Document

PRACTICE BASED COMMISSIONING PLAN 2008/9

Table of Contents

1. CHAIRMAN’S FOREWARD 3 2. INTRODUCTION 4

3. VISION 4

4. BACKGROUND 4

5. GEOGRAPHY & POPULATION 5

6. HEALTH NEEDS 6 7. COMMISSIONING PRIORITIES 6 8. IMPLEMENTATION TIMETABLE 20

9. PERFORMANCE MONITORING 29

10. PATIENT AND PUBLIC INVOLVEMENT 29

11. TRAINING & DEVELOPMENT 30

12. RISK MANAGEMENT 30

13. BEST PRACTICE 31

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1. Chairman’s Foreword The Three Valleys Commissioning Consortium is a consortium of 10 practices covering over 60000 patients. We are a maturing organisation and our aim has always been to work closely with our stakeholders to ensure that the patients we serve get the best possible health care, whilst ensuring that the scarce resources at our disposal are used efficiently. Over the last year we have worked closely with other commissioners, stand alone practices, consortia as well as the commissioning arm of the PCT to ensure good understanding and implementation of commissioning strategies that fit with national and local priorities. We believe that this work will strengthen in the next few years as health priorities identified in the Joint Strategic Needs Assessment (JSNA) are addressed and the various Health Improvement Teams’ business cases are seen through into implementation. We are fully committed to unified commissioning and sharing of knowledge, skills and resources and to develop competencies for world class commissioning. Over the last year, there have been several service developments within the consortium. Two GPwSI services are up and running at Meltham Road Surgery, Lockwood in the clinical areas of Diabetes and Cardiology. Kirkburton Surgery is part of The Year of Care pilot for Diabetes and their teenage advice service has received a Kite Mark Award. Shepley surgery were successful in their business case and have recruited a nurse practitioner to contribute to the management of people with long term conditions as well as undertake health promotion and disease prevention work. The Consortium were able to commission a Diabetes Diploma course and we are pleased that all 10 practices have at least one clinical member on the course. Meltham Group Practice now hosts an audiology service for all consortium practices and this will hopefully reduce hospital referrals to this department. The six consortium executive members have been supported very well by managers from the PCT. The team had an organisational development away day and this was very helpful in identifying our priorities for the medium term. Whilst we have not achieved any freed up financial resources for the year 2007/8, we feel that we have contributed very well to the PCT’s overall financial surplus. We now have very good clinical engagement, with all the Consortium practices regularly attending monthly GP forum meetings and quarterly plenary meetings. They all participate in peer review of referrals and fully participate in practice visits. It is not surprising that they have achieved a high number of points under the incentive scheme. We now publish a monthly Newsletter, with clinical and service development information and this has been well received. As to the future, we are in the early stages of implementing a pain self care service, we are writing business cases to strengthen health screening, health promotion and chronic disease management in primary care as well as ensuring that the valuable resource of primary care nurses is trained and developed to meet the challenges of a changing health service. We will also work closely with various Health Improvement Teams to ensure that their business cases are implemented in a way that adds value to patient care. We are also keen to see that the development of community hospitals especially Holme Valley Memorial Hospital facilitates meaningful service redesign and we will work closely with the PCT to ensure that this happens. Overall our objective is to work closely with other commissioners, service users and providers to ensure that our world class commissioning skills translate into a needs based, quality driven, health care service that is just as much locality focussed as it is customised to individual patients.

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2. INTRODUCTION This document sets out the practice based commissioning intentions for the Three Valleys Commissioning Consortium for 2008/9. The focus of the plan is on the following four areas, each of which have a number of objectives:

• Service Development and Redesign • Medicines Management • Organisational Development • Education, Training and Governance

For each of the areas identified above a number of measurable targets will be set which will ensure improvements. 3. VISION To commission services effectively and efficiently for the population we serve in order to improve care, health and well being for all and to ensure better value for all. 4. BACKGROUND The Three Valleys Commissioning Consortium was established in 2006 when the Kirklees PCT was formed and consists of 10 practices with a total practice population size of 62,011. The table below details the member practices of the consortium. 1 Dr Aggarwal and Partners Meltham Road Surgery 2 Dr Deacon and Partners Marsden Health Centre 3 Dr Lord and Partners The Surgery, Honely 4 Dr Mitchell and Partners Meltham Group Practice 5 Dr Orme and Partners Shepley Health Centre 6 Dr Pacynko Meltham Village Surgery 7 Dr Preistman and Partners Kirkburton Health Centre 8 Dr Seeley and Partners Dearne Valley Healthe Centre 9 Dr Welch and Partners Skelmanthorpe Family Doctors 10 Dr Wright and Partners Croft House Surgery

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5. GEOGRAPHY & POPULATION Geographically the area of the Three Valleys Consortium is made up of three main valleys, the Dearne Valley, HoLme Valley and the Colne Valley. The nature of the area often means that accessing services across and within the valleys as well as hospital based services out of the immediate local area can be challenging. This difficulty is further compounded by access to local transport and is particularly relevant for those who live some distance from their local community and who have no access to their own transport. Recognition of these particular characteristics, and their impact on the population is pivotal to the development of a range of services closer to home. The provision of services in one valley may not necessarily make it easier to access from another. The consortium practices fall into the three local area committee localities of Denby Dale and Kirkburton (DDK), The Valleys and South Huddersfield. This situation creates its own challenges as this means that the Consortium is not coterminous with one local area committee. Throughout 2007/8 the Consortium has been successful in developing links with Locality Managers, Local Authority and other community representatives and is committed to continuing this in 2008/9 to form effective and sustainable working relationships. The Three Valleys population generally has a higher proportion of working age and older people than Kirklees as is demonstrated in the diagram below. Three Valleys Consortium Registered Populations with KPCT Comparator (WYCSA 1st April 2008)

