Welcome Aylesbury Vale CCG Chiltern CCG Governing Bodies meeting - - PowerPoint PPT Presentation

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Welcome Aylesbury Vale CCG Chiltern CCG Governing Bodies meeting - - PowerPoint PPT Presentation

Mar 03, 2023 164 likes •559 views

Welcome Aylesbury Vale CCG Chiltern CCG Governing Bodies meeting in common in public Accountable Officer : Lou Patten Clinical Chair Aylesbury Vale CCG : Dr Graham Jackson Clinical Chair Chiltern CCG : Dr Raj Bajwa Clinical Directors

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Accountable Officer: Lou Patten Clinical Chair Aylesbury Vale CCG: Dr Graham Jackson Clinical Chair Chiltern CCG: Dr Raj Bajwa

Welcome

Aylesbury Vale CCG Chiltern CCG

Governing Bodies meeting in common in public

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Accountable Officer: Lou Patten Clinical Chair Aylesbury Vale CCG: Dr Graham Jackson Clinical Chair Chiltern CCG: Dr Raj Bajwa

Clinical Directors Presentation – 8 June 2017 Unplanned Acute Care

Dr Dal Sahota Clinical Commissioning Director, Unplanned and Urgent Care

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Accountable Officer: Lou Patten Clinical Chair Aylesbury Vale CCG: Dr Graham Jackson Clinical Chair Chiltern CCG: Dr Raj Bajwa

Snapshot - Buckinghamshire

547,084 51 GP practices 1 MIIU 5 community hospitals 1 acute

BOB STP

Adding value by working at scale

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Accountable Officer: Lou Patten Clinical Chair Aylesbury Vale CCG: Dr Graham Jackson Clinical Chair Chiltern CCG: Dr Raj Bajwa

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Accountable Officer: Lou Patten Clinical Chair Aylesbury Vale CCG: Dr Graham Jackson Clinical Chair Chiltern CCG: Dr Raj Bajwa

Finances

  • 2016-17 - 91.5 Million spent to

plan

  • 2017-18 - £27 Million budget

reflects increases in tariff charges for activity

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Accountable Officer: Lou Patten Clinical Chair Aylesbury Vale CCG: Dr Graham Jackson Clinical Chair Chiltern CCG: Dr Raj Bajwa

The Pinch points

  • BHT- non elective
  • Frimley- Non elective, vascular, immunology,

excess bed days

  • OUH – haematology, transplants
  • MK- excess bed days, cardiology
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Accountable Officer: Lou Patten Clinical Chair Aylesbury Vale CCG: Dr Graham Jackson Clinical Chair Chiltern CCG: Dr Raj Bajwa

CCG Urgent Care Team

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Accountable Officer: Lou Patten Clinical Chair Aylesbury Vale CCG: Dr Graham Jackson Clinical Chair Chiltern CCG: Dr Raj Bajwa

What have we done?

  • A lot!
  • Business as usual
  • Re-purposed Community beds
  • Primary care streaming
  • PTS
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Accountable Officer: Lou Patten Clinical Chair Aylesbury Vale CCG: Dr Graham Jackson Clinical Chair Chiltern CCG: Dr Raj Bajwa

Community Beds

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Accountable Officer: Lou Patten Clinical Chair Aylesbury Vale CCG: Dr Graham Jackson Clinical Chair Chiltern CCG: Dr Raj Bajwa

Primary care streaming

Front door direction to:-

  • GP primary care, Ambulatory emergency

care, Minor injuries, or A&E

  • 2 GPs & nurse and separate reception
  • 8am – 11pm
  • Refurb of current clinical space – 3 rooms
  • New building – 6 clinical rooms
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Accountable Officer: Lou Patten Clinical Chair Aylesbury Vale CCG: Dr Graham Jackson Clinical Chair Chiltern CCG: Dr Raj Bajwa

Achievements to date

PDU expansion completed Middle Grade appointed to support Consultant Workloads

Staffing skill mix Support services The environment

Single Checking

  • f Medications
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Accountable Officer: Lou Patten Clinical Chair Aylesbury Vale CCG: Dr Graham Jackson Clinical Chair Chiltern CCG: Dr Raj Bajwa

Discharges and Transfers April 2017

  • Patient Transport services for A&E discharge –

Buckinghamshire Healthcare NHS Trust 36.3% pre-planned (at least day before).

