SOUTH WEST CARDIFF NETWORK CLUSTER … West Cluster...September 2015-version 1.4 SOUTH WEST CARDIFF...

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September 2015-version 1.4

SOUTH WEST CARDIFF NETWORK CLUSTER ACTION PLAN 2014-17

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Cluster Plan Version Control Log

Date Version ID Action Amendments Changed By

30 September 2014 Version 1.1 Submitted to PCT

4 December 2014 Version 1.2 Update of Public Health Actions/Older People

Actions/EOL Care

1.3b /1.3d/1.3e/1.4c/1.10/1.7 a/1.7b/1.8c/1.8d/1.8g

Locality Manger

20 September Version 1.4 All completed actions that were assessed as Green in

Sept 2015 have been removed

Locality Manager

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SOUTH WEST CARDIFF NETWORK CLUSTER ACTION PLAN 2014-17

This plan has been developed by the following 11practices which operate in the South West Cluster Area, through facilitated discussion with the Community Director and Locality Manager:-

• Lansdowne Surgery

• Woodlands Surgery

• Kings Road Surgery

• St David’s Court Surgery

• Greenmount Surgery

• Canna Surgery

• Westways Surgery

• Ely Bridge Surgery

• Caerau Lane Surgery

• Taff Riverside Surgery

• Llandaff fields The original 3 year plan was established by the cluster in 2014 and this update, reflects the current cluster priorities, based on progress since March 2015 and GMS contract requirements for 2015/16. Although the strategic aims referenced within the document are reflective of guidance provided with the contract, the format primarily represents the strategic aims as identified by the cluster practices. Outline of Cluster Population Profile The latest area population estimates vary between 52,000 and 59,600, which is approximately 16% of Cardiff's total population. The neighbourhood has a higher proportion of persons aged 0-15 and 30-44 than the Cardiff average. Conversely it has a lower proportion of persons aged 16 - 29 and post retirement. According to the Census 2011 information 83.95% of residents were of white ethnic city. This is slightly lower than the Cardiff average of 84.7%. The area has higher than average levels for Cardiff of unemployment claimant rates whilst more than 50% of children aged 0-15 live in the most deprived decile of education domain in Wales according to the Welsh index of multiple deprivation. Similarly 44.6% of 0-15-year-olds live in the worst decile or tenth of communities in terms of income deprivation, more than four times the expected share.

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The Plan The plan has been informed by the practice development plans produced by practices; public health information on key health needs within the area; information provided by NWIS and Cardiff and Vale UHB in respect of referral and activity levels; a knowledge of current service provision and gaps within the area and an understanding of key UHB priorities for the next three years. The plan details cluster objectives for years 1-3 (2014/2017) that have been agreed by consensus across practices, providing where relevant background to current position, planned objectives and outcomes and actions required to deliver improvements. The cluster views this plan is a dynamic and evolving document and therefore, the plan itself will be reviewed and updated as required. The RAG rating score indicates progress against planned action (Red-work yet to start, Amber- Some progress made, Green-action has been completed). A number of key principles underpin the plan: Management of variation/reducing harm/sharing good practice: in acknowledgement of the fact that healthcare must be delivered on the basis of safety, effectiveness and efficiency, the practices have considered and analysed variation in performance and where appropriate have considered steps by which to map standardise practice based on clinical guidelines. Maximising use of Local Cluster Resources: practices have taken into account the capacity, capability and expertise that exists within primary care, community services and voluntary/third sector services to deliver more care closer to home and reduce unnecessary demands within the acute care services. Promoting integration/better use of health, social care and third sector services to meet local needs: practices have considered current arrangements/links with Cardiff Council and the voluntary sector and have also considered action plans that have been developed by the local neighbourhood partnership group. Considering and Embedding New Approaches to Delivering Primary Care: this includes increased use of technology, new roles and service models considering an embedding new approaches to delivering primary care: this includes increased use of technology new roles Maximising opportunities for patient participation: this includes consideration of models of good practice that exist with within/locality/cluster and nationally and within the rest of the UK. Maximising opportunities for more efficient and effective use of resources: this includes consideration of current resources, opportunities to utilise and current and new services more efficiently and effectively Additional contributors to the plan

• Health and social care facilitators

• Local voluntary sector providers

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• Lead consultant geriatrician for the locality