4.5%4.0%3.5%3.0%2.5%2.0%1.5%1.0%0.5%0.0%0.5%1.0%1.5%2.0%2.5%3.0%3.5%4.0%4.5%

00 to 04

05 to 09

10 to 14

15 to 19

20 to 24

25 to 29

30 to 34

35 to 39

40 to 44

45 to 49

50 to 54

55 to 59

60 to 64

65 to 69

70 to 74

75 to 79

80 to 85

85 to 89

90 and Over Males Females

Kirklees PCT

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More specifically Huddersfield South locality has the highest proportion of older people than elsewhere and the same proportion of South Asian and white people as Kirklees but a higher proportion of black people. Whilst DDK has the lowest proportion of South Asian and non- White people (JSNA 2008). 6. HEALTH NEEDS Introduction The fact that the Consortium and its constituent practices cover the three locality areas of The Valleys. DDK and South Huddersfield means that we have looked in detail at the health needs for each of these localities. Although there are many similarities between the three localities and across Kirklees as a whole there are also some significant differences that need to be considered when determining commissioning priorities in order to effectively address the variety of needs for our diverse Consortium population. Where possible this plan addresses the key health challenges identified by the JSNA for each locality area. However there are instances where needs and particular circumstances apply only to a relatively small proportion of our population and therefore whilst the Consortium recognises these commissioning priorities these specific needs are best met through individual practice plans. Outlined below is a summary of the Three Valleys population health needs as identified in the JSNA 2008. Pain and Alcohol These two areas were identified as key issues for all three of the localities making up our constituent population. Pain was amongst the most common condition reported in DDK, in The Valleys one in four of all under 65s and one in two of all over 65s had pain and in Huddersfield South one in four adults experienced pain with its older people having significantly worse health status for physical functioning, physical ability and bodily pain. Alcohol stands out as the most important issue in DDK and The Valleys with this being a particular issue for women of child bearing age in DDK. In Huddersfield South over one in three males and nearly one in three females drank over sensible limits and around two in five adults binged on alcohol in a given week. More men and women binge drank in this locality than anywhere else in Kirklees. Alcohol was also highlighted as a significant issue for children and young people across the Consortium population. In DDK young people starting drinking alcohol early, under 10 years old, with a high proportion drinking alone. In The Valleys although regular alcohol drinking was better than Kirklees as a whole it was still identified as a main health challenge and was taking place at high levels. In Huddersfield South regular drinking had increased amongst 14 year olds since 2005, potential mothers were also drinking alcohol regularly and bingeing in this group was the worst in Kirklees.

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DDK and The Valleys These localities both have very similar health needs for adults within our population with both areas experiencing better health than Kirklees overall with DDK adults reporting the best health of adults in Kirklees overall. However in terms of life expectancy DDK is well below the best in the country and the health status for adults in The Valley, although good, is worse than the national average. Although overall adults in this locality were less likely than elsewhere to be obese, have a poor diet, be inactive and smoke there were still significant numbers of people whose health was at risk because of these unhealthy behaviours. In addition to pain the most common conditions in DDK were high blood pressure, heart disease diabetes, asthma and incontinence. The Valleys had the highest rate of incontinence of urine in over 65s across Kirklees. Although both The Valleys and DDK appear to be relatively affluent with few health challenges a number of specific groups who are more vulnerable were identified within these localities. These were the high levels of older people living on low incomes, a fifth in DDK and a quarter in The Valleys and the two out of every three pensioner households where people were found to be living alone. The two localities also have the highest proportion of people about to move into retirement. Therefore supporting and encouraging them to maintain and adopt behaviours that will contribute to healthy ageing will be critical to ensuring that the health of this cohort does not deteriorate. Whilst more specifically in the Colne Valley problems with housing were identified with one in eight homes defined as unsuitable, one in five over occupied and one in four living in fuel poverty. Huddersfield South For the Huddersfield South locality the overall health status was lower than nationally and was the lowest for mental health and bodily pain. This locality also experienced higher rates of Long Term Conditions (LTC) especially amongst older people, with one in thirteen suffering from heart disease and diabetes. This locality also had higher levels than Kirklees and national levels of Income Support, Pension Credit, Disability Living Allowance and Incapacity Benefit claimants. One in seven homes were defined as unsuitable which was the highest level in Kirklees and one in four households were found to be living in fuel poverty. One in four smoked at least one cigarette a day, which was higher than the Kirklees average, one in five adults were obese and only one in five adults ate five a day which was well below the national average. Children and Young People In DDK and The Colne Valley this group was found to experience broadly better health than Kirklees overall. However alcohol is a significant health challenge. In The Valleys a higher proportion of overweight and obese women aged 18 – 44 years was identified with implications for the future health of the next generation. For both DDK and the Huddersfield South emotional well being and sexual health are key issues. In DDK the number of young people reporting feeling miserable (28%) was the highest in Kirklees and they also reported feeling lonely more than all other localities. In Huddersfield South young people were the most unhappy with themselves, most unhappy at school and got on least well with school staff. This