  • This compares to 21.6% Berkshire and

Oxfordshire 33.7% for the month of April.

  • This is a considerable local improvement.
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Accountable Officer: Lou Patten Clinical Chair Aylesbury Vale CCG: Dr Graham Jackson Clinical Chair Chiltern CCG: Dr Raj Bajwa

National Delivery Plan for Urgent and Emergency Care

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Accountable Officer: Lou Patten Clinical Chair Aylesbury Vale CCG: Dr Graham Jackson Clinical Chair Chiltern CCG: Dr Raj Bajwa

National Delivery Plan for Urgent and Emergency Care

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Accountable Officer: Lou Patten Clinical Chair Aylesbury Vale CCG: Dr Graham Jackson Clinical Chair Chiltern CCG: Dr Raj Bajwa

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Accountable Officer: Lou Patten Clinical Chair Aylesbury Vale CCG: Dr Graham Jackson Clinical Chair Chiltern CCG: Dr Raj Bajwa

Ambulance image

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Accountable Officer: Lou Patten Clinical Chair Aylesbury Vale CCG: Dr Graham Jackson Clinical Chair Chiltern CCG: Dr Raj Bajwa

SCAS

Thames Valley Contract Performance for April 2017:

  • Red 1 - (life threatening calls) 8 minute response –

Target 75% was achieved at TV contract level (77.1%), however Bucks CCGs achieved 64.7%

  • Red 2 - (potential to be life threatening) 8 minute

response – Target 75% was achieved at 75.5%, with Bucks CCGs achieving 68.8%

  • Red 19 - (requirement to have conveying vehicle to

patient within 19 minutes) Target 95% achieved at 96.1%, with Bucks CCGs achieving 94.3%

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Accountable Officer: Lou Patten Clinical Chair Aylesbury Vale CCG: Dr Graham Jackson Clinical Chair Chiltern CCG: Dr Raj Bajwa

SCAS

  • Emergency Care Improvement Programme (ECIP) collaborative

working

  • Significant reduction in Ambulance handover delays- March 2017

(see table below) 65 hours, 35% improvement on March 2016

35:04:43 27:33:55 39:13:37 51:09:23 50:43:37 13:34:47 105:26:21 65:05:17 42:52:56 117:43:55 79:53:44 2:02:05 0.0 1.0 2.0 3.0 4.0 5.0 6.0 WEXHAM PARK HOSPITAL STOKE MANDEVILLE HOSPITAL ROYAL BERKSHIRE HOSPITAL MILTON KEYNES GENERAL HOSPITAL JOHN RADCLIFFE HOSPITAL HORTON GENERAL HOSPITAL Days Excess Handover Excess Clear Up

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Accountable Officer: Lou Patten Clinical Chair Aylesbury Vale CCG: Dr Graham Jackson Clinical Chair Chiltern CCG: Dr Raj Bajwa

111 - SCAS

 Call answering performance was reported at 89.10% in April, against a target of 95%. The target has not been reached since November.  Warm transfer data continues to suggest poor performance at 25.10%. Monitoring of this is ongoing through the contract review meetings and SCAS are working to an action plan and trajectory.  The continued drop in performance is due to increased and fluctuating demand, along with staff sickness rates  There are no formal contract notices, however SCAS are working to remedial actions plans for call answer performance as well as warm transfer performance. These continued to be monitored through CRMs.  7.5% of 111 calls were transferred to the 999 service, against a KPI

  • f <10% therefore this target has been met.
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Accountable Officer: Lou Patten Clinical Chair Aylesbury Vale CCG: Dr Graham Jackson Clinical Chair Chiltern CCG: Dr Raj Bajwa

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Accountable Officer: Lou Patten Clinical Chair Aylesbury Vale CCG: Dr Graham Jackson Clinical Chair Chiltern CCG: Dr Raj Bajwa

INDICATOR OPERATIONAL STANDARD AV CCG 16/17 C CCG 16/17 Bucks CCG's 15/16 Bucks CCG's 16/17 Movement Dementia Diagnosis rate