• Relevant secondary care consultants

• Prescribing advisers

• Cardiff and Vale C HC

• ACE

• Neighbourhood Partnership References: Cardiff South West Neighbourhood Partnership Action Plan Dementia Plan 2014 GMS Contract 2015/16

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Strategic Aim 1: Identified Health Care Need within Population Serve by the Cluster: In Cardiff, 9.5% of its total population live in the 10% most health deprived Lower Super Output Areas (LSOA’s) in Wales (i.e. those ranked 1-190). This proportion varies greatly across the neighbourhood areas. Cardiff South West (23.2%) has the highest proportion of its residents living in these most deprived areas. Age standardised all-cause mortality rates for the period 2004-2008 for all persons, as well as those aged under 75, is 418 per 100,000 population in Cardiff South East, compared with a Cardiff average of 345 per 100,000 population. In 2012 the Welsh Government produced information on the combined lifestyle behaviour of adults (i.e. smoking, alcohol consumption, fruit and vegetable consumption, and physical activity). The mean number of healthy behaviours adhered to by adults in Cardiff was 1.9. Just 5% followed all four of the healthy behaviours, while 23% followed three, 39% followed two, 26% followed one, and 7% followed none. These were almost identical to the figures for Wales as a whole where the mean number of healthy behaviours was only 2.0. Data from the 2011-2012 Welsh Health Survey show that :

• 26% of adults in Cardiff reported binge drinking on at least one day in the past week, compared to 27% for the whole of Wales;

• just over a fifth (21%) of adults in Cardiff reported being a current smoker;

• only a quarter (25%) of Cardiff’s adults indicated that they did at least 30 minutes of at least moderate intensity physical activity on five or more days a week compared with an all-Wales figure of 29%

• 34% of adults in Cardiff had eaten five or more portions of fruit or vegetables on the day prior to the survey date compared to 33% for the whole of Wales.

• The latest ONS data indicates that the rate of teenage pregnancies in Cardiff is 8.6 per 1,000 for under 16s (Wales is 6.1 per 1,000), and 39.2 for under 18s (Wales 34.2)

In producing this plan, all of the cluster practices have reviewed their population needs, taking into account public health demographic data; disease registers; data provided in terms of emergency admissions/elective care referrals; review of risk patient cohorts etc.. The plan seeks to address the primary areas of health need common to the majority of practices within the cluster, acknowledging that for some practices, more specific work is required internally to meet the needs of some patient groups.

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Ref No: Key Issue Current Position Objectives/Anticipated Outcomes for Patients

Specific Actions Required

Key Enablers/Partners

Lead Responsibility

Timelines

1.1a Key lifestyle behaviours of the population of Cardiff South West

These 5 key areas of lifestyle behaviours all have major implications on health and wellbeing for the residents of Cardiff West: smoking, alcohol, physical activity, diet and immunisations

Increased basic understanding of key public health messages and where to go for further information on a topic

All relevant Practice staff undertake attend Making Every Contact Count (2.5 hours) training

Public Health Practice Staff

Public Health/Practice Managers

End 2017

1.2a Alcohol Consumption

43% of Cardiff population drink above recommended limits (39%-50% in Cardiff South West) 26% of Cardiff population binge drink (twice recommended limits on heaviest drinking day in past week) (25%-32% in Cardiff South West) PHW Observatory data Cardiff South West has high rates of alcohol-specific admissions to hospital and alcohol-specific mortality compared to the rest of Cardiff and the Vale

To reduce excessive alcohol consumption among the cluster population

All relevant staff within practices to undertake brief intervention training so that they can provide brief advice & information to patients about reducing alcohol consumption

Public Health Cluster IT consultant

Practice Managers

End of 2016

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Lead Responsibility

Timelines

1.2b Scope an IT mechanism within practices by which to embed clinical guidelines and demonstrate activity that supports reduction in alcohol consumption

Public Health Cluster IT consultant

Kings Road Surgery Community Director/Practice Managers

End of 2015

1.3a All practices should be aware of the Smoking Cessation pathway which includes referral to SSW or support at GP Practice level. Some practices use a combination of both methods. If preferring to support the client at Practice level, it is recommended that all staff are trained in Brief Intervention for Smoking Cessation and/or specific smoking cessation training to deliver a dedicated support programme. All practices choosing to support clients directly should use CO testing to validate the quit attempt.