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locality also had the second highest rate of teenage pregnancies whilst in contrast DDK had the highest rate of young people reporting having had sex at age 14(23%) but the lowest rate of teenage of teenage conceptions. In comparing these last two findings a clear indication of the diverse and sometimes contrasting health needs across our Consortium population is given and this is an instance where specific and localised needs are best met by individual practice plans. Through the commissioning priorities identified in this plan in relation to organisational development and training and education the Consortium has taken steps to ensure that its constituent practices are fully supported so that they are well equipped to develop and fulfil robust practice plans to both underpin, complement and support this Consortium commissioning plan. 7. COMMISSIONING PRIORITIES We have identified our commissioning priorities and targets after examining the health needs of our constituent population, recognising areas that are of concern to our constituent practices and considering Kirklees Primary Care Trust (KPCT) priority areas. This has been achieved through the detailed review of the Joint Strategic Needs Assessment (JSNA) for 2008, input from KPCT Public Health team, regular communication and feedback from our member practices via arrangements such as monthly GP forum, and from reference to the Operating Framework 2008/9 Vital Signs document. Within each of our four key areas the Consortium has identified specific aims for achievement in 2008/9 and these are summarised below: 1. Service Development and Redesign 1.1) To understand the high levels of activity reported for procedures not related to

a delivery event under the Obstetrics and Gynaecology N12 coding classification and where appropriate reduce levels of activity through service/ pathway redesign.

1.2) To work with the PCT and service providers to ensure that commissioned

services support the national 18 week target. 1.3) To increase the existing nursing workforce to improve the overall

management of patients with a range of conditions that impact on long term health predominantly supported by health needs assessment and self care strategies.

1.4) To establish a primary care based Pain Self Care Service enabling long term

pain self management and so improving and maintaining health function and reducing ill health.

1.5) To identify priority areas and effectively engage with the health improvement

teams to facilitate service improvement and redesign.

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1.6) To be actively involved in commissioning decisions within the scope of the Community Hospitals Programme with particular emphasis on services to be commissioned from Holme Valley Memorial Hospital (HVMH).

2. Medicines Management

To promote good prescribing practice amongst Consortium practices to further reduce prescribing costs and potential wastage. 3. Organisational Development To establish an Organisational Development plan which effectively encompasses the Executive Team, the Consortium’s constituent practices, and the wider PCT team, and sets goals for both long and short term achievement and in doing so maintain and strengthen current levels of engagement with Consortium practices and further develop the Executive Team. 4. Education, Training and Governance To identify training needs for the Consortium and develop an appropriate

training and education programme to help ensure that these needs are adequately met.

To ensure adequate governance arrangements are in place in respect of the following:

- management and development of the Consortium itself to ensure it is fit for purpose

- the commissioning of services - training and development

The Consortium recognises the need to work in conjunction with KPCT to form an effective commissioning partnership in order to best serve the need of its constituent population. Therefore the commissioning priorities identified within this plan have been developed to both address the health needs at a local level and to support the PCT’s strategic priorities. We believe that the aims outlined above will assist with improvements in a number of areas which are identified in the Operating Framework; Vital Signs document and will also help to address the health and well being issues for our local population as identified and highlighted in the JSNA. Further detailed references demonstrating this in relation to our specific aims can be found in Section 8: The Implementation Plan.

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7.1.1 N12 REVIEW Aim To understand the high levels of activity reported under the N12 coding classification from Calderdale and Huddersfield Foundation Trust (CHfT) data and where appropriate reduce levels of activity through service/ pathway redesign. Issues Detailed review of the high levels of activity may find that these are accurate and / or beyond the scope of influence of the Consortium. Difficulties and/ or time delays may be encountered in investigating the data especially when working with third parties e.g. review of Acute Trust data. Current Position Relatively high levels of N12 activity is not unusual in itself in the national context and it is recognised that the high levels of activity are an issue for PCTs and Practice Based Commissioners (PBCers) across the country. However review of local levels comparing 2006/7 activity to that in 2007/8 did reveal a significant increase which prompted action from the PCT’s Contracting Team. This review revealed that different methods of recording procedures that fall into the N12 coding category had been in place at the Acute Trust in 2006/7 compared to 2007/8 and it was this change in recording methodology that was responsible for the significant increase. Although the Consortium accept that this is a reasonable explanation for the significant variation first highlighted the levels of activity still remain high and this is an area they are committed to reviewing. Proposal

• Establish detailed set of benchmarking data to view consortium referral rates in both national and local context

• Work with Performance Analyst to gain adequate assurance through data analysis that all data received is complete & accurate

• Establish working group to progress N12 review • Work with others e.g. PCT maternity lead to fully understand referral routes

leading to procedures that are coded under the N12 category • Identify areas where changes could be influenced by the Consortium with the

potential to reduce activity levels. Expected Outcomes

• Clear understanding of reason behind the high levels of activity reported under the N21 coding category

• Timely information is received re N12 category activity levels via monthly Resource Utilisation Pack (R.U.P.) and is regularly monitored

• Action plan is in place clearly identifying areas requiring change to help reduce referrals and detailing how this will be achieved.

