AGENDA JOINT COMMISSIONING COMMITTEE · Verbal for Approval, Discussion or information By Whom 1. 3.30pm Apologies for absence. Verbal All 2. 3.35pm 5 mins Declarations of Interest

AGENDA JOINT COMMISSIONING COMMITTEE Date: 16th November 2015 Time: 3.00pm Venue: The Bevan Room, 2nd Floor, St Peters House

Item No.

Time Duration Subject Paper/ Verbal for Approval, Discussion or information

By Whom

1. 3.30pm Apologies for absence.

Verbal All

2. 3.35pm 5 mins Declarations of Interest.

Verbal All

3. 3.40pm

10 mins Minutes from the last meeting of the Joint Commissioning Committee held on 21st September 2015 and Matters Arising.

Paper – for approval

All

4. 3.50pm 15 mins Delegated Functions Self Certificate: • Discuss assurance required and internal

audit input.

Paper All

5. 4.05pm 10 mins Report from the meeting of the Primary Care Operational Group meeting held on 2nd November 2015.

Paper Lynda Helsby

6. 4.15pm 30 mins Bolton Quality Contract Update:- • Range of KPI achievement. • Example of a practice prescribing

report. • financial value relating to the

demand management KPI.

Papers – for discussion

Stephen Liversedge

7. 4.45pm 5 mins Any Other Business.

Verbal All

8. 4.50pm Time & Date of Next Meeting: Monday 18th January 2016 at 3pm in the Bevan Room, 2nd Floor, St Peters House.

Verbal All to note

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MINUTES

Joint Commissioning Committee

Date: 21st September 2015 Time: 3.30pm

Venue: Bevan Room, 2nd Floor, St Peters House

Present:

Alan Stephenson CCG Lay Member (Chair of Committee) Annette Walker CCG Chief Finance Officer Stephen Liversedge Clinical Director, Primary Care & Health

Improvement Lynda Helsby CCG Associate Director Primary Care & Health

Improvement Debra Malone Local Authority representative Amanda Clegg NHSE GM Area Team Primary Care Manager

In attendance: Jack Firth Health Watch representative Ivan Benett External GP representative

Minutes by: Joanne Taylor Board Secretary

Item Topic 25/15 Apologies for Absence

Apologies for absence were received from: • Su Long, CCG Chief Officer. • Jane Pilkington, NHSE Head of Public Health Commissioning.

26/15 Declarations of Interest

Stephen Liversedge declared an interest in the items on the agenda relating to primary care.

27/15 Minutes from the last meeting held on 27th July 2015 It was agreed that Amanda Clegg should be listed in the “present” list rather than “in attendance” due to her role as deputy to Jane Pilkington. Further to the above amendment, the minutes were approved as a correct record. Matters Arising: APMS Review It was reported that the CCG has completed an internal review of 4 out of 5 of the APMS contracts. The fifth review requires further information from NHSE which has been requested and awaited. Feedback on the other four contracts had been submitted to NHSE. It was also noted that NHSE has produced a list of all reviews across Greater Manchester, showing Bolton low down on the programme of reviews. The CCG has requested information on how the order had been decided and if Bolton could be placed higher in the review process. Amanda Clegg reported that an update to the principles paper was being presented to the next meeting of the Greater Manchester commissioning managers. Amanda also reported

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that with regard to the timetable for review, an initial assessment had been carried out on the basis of where NHSE assumed CCGs were regarding the reviews. Amanda confirmed that the timetable could be flexible and if there is a requirement to move Bolton up the list, this could be changed. The Committee requested that Bolton be placed higher in the review process. The CCG to also chase up information required from NHSE for the fifth review to be completed. Update from Health Watch on Primary Care Access Jack Firth reported that Health Watch has now completed the work they were undertaking with pharmacies. The next round of work was to review primary care access but due to staff capacity this would be undertaken over the next few months.

28/15 Updated Terms of Reference The Terms of Reference had been updated further to the approval by the Committee of the process for virtual decision making. The decision making process with each member having 1 vote, giving the CCG a stronger vote than NHSE was raised. Amanda Clegg agreed to share terms of reference from other CCG’s Joint Commissioning Committees to help Bolton review this further. The Committee approved the updated Terms of Reference with regard to the virtual decision making process and agreed that a review of the voting process be undertaken. Once clarification agreed, the Terms of Reference would be presented to the CCG Board for approval.

29/15 Report from the meeting of the Primary Care Operational Group meeting held on 8th September 2015 A request was made that, for future meetings, a report be produced rather than presenting the notes from the meetings. Members discussed the development of 7 day primary care access in Bolton. The issues of affordability, timescales and delivering the best model for Bolton were discussed. It was reported that the CCG has commenced discussions with its membership based on the proposal of developing a hub model. The report was discussed and noted. For future meetings a report would be presented to the Committee.