To increase engagement of Practices in the Smoking Pathway

All practices to consider engagement in smoking cessation pathway

SSW/Public Health Ely bridge Surgery

November 2015

1.3b Updated Dec 2014

To develop smoking cessation guidelines/template link to e-referral system

VIPC PHT/KP/NG

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Specific Actions

Required


Lead Responsibility

Timelines

1.4a Diet and Exercise

53% of adults and 27% of children in Cardiff are reported as overweight or obese. Only 25% of Cardiff adults report being physically active on 5 or more days during the previous week. Only 34% of adults in Cardiff and Vale reported eating at least 5 portions of fruit and vegetables a day.

To promote healthy lifestyle among cluster population

Engage in public

health pilot to

increase referrals to

exercise schemes &

local physical activity

opportunities

Develop template to

encourage referrals to

NERS

Public Health/Communities First/c3sc/sw Neighbourhood Partnership

Lansdowne surgery

Ongoing

1.4b Create computer templates to aid referral to services for practices in cluster to use

Community Director

March 2016

1.4c Update Dec 2014

To establish Link with Community Ambassador to maximise promotion of physical activity

To work with third sector to develop this role

ACE/Careau Lane Surgery

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Lead Responsibility

Timelines

1.5a Teenage Pregnancy

The latest ONS data indicates that the rate of teenage pregnancies in Cardiff is 8.6 per 1,000 for under 16s (Wales is 6.1 per 1,000), and 39.2 for under 18s (Wales 34.2)

To ensure adequate provision of contraceptive services, ensuring appropriate targeting of younger women/reduce teenage pregnancy rates within SW Cluster

Invite Rebecca Lewis (Public Health) to cluster meeting to discuss opportunities to maximise targeting of young people

Public Health/Communities First/Local Schools via Neighbourhood Partnership/ Team Around Family/Families First/ Sexual Health Outreach Team (SHOT)

PHT/ Westway Surgery

March 2017

1.5b Reduction in unplanned pregnancy rates

Establish inter-practice referral system for LARC within the cluster

Woodlands Surgery

March 2016

1.6 Child Health

Significant levels of young families, requiring support on a number of issues

To maximise support to young families so as to ensure maximum potential /outcomes are achieved

Practices to maximise use of Team Around the Family/Flying Start Services provided within the cluster

TAF/Flying Start/Communities First

Community Director

March 2016

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Specific Actions Required Key Enablers/Partners

Lead Responsibility

Timelines

1.7a Health Screening

Although the cluster performs reasonably well for breast screening, screening for bowel cancer and cervical screening can be improved upon

To achieve the target bowel screening target

Meet with Bowel screening Services to identify opportunities to improve uptake rates

Bowel Screening Team

Public Health Wales/Community Director

March 2017

1.7b To demonstrate improved screening uptake rates within ethnic minority communities

To continue to work with Community Leaders to discuss ways to improve screening uptake rates, plans-

Public health Screening Wales BRG communities first

St Davids court Surgery Taff Riverside Surgery

March 2017

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Lead Responsibility

Timelines

1.8a There is a need for practice staff to have specific training to best support the needs of patients with dementia 3 of the 10 practices within the cluster have received specialist training

To ensure all relevant staff have the skills to support patients with dementia

All relevant practice staff undertake Dementia Awareness Training

Public Health Practice Managers

2 years

1.8b To develop a cluster guideline to standardise annual review of patients with dementia according to UHB guidance

Cluster IT consultant Cluster Lead CD

March 2016

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Lead Responsibility

Timelines

1.9a Older People/Falls

Significant morbidity from falls. Falls a predictor of hospital admission There is an agreed C&V Falls Pathway, which has not been adopted consistently across the cluster- how many practices are using pathway

Modifiable risks are addressed reducing morbidity from falls To ensure that patients identified at risk of falls (including notifications via WAST/Emergency Unit) are assessed for falls risk and referred for relevant diagnostics/referred to relevant community services to maximise opportunities to reduce falls risks

GPs throughout the cluster will seek to increase the utilisation of C&V Falls Pathway to identify falls risk and refer to appropriate services

Day hospital/ECAS/CRTs/NERS

Lead GP within practices

6 months

1.9b A template will be developed to record activity specific to falls management within the cluster including risks associated with Polypharmacy