• Regular monitoring procedures in place to ensure action plan is implemented

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7.1.2 18 WEEKS

Aim

To work with the PCT and service providers to ensure that commissioned services support the national 18 week target. Issues If services are not commissioned appropriately and the correct levels of capacity are not built into primary care services this may place additional pressure on secondary care and increase the risk that the 18 week target is not met. Current Situation All our constituent practices participate in the Peer Review process. This process ensures that practices look in detail at their referring patterns and make improvements and or changes as necessary.

Proposal

• Continue to carry out and develop Peer Review processes further to help ensure that all referrals are appropriate

• Continue to work proactively with the wider PBC and PCT team • Commence the Pain Self Care Service • Define a model for the provision of a primary care based ophthalmology

service based on best practice learning • Commission hand/knee/hip pathways as appropriate for our local population

and to ensure value for money Expected Outcomes • All practices participate in monthly Peer Review and submit returns to PBC

Facilitator • Best practice action points are identified from the Consortium’s Peer Review

processes and are communicated to all member practices. • Potential for developing current Peer Review process further is fully investigated and considered by the Consortium • Initial phases of the Pain Self Care Service commenced (see 7.1.4.for further

detailed outcomes). • Business Case for a primary care Ophthalmology Service is developed and

commissioned.

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7.1.3 HEALTH NEEDS ASSESSMENT BUSINESS CASE Aim To increase the existing nursing workforce to improve the overall management of patients with a range of conditions that impact on long term health predominately supported by health needs assessment and self care strategies. Issues Delays in progressing the business case may be encountered due to factors out of the control of the consortia e.g. input required from other parties.

Current Position The current focus of care continues to support the management of patients with existing and often complex long term conditions, shifting the attention to preventative strategies and to those people who are either newly diagnosed or have less complex needs will ultimately improve overall health outcomes. Proposal

• Set out a framework for increasing skills and capacity within primary care to meet these challenges

• Work with Executive Team and the wider PCT team to inform development of a successful business case

• Develop and submit business case to Finance & Performance committee • Develop detailed action plan setting out agreed implementation timescales for

health needs assessment business case proposal • Monitor progress against action plan • Implement a training and development plan to ensure relevant professionals

and service users are aware of this holistic care approach Expected Outcomes • Successful Business Case and supporting action plan in place and agreed with all relevant parties. • Establishment of health needs assessment process which will achieve the

following: • Provide health care relevant to the Consortiums population needs • Stratify the population to allow resources to be more effectively utilised • Reduce referrals to secondary care • Raise awareness at both practice and patient level of new holistic care approach • Ultimately improve patient care

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7.1.4 PRIMARY CARE PAIN SELF CARE SERVICE Aim To establish a primary care based Pain Self Care service enabling long term pain self management and so improving and maintaining health function and reducing ill health. Issues Need to ensure sustainability of the service with only one GPwSI. Need to have a framework in place to support current staff working in primary care to understand the health care assessment tool and self management principles. Current Situation Patients experiencing long term pain are currently provided with a predominately bio- medical approach based on pain relief interventions. This is usually managed via access to numerous fragmented services which can negatively impact on overall health and lifestyle. A Pain Self Care business case has been developed and approved in principle which will establish a primary care based Pain Self Care Service. Work has begun and is continuing to develop a detailed action plan and the current intention is to commence the initial phases of the Service by July 2008. Proposals • To introduce a programme of care using patient led health needs assessment tool • Assessment to be carried out by a multi-disciplinary pain specialist team • A joint care plan to be developed to identify resources and network patients and health care professionals • To develop a robust implementation timetable for introduction of the service. • Progress against the implementation plan is regularly monitored and reported on Expected Outcomes • Initial introduction of the Primary Care Pain Self Care Service to take place by

July 2008 • Introduction of the service to ensure the following: • Improved self management for service users • Improved health outcomes • Individual complex needs are identified and signposted accordingly • Robust evaluation and audit procedures in place to monitor and report on the service

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7.1.5 HEALTH IMPROVEMENT TEAMS Aim To identify priority areas and effectively engage with the health improvement teams to facilitate service improvement and redesign Issues Lack of communication between HIT leads and the Consortium may restrict levels of involvement and influence. Current Situation The HITs are currently at an embryonic stage with limited engagement from PBC. There are a total of 21 HIT and this large number means that the Consortium needs to prioritise its direct input to specific HITs. The Consortium has identified the following ten areas as priorities for itself Long Term Conditions to include CHD, Respiratory, Diabetes and Therapies, Mental Health, Older People, Alcohol, Obesity, Urgent Care and Diagnostics. The PBC Manager currently sits on both the Diabetes and Respiratory HITs. Further discussion is required to establish an effective process to ensure that the Executive Team can feel confident that decisions impacting on PBC are either being fed into other HITs on their behalf or that there are no specific implications for the Consortium to consider. Proposals • To identify priority HITs and nominate representatives from the Executive Team • To engage with relevant HITs • Regular feedback from nominated representatives is provided to the Consortium • Regular review of relevance of HITs to the Consortium and its ability to influence the HITs from a PBC perspective to take place. Expected Outcomes • Awareness of planned service changes • Ability to influence commissioning decisions regarding how service models are provided locally. • To improve health outcomes with effective commissioning of those services which may be more appropriately commissioned PCT wide. • Clear identification of those services which are more effectively commissioned on a Consortium basis