30/15 Bolton Quality Contract Quarter 1 Performance Report Stephen Liversedge presented the BQC performance report for quarter 1. The report had been compiled as a practice report, based on an ‘average’ Bolton practice with an average practice size of 6,022 patients with around 3.5 GPs and 2 practice nurses working 30 hours. All 50 practices were engaged in the standards and practices are working towards the plans submitted. Two visits to each practice had been undertaken, practices were working towards individual and CCG targets and support continued to be provided from the primary care and medicines optimisation team. An update on progress on each of the standards was presented.

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Members discussed the results and in particular discussed the demand management standard and the target for outpatient first appointment where inappropriate referrals factored into this target were not being fully met. Members also discussed the health improvement standard and the challenging targets set. It was noted that Bolton was second in the country for health checks on patients 40-74 years. Members also queried standard 16 regarding phlebotomy and whether savings are being identified. It was reported that this was a block contract and although the CCG was aware of the shift in activity, there were no costs coming back to the CCG associated with this shift. The next steps were noted. This included continuing with practice visits, targeting support where required, a full review at 6 months and targeting those standards requiring further work. Members discussed the assurance required to meet the financial targets set and discussed improvements expected at the 6 month stage. Members also discussed how to present the report to the Committee at future meetings and whether the Committee would wish sight of all 50 reports or present in the same way using an average Bolton practice report. The Committee agreed to receive future presentations based on an average Bolton practice report. It was agreed it would be helpful, where appropriate, to get a feel for the range on where practices are missing the targets and how far from target they are. The Committee noted the Quarter 1 update, in particular the progress made by practices at this stage. An example of a practice reporting on the prescribing and referral review standards would be circulated to members for further information. The range on the number of practices far from target to be produced and included as part of the next update on the BQC. The financial value relating to the demand management standard on outpatient first appointment would also be included in future reports. Exception Reporting – Proposal to change KPI Target Stephen Liversedge reported on the changes to the way QoF now count exceptions. CCGs had only just been made aware of this. The Committee was presented with the exception reporting as it was in 2012/13 on which data has been based and agreement reached that practices do not exception report on more than 3%. From the reporting on the 3% target for 2013/14, this had shown an increase in the number of practices exception reporting. This was due to the different way this was counted by QoF, putting 44 practices off target. To reduce variation, the proposal was to change the target to less than 6% in the way this is now counted. It was noted that there would be no detriment to public if the target was changed. It was further noted that NHSE has been involved in discussions regarding this change and agree to this proposal. The Committee supported the change of the KPI target from 3% to 6%.

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31/15 Any Other Business There was no further business discussed.

32/15 Date of Next Meeting Agreed as 16th November 2015 at 3pm in the Bevan Room, 2nd floor, St Peters House.

1

Joint Commissioning Committee AGENDA ITEM NO: ………5……………… Date of Meeting: ……16th November 2015……………………… TITLE OF REPORT:

Report from the Primary Care Operational Group meeting – 2nd November 2015

AUTHOR:

Lynda Helsby, Associate Director Primary Care & Health Improvement

PRESENTED BY:

Lynda Helsby

PURPOSE OF PAPER: (Linking to Strategic Objectives)

To update the Joint Commissioning Committee on discussions held at the Primary Care Operational Group.

RECOMMENDATION TO THE COMMITTEE: (Please be clear if decision required, or for noting)

To note the discussions held and comment further on any of the items discussed.

2

Report from the Primary Care Operational Group meeting – 2nd November 2015 1 Executive Summary This report provides a summary of the discussions held at the last meeting of the Primary Care Operational Group meeting held on 2nd November 2015. 2 Attendees Stephen Liversedge, CCG Clinical Director, Primary Care & Health Improvement Lynda Helsby, CCG Associate Director, Primary Care & Health Improvement Kathryn Oddi, CCG Primary Care Performance & Support Manager Stephanie Hodkinson, CCG Finance Manager Rachael Chambers, NHSE GMAT Business Manager 3 Items Discussed Level 3 Delegated Responsibility Members discussed the possible changes that may occur to the Joint Committee/ Operational Group if Bolton moves to level 3 delegated responsibility and agreed to review NHSE representation in April 2016. Lynda Helsby also updated that Bolton CCG would be submitting an expression of interest in going forward to level 3 delegated responsibility by the deadline of 6th November. Discussions with the membership would be held throughout November. Unplanned Admissions DES Rachael Chambers confirmed that the number signed up to the Unplanned Admissions DES was 50. BQC Performance The differences with reporting prescribing performance through the Board CFO report and BQC report was discussed. It was noted that the CFO Board report focuses on prescribing in its totality, whereas the BQC prescribing report relates to GP prescribing where differences can be made. Stephen Liversedge had reported this at the last Board meeting. The report for October was being finalised for submission to the next Joint Commissioning Committee. The report would assure that work was happening with all practices across all the standards. There was more work to do on the range of performance rather than the average. Partnership Dispute No 1 Rachael Chambers updated the group on the information received from the medical team. There were currently 2 salaried GPs supporting the practice as one partner had been suspended as a performer for over a year and the remaining partner was on long term sick. The group discussed the need for resolution with clear timescales when these issues will be resolved. Rachael agreed to seek an update urgently and Kath Oddi agreed to liaise with the CCG GP Reference Group.