Cluster IT consultant CRT Cluster pharmacist

Community Director

6 months

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Specific Actions Required Key Enablers/Partn

ers

Lead Responsibili

ty

Timelines

1.9c

Care and Repair- Healthy at Home Project. This project offers individuals (at 75 years) the opportunity for specialist support in relation to repairs, adaptations and general home maintenance, thus enabling them to remain independent at home for as long as possible and reducing risks’ such as falls. The scheme has been presented to all practices within the cluster. Some practices are already engaged Currently only 4 practices within the cluster are engaged Updated Dec 2014- all practices now engaged

Increase awareness of care and repair services offered. Enabling older people requiring modifications at home to have option to make contact with local reliable partner to carry out rep[airs/modifications to their home Reduce falls risk within the home

All practices within the cluster Practices to engage in Care and Repair Care @Home Project for 2015/16

Project Leads/publicity/infrastructure to support scheme implementation provided by

Practice Mangers

November 2015

1.9d Although the growth in older population is not as great as in some areas, the Cluster has a number of nursing and residential homes, not all of which are covered by the Nursing home enhanced service

To ensure adequate levels of proactive support to people in care homes

Cluster practices to consider uptake of newly released NH LES to enhance levels of input into all NHs within cluster

Community Director/Locality Manager

All practices to consider uptake of LES

Within 6 months

1.9e Practices to consider adoption of frailty scale to direct referrals to community services

LSD Lead GPs

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Lead Responsibility

Timelines

1.10 Diabetes The Cluster Practices are currently engaged in the Community Diabetes Model

To maximise opportunities to increase the level of community based diabetes care

Practices will continue to engage in the Community Diabetes Model

Consultant Lead Lead GPs Ongoing

1.11a Flu Immunisation

Tier 1 target. Cluster practices have traditional achieved better uptake rates in patients aged 65 year + but uptake in high risk groups has been difficult to achieve

To promote uptake of flu immunisation among target population within the cluster

Provide promotional material to be displayed in community settings.

To promote uptake of flu immunisation among target population within the cluster

Public Health/Practice Manager

March 2015

1.11b Investigate IT support systems to allow recall of eligible patients

Westways Surgery

Sep 2015

1.11c To adopt the pacesetter pathway for flu and pneumococcal immunisation in at risk groups

Primary care Practice Managers

Sep 2015

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Lead Responsibility

Timelines

1.11d Update Dec 2014

All practices to identify immunisation champion within practice to coordinate immunisation activity and engage in a champions network group

Practice Managers Practice Manager from Westways to coordinate updates from cluster on progress

Dec 2015

1.12 Domestic Violence

27,537 Domestic Abuse incidents in South Wales 2012-13

To reduce incidents of Domestic Abuse in SW Cluster

To ensure the cluster is appropriately engaged in SW Police and Crime Reduction Action Plan 2014-17 Iris Project

Caerau Lane LSD GP Lead

March 2017

Strategic Aim 2: To ensure Sustainability of Core GP Services and Access Arrangements that Meet Reasonable Need (including new approaches to Delivering Primary Care)

As part of their Practice Development Plans, all practices within the cluster have reviewed issues such as number of GP appointments provided to practice population , hours of services, inappropriate use of GP OOhrs services by patients, DNA rates, use of technology such as My Health on Line/Texts messaging etc. This plan identifies areas of commonality across the Cluster Practices, accepting that some practices will have identified specific internal developments that they will take forward as part of PDPs.



Lead Responsibility

Timelines

2.1 Interface Limited use of technology to support interface between primary and secondary care

Establish more virtual consultation processes with Secondary Care Services

Maximise opportunities to improve interface with secondary care specialist (eg as per Paediatrics/Community Diabetes Model)

Medicine Clinical Board/ Specific Directorate

Community Director

March 2016

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Lead Responsibility

Timelines

2.2 Patient Participation

Other than the annual CHC patient satisfaction process, there is no structured, consistent means of seeking patients views within the cluster

Improve Patient Participation and Influencing Service Delivery

Scope the potential of third sector coordinating a patient participation group on behalf of the cluster

C3Cs Locality Manager/PMs from Ely Bridge, Westways, St Davids Court

November 2015

2.3 infrastructure

Cardiff LDP when passed will lead to significant housing developments in Cardiff South West Cluster