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7.1.6 COMMUNITY HOSPITALS PROGRAMME Aim To be actively involved in commissioning decisions within the scope of the Community Hospitals Programme with particular emphasis on services to be commissioned from Holme Valley Memorial Hospital. Issues The contract for GP/medical input to Maple Ward at HVMH is due to end imminently. This presents an opportunity for review of how this input may be provided in the longer term and the Consortium needs to ensure that it is aware of and where necessary involved in these discussions. Current Situation Work is currently ongoing to develop a local treatment model for Urgent Care. The Consortium is directly represented on the working group established to progress this work and is therefore maximising its opportunity to influence outcomes regarding Urgent Care provision. The Director of the Community Hospitals Programme has been invited to provide regular updates to the Consortium regarding the revised scope of the programme, identification of work streams and development of action plans. Proposals • Invite the Programme Director to attend/ provide regular feedback to the Consortium Executive Team • To actively identify opportunities to influence service redesign such as improving patient information flows between HVMH and referring practices • To actively identify opportunities to commission services linked to the Community Hospitals Programme • To review the opportunities linked to the Urgent Care work concerning the availability of minor injuries facilities Expected Outcomes • The receipt of accurate and timely information regarding the Programme • Attendance of Consortium representative(s) at relevant events • Active input to the Programme from the Consortium where opportunities have been identified to influence service redesign and the commissioning of local services.

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7.2 MEDICINES MANAGEMENT Aim To promote good prescribing practice amongst the Consortium practices to further reduce prescribing costs and potential wastage. Issues • Community pharmacists may not support practices with initiatives e.g. performance of timely DDA assessments • Some practices may not be able to fully support any Consortium decisions that may be made regarding best practice prescribing • Lack of knowledge concerning appropriate prescribing levels for items such as dressings and nutrition Current Situation Through recent work that has been undertaken between practice managers and the Consortiums PCT Medicines Management representative a number of areas where improvements to prescribing practice can be made have been identified. For example in regard to Dosette boxes. Historically medicines for these boxes have been issued on a seven day prescription. The administration processes involved for this for practice staff are often time consuming and the potential to reduce the burden on staff time has been recognised. The Consortium is committed to reviewing other prescribing practices with a view to identifying best practice to help improve efficiency and reduce potential wastage. Proposals • To support and raise awareness of the introduction of the Wound Formulary – audit use of wound formulary on a quarterly basis via PACT data. • To promote and help implement best prescribing practice in relation to Dosette boxes. • To help develop Dressings Pilot scheme being led by PCT Medicines Management Team • To reduce costs and wastage in relation to prescribing of dressings • To develop an understanding of prescribing patterns for nutrition and appliances • To monitor more closely prescribing patterns in relation to nutrition and appliances with a view to establishing best practice guidance & reducing high levels of prescribing as appropriate and applicable. • To work closely with and support the work of PCT medicines management team Expected Outcomes • Universal implementation of the Wound Formulary • All new patients requiring a Dosette box have a DDA assessment carried out and 28 day prescriptions are issued • Where possible all existing patients on Dosette boxes have DDA assessment carried out • A reduction in number of prescriptions issued for Dosette boxes

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• A reduction in practice staff time spent in administering prescriptions for Dosette boxes • Establishment of a local dressings store • Protocols in place for the appropriate disposal of unused stock • Best practice guidance for prescribing patterns and the processes for prescribing nutrition and appliances is established • The identification of areas where reductions in prescribing levels for nutrition and appliances may be appropriate • Action plans in place to reduce prescribing levels for nutrition and appliances 7.3 ORGANISATIONAL DEVELOPMENT Aim • To establish an Organisational Development plan which effectively encompasses the Executive Team, the Consortiums constituent practices, and the wider KPCT Team, and sets goals for both long and short term achievement and in doing so maintain and strengthen current engagement levels with our constituent practices and further develop the Consortiums Executive Team Issues There is the need to maximise the skills and input from the wider PCT Team in order to achieve this. Circumstances may change for individual practices which may mean that they no longer wish to be part of the Consortium. The Executive Team has a defined term of office with a further 11 months to run. There is therefore a need to consider both short and longer term goals to ensure sustainability and continuity of achievement. A total of six out of our 10 constituent practices are currently directly represented on the Executive Team and as such it is vital that we ensure that all practices feel fully engaged and part of the Consortium. Current Situation Throughout 2007/8 the Consortium has succeeded in ensuring good engagement levels with our member practices through a variety of means including regular plenary’s, establishment of a GP forum and a series of practice visits. However this needs to continue and to be developed further to maintain support from member practices and to encourage growth of the Consortium. In order to help achieve this an effective Executive Team is essential and foundations have been put in place in 2007/8 to ensure good team working. Again this needs to be built on in 2008/9 with a programme for the development of the Executive Team to be put in place.