Dementia Diagnosis rate

66.7% 69.3% 64.5% 61.6% 66.2%  A&E - 4 Hour Wait Buckinghamshire Healthcare Trust 93.1% 90.5%  Milton Keynes University Hospital 93.9% 92.1%  Frimley Health 94.7% 91.6%  Oxford University Hospital 89.1% 86.1%  Category A Ambulance Calls (SCAS) Category A calls emergency response arriving within 8 minutes (Red 1) 75% 63.67% 65.86% 64.12% 65.00%  Category A calls emergency response arriving within 8 minutes (Red 2) 75% 67.08% 64.18% 65.17% 65.24%  Category A calls ambulance arriving at the scene within 19 minutes 95% 91.12% 92.47% 90.74% 91.97%  Mixed Sex Accommodation Breaches of Same Sex Accommodation 3 2 3  Healthcare Associated Infection Incidence of healthcare associated infection - MRSA 1 3 1  Incidence of healthcare associated infection - C difficile 39 (49) 63 (61) 120 (110) 102 (110)  (Yearly Objective) Dementia Diagnosis rate 95% Yearly Target 0 A&E waits SCAS MSA Healthcare Associated Infection

Year-End Performance 2016/17

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Accountable Officer: Lou Patten Clinical Chair Aylesbury Vale CCG: Dr Graham Jackson Clinical Chair Chiltern CCG: Dr Raj Bajwa

Acute trusts-BHT

  • Establish a Frailty Assessment Unit
  • Establish 7 day ambulatory emergency care
  • Roll out of SAFER across all wards
  • Front Door primary care streaming
  • Discharge to Assess models - Home First

model

  • Trusted Assessors
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Accountable Officer: Lou Patten Clinical Chair Aylesbury Vale CCG: Dr Graham Jackson Clinical Chair Chiltern CCG: Dr Raj Bajwa

Acute Trusts- Wexham Park Hospital

  • Director level conference calls to oversee an urgent care

improvement plan

  • Natalie Fox attends A+E delivery board
  • Medically Fit for Discharge (MFFD) data discrepancy
  • Part funded GP for discharges
  • Weekly system call to unblock delays
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Accountable Officer: Lou Patten Clinical Chair Aylesbury Vale CCG: Dr Graham Jackson Clinical Chair Chiltern CCG: Dr Raj Bajwa

In May our best performance was in the first week, and while we had a drop in performance in the weeks following our monthly average was slightly better then April. Looking at the last 5 months we can see that system performance improved from Jan – March 17, and we have sustained an average of 90% since then.

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Accountable Officer: Lou Patten Clinical Chair Aylesbury Vale CCG: Dr Graham Jackson Clinical Chair Chiltern CCG: Dr Raj Bajwa

Thames Valley 111 Integrated Urgent Care (IUC)

  • On track for September 2017 go live
  • Aylesbury Vale and Chiltern CCG governing

bodies have previously signed off the contract award

  • Core principles reflect the national ambition

for 111

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Accountable Officer: Lou Patten Clinical Chair Aylesbury Vale CCG: Dr Graham Jackson Clinical Chair Chiltern CCG: Dr Raj Bajwa

TV 111 IUC

  • Be always available, 24 hours a day, 365 days a year
  • Be accessible, personalised and based on their individual needs
  • Have knowledge of when they have previously contacted NHS 111 so they do not need to repeat

their story

  • Be able to connect them to a clinician with access to important health records and notes
  • Be safe and give the right advice based on the best and most up to date clinical and medical

knowledge available

  • Definitively resolve health concerns without the need to go anywhere else
  • Book appointments with the urgent care provider they need
  • To dispatch an ambulance without delay
  • Be able to access the service through digital or online channels both to give better access to

information and to meet specific needs people have

  • Make sure that specific health needs, such as palliative care, mental health and long term

conditions are properly catered for.

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Accountable Officer: Lou Patten Clinical Chair Aylesbury Vale CCG: Dr Graham Jackson Clinical Chair Chiltern CCG: Dr Raj Bajwa

Principles - local commissioners

  • Work with callers for the best local urgent

care option

  • Pragmatic safe intuitive approach
  • Clinical audit- when people do not take the

advice given to them

  • Positive impact on the use of urgent care

services and the choices people make

  • Joined up seamless transfers of care
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Accountable Officer: Lou Patten Clinical Chair Aylesbury Vale CCG: Dr Graham Jackson Clinical Chair Chiltern CCG: Dr Raj Bajwa

Minor Injury and Illness Unit (MIIU)

  • MIIU continues to perform well with all quality targets met with the exception of MIIU08i

‘Re-attendance rates - 3 months’, which missed the <15%, this is the sixth consecutive month the target has been missed.