Maintain high levels of access to appropriate health care professionals for all patients of Cardiff South west Cluster

Community Director, Locality Manager and GP Lead from Westways to continue discussions with PCIC Board and key stakeholders to identify opportunities to improve health access within SW Cardiff

PM’s PCIC Locality CD’s

Community Director/Lead GP Westways and Locality Manager

March 2016

2.4a IT Varying use of technology to improve access across the cluster

Greater use of My Health Online to improve appointment access; and prescription services

Greater adoption by PHCT’s across Cluster Group

Practice Managers

Practice Managers March 2016

2.4b Undertake a scoping exercise across the cluster to determine opportunities that IT brings for maximising access

Practice Managers Primary Care Foundation

Community Director

March 2015

2.5 Use of Health Services

Some Populations with North cluster are very diverse, there are difficulties associated with language barriers and cultural views as to how health services should be used

To ensure patients are fully aware of the services that can/ should be accessed to support them

Utilise communities First to support education of local communities

Communities First/C3sc

Neighbourhood partnership Office SW

ongoing

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Strategic Aim 3: Improve Management of Planned Care (including use of Care Pathways) to ensure that patients needs are met through prudent care pathways , facilitating rapid, accurate diagnosis and management and minimizing waste and harm

The Cluster Practices have, over the past 2 years engaged in a number of the elective care pathway developed within C&V UHB in an attempt to either reduce inappropriate referrals to acute hospital specialists/improve of the quality of referrals. All practices have given a commitment to continue to utilise pathways that were adopted previously, but there are clearly opportunities to extend the use of elective care pathways through further primary care developments



Key Enablers/Partners Lead Responsibility

Timelines

3.2a Warfarin Pathway

To provide a comprehensive community based pathway of care for a patient on Warfarin

All practices to consider adopting computerised dosing system and where appropriate, consider level 4 anticoagulation monitoring

PCIC PHCT’s IT system software providers

LSD GP leads March 2016

3.2b All practices to consider taking part in slow loading of warfarin enhanced service

LSD GP leads March 2016

3.3 Mirena Coils Not all practices can provide Mirena Coil insertion – defaults to secondary care referral (gynae or ISH)

Equitable access for all patients’ living in Cardiff North Cluster wishing Mirena Coil insertion

Scoping exercise to determine feasibility of inter-practice referrals for Mirena insertion

PCIC Interested PHCT’s (ISH/Gynea for training)

PM’s Woodlands Surgery

March 2016

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Ref No:

Key Issue Current Position

Objectives/Anticipated Outcomes for Patients



Lead Responsibility

Timelines

3.4 Joint and Soft Tissue Injections

Inequitable service provision across cluster e,g, types of injection; skill sets etc

Reduce secondary care referrals

Identify skill sets and lack of service provision

PHCT GP’s Rheumatology

LSD GP Lead to be agreed

March 2016

3.5 Mental Health Currently there is a lack of counselling provision within practices- long waiting lists for access resulting in referral to secondary care services

To provide sufficient counselling capacity within practices to meet demands

To scope setting up social prescribing for voluntary sector mental health support

CAVAMH Barnardos Community mental health team

Community Director NPO, Caerau Lane Surgery

May 2016

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Strategic Aim 4: To provide high quality, consistent care for patients presenting with Urgent Care Needs/At high Risk of Admission and support the continuous development of services to improve patients experience, coordination of care and the effectiveness of risk management

All cluster practices engaged with a number of emergency care pathways aimed at reducing unnecessary referrals to Secondary Care/attendances at the Emergency Unit. SAs with elective care pathways, practices have committed to engage in the pathways adopted last year, however, further work can be undertaken within Primary care/community to appropriately meet the needs of individuals within the community setting. This section cross references a number of actions from section 1.



