Circle Clinical Services Limited

Quality Account (‘Circle

Integrated Care’)

June 2019

Contents

2

Part One

Introduction Page 3

Statement from the Registered Manager (Director of Operations)

Circle Integrated Care (CIC)

Page 4

Circle Integrated Care’s Vision Page 6

The Circle Credo Page 7

What are Circle Integrated Care Services? Page 8

CIC Bedfordshire Achievements 2018/19 Page 10

CIC Greenwich Achievements 2018/19 Page 11

The MSK Teams Page 13

The CIC Operational model Page 19

CIC Facilities Page 21

Core services Provided at CIC Hubs Page 22

CIC Bedfordshire Community and Secondary Care Providers Page 25

CIC Greenwich Community and Secondary Care Providers Page 27

Ensuring the Quality of Providers Page 29

Part Two

Bedfordshire Achievements against Quality Improvement

Priorities for 2018/19

Page 32

Greenwich Achievements against Quality Improvement Priorities

for 2018/19

Page 34

Best Clinical Outcomes Page 36

Clinical Innovation Page 39

Best Patient Experience Page42

Staff Engagement Page 49

Operational Updates Page 50

Staff Engagement Page 51

Quality Improvement Priorities for Bedfordshire 2019/20 Page 53

Quality Improvement Priorities for Greenwich 2019/20 Page 54

Mandatory Statements Page 55

Acronyms in the Quality Account Page 63

Comments from:

Bedfordshire Clinical Commissioning Group Page 64

HealthWatch Bedford Borough (HBB) Page 65

HealthWatch Central Bedfordshire Page 66

HealthWatch Greenwich Page 67

The Health Act 2009 requires all providers of healthcare services to NHS patients to publish

an annual report about the quality of their services; this report is called a Quality Account.

Amendments were made in 2012, such as the inclusion of quality indicators according to

the Health and Social Care Act 2012. The primary purpose of a Quality Account is to

enhance organisational accountability to the public, to engage Boards and leaders of

organisations in fully understanding the importance of quality across all of the healthcare

services they provide, and to promote continuous improvements on behalf of their

patients. The quality of the services is measured by looking at patient safety, the

effectiveness of treatments that patients receive and patient feedback about the care

provided.

This report summarises the quality of the service Circle Clinical Services Limited (CCSL)

have delivered in the financial year 2018/19. To do this, it uses the quality improvement

targets set during the previous year as a measure for patient experience, clinical outcomes

and engaged staff.

The key requirements of this Quality Account include:

1.A statement summarising the Registered Manager’s view of the quality of services

provided to NHS patients

2.A review of the quality of services provided over the previous financial year (2018/19)

3.The quality priorities for the forthcoming financial year (2019/20)

We have used the Department of Health’s Quality Accounts Toolkit as a guide for our

Quality Account.

To supplement all the mandatory elements of the account, we have also worked closely

with our patients, clinicians, commissioners and other partners including local providers

and Healthwatch to ensure this account truly reflects the quality measures in place and

provides readers with an accurate and comprehensive insight into the organisation.

CCSL is known locally as Circle Integrated Care and will be referred to as CIC throughout

this report.

Introduction

3

Statement from the Registered Manager (Director of

Operations)

Circle Integrated Care (CIC) is responsible for and dedicated to the care of adults with

musculoskeletal (MSK) conditions, coordinating a patient’s journey from their initial

referral to their final follow-up appointment. It is our mission to ensure patients see the

right person first time, and to work with our community and secondary care providers to

provide outstanding treatment and support. As a provider of musculoskeletal healthcare

services to NHS patients in Bedfordshire and Greenwich our Quality Account is an annual

report published about the quality of the services we provide.

This Quality Account reports on the services CIC provide to the NHS which were delivered

in 2018/19.

CIC began providing these services in Bedfordshire in 2014 and Greenwich in 2017. We also

deliver electronic referral triage services for Northamptonshire and Rushcliffe,

Nottinghamshire which commenced in 2018. As CIC are not responsible for seeing these

patients this account concentrates on Bedfordshire and Greenwich.

At a time when demand is growing and it is important to provide value for money we

continue to maintain excellent standards of patient care offering a range of quality patient

focused services in locations close to patient’s homes.

4

Statement from the Registered Manager (Director of

Operations) continued

CIC achieve continuous improvement by having a well defined clinical governance

structure in place. This means that we have strong clinical leaders holding clear

responsibilities and systems and processes to ensure we operate safely and monitor the

quality of care we offer to our patients.

Over the last few years CIC have found that successful partnerships with NHS services and

independent sector services allow an integrator service such as ours to streamline patient

pathways in collaboration with local stakeholders.

CIC had a CQC inspection on 20th September 2018. In summary they found that CIC are

delivering safe, effective, caring, responsive and well led services in accordance with the

relevant regulations. The CQC believe that we are delivering:

“a service that has vision and values and is set to provide a quality service with the

leadership in place to achieve the vision”

Our staff are the backbone of our business and our services have grown over the reporting

time period. This has led to a new site being sourced for the Greenwich service to provide

more locations for patients. The Bedfordshire service staffing levels have increased and a

hub move for administration staff occurred on 29th April 2019.

CIC have already achieved much in the time we have been providing these services, in this

document we will present an overview of the services provided so far. Primarily though, we

will tell you about what we are working on in the year to come.

In putting together this publication we have sought feedback from colleagues,

Bedfordshire and Greenwich CCG’s and Healthwatch and I would like to take this

opportunity to thank them for their input into the process.

I can confirm that to the best of my knowledge, the data and information in Part 2 of this

report reflect both the success and the areas we have identified for improvement over the

next 12 months.

Amanda Phillips

Director of Integrated Care Operations

5

Circle Integrated Care’s Vision

6

The Circle Credo

Our purpose

To build a great organisation dedicated to

our patients

Our parameters

We focus our efforts exclusively on:

What we are passionate about;

What we can become best at;

What drives our economic sustainability

Our principles

We are above all the agents of our

patients

We empower our people to do their best

We are unrelenting in the pursuit of

excellence

What this means for patients

• Fast access to MSK specialists

• One-to-one discussions and tailored

treatment plans

• Options to talk about treatment over the

phone

• Shared decision making so patients are

involved in their care

• Choice of hospital or local service

• Choice of appointments in the community,

closer to home

• Opportunity to give feedback and shape the

service

• A co-ordinated journey through the

healthcare system for treatment of their MSK

condition

7

What are Circle Integrated Care Services?

Circle Clinical Services Limited (CCSL) is the CQC registered entity. This was known

locally as Circle MSK. We rebranded at the end of 2018 to Circle Integrated Care (known

as ‘CIC’). CIC deliver MSK services in Bedfordshire and Greenwich and deliver triage

services in Northampton and Rushcliffe and is part of a group of companies owned by

Circle Health. CIC has a dedicated team of experienced healthcare professionals, as well

as support staff, and our purpose is to provide patients with high quality, best value,

outcomes focused care. Circle’s approach is based on the premise that clinicians are best

placed to decide how to deliver the best care for patients and our Credo commits us to

being ‘above all the agents of our patients’.

CIC have been commissioned by the local Clinical Commissioning Groups (CCGs) to

manage all NHS musculoskeletal (MSK) problems (apart from emergencies) for the

populations of Bedfordshire and Greenwich and deliver triage services for Northampton

and Rushcliffe. This includes conditions involving muscles, joints, bones, tendons,

ligaments, some nerve-related conditions and associated pain. CIC Bedfordshire was the

first service of its kind in the United Kingdom and has been operational since April 2014.

CIC Greenwich has been operational since April 2017 and uses the same model.

CIC provide streamlined triage and treatment services for patients with MSK conditions.

Combining the expertise of multiple clinicians ensures patients receive the right

treatment, at the right time, in the right place, with the right person. CIC have contracts

with local NHS and private providers covering the whole range of services needed to

manage MSK conditions, so that we can provide an integrated, efficient, high-quality NHS

service.

Scope of CIC Services

The scope of our MSK services in Bedfordshire and Greenwich include:

• MSK related Physiotherapy

• MSK related Podiatry

• Community Triage Clinics (Advanced Practice Physiotherapist -APPs & MSK Physicians)

• Orthopaedics

• Rheumatology

• Pain Services

• Fracture clinic follow-ups (Greenwich)

8

Rationale for Integrated MSK Services

CIC was commissioned to streamline patient pathways and ensure best practice national

guidelines were followed for MSK conditions.

This was important as rising numbers of patients presenting with MSK conditions, driven by

demographic growth, was causing financial pressures for local health economies.

The community model adopted by CIC allows for appropriate activity to be delivered in

community settings near patient’s homes. This relieves the burden on local hospitals.

The NHS Long Term Plan

On 7th January 2019, NHS England published the NHS Long Term Plan, setting out its

priorities for healthcare over the next ten years and showing how the NHS funding

settlement will be used. The areas covered are:

How the NHS will move to a new service model in which patients get more options, better

support, and properly joined-up care at the right time in the optimal care setting.

Action the NHS will take to strengthen its contribution to prevention and health

inequalities.

The NHS’s priorities for care quality and outcomes improvement for the decade ahead.

How current workforce pressures will be tackled and staff supported.

A wide-ranging and funded programme to upgrade technology and digitally enabled care

across the NHS.

How the 3.4% five year NHS funding settlement will help put the NHS back onto a

sustainable financial path.

9

CIC Bedfordshire Achievements 2018/19

CIC Bedfordshire has managed a 14.2% referral growth on a capitated budget saving the

CCG over £19m to date. A single point of access has been set up with all referrals triaged

within 24 hours. In 2018/19 48,187 referrals were received through the hub and over 100%

of referrals into the hub are electronic.

Activity has increased from 33% of activity in the community in 2013 to 64% in 2018/9.

We have provided self-management tools and CIC website to empower patients; and

PhysioLine for early telephone access to physiotherapy advice and treatment.