3

Family and Friends Test There was an issue with one practice not submitting regularly. It was noted that a formal letter was being sent from the national team regarding the future issuing of breach notices. Information was being received monthly which the CCG continued to analyse. DES Minor Surgery and LES Asylum Seekers Review A meeting was being convened to discuss these reviews in more detail. BQC payment process and impact of the reduction of PMS premiums from 1st October It was noted that the changes due to the payment method from 1st October had now been delayed to 1st April 2016, therefore the premium would not start to reduce yet. CCG Quarterly Report: The quarterly report had not been received from NHSE. QoF information provided by NHSE was tabled at the meeting and reviewed by the group. The CCG agreed to review the information in more detail through the primary care manager team meetings. CQC Issues It was reported that the next round of visits were due to take place. The CQC had not yet formally reported on the 2nd round of visits undertaken. Individual Performer Affairs/CCG Reference Group The main issue to report was regarding the ongoing dispute between 2 GP partners. Meetings had taken place with Laura Browse and Ann Gough. The options available were limited. No formal correspondence had yet been sent to the practice and GPs involved. An update from NHSE regarding formal communication to the practice was requested urgently. Rachael Chambers reported that the medical team was undertaking an extensive findings exercise. It was noted that currently there were no performance issues to report. Enhanced Services No changes to report. All enhanced services were continuing. It was reported that the CCG would be expected to manage DESs if the CCG was successful with Level 3 delegation. The group questioned whether unplanned admissions DES would be continuing next year. Rachael Chambers reported that notification on this was expected mid February 16. APMS Kath Oddi reported on the meeting held with NHSE and the further information received on the health needs assessments for one practice with 4 branch surgeries and whether the practice needs to report HNAs as 1 or 4 separate practices. It was also reported that the cycle for reprocurement had now commenced and there had been a change in the order with Bolton nearer the top of the list.

4

PMS Review The ongoing reviews were noted. The group noted the change to the date of 1st April 2016. GP Access The group discussed the requests from practices struggling with closing for an hour for training/meetings etc., and a request from a branch surgery to close Wednesday afternoons. As per the requirements of the BQC, practices were expected to open from 8am to 6.30pm Monday to Friday. The group agreed that the direction should be followed. RC reported that any practices requiring closure for staff training can formally write to NHSE and arrange sub-contracting arrangements for this purpose. With regard to the bid being developed for 7 day access. The CCG has linked with NHSE on the development of local plans. There were issues regarding IT, the development of a GP federation and some confusion with the communications being received from NHSE relating to funding. It was noted that the admission avoidance hub would commence in December. Feedback from NHSE/NHS Bolton Joint Commissioning Committee Lynda Helsby updated from the last Committee meeting and highlighted the following areas:

• Update on APMS review received. • Health Watch to undertake a review of primary care access on behalf of the

CCG. • ToR approved regarding the update on the process for virtual decision

making. • Operational Group update received. • BQC quarter 1 performance report received – Committee requested

information on a range of KPI achievements, an example of a practice prescribing report and the financial value relating to the demand management KPI.

• The Committee approved the KPI for exception reporting. • The Committee discussed standard 16 for phlebotomy and the possible

reduction of the block contract.

The group discussed the SLA currently in place regarding phlebotomy services to a number of practices and the review required to ensure payments were not duplicated. Estates Update Kath Oddi updated that the PCIF bids had not yet been fully approved. The outcome of the due diligence process was awaited. Members discussed the need to understand the revenue implications before a CCG decision could be made on each bid. It was noted that CCGs had not yet been asked to provide a formal response on these bids. Finance Update Stephanie Hodkinson reported that the BQC is currently within budget. Review of the budget and anticipated reduction in activity would be monitored through the BQC

5

Steering Group and individually at practice level. Rachael Chambers reported that month 4 information had been received. Closed Lists Kath Oddi reported on 2 practices who had allegedly been refusing to register patients despite there being no practice in the borough that currently operated a closed list. The CCG has written to both practices requesting assurance that the practice would only turn patients away in line with their contractual responsibilities. The CCG had received written assurance from one practice and verbal assurance from the other practice, with the agreement that written assurance would also be provided. E-Declaration It was noted that the electronic declaration has opened from November to 16th December. It was further noted that it is contractual for practices to complete. 4 Recommendations The Committee is asked to note the discussions held and comment further on any of the items discussed. Name of person presenting the paper: Lynda Helsby Title: Associate Director, Primary Care & Health Improvement Date: 9th November 2015

Bolton Quality Contract Update Joint Committee

Dr Stephen Liversedge

16th Nov 2015

Outline

1. Update on KPIs

2. Update on process measures

3. Financial position

4. Key messages

5. Next steps

Standards & KPIs

The average practice

This presentation is based on data for the average Bolton practice: • Yellow cluster

• Population – 6,048

• Number of GP – 3.4 (inclusive of partner, salaried and long-term locums)

• Practice Nurse hours – 48 hours

• Index of Multiple Deprivation (IMD) –33.8 average score (Bolton - 31.43)