Key Enablers/Partners Lead Responsibility

Timelines

4.1 Dental Care/Eye Care

Patients often access GPs inappropriately to assist with urgent dental complaints and eye problems

To ensure patients access right care/right time/right place

Explore options to improve pathways to access other independent contractor services (Dental services/optomotrists)

Primary Care Leads WECS

Community Director

March 2016

4.2 Access to Specialist Opinion

GPS do not have ready access to specialist opinion and as a result feel referral to EU is only option

To provide more seamless access to specialist opinion/reduction in referrals to EU (paediatrics/respirator)

To meet with Consultant Leads for Secondary Care Specialties to identify mechanism for more effective/efficient communication

Secondary Care Consultants

Community Director

September 2015

Strategic Aim 5: Ensuring Effective Use of Diagnostic Services

Cluster practices have, as part of the engagement with elective pathways, sought to improve their use of diagnostic services, they are however aware of the need to review the current variation in both radiological and laboratory testing and to modify practice best on clear clinical evidence/guidelines.

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Lead Responsibility

Timelines

5.1 Laboratory Testing

There is variation both within the Cluster and across Locality/Cardiff and Vale in respect of laboratory testing

To ensure consistency in practice based on clinical guidelines

To agree clinical guidelines for Vit D and develop Vision guideline to standardise adherence across the cluster

Medical biochemistry VIPC

Greenmount Surgery

March 2015

5.2 Radiology Requests

There is variation both within the Cluster and across Locality/Cardiff and Vale in respect of radiology requesting- specifically shoulder ultrasound

To ensure consistency in practice based on clinical guidelines/reduce costs associated within unnecessary Xray Requests

To agree pathway for shoulder ultrasound with Consultant Leads and discuss implement in a cluster meeting

Community Director

March 2015

Strategic Aim 6: To support Delivery of Improvements Against National Priority Areas for Cancer Care, Minimising the Harms of Polypharmacy and Improving End of Life Care

Ref No: Key Issue Current Position Objectives/Anticipated

Outcomes for Patients Specific Actions Required Key

Enablers/Partners Lead Responsibility

Timelines

6.1 Targeting the Prevention and Early Detection of Cancer

Practices to engage in completion of audit of all patients newly diagnosed between 1 January 2015 and 31 December 2015 with lung, digestive system and ovarian cancer and to summarise/share learning and feedback findings to cluster at annual review meeting

All practices March 2016

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Timelines

6.2a Polypharmacy

Improve the safety of care delivered to patients

1.Identify and record numbers and rates for patients aged 85 years or more receiving 6 or more medications ( excluding dressings etc) 2. Undertake face to face medication reviews, using the ‘No Tears’ approach (Appendix 1) for at least 60% of the cohort defined in 1. above (for a minimum number equivalent to 5/1000 registered patients. If the minimum number of reviews cannot be undertaken because of the small size of the cohort defined in 1 above, consider reducing the age limit until the minimum is reached.)

3. Identify any actions to be addressed in the Practice Development Plan.

4. Summarise themes and actions for review with the cluster network and share information with the Health Board as required identify and report the number /% of patients aged 86years or more receiving 6 or more medications

Cluster pharmacists Cluster IT consultant


6.2b To reduce the risk of falls associated with Polypharmacy

To adopt the pacesetter pathway Primary care All practices March 2016

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Timelines

6.3a End of Life Care

Identify all deaths occurring between 1 January 2015 and 31 December 2015 and significant event analysis to assess delivery of end of life care for 2/1000 registered patients. Summarise and share themes/learning with other practices


6.3b To adopt a cluster palliative care IT guideline developed by Macmillan GP

Palliative care Cluster IT consultant

Woodlands surgery

March 2016

6.4 Advanced Care Planning To enable individuals living in nursing homes have choice in terms of preferred place of death

For those practices who provide an enhanced service to nursing homes, there will be a plan in place to ensure all current residents are offered the opportunity to engage in an advanced care plan

All practices engaged in nursing home enhanced service

March 2016

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Strategic Aim 7: Deliver consistent, effective systems of Clinical Governance




Timelines

7 Clinical Governance CGPSAT

The contractor updates the Clinical Governance Practice Self Assessment Toolkit 121 (CGPSAT) and to confirm completion and submission to the LHB by 31 March 2016. The contractor participates in a review of the appropriate healthcare standards in relation to the promotion of safeguarding vulnerable adults; adults with a learning disability; safeguarding children. Practices are expected to achieve at least level 2 CGPSAT assurance. Any improvement actions to be identified by 31 March 2016, or actioned during the year if early identification Practices should consider key issues from the CGSAT for discussion at GP cluster meetings where there may be potential to identify common themes that might be addressed through agreed actions.


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