Physitrack® has been introduced for our PhysioLine patients, allowing videos of exercises

to be sent to patients rather than sheets of exercises, also allows interaction with their

physiotherapist if questions or further advice is needed.

Patients have true choice for every part of the system and are empowered through shared

decision making to be involved in their care.

The patients have had the choice of non-surgical options for hip and knee conditions

including Ossur braces and APOS Therapy.

The patients have had the choice of options for spinal rehabilitation with Nordic

rehabilitation equipment.

Introduction of Synertec, a technology which enables us to send letters to patients which

meet their accessible information standard needs e.g. in a particular font size.

We have created a referral and treatment pathway in collaboration with the Bedfordshire

Wellbeing service to ensure patients receive the most appropriate treatment within the

relevant service.

96% of patients would recommend the Circle run community hubs, with complaints less

than 0.1%. Patient representatives are involved in the service and we have developed links

with Healthwatch to support patient events, obtain feedback on the system and we have

commissioned them to undertake independent reviews.

Continual GP engagement in the system through practice visits, locality meetings, GP

surveys, and participation in MSK forums to support service re-design.

Visits to GP locality boards have been undertaken to update on the service and answer

questions about any issues.

Worked with Bedfordshire Clinical Commissioning Group to roll out the First Contact

Practitioner trial which is a nationwide programme. This is an extension to the MSK

Practitioner roles we have offered to GPs for the last 3 years.

10

CIC Bedfordshire Achievements 2018/19 continued

Engagement of clinicians from providers occurs on alternate months through the clinical

steering group (participants include GPs from each locality, Orthopaedic, Rheumatology &

Pain Consultants, Physiotherapists from different providers, APPs, and MSK Physicians).

Operational relationships have been built in the nine community hubs as well as local

provider sites (see Appendix for details).

Integration of the MSK system has occurred through operational, contractual, and clinical

engagement as well as development of technology to support tracking of patients and

system analysis.

National PROMS (Patient Reported Outcome Measures) following Hip and Knee surgery are

better than national average for Bedfordshire patients.

Evidence based pathways ‘The Circle 6’ have been developed from national guidance to

ensure all patients with particular conditions are offered the most appropriate options

according to the current evidence base.

Developed ‘one stop shop’ clinics for particular conditions to make patient treatment

pathways more effective and efficient.

Significant capture of outcome measures (>239,793) not previously collected to drive up

clinical quality and support clinicians development.

CIC Greenwich Achievements 2018/19

CIC Greenwich has managed an increased population growth on a capitated budget saving

the CCG £1.9m to date. A single point of access has been set up with all referrals triaged

within 24 hours. 24,627 referrals have been received over the year 2018/19 (an average

2,052 per month) and 100% of referrals into the hub are electronic.

Activity has increased from 41.15% of activity in the community in 2017/18 to 73%

in 2018/19.

A new clinic in Woolwich (Grabadoc) offering an additional location to the existing Eltham

Community Hospital for patients to access CIC services.

A self-management web based tool called ‘Physitrack®’ has been implemented to assist

patients with self-management of their MSK condition.

PhysioLine for early telephone access to physiotherapy has increased as well as

implementation of self-referrals which is a new initiative in Greenwich.

Patients have true choice for every part of the system and are empowered through shared

decision making to be involved in their care.

11

CIC Greenwich Achievements 2018/19 continued

The patients have had the choice of non-surgical options for hip and knee conditions

including Ossur braces and APOS Therapy.

On average 98.5% of patients in 2018 would recommend the Community Clinics; 6 total

complaints received in 2018, on average 1 every other month which is 0.02% of all

referrals.

Healthwatch Greenwich undertook an independent review of the service in June 2018.

Continued GP engagement in the system through practice visits, syndicate meetings, GP

engagement and training events, and participation in MSK forums to support service re-

design.

Dedicated GP support and advice line/emails have been set up and free resource (First

Contact Practitioners) has been provided to surgeries to support GPs workload and provide

early access to an MSK clinician in primary care for patients. GPs feedback as a result of

these are they welcome the support and rapid access to advice.

Engagement of clinicians from providers occurred at alternate months through the clinical

steering group (participants include local GPs, Orthopaedic, Rheumatology & Pain

Consultants, Physiotherapists from different providers, APPs, and MSK Physicians).

Waiting times have decreased significantly for the Borough.

CIC captured Community based outcome measures for every patient to drive clinical

quality and support pathway development.

Making Every Contact Count Questionnaires are embedded into our initial clinical

consultation which enables us to signpost patients to services which support healthier

lifestyles.

CIC Greenwich’s progress with the MSK service KPIs are as follows:

• 89% of patients treated in the community hub have had an improvement in pain and/or

function

• 88% of Patients being referred to Secondary Care have had a dedicated shared decision

making (SDM) consultation

• Choice of provider for further treatment – 100% patients offered choice; 96% had a

dedicated patient choice telephone conversation

• Local GP training and support for MSK care –GP visits and Education events held

• All patients over 65 are asked if their condition is a result of a fall

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The MSK Teams

Across our sites, the CIC team consists of:

• Physiotherapists

• Advanced Practice Physiotherapists (APP’s)

• Specialist Podiatrist (CIC Greenwich)

• MSK Physicians

• Pain, Orthopaedic and Rheumatology Consultants

• Clinical Psychologist (CIC Bedfordshire)

• Specialist Pain Nurses (CIC Bedfordshire)

• Specialist Hand Occupational Therapist (CIC Bedfordshire)

• Shared Decision Makers

• Health Care Assistants (HCA’s)

• MSK (First Contact) Practitioners

They provide specialist MSK clinical triage, assessment, and treatment within the

CIC run community MSK hubs across Bedfordshire and Greenwich and triage for

Northampton and Rushcliffe (electronic review and signposting of referrals).

Advanced Practice Physiotherapists (APP) are experienced physiotherapists who

have undertaken further postgraduate training to provide an advanced practice.

Advanced practice is a combination of advanced skills, knowledge and attitudes

together with the core set of physiotherapy skills and knowledge, tailored to

individual patients and local environments. For example, they can request

investigations such as ultrasounds or MRIs, interpret the results of investigations to

plan management with patients, and many are trained in the administration of

steroid injections; some can also prescribe medications, and some are able to carry

out advanced treatments such as ultrasound-guided injections, diagnostic

ultrasounds and shockwave therapy.

MSK Physicians are doctors that have undertaken further training and

assessment to develop the expertise to deliver a high quality clinical service to

patients with musculoskeletal problems, beyond the scope of their core

professional role. They can also carry out advanced treatments such as

ultrasound-guided injections and shockwave therapy.

13

“Appointment was on time and consultant very friendly and explained everything -

nothing could be improved”

CIC Bedfordshire

CIC Bedfordshire has:

One Clinical and Governance Lead

Two Triage and Audit Leads

Twenty two APPs

One Physiotherapy Lead

Five Physiotherapists

Five MSK Practitioners (Senior Physiotherapists)

Six MSK Physicians

One Clinical Psychologist

Four Healthcare Assistants

One Rehabilitation Assistant

Three Pain Consultants

Two Spinal/ Neurosurgery Orthopaedic Consultants

One Upper Limb Consultant

Three Lower Limb Consultants

Two Rheumatology Consultants

Two Pain Nurses who work within the MSK hubs

These Consultants are linked to three contracted secondary care providers.

They provide outpatient appointments in the Circle community hubs and direct

list to their hospital of employment for surgery as appropriate

14

CIC Greenwich

CIC Greenwich has:

One Clinical and Governance Lead

One Triage and Audit Lead

Six APPs

Clinical Chair

One Physiotherapy Lead

Five Physiotherapists

Two MSK Practitioners (Senior Physiotherapists)

Three MSK Physicians

One Clinical Psychologist

Four Healthcare Assistants

One Rehabilitation Assistant

Two Pain Consultants

Two Upper Limb Consultant

Five Lower Limb Consultants

Two Rheumatology Consultants

The Consultants are sourced from Lewisham & Greenwich Trust as a result of a

tripartite agreement with the trust and CCG and Dartford & Gravesham Trust.

15

16

Supporting Members

17

CIC are supported by:

Director of Integrated Care

Director of Operations

Head of Clinical Services

Head of Finance and Contracts

Head of Operations

Head of Service Transformation

Two Quality and Contracts Managers

One MSK Service Manager

One Service Coordinator

A patient choice team

An 18 Week team

Two Quality and Assurance Facilitators

A Service Transformation team

An administrative team who are responsible for referral management, co-ordinating

patient appointments in the community setting, managing the flow of patients to our

providers and importantly act as a point of contact for patient and GP queries at any point

in the clinical pathway.

Amanda Phillips

Director of Integrated Care

Julie Yanni

Head of Clinical Services

Ben Millard

Head of Finance and Contracts

Supporting Members- Executive Board

18

CIC has a team of seven Executives who meet monthly at the Executive Board. The

purpose of the Executive Board is to implement the strategic direction and group policies

and objectives set by the Circle Health Executive Team. The Executives that sit on the

Board include:

Director of CIC

Director of Operations

Clinical Chair

Head of Clinical Services

Head of Finance and Contracts

Head of Service Transformation

Head of Operations

The Clinical and Governance Risk Management Committee (CGRMC) which is responsible

for overseeing and delivery of both reactive risk management, including complaints

handling and incident reporting, analysis and learning, and proactive risk management,

including clinical audits, risks on the risk register and research governance.

The CIC Operational Model

The model is centred on an integrated provider hub (IPH) which:

• Provides a single triage hub for all MSK referrals

• Ensures patients are directed to the right treatment first time

• Ensures patients are given choice over secondary care

• Reduces inappropriate surgery

• Outcomes can be measured

GP’s and patients refer into the Integrated Provider Hub (IPH) which manages all referrals

and provides multidisciplinary care for patients utilising our team of clinicians. All referrals

are triaged within 24 hours of receipt of the referral. Patients are then guided to the most

appropriate part of the system. This includes PhysioLine (early access to assessment and

advice over the phone), physiotherapy or podiatry in the community; and Secondary Care

hospital treatment for those patients requiring surgery or Consultant expertise. Community

clinics provide expert MSK assessment, further investigations and additional treatments,

such as ultrasound guided injections.