• Ethnicity – 23.8% (Bolton – 14%)

Standard 1 - Access

Summary: OOH - The average practice had a target to reduce by 38. All practices are on target to achieve A&E – The average practice had a target to reduce by 10. The average practice still needs to reduce by 10 . 17 practices have already achieved their target Patient experience – awaiting updated patient survey results

Baseline2015/16 Target

Annual Forecast No of practices achieving the

Target

809 771 516 50

233 223 233 17


No of practices achieving the

Target

73.5% 77.0% - 33

77.3% 80.7% - 9

79.3% 82.0% - -

86.3% 89.3% - -

79.6% 83.0% - -

79.4% 3%

Standard 1: ACCESS

Reduction in A&E minor attendances (in hours, excluding Bank Hols, self referred with prescription or guidance only)

5 months to Aug15 97 10

Improving access to general practice: 10 bookable sessions, access to male and female GP, opening times 8 - 6.30 Mon - Fri, 75 contacts per 1,000 population, pre-bookable appointments 1 month in advance, telephone consultations, children under 12 assessed by clinicians same day, accept deflections from A&E/NWAS/Community Services, improve on patient survey measures.

Access

Period of dataLatest available

figure

STATUS: On target or Gap based on

forecast

5 months to Aug15 215 On TargetReduction in OOH attendances

Patient Experience


figureSTATUS: On target

or Gap

Last time you wanted to see or speak to a GP or nurse from your GP surgery, were you able to get an appointment to see or speak to someone?

Practice report (July 2015 publication)

Contains aggregated data collected from Jul-Sept 2014 and

Jan-Mar 2015

77.0% On Target

Generally, how easy is it to get through to someone at your GP surgery on the phone?

Overall, how would you describe your experience of your GP surgery?

85.9% 3%

Would you recommend your GP surgery to someone who has just moved to your local area?

79.3% 4%

74.5% 6%

How satisfied are you with the hours that your GP surgery is open?

Standard 1 - Access Baseline Access Audit Initial audit (May 2014) - across all practices to measure the number of appointments offered, per week, per 1000 patients Repeat Access Audit Repeat audit (November 2015) - practices were asked to pick any two week period from the preceding two months in order to assess the impact since the commencement of the BQC. Results to be published in December 2015 Patient Survey Next survey results due January 2016

Standard 2 – Prescribing

Summary: • The average practice had a target to reduce by £59,540 • The latest data shows a reduction of £21,091 • 17 practices are currently on target



Target£956,114.33 £941,398.70 £979,848.39 17


figure


forecast

Standard 2: PRESCRIBING

Effective prescribing - war on wasteReview clinical record and the patient to facilitate improvement, undertake audit, prescribe in line with national and local strategy, apply CCG standards to repeat prescribing, attend 3 events per year, participate in prescribing development scheme.

All Prescribing spend 5 months to Aug15 £408,270.16 £38,449.69

Standard 2 – Prescribing

Repeat prescribing process (high priority) Policy implemented early in 2015. MOT involved in overall management of ‘minor’ and ‘major’ incidents, so far 6 ‘major’ meetings with pharmacies. Contributing to overall reduction in growth across the CCG Educational Event (quality and finance) Focussed on antibiotic prescribing and ‘Do Not Prescribe’ in Primary Care list. Taken forward to the CCG clinical executive as there is a clear appetite from Practices to collaborate and drive this agenda Prescribing Development Scheme (quality and safety focussed) Prescribing safety searches and feedback from practices on actions taken as a result of highlighted potentials for harm War on waste campaign Launched August 2015 following initial war on waste event back in February

Prescribing Waste

Prescribing Campaign

Standard 3 – Demand Management

Summary: PLCV - The average practice had a target of reducing PLCVs by 10. The forecast suggests they will have increased by 3. 9 practices are currently on target Out-Patient 1st Appt. - The average practice had a target of reducing 1st appointments by 14. The forecast suggests they will have reduced by 87. 35 practices are currently on target Follow ups - The average practice had a target of reducing referrals by 52. The current forecast suggests they will only reduce by 14. This will mean a shortfall of 38. 27 practices are currently on target

Baseline data - ALL PROVIDERS


Target

35

27

Outpatient first appointment - ALL PROVIDERS

CCG Target - reduce by 1%

1,430 1,416 5 months to Aug15 560 1,343 On Target

Outpatient follow up - ALL PROVIDERS

CCG Target - reduce by 1%

5,232

Standard 3: DEMAND MANAGEMENT


forecast

Procedures of Limited Clinical Value

CCG Target - reduce by 20%51 41 5 months to Aug15 22 54 13

Ensuring effective use of resources:Reflect on referral behaviour, improve referral quality, comply with EUR policy, use DXS, complete 2015/16 QP project, use Choose & Book

9

5,180 5 months to Aug15 2,174 5,218 38

2015/16 Target Period of dataLatest available

figure

Standard 3 – Demand Management

Pathways update • DXS Improvement Project • A review of all existing pathways is being undertaken