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Proposals • To establish an overarching Organisational Development Plan focusing on objectives for the next two years • To engage in a collaborative working approach involving wider PCT team • To continue plenary and forum meetings and ensure that their content is relevant

and timely • To develop and maintain a programme of practice visits building on 2007/8 learning • To develop existing skills within the Executive Team and improve team working • To identify training needs within the Executive Team and support staff and to

take action to address the needs identified • To promote the work of the Consortium with a view to encouraging growth of the Consortium as appropriate • To develop a framework to support the ongoing development of practice nurses • To develop a business case proposal to support the above and submit this to Finance & Performance Committee Expected Outcomes • Organisational Development plan in place supported by a training programme • Programme in place for quarterly plenary and regular GP Forums • Programme in place for practice visits • Further team development day(s) planned and held • The work of the Consortium is effectively communicated to and beyond sphere of member practices • The Consortium is actively involved in / represented at regional/ national PBC development events • The development and implementation of business case proposal for the professional development of practice nurses 7.4 EDUCATION, TRAINING & GOVERNANCE Aims • To identify training needs for the Consortium and develop an appropriate training and education programme to help ensure that these needs are adequately met. • To ensure adequate governance arrangements are in place in respect of the following:

- management and development of the Consortium itself to ensure it

is fit for purpose - the commissioning of services - training and development

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Issues Support from the wider PCT team and other third parties may be required in order to address all training and education needs identified. Current Situation Although the Consortium has attempted to meet the training needs of its Executive Team and wider teams within its constituent practices as and when they have arisen, no formal process has been in place for this to ensure that the needs of all levels of staff are consistently captured, prioritised and addressed. Proposals • To ensure that all the training needs associated with business cases are well thought out, documented and reported to practices to help ensure successful implementation of the business cases. • To develop a training programme to support the Organisational Development plan • To continue and further develop the non-clinical and clinical training and information sessions held at quarterly Plenarys • To carry out audits as appropriate to support change management work led by the Consortium Expected Outcomes • A robust training and development plan is in place • Plenarys include clinical and non clinical training and information sessions • The establishment of an audit programme addressing areas such as significant event auditing, and protocol management. • The audit programme is clearly communicated to and agreed with Consortium practices. • The identification of any training needs regarding the performance of audits • Audit training carried out as appropriate to meet identified needs • Regular and timely feedback on audit results to be communicated to practices

8. IMPLEMENTATION TIMETABLE Ta

rget

Description Brief outline of rationale for choosing target

Detailed actions required to achieve target

Completion date

Nominated lead / leads

Key Links

1.1 To understand the high levels of activity reported under the N12 coding classification from CHfT data & where appropriate reduce levels of activity through service redesign

Reduction in relatively high cost and high activity level procedure will help Consortium to stay within its budget and may realise potential cost savings through pathway redesign. Good financial management at a Consortium level and any cost savings will ultimately help the PCT achieve financial balance.

Establish detailed set of benchmarking data in both national and local context

April 2008

Dr Ollerton

Work with Performance Analyst to gain adequate assurance that all data received is accurate and complete

May 2008 Dr Ollerton

Establish N12 working group May 2008 Dr Ollerton Adrienne Harmon

Work with others to fully understand referral routes leading to procedures coded as N12’s

June 2008 Dr Ollerton Adrienne Harmon

PCT Maternity services lead/ Midwifery Service Acute Trust

Identify areas where changes could be influenced by the Consortium to reduce activity levels

August 2008

Dr Ollerton Adrienne Harmon

Develop & monitor action plan to achieve any changes

September 2008 & then ongoing

Dr Ollerton Adrienne Harmon

Executive Team for monitoring

1.2 To work with the PCT and service providers to ensure that commissioned services support the national 18 week target.

Consortium commitment to this will help ensure that the PCT achieves national 18 week target.

Practices participate in monthly Peer Review and submit returns to PBC Facilitator

Monthly Sarah Crossley Constituent Practices

Best practice action points are identified from Peer Review Process & noted on returns

Monthly Sarah Crossley Constituent practices

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rget



Completion date

Nominated lead / Key Links leads

Best practice action points are collated & communicated to all practices via Consortium newsletter.

Monthly Sarah Crossley Dr Aggarwal

Potential for developing current Peer Review process further in line with best practice is fully investigated and considered

October 2008

Sarah Crossley Executive Team

Commence Pain Self Care Service initial phases. See also target 1.4 for further detailed actions.

July 2008 Sarah Bow Dr Francis Cole Wider PCT Team – finance/ Contracting Medicines Management

Develop and commission business case proposal for a primary care Ophthalmology service.

develop by November 2008

Dr Aggarwal Sarah Bow/Sarah Crossley

Wider PCT team Ophthalmology Consultant/ GPwSI

1.3 To increase existing nursing workforce to improve the overall management of patients with a range of conditions that impact on long term health predominantly supported by health needs

This target supports the wider PCT targets in relation to patient experience of access as it will increase capacity in primary care and also in relation the proportion of

Develop business case proposal and submit to Finance & Performance Committee

May 2008 Dr Ashraf Sarah Bow

Patient & Professions Directorate Wider PCT team – Finance/ Med Man/ Public Health

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rget



Completion date


assessment and self care strategies.

people with long term conditions supported to be independent and in control of their condition. In addition the need for this is highlighted in the JSNA where significant health challenges regarding alcohol and obesity as well as high numbers of the Consortium population suffering from long term conditions were identified.