19

The IPH manages the patient from referral to discharge so if the first treatment

pathway is unsuccessful, the hub co-ordinates care to another appropriate part of

the system (eliminating the need for patients to be referred back to their GP, saving

both patients and GP’s time). The IPH also has Consultants from a range of hospitals

so patients can see a consultant closer to home and then be referred into a hospital

for surgery if required. Their follow up care can also be undertaken in one of our

community hubs and closer to home.

Patient choice is offered at all stages, however patients being referred to Secondary

Care are spoken to by Patient Choice Advisors, to enable patients to understand

their options. Patient Choice advisors provide links to all the hospitals operational

teams and have non-clinical conversations regarding information on Consultants,

travel and current waiting times, which may influence patients’ choice and enables

waiting times to be more controlled. Similarly, although Shared Decision Making

(empowering patients to be involved in their care) is part of our ethos, we have

dedicated Shared Decision Makers (Senior Physiotherapists) who speak to patients

before major surgery (such as total hip and total knee replacements). They enable

patients to understand the implications of surgery, ensure conservative measures

have been optimised, surgical thresholds are met and that patients want surgery.

Where appropriate we do offer non- surgical alternatives and these will be

discussed with patients who meet the criteria. This ensures that the patient needs

and wants surgery and is more prepared for it.

In addition we work collaboratively with all our providers to streamline pathways,

create innovative services and manage the quality of all the providers in the

system. We do this through having a dedicated Quality and Contracts Manager,

monthly contract meetings with quality reporting; clinical pathway meetings and a

bi-monthly clinical steering group with GPs, Physiotherapists, APP’s, MSK Physicians

and Consultants to gain feedback about performance and discuss best practice

pathways and service changes. We have also worked with the Bedfordshire CCG to

be able to provide MRI, Ultrasound and Nerve Conduction Studies in the Integrated

Hubs, closer to patients’ home, which streamlines pathways and reduce waiting

times. In Greenwich we have worked with the CCG to source MRI and Nerve

Conduction Studies through other providers which has reduced waiting times.

20

“Very clear explanation and friendly. Didn’t feel rushed.

Left feeling there was a plan in place- thank you”

CIC Facilities

At the end of 2018/19, CIC Bedfordshire provided Services from the following

facilities:

• The Enhanced Services Centre – 3 Kimbolton Road, Bedford MK402NT

• Bedford Consulting Rooms – 4 Goldington Road, Bedford, MK403NF

• Church Lane Surgery – 147a Church Lane, Bedford, MK410PW

• Flitwick Surgery – Highlands, Flitwick, MK451DW

• Ivel Medical Centre, ChestnutAvenue, Biggleswade, SG18 0RA

• Toddington Surgery – Luton Road, Toddington, LU5 6DE

• Salisbury House Surgery – Lake Street, Leighton Buzzard, LU71RS

• Bassett Road Surgery – 29 Bassett Road, Leighton Buzzard, LU71AR

• Greenfields (Aldwyck Housing Group), Leighton Buzzard, LU7 9SP

• Rothesay Clinic Rooms, 14 Rothsay Place, Bedford, MK40 3PX

At the end of 2018/19, CIC Greenwich provided Services from the following

facilities:

• Eltham Community Hospital, 30 Passey Place, London, SE9 5DQ

• Grabadoc, 394 Shooters Hills Road, London, SE9 5DQ

21

Core Services Provided at CIC Hubs include:

22

Lower Limb

Service Bedfordshire Greenwich What it is

Ossur Knee

Brace

Ossur is a brace offered as biomechanical

device for treating Osteoarthritis of the

knee

APOS therapy

– Hip & Knee

APOS is a boot-like device for patients

with chronic pain from osteoarthritis of

the knee or hip.

Consultant in

the Hub Hip

and Knee

A consultant that holds outpatient

appointments in Circle CIC clinics and

direct lists patients to their hospital as

appropriate.

Shockwave

therapy Focused sound waves which work by

increasing blood flow to the injured area.

Non-specific

Service Bedfordshire Greenwich What it is

Ultrasound

guided

injection

Injections are given with ultrasound

guidance.

In-house

physiotherapy Wide range of treatment options, most

often a programme of specific exercises

targeted to help a particular condition.

In-house

Rheumatology

A consultant that holds outpatient

appointments in Circle MSK Hubs and

direct lists patients to their hospital if

required.

In-house

Podiatry

A specialist podiatrist who provides

expert assessment and treatment of foot

and ankle related conditions.

Pain

Service Bedfordshire Greenwich What it is

PMP (Pain

management

programme) /

LEAP (Lifestyle,

education,

activity and pain

management)

The Pain Management Program (PMP)

is a group intervention for people

with long-term musculoskeletal pain.

There is strong evidence that this

type of help is effective for those

affected by persistent pain

Pain MDT drop in

clinic

A clinic with a pain nurse and pain

APP so the patient can see multiple

clinicians in one visit

Clinical

Psychologist

A psychologist who undertakes

individual appointments with

patients to empower them to self

manage their pain symptoms and to

facilitate their progression along a

treatment pathway

Pain Consultant in

the Hub

A consultant that holds outpatient

appointments in Circle MSK Hubs and

direct lists patients to their hospital

for procedures as appropriate.

23

Spinal

Service Bedfordshire Greenwich What it is

iBest (Back

skills

training)

A bio-psychosocial approach where

patients would benefit from a CBT type

approach with combined exercise

Nordic Health

Nordic Health are a range of

rehabilitation machines used

specifically for treating spinal pain and

improving outcomes.

Consultant in

the Hub

A consultant that holds outpatient

appointments in Circle MSK Hubs and

direct lists patients to their hospital as

appropriate.

24

Upper Limb

Service Bedfords

hire

Greenwich What it is

Barbotage

An ultrasound guided needle is injected

into a deposit of calcium which has

occurred within a tendon. The needle is

used to break up the calcium and help the

body to remove it naturally (usually in the

shoulder).

Hydrodilatation

This is an image guided injection

procedure, whereby a needle is inserted in

to the shoulder joint under direct

ultrasound vision to allow the injection of

between 20-30mls of fluid.

It is performed as part of the treatment of

Frozen Shoulder, a condition where the

shoulder becomes very stiff and painful.

High volume injection is considered when

the pain and stiffness hasn’t settled with

rest, painkillers, exercises or a previous

unguided steroid injection.

Consultant in the

Hub Upper Limb

A consultant that holds outpatient

appointments in Circle MSK Hubs and

direct lists patients to their hospital as

appropriate.

CIC Bedfordshire Community Therapy

Via the CIC Bedfordshire service we have access to physiotherapy, podiatry (together with

podiatric surgery) and hand therapy across Bedfordshire as demonstrated below:

25

• Essex Partnership University NHS

Foundation Trust

• Gilbert Hitchcock House Bedford

• Gilbert Hitchcock House Biggleswade

• ICE Ampthill

• Ampthill & Flitwick Chartered

Physiotherapy Clinic

• Asplands Medical Centre

• Bedford Physiotherapy Centre

• ICE Olney

• Luton & Dunstable Hospital Trust

• Luton & Dunstable Outpatient

Physiotherapy and Hand Therapy

Department

• Parks Therapy Centre, Biggleswade

• Parks Therapy Centre, Church Lane

• Parks Therapy Centre, Elstow

• Parks Therapy Centre, St Neots

• Woodside Clinic, Leighton Buzzard

• Woodside Clinic, Dunstable

• The Physiotherapy Clinic, Stotfold

For Secondary Care the CIC Bedfordshire service has access to a range of hospitals in and

around Bedfordshire as demonstrated below:

26

• BMI Three Shires Hospital

• BMI The Manor Hospital

• BMI The Saxon Clinic

• Ramsay Blakelands Hospital

• Ramsay Woodlands Hospital

• Ramsay Pinehill Hospital

• Spire Harpenden Hospital

• Spire Cambridge Lea Hospital

• Northampton General Hospital NHS Trust

• Milton Keynes University Hospital

• Stoke Mandeville Hospital

• North West Anglia Foundation Trust

• Bedford Hospital NHS Trust

• Luton and Dunstable University Hospital

• East and North Hertfordshire NHS Trust

• Addenbrooke’s Hospital

CIC Bedfordshire Secondary Care Providers

CIC Greenwich Community Therapy

• Oxleas NHS Foundation Trust - Manor

Brook Medical Centre

• Oxleas NHS Foundation Trust - Eltham

Community Hospital

• Oxleas NHS Foundation Trust - Clover

Health Centre

• Oxleas NHS Foundation Trust - The

Greenwich Centre

• Oxleas NHS Foundation Trust - Kidbrooke

Village Centre

• Lewisham & Greenwich Trust - Manor

Brook Medical Centre

• Lewisham & Greenwich Trust - Gallions

Reach Health Centre

• Lewisham & Greenwich Trust - South

Street Medical Centre

• Lewisham & Greenwich Trust - Queen

Elizabeth Hospital

• Vanbrugh Group Practice

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CIC Greenwich also has access to both community and secondary care providers for

therapy:

28

For Secondary Care the Circle MSK Greenwich service has access to a range of hospitals

in and around the borough as demonstrated below:

CIC Greenwich Secondary Care Providers

• Queen Elizabeth Hospital

• University Hospital Lewisham

• BMI The Blackheath Hospital

• Darent Valley Hospital

• King's College Hospital NHS Foundation

Trust

• Guy's and St Thomas' NHS Foundation

Trust

• Royal National Orthopaedic Hospital

• Oxleas NHS Foundation Trust

• BMI The Sloane Hospital

• BMI Shirley Oaks Hospital

• Queen Mary’s Hospital

Ensuring the Quality of Providers

29

Quality Management

CIC believes it is important to monitor the quality of the sub-contracted providers to

ensure all patients receive the best care. CIC’s approach to quality management adopts a

number of approaches. CIC requires a formal submission of quality metrics but also places

great value on maintaining good relationships with contracted providers. CIC use a monthly

Service Quality Performance Report (SQPR), a Quarterly Quality Report, and a combination

of CQUIN schemes and SDIPs (Service Delivery Improvement Plans) to improve the quality of

the service that our sub-contracted providers deliver on our behalf.