• Development of new pathways:

Management of iron deficiency in Primary Care Fertility Dizziness Liver –isolated ALT rise

Standard 3 – Demand Management Outcome of QP project • 50 practices submitted a review of referrals within the practice • A total of 1,684 referrals (average 34 referrals per practice) were reviewed

Referrals were measured against the following criteria: Problem – 98% referrals stated the problem History – 95% referrals had the relevant history Examination – 57% referrals had evidence of an examination Investigation – 32% referrals had evidence of appropriate investigations PMH – 47% referrals had the relevant past medical history Meds – 51% referrals included medications Appropriate – 79% referrals were deemed appropriate

Standard 4 – Health Improvement

Summary: Health checks - The average practice had a target to increase health checks by 409. So far, they have increased by 360, but need to do an extra 49. 12 practices are currently on target. Audit C - The average practice had a target to increase by 1016. So far, they have increased by 228, but need to do an extra 788. 26 practices are currently on target. Diabetes screening - The average practice had a target to increase by 298. So far, they have increased by 287, but need to do an extra12. 28 practices are currently on target. Pulse checks – awaiting outcomes from the Flu Vacc. period. The average practice would need to do an extra 267 compared with last year



Target58 55 64 -


Latest available %


Target

Standard 4: HEALTH IMPROVEMENT

Preventing ill health, diagnosing earlier and reducing health inequalities:Attend a CCG health improvement event, offer a Bolton NHS Health Check to everyone aged 40 - 74 years without existing CVD or diabetes (every 5 years), offer a diabetes screen to everyone aged 40 years and over without diabetes, offer opportunistic pulse checks annually to patients aged 65 years and over, undertake alcohol screening on patients aged 16 years and over (every 2 years)

12

26

28

5


figure


forecast

Screening for diabetes - 40 years + without existing diabetes, tested for HbA1c (BS)CCG Target - 82%

NHS Health Checks - patients 40-74 years <> CVDCCG Target - 82%

5 yr to Sept 2015 825 56.1% 360

CVD non-elective admissions 5 months to Aug15 27 9



or Gap

1,185776

5 yr to Sept 2015 2,066 81.0% 12

Audit C - for patients aged 16 years +CCG Target - 50%

2 yr to Sept 2015 2,334 48.5% 228 2,562

2,077

1,546

1,779

Pulse checked - 65 years +CCG Target - 80%

12 months to Sept 2015

448 46.3% 267 715580

Standard 4 – Health Improvement • 3 Health Improvement Events –

• GPs, Practice Nurses, Health Care Assistants/Health Trainers

• 50 practices attended the GP event - even though it wasn’t mandatory

• Last 5 years – 56% of eligible population have had a health check. Bolton is in the top 5

Local Authorities for achievement • Every practice has had at least 2 visits from Specialist Nurses to support improvement

• New templates for Practice systems • Health Check events are being organised by Practices

• At risk of diabetes – latest evaluation shows that 82% of patients can be supported to

improve their glycaemic status, and 49% can revert back to normal levels of HbA1c • 15% increase in the number of people undertaking AUDIT 10

Standard 5 - Screening

Summary: Breast - The average practice had a target to achieve 573. So far, they have achieved 513, but need to achieve an extra 60 *This is a 3 year target* 4 practices are currently on target Bowel - The average practice had a target to achieve 291. So far they have achieved 238, but need to achieve an extra 53. 2 practices are currently on target. Cervical - The average practice had a target to achieve 1,166. So far they have achieved 1,071, but need to achieve an extra 95. 2 practices are currently on target.


Latest available %


Target

503 573 71.8% 4

243 291 56.9% 2

2

Standard 5: SCREENING

Improving cancer screening rates:Follow up DNAs to encourage uptake, feedback learning to CCG



or Gap

Breast screening of women between 50-70 yearsCCG Target - 80%

3 yrs to Mar 15 513 60

Bowel screening for patients 60 - 74 years +10% above peer average

12 months to Mar 15 238 53

Cervical screening of women aged 25 - 64CCG Target - 80%

Screened 42/66 months to Mar 15

1,071 73.5% 95 1,1661,119

Standard 5 – Screening

• AAA Screening – feedback from 33 practices so far • Lack of general knowledge in the population about this

condition • One practice rang 8 patients who DNA’d – 5 have

subsequently attended • GPs – very influential in getting patients to attend

• Breast – 3 year target

• New process agreed with Breast Unit for contacting DNAs

• Bowel • Receptionists are key to delivering messages – how to

organise kits etc. • Low uptake in high ethnic practices – working with Bolton

Council of Mosques (BCOM) and CVS to improve understanding

Standard 6 – Health Protection

Summary: Seasonal flu - awaiting outcomes from Flu Vacc period. The average practice needs to increase by 5.9% <65 flu - awaiting outcomes from Flu Vacc period. The average practice needs to increase by 6.3% Pneumococcal - awaiting outcomes from Flu Vacc period. The average practice needs to increase by 6.4%