  • Themes of complaints have been around waits and communication at the front desk
  • Themes of compliments have been about quality if care
  • The percentage of users that would recommend the service is consistently high and for

April is 96.5%

  • CQC- Following inspection of MIIU and OOH’s CQC recorded an overall requires

improvement for the MIIU (Safe and well led domains) OOH’s was recorded as Good.

  • Good rota fill mostly > 95% rota fill

2700 2900 3100 3300 3500 3700 3900 4100 Monthly Patient Volume 2015-2016 Monthly Patient Volume 2016-2017 Monthly Patient Volume 2017-2018

  • Actual activity increased in April

from March; however it was up 8% against last year, likely due to the Easter bank holiday falling later in the year.

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Accountable Officer: Lou Patten Clinical Chair Aylesbury Vale CCG: Dr Graham Jackson Clinical Chair Chiltern CCG: Dr Raj Bajwa

A&E Delivery Board

  • Submit and assured A&E delivery

improvement plan to NHSE

  • Implement key workstreams to ensure

system responsiveness to the 7 domains

  • Increased collaborative relationships

following transition from SRG format

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Accountable Officer: Lou Patten Clinical Chair Aylesbury Vale CCG: Dr Graham Jackson Clinical Chair Chiltern CCG: Dr Raj Bajwa

7 UEC Priorities

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Accountable Officer: Lou Patten Clinical Chair Aylesbury Vale CCG: Dr Graham Jackson Clinical Chair Chiltern CCG: Dr Raj Bajwa

Winter Pressures Campaign

  • Health Help Now- 61% users 18-34
  • “ stay well this winter” – pharmacies
  • Promote earlier & more heavily in

communities with highest non urgent A&E use

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Accountable Officer: Lou Patten Clinical Chair Aylesbury Vale CCG: Dr Graham Jackson Clinical Chair Chiltern CCG: Dr Raj Bajwa

The Impact

500 1,000 1,500 2,000 2,500 3,000 3,500 A&E Attendances by financial month (Apr 12 - Jun 16) by 5 year age band for Bucks CCGs 2015/16 2016/17

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Accountable Officer: Lou Patten Clinical Chair Aylesbury Vale CCG: Dr Graham Jackson Clinical Chair Chiltern CCG: Dr Raj Bajwa

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Accountable Officer: Lou Patten Clinical Chair Aylesbury Vale CCG: Dr Graham Jackson Clinical Chair Chiltern CCG: Dr Raj Bajwa

Pyjama Paralysis

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Accountable Officer: Lou Patten Clinical Chair Aylesbury Vale CCG: Dr Graham Jackson Clinical Chair Chiltern CCG: Dr Raj Bajwa

Current Process

  • Assessments in hospital
  • Walking ( on shiny floors)
  • Walking up hospital stairs ( not like home)
  • Make tea in a strange kitchen
  • Asked how you wash and dress and then

watched to see how you do it

  • Access visit
  • Home visit
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Accountable Officer: Lou Patten Clinical Chair Aylesbury Vale CCG: Dr Graham Jackson Clinical Chair Chiltern CCG: Dr Raj Bajwa

Future Delivery

  • Admission only if clinically required
  • Start at the beginning- set expectations
  • Set clear clinical and functional plan
  • Ensure that value is added every day
  • Speedy return home once acute needs met
  • Support as required assessed at home
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Accountable Officer: Lou Patten Clinical Chair Aylesbury Vale CCG: Dr Graham Jackson Clinical Chair Chiltern CCG: Dr Raj Bajwa

The system backend

  • Discharge to assess
  • Trusted assessor
  • Collaborative working with Social services

via A&E Delivery Board.

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Accountable Officer: Lou Patten Clinical Chair Aylesbury Vale CCG: Dr Graham Jackson Clinical Chair Chiltern CCG: Dr Raj Bajwa

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Accountable Officer: Lou Patten Clinical Chair Aylesbury Vale CCG: Dr Graham Jackson Clinical Chair Chiltern CCG: Dr Raj Bajwa

We’ve got the antidote!