The SQPR metrics are collated into a county wide dashboard for sub-contracted providers,

and is presented to both CIC’s internal CGRMC (Clinical Governance and Risk Management

Committee) and the local CCG at the monthly contract meetings.

Due to all reporting reviewing activity that is two months in arrears, CIC also asks sub-

contractors to make them aware of any incidents that have happened in the interim, or

give a “lag report” covering the time from the reported metrics to the date of the

meeting. All sub-contractors are also required to report in line with NHS national timelines

any Serious Incidents or other reportable incidents as defined by the CQC.

Sub-contractors are also required to submit a Quarterly Quality Report as a platform for

service providers to give more narrative and context to the quarter’s activity. These

submissions are then collated into a county-wide report that is submitted to the CIC’s

CGRMC and relevant CCG on a quarterly basis. These quality reports and documents are

monitored through a monthly Contract Meeting forum.

The attendees for the meeting will depend on which hospital/Trust the meeting is with,

however there must be at least the following for the meeting to be of value:

• Quality and Contracts Manager (Circle)

• Hospital Director/Executive Director/General Manager (PrivateHospitals)

• General Manager / Service Lead (NHSprovider)

• Finance (both parties)

• Quality representative (both parties – usually Quality & Contracts Manager from Circle)

• 18 week/patient choice/Operations Lead from CIC asrequired

During the month of submission of the report, each sub-provider has a Quality meeting in

addition to the Contract meeting in order for CIC to fully understand the content of the

report. All submitted quality metrics are reviewed on a monthly basis at the Quality

Performance Committee, a sub-committee of the CGRMC. CIC also undertake quality

visits at the sub-contracted provider’s location, often in conjunction with the local CCG.

Ensuring the Quality of Providers

30

Quality Improvement

Selected sub-contractors have Quality Improvement Schemes in their contracts,

which follow the same mechanisms as a CQUIN scheme on a Standard Acute NHS

Contract i.e. 2.5% of quarterly activity that the sub-contractors can earn back

dependent on achievement of pre-agreed quality improvement criteria. These are

submitted on a quarterly basis, and reviewed in line with the NHS contractual

mechanism i.e. submission to CIC, request for additional information sent from

CIC, final submission.

Outside of this contractual mechanism, CIC also reviews existing pathways on a

regular basis as required, and promotes a culture of continuous improvement with

the contracted relationships, and with the CCGs. Sub-contractors are aware of the

methodology that CIC employs, and that new approaches to patient pathways are

always welcomed.

The standard approach that CIC also employs with sub-contracted providers is one of

collaborative working if a challenge arises. Once an area of concern is raised, CIC

will work with sub-contracted providers in order to resolve any issues and ensure the

best outcome for patients.

Approach to feedback to drive improvement

Patients are at the heart of everything CIC do and the service seeks to develop

strong relationships with patients, carers and the public to create a responsive

service which empowers patients, improves health outcomes and drives quality.

Patient outcome and experience measures are the foundation blocks of CIC’s

continuous improvement methodology and forms a key component of the Circle

Operating System.

CIC actively seeks patient feedback, inviting patients to share their comments and

views using feedback cards, telephone, SMS and face to face meetings. Patient

representatives have participated in our partnership sessions for all staff. This

provided valuable and powerful insight into the experience of a service user.

Patient comments and suggestions are reported via Quality dashboards and

interrogated in the various clinical and governance meetings.

A range of forums enable staff to discuss patient focussed service and take

collective responsibility for their delivery, tracking and reviewing progress in

subsequent meetings.

“Appointment wasn’t

rushed, symptoms

discussed.

Examination given and

discussed and

diagnosis given and

explained well, no

improvement needed

with my

appointment”

Bedfordshire Achievements against Quality Improvement

Priorities for 2018/19

32

Quality

Domain

Our Quality

Priorities

for 2018/19

Success Measures for

2018/19

2018/19

Progress

Status

Best Patient

Experience 98% of

patients

‘would

recommend’

in the friends

and family

test feedback

Continual improvement of

communication, data quality

and adherence to processes to

ensure effective patient

experience as evidenced by

reduction in volume & themes

on Datix.

95% of patients ‘would

recommend’ consistently from

May 2017

The average for

2018/19 was 96%

for ‘would

recommend’.

There has been a

reduction in

number of issues

with ‘accessing

the service’

themes on Datix

Partially

achieved

Consistently

over 50%

response rates

for our

feedback in all

hubs

Consistently >50% response

rate in all hubs for every

month.

The response

rates have not

reached over

50% for

feedback. A plan

is in place to

improve this for

next year

Not

achieved

Best Clinical

Outcome

100% of all

audits

undertaken

being captured

within a

dashboard

Audit tool to be set up from

May 2017 to present all audits.

We have an

audit tool that

captures all of

the mandatory

audits, clinical

audits are

captured

separately

Partially

achieved

Bedfordshire Achievements against Quality Improvement

Priorities for 2017/18

33

Quality

Domain

Our Quality

Priorities

for 2018/19

Success

Measures for

2018/19

2018/19 Progress Status

Best

Clinical

Outcome

100%

utilisation of

all clinic slots

within hubs

Monitor usage of

clinic slots

weekly.

Clinic utilisation is reviewed on a

weekly basis in the Ops Pack. This

has helped monitor utilisation to

ensure efficiency

Achieved

The

organisation

identifies

safety risks

inherent in its

patient

population

increase of

holistic

assessments to

cover physical

and

psychological

impact of

chronic pain and

its challenges for

patients

CIC have collaborated with the

Lifestyle hub to provide clinics for

CIC patients within our hubs.

Our one to one appointments with

the Clinical Psychologist are well

embedded as part of our pain

pathway.

Achieved

Improve

effectiveness

of

communicatio

n amongst

caregivers

Report critical

results of tests

and diagnostic

procedures on a

timely basis

Ensuring clinic usage is optimised

has improved the communication of

test results to patients and

caregivers. There is ongoing

monitoring on a weekly basis of

clinic usage.

Partially

achieved

Most

engaged

staff

To create a

feedback

board

including what

challenges we

faced that day

as a company

and how we

overcame

them

Monitor usage of

board, feedback

from staff on

effect of board

on engagement.

A staff feedback board has been in

use for 2018/19, also our Circle

Operating System (COS) champions

have a feedback box which is

reviewed at the fortnightly COS

meetings.

Achieved

Cross

shadowing

between

different

members of

the team

To encourage

and support all

staff to develop

core skills and

create

opportunities to

help progress job

role/satisfaction

(evidenced by

working at Circle

survey and 1-2-1

documentation).

As part of our induction process

staff spend time with different

members of the team to gain an

understanding of the different roles

within the service. There is a

programme of rolling this out to

existing staff members.

Partially

achieved

Greenwich Achievements against Quality Improvement

Priorities for 2018/19

34

Quality

Domain

Our Quality

Priorities

for 2018/19

Success Measures

for 2018/192018/19 Progress Status

Best Patient

Experience

98% of patients

‘would

recommend’ in

the friends and

family test

feedback

Continual

improvement of

communication,

data quality and

adherence to

processes to ensure

effective patient

experience as

evidenced by

reduction in volume

& themes on Datix.

96% of patients

‘would recommend’

consistently from

June 2017.

The average ‘would

recommend’ score for

Greenwich over 2018/19

was 98%.

There has been a

reduction in number of

issues with ‘accessing the

service’ themes on Datix

Achieved

Consistently over

40% response

rates for our

feedback in all

hubs

Consistently >40%

response rate in all

hubs for every

month.

Response rates have not

been consistently over

40%. A plan is in place to

improve this for next

year.

Not

achieved

Best

Clinical

Outcome

100% of all audits

undertaken being

captured within a

dashboard

Audit tool to be set

up from December

2017 to present all

audits.

We have an audit tool

that captures all of the

mandatory audits, clinical

audits are captured

separately

Partially

achieved

Greenwich Achievements against Quality Improvement

Priorities for 2017/18

35

Quality

Domain

Our Quality

Priorities

for 2018/19

Success Measures

for 2018/192018/19 Progress

Status

Best

Clinical

Outcome100% utilisation

of all clinic

slots within

hubs

Monitor usage of

clinic slots weekly.

Clinic utilisation is reviewed on

a weekly basis in the Ops Pack.

This has helped monitor

utilisation to ensure efficiency

Achieved

Review patient

pathways for

best practice

Annually clinical

staff to meet to

review all triage

pathways.

Triage guidance and surgical

thresholds were update to

reflect new national guidance in

2018/19

Achieved

Most

engaged

staff

To create a

feedback board

including what

challenges we

faced that day

as a company

and how we

overcame them

Monitor usage of

board, feedback

from staff on effect

of board on

engagement.

At Eltham facilities do not allow

boards to be put up. Feedback

is sent to staff on a monthly

basis and raised at meetings

with all staff. COS sessions have

also been set up to monitor

staff feedback

Partially

achieved

Cross

shadowing

between

different

members of

the team

To encourage and

support all staff to

develop core skills

and create

opportunities to

help progress job

role/satisfaction

(evidenced by

working at Circle

survey and 1-2-1

documentation).

All staff meet once a month at a

meeting. New staff shadow

other staff as part of their

induction. A programme of all

staff shadowing is being rolled

out

Partially

achieved

Best Clinical Outcomes

CIC recognises that in order to have both a positive and informative reporting

system, it is necessary to maintain a culture where staff feel able to report

incidents without fear of reprisal or blame.