Target

3

7

12

Seasonal Flu Vaccine Uptake. (< 65 at-risk only) CCG Target - 60%

January 15 54% - 6.3%

Seasonal Flu Vaccine Uptake (≥ 65 years)CCG Target - 80%

January 15



or Gap

Standard 6: HEALTH PROTECTION

Protecting people from vaccine preventable disease:Improve vaccination rates for flu and pneumonia for patients aged 65 years and over, and for those at risk

74% - 5.9%

80%70%

55%

74% 80%

60%

Pneumococcal (PPV) Sentinel Vaccine (≥ 65 years)CCG Target - 80%

April 15 74% - 6.4%

Standard 7 – Sexual Health

Summary: The CCG target is 5%. The average practice had a target of 37 screens. So far, they have done 13, but the forecast suggests there will be a shortfall of 7. 14 practices are currently on target.



Target

Standard 7: SEXUAL HEALTH

Improving sexual health outcomes:Opportunistic or targeted screening for patients aged 15 - 24 years, provide access to emergency contraception, offer a full range of contraception options, signpost to local sexual health services

14


figure


forecast

Chlamydia screening for 15-24 year oldsCCG Target - 5%

Apr15 - Sept15 13 30 7 376

Standard 7 – Sexual Health

• R U Clear Process • Lots of work to refine the process – practices directly involved

in developing the new system • Numbers increasing steadily since the above • R U Clear team – very supportive of the Contract

• New templates on practice systems • Engaging Primary Care in the sexual health agenda

Standard 8 – Cancer Standard Standard 8. CANCER REFERRAL

Improving health outcomes for cancer:Identify a Cancer Lead, process 2 week rules within 24 hrs, develop a process to ensure that a patient attends, follow up DNAs, undertake an audit of 2 cancer diagnoses and feedback learning to CCG, review patients with new diagnosis using the cancer review template.

Identify a Practice Cancer Lead 66% reported back a named lead so far still awaiting some full feedback forms Practice Cancer Lead to attend Cancer Education Event • 2 events - one was on 2nd Sept and one pending in January 2016. 44

people attended 2nd Sept event • So far 66% of the leads attended, assumed rest will attend the January

Event • 25% increase in confidence around cancer knowledge, skill, awareness • 100% would recommend the event to colleagues

Review patients with a new diagnosis of cancer using the Cancer Review Template All practices now have the new cancer review template on their system Final data is expected by practice in Quarter 4

• Develop a system to prevent DNA of 2 week waits (2ww)

• Undertake an audit with learning of 2 cancer diagnoses (particularly emergency presentations) in the last 12 month and feedback learning to CCG

We are receiving cancer audits and learning from these is being feedback via the clinical leads and learning and development newsletter

Standard 9 – Long-term conditions

* Non –elective admissions are not a practice KPI



Target16 16 15 -7 7 8 -8 8 6 -

14 13 15 -



Target1,581 1,708 -699 737 - 2275 309 - 22415 438 - 13192 225 - 40


Latest available %


Target

Standard 9: LONG TERM CONDITIONS

Improving health outcomes and reducing health inequalities for long term conditions:Provide annual reviews for patients on the 4 Best Care registers, optimally manage the care of patients on Best Care registers, use templates developed by the CCG, submit quarterly data.

Improvement in Best Care scores

Annual Reviews of patients at 20% risk of CVD

4


figure


forecast

Best Care / LTC - non-elective admissions COPD 5 months to Aug15 6 On Target

Best Care / LTC - non-elective admissions Diabetes 5 months to Aug15 6 2

Best Care / LTC - non-elective admissions HF 5 months to Aug15 4 2Best Care / LTC - non-elective admissions Asthma 5 months to Aug15 3 On Target


scoreSTATUS: On target

or Gap

Aggregate Best Care scores Sept 2015 1,700 8Best Care scores in diabetes Sept 2015 673 64Best Care scores in asthma Sept 2015 314 On TargetBest Care scores in COPD Sept 2015 407 31Improve Best Care scores in HF with LVD Sept 2015 306 On Target


scoreSTATUS: On target

or Gap

Annual reviews of patients ≥20% risk of CVDCCG Target - 80%

12 months to Sept 2015

64 47.2%11748 53

Standard 9 – Long-term conditions Summary: Best care Diabetes - The average practice had to increase their score by 127. The latest data shows the average practice still needs to increase by 64. 2 Practices on target Best care Asthma - The average practice had to increase their score by 34. The latest data shows the average practice has increased by 39 and are on target. 22 practices currently on target Best Care COPD - The average practice had to increase their score by 23. The latest data shows the average practice still needs to increase by 31 13 practices currently on target Best care HF - The average practice had to increase their score by 33. The latest data shows the average practice has increased by 114 and are on target. 40 practice are currently on target Annual reviews - The average practice had to increase their reviews by 69. The latest data shows the average practice needs to do a further 53. 4 practices are on target to achieve