Develop action plan to support implementation of the business case

June 2008 Dr Ashraf Sarah Bow

As above

1.4 To establish a primary care based pain self care service enabling long term pain self management and so improving and maintaining health function

This target supports the national 18 week target by providing greater access to services/ treatment in primary care helping to reduce pressure on

Develop robust action plan with adequate monitoring and reporting procedures to support the implementation of this service.

April 2008 Sarah Bow Dr Francis Cole Wider PCT Team – finance/ Contracting Medicines Management

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secondary care services as good pain management and self care will help to reduce and delay potential escalation of patient conditions. Pain was identified as a key health challenge across the Consortium population in the JSNA.

Initial phase of the service to be operational

July 2008 Sarah Bow As above

1.5 To identify priority areas and effectively engage with the health improvement teams to facilitate service improvement and redesign

This target addresses many of health issues highlighted in the JSNA. The Consortium priority areas include obesity, alcohol, mental health and LTC amongst others all of which directly rate to health challenges for our constituent population.

Identify priority HITs and nominate representatives from the Executive Team

April 2008 Sarah Crossley Executive Team

Engage with the relevant HITs Ongoing Nominated reps – Executive Team members

HIT leads

Regular feedback from nominated reps is provided to the Consortium

Monthly As above

Regular review of the relevance of the HITs to the Consortium as well as the Consortiums ability to influence the HITs to take place.

October 2008

Executive Team

Clearly identify which services are more effectively commissioned on a Consortium basis

October 2008

Executive Team

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Influence commissioning decisions regarding development of service models for services to be provided locally

October 2008

Executive Team

1.6 To be actively involved in commissioning decisions within the scope of the Community Hospitals Programme with particular emphasis on services to be commissioned from HVMH

This is a priority for the Consortium in order to influence the development and commissioning of services relevant to and closer to home for its constituent population.

Invite Programme Director to attend/ regularly update the Executive Team re progress of the programme.

April 2008 Sarah Crossley

Identify opportunities to influence service redesign and actively engage with relevant forums to achieve this.

June 2008 Dr Ashraf Community Hospitals Programme Director

Review opportunities linked to the Urgent Care portfolio concerning the availability of minor injuries facilities

November 2008

Dr Ollerton (Urgent Care) Dr Ashraf

2

To promote good prescribing practice amongst the Consortium practices to further reduce prescribing costs and wastage

This objective supports the Consortiums in managing its budgets well and may realise cost savings which will ultimately help the PCT achieve its target of financial balance. Striving to reduce inefficiencies and to promote best practices will also benefit patient care.

Wound Formulary Support the PCT medicines management team’s education and training programme to accompany the launch of the new Wound Formulary.

May 2008 Dr Aggarwal PCT Medicines Management Team

Promote the use of the Formulary amongst constituent practices through forums such as the plenary, GP forum and practice managers meetings & to nursing home staff.

May/ June 2008

Dr Aggarwal Michael Duckworth Sarah Crossley

PCT Medicines Management Team

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Dosette Boxes Promote and help implement best prescribing practice in relation to Dosette boxes.

May 2008 Dr Ashraf Josephine Anderson

Medicines Management Team Constituent practices

Hold awareness session at the plenary

May 2008 Dr Ashraf Michael Duckworth Josephine Anderson

Practice mangers to work with medicines management team to ensure changes to adopt best practice are fully supported.

May 2008 Josephine Anderson

Michael Duckworth

Dressings To develop local Dressing pilot

August 2008

Michael Duckworth Dr Ashraf

Medicines Management Team

Establish local dressings store To be determined



Develop and issue protocols for the appropriate disposal of unused stock

To be determined



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Nutrition Establish and promote awareness of best practice guidance for prescribing patterns/ processes for nutrition.

December 2008

Josephine Anderson Dr Ollerton

Michael Duckworth & wider Medicines Management Team Dietician

Identify areas where reductions in the levels of prescribing of nutrition items may be made

January 2008


Dietician Medicines Management Team

Develop an action plan to progress above as applicable

February 2008


Appliances Establish and promote awareness of best practice guidance in relation to prescribing patterns and the processes for prescribing appliances.

December 2008


Relevant Health care professionals – stoma care nurse Medicines Management

Identify areas where reductions in the levels of prescribing of appliances may be made

January 2008


As above

Develop an action plan to progress above as applicable

February 2008


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Work closely with and support work of PCT Medicines Management Team

Ongoing Josephine Anderson

All Executive Team

3 To establish an Organisational Development plan which effectively encompasses the Executive Team, the Consortiums constituent practices and the wider PCT team and set goals for both long and short term achievement.

Commitment to organisational development will help to ensure the continued success of, and adoption of good working practices by the Consortium which will help it to achieve its other commissioning priorities which directly address the health needs of its population and support PCT targets.

Establish an overarching OD Plan focusing on objectives for the next two years

June 2008 Josephine Anderson Adrienne Harmon

Sarah Bow

Engage in collaborative working with the wider PCT team in order to achieve the above

June 2008 Josephine Anderson Adrienne Harmon

Wider PCT Team – eg HR/Prof Development Leads

Continue plenary and forum meetings and ensure their content is relevant and timely

Quarterly & monthly

Executive Team

Develop and maintain a programme of practice visits building on 2007/8 learning

June 2008 Sarah Crossley Executive Team

Identify the training needs within Executive Team and support staff and take steps to address these

August 2008

Josephine Anderson Adrienne Harmon

Hold further OD day(s) for Executive Team

September 2008 (then 6 monthly)

Sarah Bow/ Sarah Crossley

Executive Team

Promote the work of the Consortium with a view to encourage growth

Ongoing All Executive Team

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Consortium representatives to attend regional and national events as appropriate to encourage professional and organisational development

As arise All Executive Team

Develop business case proposal for the professional development of practice nurses and submit to PCT’s Finance & Performance Committee.