An organisation with high incident reporting is a mark of a ‘high reliability’

organisation. Research shows that organisations with significantly higher levels of

incident reporting are more likely to demonstrate other features of a stronger

safety culture, such as a high patient satisfaction rate, positive peer review

assessments and a low number of clinical negligence claims. The commitment to

reporting demonstrates a commitment to our patients and their safety. This is

recognised by the Care Quality Commission Fundamental Standards of Quality &

Safety and further reinforced by the Report of the Mid Staffordshire NHS

Foundation Trust chaired by Robert Francis QC (February 2013). An organisation

with a high reporting rate of no harm incidents is a safe place to be.

Staff at CIC Bedfordshire reported a total of 449 incidents in 2018/19 as opposed to

497 incidents in 2017/18;

1a. Graph showing number of incidents by reported date per month from 1st April

2018 to 31st March 2019 for CIC Bedfordshire

Staff at CIC Greenwich reported 404 incidents in the year 2018. All staff have been trained

in the importance of reporting incidents to ensure we monitor the themes in relation to

incidents and use this to continuously improve the service

36`

35

22

40

51

37

31

46

57

34

28

46

22

0

10

20

30

40

50

60

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

1b. Graph showing number of incidents by reported date per month from 1st April 2018 to

31st March 2019 for Circle Integrated Care Greenwich

37

257

66

38

2517

Access, Appointment,Admission, Transfer,Discharge

Patient Information(records, documents,test results, scans)

Clinical assessment(investigations, imagesand lab tests)

Consent, Confidentialityor Communication

The top five incident categories for 2018/19 for CIC are detailed below and

divided between our Bedfordshire and Greenwich services. Altogether there were

449 Incidents for Bedfordshire and 404 Incidents for Greenwich, all of which

were ‘No harm to staff and patients’. As graphs 1c and 1d demonstrate, the main

categories of incidents provide problems with the administrative processes in

relation to the patients’ pathway. As a result, a full review on the administrative

processes and supporting operating procedures has been undertaken in an effort

to minimise the number of incidents associated with process errors.

We have used this information to inform our Quality Improvement Priorities for 2019/20.

1c. Graph showing top 5 incidents from 1st April 2018 to 31st March 2019 for CIC

Bedfordshire

1d. Graph showing top 5 incidents from 1st April 2018 to 31st March 2019 for CIC

Greenwich

Serious Incidents and Never Events

• Serious Incidents are defined as ‘incidents where care management failures are

suspected, which result in serious neglect, serious injury, major permanent harm or

death (or the risk of) to a patient as a result of NHS funded health care’

• Never Events are defined as ‘serious, largely preventable patient safety incidents that

should not occur if the available preventative measures have been implemented’

Safety Alerts

Alerts issued via the Central Alerting System (CAS) relate to key safety issues that have the

potential to cause harm if not acted upon promptly. Safety alerts are an important source

of information which enables CIC to ensure that safety of clinical services is our first

priority.

Timely and effective implementation of safety alerts form part of the CQC (Care Quality

Commission) Fundamental Standards. Failure to implement safety alerts could result in

incidents, complaints, claims and/or inquests and have a significant impact on both staff

morale and patient confidence.

CIC received 74 safety alerts during 2018/19, 4 of which were applicable for Medical

Devices and 1 for the Estates & Facilities services.

Incidents and events Total

Serious Incidents 0

Never Events 0

38

271

48

22

2018

Access,Appointment,Admission,Transfer, Discharge

Patient Information(records,documents, testresults, scans)

Consent,Confidentiality orCommunication

Clinical Innovation

39

Rheumatology

CIC is now running twelve consultant clinics per month with short waiting times. In

Greenwich CIC we have a rheumatologist who specialises in osteoporosis who assesses this

cohort of patients. This will reduce pressure on secondary care, reduce waiting times and

consequently benefit patients care.

Pain Psychology

A total of 588 individual psychology appointments were booked between April 2017 and

31st January 2019. Main diagnoses were depression, anxiety and post-traumatic stress

disorder.

The majority of patients were either referred on to our in-house CIC Pain Management

Programme (PMP) or signposted to Bedfordshire Wellbeing Service (BWS).

228 indirect psychology consultations with other clinicians about patients occurred May

2017-31 Jan 2019. This included discussions about potential risk and a management plan;

where to signpost, advice regarding complex psychological/mental health issues, and

whether a referral to Pain Psychology would be appropriate.

Previously these 816 patients would have been referred to Secondary Care Pain Clinics.

Outcome measures consisting of the PHQ-9 (depression scale), GAD-7 (anxiety scale),

Sickness Impact Profile (SIP), Pain Coping Strategies Questionnaire (PCQ) and Self-Efficacy

Scale (SES) are collected at pre-assessment and post-therapy stages. 160 completed

questionnaires have been collected for completed episodes of care demonstrating

• 81% of patients improve on the depression scale PHQ-9

• 75% of patients improve on the anxiety scale GAD7

• 69% improvement on the Sickness impact profiles and Self efficacy profile

Coping strategies scoring demonstrated 57% of patients improved in their ability to re-

interpret pain; 63% of patients showed improvements in not catastrophising pain and 57%

were able to think positively about coping by themselves.

Given these patients are the most complex pain patients we see, these outcomes are

positive.

Clinical Developments

40

41

LEAP Programme

LEAP is a group environment that offers motivational interviewing and a 6 week pain

management programme. In our Quality Account for 2017/18 we announced the

commencement of the LEAP groups. This year we are reporting on the outcomes for

patients following the group sessions.

Psychology metrics have been measured post these groups.

128 questionnaires for depression showed 35% of patients improved post pain

management classes. 116 questionnaires for anxiety showed 50% of these patients

improved. As these classes are designed to empower patients to self-manage pain and

are not directed at reducing anxiety and depression per say, these results show a wider

impact for these classes.

Clinical Innovation

Best Patient Experience

Patient Surveys

CIC believes that patient feedback is essential as it provides a rich source of

information about the quality of the services we provided. As an organisation we

have set out the key principles in our Credo to ensure we listen and act upon what

our patients tell us. The most effective way has been through the collection of

rapid response feedback, which provides real time information which is promptly

acted upon by the teams.

CIC participates in the ‘Friends and Family Test (FFT)’ using paper based collection

cards. This is supplemented with the use of text message and electronic collection

through an iPad. This enables patients to provide feedback through different

methods.

The ‘would recommend’ score is the number of responses recommending the

service over the total number of response cards received. A score of 95% or above is

considered high. During 2018/19, our average recommendation for CIC Greenwich

‘would recommend’ was 98.5%. For CIC Bedfordshire, our average ‘would

recommend’ for 2018/19 was 96%. CIC fell below the target of 40% response rate for

feedback. We recognise this may be a result of a change in methods of capturing

patient feedback as we have also promoted patients to give feedback via PALS and

NHS Choices. Subsequently, our MSK Team will be promoting patient feedback

through all methods used to capture feedback, including a new emphasis on

feedback cards to improve response rate.

In taking patient feedback seriously we have recruited a Patient Representative to

build the connections with patients, the local community and staff. The role of the

Patient Representative involves being an active member of the patient community

by attending borough-wide GP Surgery Patient Participation Groups (PPGs) and

providing feedback to CIC, being a portal of communication between patients and

the MSK service, and assisting the recruitment of members of the CIC PPG. The

Patient Representative is also involved in staff events such as our Quarterly

Partnership Sessions where we discuss performance, patient feedback and service

improvements, to truly embed that link between patients and the service.

42

CIC have strengthened our relationship with our local Healthwatch groups, working with

them to undertake patient focus groups and surveys and supporting some of their events to

meet more of the local community and hear their views. A dedicated team from CIC

Bedfordshire regularly have meetings with Bedford Borough Healthwatch and Central

Bedfordshire Healthwatch. These meetings facilitate conversations regarding patient

experience and ways in which the service can improve its relationship with the community.

Following the Central Bedfordshire independent review of CIC Bedfordshire, the service

presented updates to the suggested action points in the review to the open board meeting

of the Central Bedfordshire Healthwatch.

CIC Greenwich has been working with Healthwatch Greenwich since April 2017 to

proactively seek feedback. Healthwatch have visited the Greenwich Hub on several

occasions in 2017 and 2018. Both Greenwich and Bedfordshire Healthwatch’s have taken a

patient survey on CIC’s behalf to provide knowledge on patient experience and patient

perception of the service.

Senior staff have attended CCG Patient Participation Groups to report on the service and

discuss any issues, they have also attended locality boards for GP’s and Practice Manager

forums.

43

“Lots of relevant questions asked and time to explain given.

Nothing to improve next time.”

“Really good service felt he took plenty of time to go through

everything with me”

“Appointment on time ,excellent clinician, everything explained,

further appointment made. First class service. Thankyou”

Complaints, Concerns, Comments, Compliments (4Cs) & PALS

Circle Integrated Care places feedback from our patients at the very heart of the

service and utilise this feedback to ensure that we are maintaining high standards of

care. We operate a complaints process that responds flexibly, promptly and

effectively to the justifiable concerns of complainants, which therefore enables CIC

to address unacceptable practices promptly, support complainants effectively and

promote public confidence in our services.

CIC Bedfordshire received 499 pieces of feedback during 2018/19 which comprised of:

• 57 complaints

• 29 concerns

• 19 comments

• 394 PALS (Patient Advice & Liaison Service) enquiries

• 12 compliments

Patients who complained represent only 0.1% of the referrals CIC Bedfordshire

received.

1e. Chart showing types of feedback from 1st April 2018 to 31st March 2019 for CIC

Bedfordshire

44

57

29 12

19

394

Complaints by Type

Complaint

Concern

Compliment

Comment

PALS

Complaints, Concerns, Comments, Compliments (4Cs) & PALS continued

CIC Greenwich received 102 pieces of feedback in 2018/19 which comprised of:

• 6 complaints

• 8 concerns

• 2 comments

• 73 PALS (Patient Advice & Liaison Service) enquiries

• 13 compliments.

Patients who complained represent only 0.02% of the referrals CIC Greenwich

received. The Quality & Assurance Facilitators manage the 4Cs and PALs process (as

well as the wider governance agenda). The Facilitators support staff to ensure that all

feedback is captured on the Circle’s Risk Management System to ensure full visibility

and reporting, and to enable learning from this feedback.