• Every Practice has had at least 2 support visits from Specialist Nurses • New templates on practice systems • Annual Review events have been offered to all 50 Practices – supported by the Health Trainer Service • On target to reduce non-elective admissions for Asthma and COPD – but more work to do in relation to

unplanned admissions for Heart Failure and diabetes

Standard 10 – Exception Reporting

Information re QOF and exception reporting provided by NHSE and has been shared with practices Baseline changed following agreement with Joint Committee to reflect changes to reporting mechanisms by NHSE


Target

Standard 10: EXCEPTION REPORTING

Exception reporting ≤ 6% 4.2% 6.0% - -

2015/16 CCG Target Exceptions 2012/13 Exceptions 2013/14

Standardising exception reporting across Bolton:Develop practice policy for exception reporting, apply CCG standards to exception reporting

24

N.B - Exceptions data for 2014/15 will be available around Nov 15

Summary: 24 practices are on target to achieve

Standard 11– End of Life Care Standard 11. END OF LIFE CARE

Improving End of Life (EOL) care:Identify an EOL Clinical Lead, Clinical Lead to attend education and communication training, hold a monthly GSF meeting, complete the EOL template for patients on GSF, use prognostic indicator guides to improve detection of non-cancer EOL patients.

Identify End of Life Care Lead within practice

94% of practices have achieved this End of Life care lead to attend EoL care education and awareness event

• 2 events done : 30th September and 7th October • 94% of leads attended • Total 129 people attended • 28% overall increase in confidence in EoL care knowledge, skill, awareness. • 94% of delegates would recommend the education event to colleagues

Have the new EoL care template on your system to use with GSF patients reviews at MDT • ALL practices now have this in place on there systems Finalised data to be in Quarter 4

• Hold a monthly Gold Standards Framework (GSF) meeting.

• Use prognostic indicator guides to improve detection of non-cancer end of life patient

• Audit any patient of the GSF register who died in hospital or audit one patient who has died on the GSF register

Standard 12 – Emergency Planning Standard 12. EMERGENCY PLANNING

Planning for emergencies: Develop a business continuity plan, to include a process for emergency prescribing, submit plan to CCG, provide support to rest centres when requested

Mandatory Standard 50 business continuity plans received

Standard 13 – Patient Safety Standard 13. PATIENT SAFETY

Incident reporting and safeguarding:Identify a safety champion who will attend a CCG patient safety event, submit 3 clinical incidents per substantive clinician per year, identify a safeguarding lead who will attend a CCG safeguarding event, provide access to safeguarding training for all staff, produce safeguarding reports, contribute to information sharing processes, provide assurance of improved outcomes based on recommendations from safeguarding reviews.

• A Quality & Safety event is arranged for 23rd March 2016.

• Between April 2015 and October 2015, 368 incidents were reported by 44/50 practices. Six practices are still to report incidents in line with BQC requirements.

• An initial safeguarding event was held on 22nd April 2015. This was attended by representatives from 49 out of 50 practices.

Standard 14 – Membership Engagement Standard 14. MEMBERSHIP ENGAGEMENT

Engaging with the CCG:Identify a Clinical Lead, attend at least 10 of the 12 clinical leads meetings, provide feedback to the practice, send 2 representatives to CCG events (at least 1 GP), engage with the Primary Care Development team, use Choose & Book and CCG templates, allow referral reviews, comply with CCG pathways and EUR policy, engage in primary care access audit, undertake 2 clinical audits per year, submit quarterly data to CCG.

Mandatory Standard • Compliance with attendance at clinical leads meetings Based on the attendance sheets for clinical leads meetings from April - October, 41 out of 50 practices have attended every meeting. 9 practices have missed more than 2 meetings • Compliance with attendance at CCG events CCG and prescribing events from April - October, 45 out of 50 practices have sent a least 1 GP representative to the events 2 practices failed to attend any 3 practices attended CCG events only • Full participation in referral reviews • 49 practices have participated in MS audit – details to follow • Further audit to be confirmed

Standard 15 – Mental Health

Expected prevalence

2015/16 Target


Target

Latest actual register

2015/16 Target


Target

Register size

2015/16 Target


Target



or Gap

Sept 2015 30 -

Standard 15: MENTAL HEALTH

Improving mental health and wellbeing:Offer annual health checks to patients on MH and LD registers, participate in LDSAF, offer access to screening for MH and LD patients, opportunistic dementia screening, annual reviews on dementia patients, record armed forces veterans

31

60 42

Physical health checks for patients on LD register CCG Target - 80%

1923

Annual reviews for patients on dementia registersCCG Target - 80%

Sept 2015 23

6

Latest available figure

STATUS: On target or Gap

Physical health checks for patients on MH registerCCG Target - 80%

4556 3

5

3645

13 -

-22

Sept 2015 6

29 On Target-45Sept 2015Expected dementia diagnosis size CCG Target - 70% of expected

STATUS: On target or Gap

Latest actual registerPeriod of data

Summary: Dementia – expected prevalence for the average practice was 42, the latest register size is 45, therefore the average practice has exceeded their target Dementia Annual reviews – The average practice needed to do 36 reviews, the latest data shows there is a further 6 to do. 31 practices are on target MH health checks - The average practice needed to do 45 health checks, the latest data shows there is a further 23 to do. 3 practices are on target to achieve LD health checks - The average practice needed to do 19 health checks, the latest data shows there is a further 6 to do. 5 practices are on target

