With partners, explore the use of innovative contracting models for improved patient

experience / outcomes and better VFM e.g. prime provider and/or alliance contracting

• Repatriation of activity where possible and without additional financial risk e.g elective

PCI from LHT to Warrington & Halton Hospitals NHS Trust

• Utilise AQP for selected market testing across all service sectors
• Linked with Joint Information / Technology / Digital strategies, ensure technological

solutions are implemented to reduce avoidable hospital appointments e.g. use of telephone follow ups / use of ‘virtual’ clinics and develop appropriate local tariffs

• Consider whether self-management thresholds criteria should be implemented prior to

secondary care referral to improve clinical outcomes

• Reflect our commissioning intentions (including but not limited to service specification

development, associated outcome measures and contractual obligations) within our 2014/15 contracts

• Reflect on the “real time” feedback from the Friends and Family Test as it is rolled out

(NOF 13/14 - 4c)

• Develop a robust baseline and methodology to assess the level of hospital deaths

attributable to problems in care in accordance with the new outcome (NOF 13/14 - 5c)

• Ensure drug tariff reductions are fully reflected in appropriate provider contracts e.g.

AMD local tariff negotiation

• Explore opportunities for greater integration of services / pathway delivery