1f. Chart showing types of feedback from 1st April 2018 to 31st March 2019 for Circle

Integrated Care Greenwich

45

68

13

2

73

Complaints by Type

Complaint

Concern

Compliment

Comment

PALS

Complaints, Concerns, Comments, Compliments (4Cs) & PALS continued

46

Complaints and concerns represent 17% of the feedback received for the CIC Bedfordshire

during 2018/19 as opposed to 61% during 2017/18.

There has been an increase in PALS from 19 in 2017/18 to 394 in 2018/19.

Complaints and concerns represent 13% of the feedback received for the CIC Greenwich

during 2018/19 as opposed to 62% during 2017/18.

There has been an increase in PALS from 6 in 2017/18 to 73 in 2018/19.

CIC strive to provide support for all patients who feel they have not had a positive

experience in the service and want to learn from their concerns to improve services as

appropriate. CIC services are guided by the patient as to how they want to proceed with

their concerns or raise complaints. Most importantly patients have the opportunity to feel

heard, this helps CIC deliver a great service.

Over the past year we have further strengthened our feedback processes through inviting

patients who have made a complaint into the service to meet some of the team members

and have a face to face discussion so we can understand their concerns in more detail and

take further action as appropriate. Complainants are identified by the Quality & Assurance

Facilitators upon raising their complaint, and are then invited in to CIC to have a meeting

with a senior clinician, Operations Lead and the Quality & Assurance Facilitator.

During the meeting, patients have the opportunity to discuss their individual complaint, as

well as identify ways in which CIC could improve the service. This is advantageous to CIC’s

development and integration in the community, as well as for improvement to patient

pathways.

“Very friendly person on the phone. Clear questions.

Appreciated being able to speak to someone. Can't think of

anything that could be done differently”

The top 5 themes from complaints and concerns during 2018/19 for CIC

Bedfordshire are as follows. We have used this information to feed into our

Quality Improvement Priorities for 2019/20.

1g. Chart showing top 5 themes of complaints and concerns from 1st April 2018 to

31st March 2019 for CIC Bedfordshire

1h. Chart showing top 5 themes of complaints and concerns from 1st April 2018 to

31st March 2019 for CIC Greenwich

47

30

21

8

7

5

Complaints by Subject

Communication (oral)

Appointment

Communication(written)

Attitude and behavior

Clinical treatment

5

3

2

1

1

Complaints by Subject

Communication (oral)

Appointment

Attitude and behavior

Clinical treatment

Communication(written)

As these themes demonstrate, patients raise concerns around appointments,

communication and explanations about their pathway. In response to these themes we

have already provided customer service training to the team and amended our phone

system to enable people to get to the right person to help with their query. We are in the

process of installing a more sophisticated phone system. CIC reviews our waiting times in

the hub weekly with the aim of ensuring they are as low as possible. All patient feedback is

shared with our clinicians to support learning where inappropriate behaviour has been

identified. This is managed through one-to-one meetings with line managers to encourage

staff to reflect and learn from feedback.

48

“I feel confident that my condition is being taken seriously and that there is a

plan in place to help treat it. I can't think of how you could improve things. I

think the system works well for me.”

Staff Engagement

Circle Operating Systems (COS) Partnership Afternoon

Clinical and non-clinical staff members of CIC regularly come together at quarterly Circle Operating

System (COS) Partnership Afternoons. These afternoons consist of ‘Team Updates’ where we review the

opportunities for the team and discuss where we are in terms of performance and feedback. These

sessions are interactive where staff are encouraged to participate in activities that re-iterates what

Circle stands for and our six behaviours (Passion, Disruption, Agility, Humanity, Partnership and

Resilience). Speakers are invited to cover relevant topics to support continuous learning and service

improvement. They may be internal or external including Patient Representatives, local Healthwatch

and Security Management specialists. These sessions are well attended by both Bedfordshire and

Greenwich teams, as well as those from other Circle hospital sites and Circle Head Office. The 9 CIC

COS Champions run the session. COS Champions are recruited on the basis of enthusiasm and dedication

to the service and its patients. COS Champions regularly instil this into the everyday working

environment alongside the COS Partnership Afternoons in order to ensure we have our culture of being

agents of our patients, empowering staff and continuous learning is maintained.

The COS team covered the following topics to reinforce our Circle Behaviours in the last year:

Q1 – SWARM & Stop the Line (problem solving approach and ability for any member of the

team to ask for a halt to activity if they see something unsafe)

Q2 –Updating on the Governance structure and decision making hierarchy)

Q3 – Improvement projects (plan, do, check, act).

Q4 – Partner Empowerment –how do we live the credo and our behaviours?

49

Operational Updates

50

Hub relocation

In 2018/19 CIC took on two triage services, as well as increased more MSK activity into the

community. This meant an increase in the number of administration staff. In order to

accommodate these staff and provide suitable space for meetings and an optimal work

environment it was decided to relocate the staff who were based on the second floor of

the Enhanced Services Centre in Bedford to premises in Regent House on the Woburn Road

industrial estate. This move happened on 29th April 2019. The first floor of the Enhanced

Services remains the main clinical location for the service.

Telephone system

In 2019 Circle moved telephone platforms to UCONE successfully. This cloud based

platform bring greater flexibility in allocating call handlers to meet incoming demand and

provided patients with clearer routes to deal with their enquiries. Alongside this we have

gained greater visibility of call volumes and reason for call. With this greater visibility we

are now responding to this information to maximise patient experience as well as that for

our sub contracted providers.

Synertec

In February 2019 CIC introduced an IT solution to automate the printing of patient letters

including postage. This solution provides a great way for ensuring patients receive timely

communication by letter when needed, it also allows reporting on letters sent therefore

quickly identifying any potential issues. We are in the process of maximising this

technology to incorporate enhanced features such as braille and large print. This ensures

compliance with the Accessible Information Standard.

Staff survey

In 2018/19 the staff survey was undertaken. There was a change in the levels of

satisfaction shown compared to the previous year. CIC acknowledges that the survey was

undertaken at a time of considerable change during the hub move and will be redoing the

survey a few months after the move. Any issues still being raised in the second survey will

be addressed by the service.

Staff Engagement

MSK Academy

The MSK Academy has been embedded in CIC Bedfordshire in 2017/18 and is being rolled

out in CIC Greenwich in 2018/19. Alongside the Academy a new career pathway has been

introduced which links with the Academy competencies. This gives clinical staff a clear

and structured pathway to further their career in CIC.

Employee Assist Scheme

Circle Health initiated a group wide change to the scheme provided for staff. This

Employee Assist scheme is independent of CIC and offers advice on many issues e.g.

stress, financial issues. Staff access this scheme individually and in confidence. This

allows CIC to provide appropriate support to ensure staff wellbeing.

Circle Operating System Partnership days

CIC Bedfordshire have embedded the partnership days in 2018/19 and CIC Greenwich have

held their first partnership days. These partnership days ensure staff are empowered to

get involved in the evolution of the service.

51

Staff Engagement

Salutations (Greetings)

CIC has embedded call salutations for administrative teams to ensure patients receive the

same consistent and high calibre care each time they interact with the service. This has

also given administration teams increased confidence on the telephones.

Awards and Conferences

CIC were shortlisted for two awards in 2018/19, Laing Buisson and Health Investor Best

Public-Private Partnership Awards. CIC have been awarded a 2 year extension in our

Bedfordshire contract . This has given us a stronger platform to continue to innovate

across the Community. CIC were asked to present at the Heath + Care Conference in June

2018 and HSJ Integrated Care Summit in September 2018.

Staff Safety and Wellbeing

CIC strongly promote an environment free from abuse and bullying. We operate a Zero

Tolerance Policy that means no member of staff will be accepting of any act of

aggression, violence or intimidation, both physical and non-physical from any member of

staff, patient or member of the public.

52

Quality Improvement Priorities for Bedfordshire 2019/20

53

CQC

Domain

Our Quality

Priorities

for 2019/20

Success Measures for 2019/20

Monitoring &

Reporting

Responsibilities

Responsive

Caring

Well Led

Feedback from

service users to be

collected across a

variety of sources

Feedback form service users to be

collected by methods to include

HealthWatch surveys, focus groups

and patient champions in addition

to cards and texts

Executive Board

Patient education

sessions to be held

around the county,

increasing on the

number held in the

previous year

An increase in the number of

sessions and the locations they are

held atExecutive Board

Safe

Effective

Ensure evidence

based treatment

pathways are

embedded using the

‘Circle 6’

Audits of pathways to show

compliance with evidence based

pathways and treatments offeredExecutive Board

Review of current

Patient Related

Outcome

Measures(PROMs) to

ensure most effective

are being used

Embedding any recommendations

within the assessment templatesExecutive Board

Caring

Responsive

Well Led

Implement a review

of the staff wellbeing

strategy

Staff survey results to be analysed

and an action plan to be put in

placeExecutive Board

Offer an ‘In Your

Shoes’ opportunity to

all staff to shadow

other staff members

All staff survey results to be

analysed to ensure compliance Executive Board

Quality Improvement Priorities for Greenwich 2019/20

54

CQC

Domain

Our Quality

Priorities

for 2019/20

Success Measures for 2019/20

Monitoring &

Reporting

Responsibilities

Responsive

Caring

Well Led

Feedback from

service users to be

collected across a

variety of sources

Feedback form service users to be

collected by methods to include

HealthWatch surveys, focus groups

and patient champions in addition

to cards and texts

Executive Board

Patient education

sessions to be held

around the county,

increasing on the

number held in the

previous year

An increase in the number of

sessions and the locations they are

held atExecutive Board

Safe

Effective

Ensure evidence

based treatment

pathways are

embedded using

the ‘Circle 6’

Audits of pathways to show

compliance with evidence based

pathways and treatments offeredExecutive Board

Review of current

Patient Related

Outcome

Measures(PROMs)

to ensure most

effective are being

used

Embedding any recommendations

within the assessment templatesExecutive Board

Caring

Responsive

Well Led

Implement a

review of the staff

wellbeing strategy

Staff survey results to be analysed

and an action plan to be put in

placeExecutive Board

Offer an ‘In Your

Shoes’ opportunity

to all staff to

shadow other staff

members

All staff survey results to be

analysed to ensure complianceExecutive Board

Mandatory Statements

Review of Services

During 2018/19 CIC Bedfordshire provided and/or sub-contracted a number of NHS services

including MSK related physiotherapy, MSK related podiatry, community triage clinics

(Advanced Practice Physiotherapists -APPs & MSK Physicians), Orthopaedic Surgery, Pain

Management and Psychology, Rheumatology and Chronic Pain; with some associated

diagnostic procedures.