May 2008 Dr Ashraf Sarah Bow

Patient & Professions Directorate

Develop a robust implementation plan for the above business case proposal

June 2008 Dr Ashraf Sarah Bow

Commence professional development programme for practice nurses

October 2008

Dr Ashraf Sarah Bow

4 To identify training needs for the Consortium and develop an appropriate training and education programme to help ensure that these needs are adequately met

Identify training needs in relation to business case proposals

Initially June 2008 then as arise in year

Josephine Anderson Adrienne Harmon Sarah Bow Sarah Crossley

Practice nurse lead from Consortium (tbc)

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8. IMPLEMENTATION TIMETABLE

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Targ

et Description Brief outline of rationale

for choosing target Detailed actions required to achieve target

Completion date

Nominated lead / leads

Key Links

Develop robust training and education programme to support OD plan taking into account learning from Training & Ed initiatives introduced 2007/8 and level of practice support for these.

June 2008 Josephine Anderson Adrienne Harmon Sarah Bow Sarah Crossley

Wider PCT Team Constituent Practices

Continue to include non- clinical and clinical education sessions at quarterly plenary.

Quarterly All Executive Team

To ensure adequate governance arrangements are in place for:

- the management and development of the Consortium itself to ensure it is fit for purpose

- the commissioning of services

- training & development

Regular review of Consortium ways of working to ensure fit for purpose eg. at OD day

Bi- annually All Executive Team

Establish audit programme – content & timing of audits tbd from monthly R.U.P. & Prescribing Reports.

Monthly – as appropriate


Audit programme to be clearly communicated to and agreed with Consortium practices


Identify any training needs regarding performance of audits


Regular and timely feedback on audit results to be communicated to practices


9. PERFORMANCE MONITORING The consortium is committed to ensuring that the areas outlined in this plan are achieved and progress against the plan will be monitored and reported on at the Executive Team meetings. Detailed performance monitoring indicators are described in the expected outcomes section at the end of each identified commissioning priority. 10. PATIENT & PUBLIC INVOLVEMENT The involvement of patients and the public in its decision making processes is extremely important to the Consortium. The Consortium’s ultimate vision in commissioning services is to provide better care, health and well being for all and this can not be achieved without appropriate consultation with and input from service users. Aim To ensure that all services commissioned by the Consortium are supported by appropriate levels of patient and public involvement. Issues Difficulties may arise in engaging particular cohorts of the Consortium’s diverse population. Due to the geographical nature of the Three Valleys and the ageing population that is prevalent in some areas achieving good levels of patient involvement may be problematic. Proposals • To establish development plan to map out requirements and intentions to

improve patient and public involvement • To develop greater understanding of PPI measures already in place at practice level throughout the Consortium • To take active measures to promote greater awareness of PBC and the Consortium • When commissioning new services and/ or influencing service redesign fully take into account how these are informed by local knowledge and service user opinion • To work along side the PPI Team to test out locality approach to inform the continuing work of the Consortium • Consideration to be given to other options to engage with PPI e.g. public event/ utilisation of software tools/ links with more community forums/ agencies Expected Outcomes • Map of current PPI initiatives and ongoing work throughout Consortium at all levels • Development plan for PPI is in place and is supported by robust monitoring mechanisms • Greater awareness of the Consortium website • Identification of a range of appropriate methods of understanding service user

Perspective for the Consortium and plans in place to develop/ utilise these as appropriate.

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TRAINING AND DEVELOPMENT The consortium recognises the importance of training and development to support the implementation of this plan and the work of the consortium as a whole. Training and development issues both for the Executive Team and the wider needs that may be identified within member practice staff are addressed both in the training and development priority section and within individual commissioning objectives as appropriate. RISK MANAGEMENT Key Risks: • Plan may not be adopted and supported by all Practices The Consortium is committed to a collaborative style of working which ensures that all its constituent practices feel engaged with the Consortium and part of its decision making process. Therefore the non adoption of any proposed service changes is very unlikely. • Increase in workload in primary care As care pathways are redesigned and more services move from secondary care to primary care there will be an associated increase in workload in GP practices. These changes may result in practices having difficulties in managing their workloads and achieving PCT targets. • Conflicts of interest of members Adequate arrangements are in place to ensure the probity and propriety of Consortium business. • No freed up resources are generated All initiatives undertaken by the Consortium will be closely monitored in year to ensure adequate progress is made. This will ensure that any impact on projected costings will be identified, investigated and appropriate action taken to minimise financial risk. 13. BEST PRACTICE The consortium will continue to participate in national, regional and local discussions in order to learn from others PBC experiences, including both successes and failures. This will include the continued attendance of Executive Team members at the Yorkshire and Humber PBC Forum. The consortium is committed to understanding and building on this learning to ensure that where possible best practice is adopted.

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