During 2018/19 CIC Greenwich provided and/or sub-contracted a number of NHS services

including MSK related physiotherapy, MSK related podiatry, community triage clinics

(Advanced Practice Physiotherapists -APPs & MSK Physicians), Orthopaedic Surgery,

Rheumatology and Chronic Pain; with some associated diagnostic procedures.

CIC has reviewed all the data available to them on the quality of care provided in all of

these NHS Services.

Registration and External Review

Circle Clinical Services Limited is required to register with the Care Quality Commission

and its current registration status is registered and has been inspected. This registration

covers both CIC Bedfordshire and Greenwich. The Care Quality Commission has not taken

enforcement action against Circle MSK services during 2018/19.

Site Regulated Activity

Registered Address –

Circle MSK Bedfordshire

Enhanced Services Centre

3 Kimbolton Road

Bedford

Bedfordshire

MK40 2NT

• Diagnostic and screening

procedures

• Surgical procedures

• Treatment of disease, disorder or

injury

Local Greenwich Satellite –

Circle MSK Greenwich

30 Passey Place

Eltham

London

SE9 5DQ

• Diagnostic and screening

procedures

• Surgical procedures

• Treatment of disease, disorder or

injury

55

CQC Inspection Area Ratings

The CQC inspected CIC on 20th September 2018. The inspection was carried out under

Section 60 of the Health and Social Care Act 2008 as part of the CQC regulatory functions.

The inspection team consisted of a lead CQC inspector, a GP specialist advisor and a nurse

specialist advisor to the CQC.

The summary of findings from the report were stated as :

Are services safe?

We found that this service was providing safe care in accordance with the

relevant regulations.

Are services effective?

We found that this service was providing effective care in accordance with

the relevant regulations.

Are services caring?

We found that this service was providing caring services in accordance with

the relevant regulations.

Are services responsive?

We found that this service was providing responsive care in accordance with

the relevant regulations.

Are services well-led?

We found that this service was providing well-led care in accordance with

the relevant regulations.

56

CQC Inspections and rating for specific services

The CQC inspection was undertaken under the Doctor/GP framework, at the time of

inspection this framework did not provide an overall rating. A link to the full CQC report

can be found at https://www.cqc.org.uk/location/1-2955328850.

Commissioning for Quality and Innovation (CQUIN) Payment Framework

A proportion of CICs income in 2018/19 was conditional on achieving quality improvement

and innovation goals agreed between CIC and their respective CCG’s, through the

Commissioning for Quality and Innovation payment framework. The Bedfordshire scheme

related to the setting up of a patient helpline, stakeholder engagement, falls prevention

and patient education. The Greenwich scheme related to improving staff health and

wellbeing, advice and guidance for GP’s, Preventing ill health by risky behaviours – alcohol

and tobacco, Improving the uptake of flu vaccinations for frontline clinical staff.

Data Quality

CIC maintains a high level of data quality and regularly reviews this to ensure we have a

robust view of the service performance in order to gain assurance that the data used to

manage the service and understand current performance is accurate. We do this through

reviewing metrics on a daily, weekly and monthly basis. This is supported by a suite of

reports generated from strategic reporting in SystmOne and our bespoke Data Warehouse.

This is further supported by a regular review of the data behind the reports to ensure

accuracy. Investigations are undertaken on ad hoc where data anomalies are identified

during our regular reviews of the data.

Secondary Uses Services

CIC services submitted records during 2018/19 to the Commissioning Data Set for inclusion

in the Hospital Episode Statistics which are included in the latest published data.

The percentage of records in the published data which included the patient’s valid NHS

Number was:

• 100% for outpatient care

57

Participation in Clinical Audits & National Confidential Enquiries

During 2017/18, there were no national clinical audits and no national confidential

enquiries that covered NHS Services that CIC provides.

The local clinical audits that CIC Bedfordshire and CIC Greenwich undertook in during

2017/18 are as follows:

Name of AuditAudit

CategoryComplete/Ongoing

When

measured

Referral to secondary care from clinic Internal Ongoing Daily

Referrals triaged to Secondary Care Internal Ongoing Daily

Reason for rejected referrals Internal Ongoing Monthly

‘Red flags’ notes audit Internal Ongoing Biannually

Medical Records (Clinical Notes Audit) Internal Ongoing Quarterly

Infection Prevention & Control Internal Ongoing Annual

Hand Hygiene Internal Ongoing Monthly

Environmental Audit Internal Ongoing Monthly

Fire Safety External Complete Annually

Compassion in Care Internal Ongoing Monthly

Resuscitation Equipment Internal Ongoing Weekly

Peer review of clinical assessments and

injection techniques

Internal Ongoing Biannually

Injection Clinical Outcomes Internal Complete Annually

Diagnostic request audit Internal Complete Annually

Fire Warden Audit Internal Ongoing Monthly

Out of Hours Audit Internal Complete Annually

ISO 27001 Internal Audit Report External Complete Annually

Health and Safety Audit Internal Ongoing Monthly

Health and Safety Audit Internal Complete Annual

Waste management audit (Greenwich

only)

Internal Ongoing Monthly

58

The aim is to take the following action to improve the quality of the healthcare provided:

• Share findings of audits at the CGRMC.

• Ensure dissemination of learned themes from audits.

• Give visibility to all team members of the audits that are planned for the year.

• Utilise the results of audits to improve clinical outcomes and improve patient

pathways.

Participation in Clinical Research

CIC is working in collaboration with Loughborough University to scope research projects

only with patients express consent and aligned to GDPR guidance..

Data Security and Protection Toolkit

A group-wide submission for the DSPT was submitted in March 2019.

Safeguarding

The Executive Board is accountable for and committed to ensuring the safeguarding of

children and all adults in their care. CIC also has a responsibility to liaise with other

agencies and provide information to them where necessary, to ensure the ongoing safety of

children and vulnerable adults once they leave our care.

Circle has a Safeguarding Policy that applies to all its facilities including CIC, the current

policy was issued in May 2018. CIC Bedfordshire adheres to the Bedford Central and

Bedford Borough Local Authority safeguarding procedures. CIC Greenwich adhere to the

Greenwich Borough Local Authority Safeguarding Procedures. All policies are available to

staff via the electronic policy library.

CIC provides all staff with Level 2 training in safeguarding. CIC has two dedicated

Safeguarding Leads who have Level 3 training (Clinical and Governance Leads). This has

been reviewed in line with the January 2019 intercollegiate document. The NHS

safeguarding app is available to all staff through the Circle Intranet and staff are

encouraged to download the app onto their mobile phone providing staff with the up to

date contact numbers and guidance where required.

The Corporate Quality and Assurance metrics reports safeguarding incidents and these are

discussed at the Clinical Governance and Risk Management Committee. The Executive

Board takes the issue of safeguarding extremely seriously and receives an annual report on

safeguarding.

59

Payment by Results

CIC was not subject to the Payment by Results clinical coding audit during 2018/19 by the

Audit Commission

Duty of Candour

Circle implements the statutory Duty of Candour Regulation of the Health and Social Care

Act 2008 (Regulated Activities) Regulations 2014 which came into legal force in 2015 and

builds on the requirements set out in the Being Open Framework 2009 “Being Open –

Saying Sorry When Things go Wrong” National Patient Safety Agency (NPSA), and Safety

Alert 2009

Circle has a Duty of Candour policy that applies to all facilities within Circle, this policy

was issued in November 2016. The aim of the policy is to help all health professionals to

apply Duty of Candour principles within their daily work. All incidents which involve Duty

of Candour are discussed within the Clinical Governance and Risk Management committee

meetings on a monthly basis, which are then taken to the Executive Board

There has been no statutory reporting to the CQC for Duty of Candour for CIC services

during 2018/19

Revalidation

CIC has embraced the process of revalidation for medical staff in 2018/19. This is fully

implemented and compliance is monitored quarterly by the Circle Integrated Governance

Committee

Freedom to Speak Up

Circle Health is committed to the principles of the Freedom to Speak Up review; listening

to our staff, learning lessons and improving patient care. Anyone who works (or has

worked) at Circle Health can raise concerns. This includes agency workers, temporary

workers, students and volunteers. Staff can speak up if they have concerns over risk,

malpractice or wrong doing. Examples of this may be regarding the quality of care, patient

safety or bullying and harassment within the organisation.

Circle has a Director who is the Freedom to Speak Up Guardian with board level

responsibility and each Circle site has Speak Up Guardian champions who staff can raise

concerns with. In addition, there is a non-executive Director with responsibility for

whistleblowing.

60

Freedom to Speak Up

Staff are encouraged where appropriate, to raise concerns formally or informally with

their line manager. Where they don’t think it is appropriate to do this, they are

encouraged to contact the Freedom to Speak Up champions or guardian. Concerns can be

raised in person, by telephone or in writing (including email).

Circle hopes that staff feel comfortable raising concerns openly, but we also appreciate

that they may want to raise it confidentially or anonymously. Where an individual wishes to

remain anonymous, Circle will keep their identity confidential unless required to disclose it

by law.

Any individual who raises concerns can expect to be treated with respect at all times.

When a concern is raised, we discuss the concerns with the individual to understand

exactly what they are worried about. We confirm how long we expect the investigation to

take and agree how we will keep the individual up to date with its progress. Wherever

possible, we share the full investigation report with the individual who raised the concern.

Where an investigation identifies improvements that can be made, these are monitored by

the site executive board and lessons are shared with teams across the organisation through

the Integrated Governance Committee.

The Circle Group Operating Board has company wide responsibility and oversight for

quality and assurance. The Freedom to Speak Up Director provides the board with high

level information about all concerns raised by our staff through this policy and actions

taken to address any problems.

61

62

Getting in touch

Contacts

Comments and Complaints

Please speak to or address your correspondence to the Quality & Assurance

Facilitator.

Telephone: 01234 639089

In writing: Regent House, Wolseley Road, Woburn Road Industrial Estate, Kempston,

Bedford, MK42 7JY

Via email: PALS@circlemsk.co.uk

Bedfordshire (CQC Registered address)

Enhanced Services Centre,

3 Kimbolton Road,

Bedford,

Bedfordshire,

MK40 2NT

01234 639000

Greenwich

Eltham Community Hospital

30 Passey Place,

London,

SE9 5DQ

0203 893 8382

Acronyms

A glossary of all acronyms in the Quality Account

CAS – Central Alerting System

CCSL – Circle Clinical Services Limited, or CIC for short.

COS – Circle Operating System

CQUIN - Commissioning for Quality and Innovation

APP – Advanced Practice Physiotherapist

FFT – Friends and Family Test

HCA – Health Care Assistant

IPH – Integrated Provider Hub

LEAP – Lifestyle, Education, Activity and Pain management Programme.

MDT – Multi-disciplinary team

MSK – Musculoskeletal

PPG – Patient Participation Group

SDIP – Service Development Improvement Plan

SQPR – Service Quality Performance Report

63

Comments

Bedfordshire Clinical Commissioning Group (BCCG)

Comments from Bedfordshire Clinical Commissioning Group on Circle Quality

Account 2018/19

Bedfordshire Clinical Commissioning Group (BCCG) acknowledges the receipt of Circles Quality

Accounts 2018/19, which has been shared for comments.

We have appraised the information provided within the Quality Account and cross referenced

data with information that is submitted to BCCG as part of Circles contractual obligation.

BCCG is pleased to note Circle Health’s CQC inspection in September 2018 and

recognise Circle Bedfordshire are reported by CQC as providing safe, effective, caring,

and responsive and well led services.

The Circle quality account reflects on priorities for 2018/19 and achievement and progress

against these. 2018/19 focussed on referral activity and implementing support for patients

using alternative treatments and videos instead of paper exercise sheets. We recognise

the demonstration of improvement that is outlined in these accounts

Circle’s quality priorities for 2019/20 are a continuation of the quality strategy priorities and

are based on the feedback received from patients in 2018/19.We note that a developed

structure is in place for measurement and reporting of performance against these

priorities.

Bedfordshire Clinical Commissioning Group welcomes the opportunity to comment on this

report and looks forward to a new year of working with colleagues at Circle to monitor the

continued Quality and Safety and increased service user input in the wide range of service

provision for patients in Bedfordshire.

Anne Murray Chief Nurse Bedfordshire, Luton & Milton Keynes Commissioning Collaborative

64

Comments

Healthwatch Bedford Borough (HBB)

65

Community Interest Company No 8385413

21 - 23 Gadsby Street Bedford MK40 3HP Telephone 01234 718018 Email:enquiries@healthwatchbedfordborough.co.uk Website: www.healthwatchbedfordborough.co.uk

Ms Amanda Phillips Director of Integrated Care Operations Circle Integrated Care

(by email)

Dear Amanda

Circle Integrated Care (CIC) Quality account 2018 - 2019

19th June 2019

Healthwatch Bedford Borough (HBB) is pleased to be requested to comment on this important document.

As you will be aware HBB has been supporting CIC in its desire to become “user” (Patient) driven.

It is pleasing to note on page 10 about the savings of over £19 million for the BCCG, which is hopefully being channelled into further improvements in patient care in Bedfordshire.

The CIC Operational Model shown on page 19 is to be commended, but it will rely on all elements of the Integrated Provider Hub being fully effective at all times.

On page 44 there is reference to 499 pieces of feedback during 2018/19 which comprised of complaints, concerns, comments and PALS (Patient Advice & Liaison Service) enquiries. It would be helpful to know whether the number of PALS enquiries shown includes complaints at all, or whether they are purely

“directional” enquiries.

HBB has looked at the processes for Concerns and Complaints as published on the CIC website – it is really not quite clear how a patient should distinguish between a “concern” and a “complaint”. Indeed it indicates that in respect of a concern “to confirm all the points you have raised which will be investigated. This gives you an opportunity to amend the points as appropriate and you will be moved to the complaints process”. Some clarification on these matters might be appropriate.

On page 50 there is the comment that “In 2019 Circle moved telephone platforms to UCONE successfully”. HBB is not quite clear as to whether this is the system referred to in the November 2018 letter from the Director of Operations.

In summary the Quality Account presents a positive position and HBB is pleased to see the Quality Improvement Priorities for Bedfordshire 2019/20.

Yours sincerely

Laurie Hurn Laurie Hurn Manager and Company Secretary

Comments

Healthwatch Central Bedfordshire

66

Circle Clinical Services Limited (‘Circle Integrated Care’) Quality

Account June 2019

Review by Healthwatch Central Bedfordshire

Circle Integrated Care are in the fifth year of delivering musculoskeletal (MSK) healthcare

in Bedfordshire.

Healthwatch Central Bedfordshire (HWCB) continue to have contact with patients from the

service, who have concerns or issues, ranging from: access, communication, treatment

issues and choice. We are encouraged by the prompt and thorough responses that we have

received from the PALS team.

HWCB are concerned to see that patient issues are often about similar themes, which the

service needs to consider and investigate further, as common themes often highlight

problems in the system, and if addressed, can drive improvements in practice. We will

continue to monitor the feedback we receive and communicate both individual cases and

thematic issues as appropriate.

In relation to sub-contracting provision, Circle has robust quality monitoring processes in

place, however it would be helpful to understand how much of the work is delivered under

these arrangements.

The quality improvement priorities table clearly sets out what Circle is looking to achieve

and HWCB would like to see more examples in the Quality Account on how these

achievements and other work have improved the patient experience.

In relation to patient feedback we note that there are four categories including enquiries,

complaints, concerns and compliments. It is encouraging to see that ‘Patients who

complained represented only 0.1% of the referrals’. It is, however, important to consider

that this is only representative of those who actually make contact to raise their concerns.

We are pleased to see that Circle continues to explore new ways to gain patient feedback.

HWCB also feel it is important that the range of staff, with differing job descriptions, should

communicate their roles and responsibilities more effectively to prospective patients. This

will help build patient confidence in non-clinical/less qualified staff.

Healthwatch Central Bedfordshire would welcome the opportunity to build on the patient

experience work undertaken in April 2018 to include an open dialogue with the Patient

Representative. HWCB are also keen to include Circle MSK in our public events, such as the

Festival for Older People in October, where their presence in the past has been valued by

visitors.

Healthwatch Central Bedfordshire Capability House, Wrest Park, Silsoe, MK45 4HR Email: info@healthwatch-centralbedfordshire.org.uk Tel: 0300 303 8554

www.healthwatch-centralbedfordshire.org.uk

Comments

Healthwatch Greenwich

67

Healthwatch Greenwich Response to Circle MSK 2018-2019 Quality Account

Healthwatch Greenwich welcomes the opportunity to comment on the quality of service provided by

Circle MSK as compiled in the 2018-2019 Quality Account.

General Comments

Healthwatch Greenwich would like to praise the wide range of improvements on quality of service and

patient experience in 2018/19 as compared with the previous year. In future reports, it would be useful

to see trends set out over a longer time period (three years) rather than from year to year.

We welcome the addition of the glossary, as suggested in our feedback to the 2017/18 Quality Account.

As suggested last year, the addition of a brief executive summary and an Easy Read version would

increase accessibility of this document and we are disappointed not to see them.

Service Progression

We are pleased to see all referrals triaged within 24 hours and a decrease in waiting times. We welcome

the new community location (Grabadoc) giving additional convenient access for Greenwich residents, a

significant increase in community activity and high patient satisfaction ratings for community clinics. Easy

access to services is of key importance to Greenwich residents and we are pleased with the progress CIC

has made to facilitate this.

Some Greenwich residents report difficulties getting through on telephone lines to the service and

needing to ‘chase’ appointments, suggesting there are administrative concerns that need to be

addressed. Our findings mirror the data provided by CIC in which the main categories of non-positive

feedback concern problems with administrative processes. We are pleased to see that a full review of

administrative processes has been undertaken.

The introduction of innovation in self-management (Physitrack and Physioline) are useful additional

tools, however without independent evaluation it is difficult to form a view on patient experience in the

use of these tools. Healthwatch Greenwich are keen to work with CIC to evaluate patient experience in

the use of these new tools as part of an annual independent review of the service (as we did in 2017/18).

Healthwatch is pleased to see that no serious incidents or ‘never events’ were recorded for 2018/19.

Patient Engagement

CIC carry out a broad range of internally led activity to gather patient feedback experiences, satisfaction

levels are high and complains and concerns have reduced significantly from 2017/18. However, response

rates for patient feedback have not met agreed targets. There is still some work to do to increase

response rates and analyse responses by protective characteristics to ensure all service users have a

Comments

Healthwatch Greenwich

68

positive experience. Overall, CIC would benefit from an annual, independent, review of patient

experience.

Quality Improvement Priorities for 2019/20

We are pleased to see an emphasis on patient experience and welcome the use of broader methods to

collect feedback. However, the priorities lack measurable success thresholds. This will make it difficult to

assess the extent to which these targets have been met in 2019/20.

Healthwatch Greenwich

June 2019

69

Enhanced Services Centre, 3 Kimbolton Road,

Bedford, Bedfordshire, MK40 2NT