Standard 15 – Mental Health

• Participation in LDSAF – not running this year • Number of patients on military veterans register – 141 patients currently

identified • On target to achieve expected increase in dementia registers

• On target to achieve expected number of annual reviews on dementia patients

• New templates being developed for physical health checks on MH and LD

patients

Standard 16 – Phlebotomy Standard 16. PHLEBOTOMY

Providing services closer to home:In-house phlebotomy for patients aged 12 years and over, provide shared care monitoring, OGTT as per local diabetes identification protocol

Mandatory Standard In- house phlebotomy provided by 50 practices Shared care monitoring provided by 50 practices under strict guidelines – supported by MOT as required

Standard 17 – Carers

• 50 practices have identified carers lead


-No of practices achieving the

Target

86 121 - 16

- 97 - 1

Standard 17: CARERS

Improving the health of carers:Identify a Carers Lead, maintain and update a carers register, ensure all staff are carer aware, annual health checks, use electronic referral form, display information in waiting room.



or Gap

Development of carers registerCCG Target- 2% of list size

Sept 2015 125 On Target

Annual Health Checks on CarersCCG Target - 80%

Sept 2015 25 71

Summary: Carers register – the average practice needs to increase their register by 35. Latest data shows they have increased by 39 and have exceeded their target. 16 practices are on target Carers health checks – the average practice needed to do 97 health checks, the latest data shows they need to do a further 71. 1 practice is currently on target

• New template being developed for carers health check

• All 50 practices have a Carers Lead – referrals to Bolton Carers Support have increased

Standard 18 – Transfer of Care Standard 18. TRANSFER OF CARE

Accepting transfer of care from secondary care:Comply with the recommendations from the Clinical Standards Board

Mandatory Standard In order to facilitate the transfer of care in a manner which does not impact on the quality of patient care, 6 principles were recently agreed at CCG/FT Clinical Standards Board. These are: • The clinician who wishes to prescribe medication for the patient should arrange all

appropriate tests prior to initiating the treatment. They are also responsible for communicating the rationale for treatment and arranging any follow-up requirements that might be necessary for the patient

• The clinician who wishes to initiate a medication should provide the initial prescription and a 28 day supply of the medication in line with the Out-Patient Prescribing Policy

• The clinician who arranges a test for a patient is responsible for ensuring that the results are looked at and any action required is taken. This may be delegated to another provider but only with the consent/agreement of that provider

• Clinicians should not recommend treatments for patients that need to be delivered by another service unless they are sure the other service is prepared to provide the treatment

• Clinicians who are not trained to prescribe should discuss any requests for medication with a prescriber and document who that prescriber is

• Secondary care Consultants are usually asked to address a specific issue for a patient. The CCG understands that sometimes this issue may require onward referral to another specialist and in such cases approve that referral to be made. However, should an unrelated and non-urgent issue arise in the course of the consultation the CCG would prefer it be referred back to the GP for assessment in primary care rather than referred immediately for a secondary care opinion

Standard 18 – Transfer of Care

Standard 18 – Transfer of Care

Clinical Standards Board Decisions: • Dexa scans for patients on Letrazole – Breast Unit • Genetics testing – GP to arrange • Blood requests by DVT clinic – Clinic to give patient form, GP practice to take

blood • Prescribing in pregnancy – GP responsibility • Out patient prescribing – wider implementation of policy, still in progress • Pre-op decolonisation MRSA –still in progress • Central line flushes – GP responsibility with clearer pathway • Immunisations for patients with low antibodies – secondary care clinics

Standard 19 – Patient Experience Standard 19. PATIENT EXPERIENCE

Improving patient experience:Encourage patients to participate in the Friends and Family Test, quarterly patient forums, improve on patient survey measures

Insert friends and family results Participation rates Patient forum compliance Insert KPI from access audit

Financial Impact

Financial Impact QIPP (non prescribing)

Activity

Area 2014/15 Baseline 2015/16 QIPP Target Planned Reduction 1st Quarter Activity Actuals YTD Activity Actuals Forecast Activity Forecast Reduction

A&E 11,660 11,180 480 2891 3855 11868 -208

OOH 31,557 29,676 1,881 6,965 9287 25,800 5,757

NEL 2,301 2,179 122 551 735 2,214 87

POLCV 3,209 2,593 616 727 969 2,679 530

Finance

Area 2014/15 Baseline 2015/16 QIPP Target Planned Savings 1st Quarter Cost Actuals YTD Cost Actuals Forecast Cost Forecast Saving

A&E £696,522 £667,853 £28,669 £172,697 £230,262 £708,947 -£12,425

OOH £1,885,089 £1,772,744 £112,345 £416,061 £554,748 £1,541,189 £343,900

NEL £4,691,782 £4,450,308 £241,474 £1,168,120 £1,557,492.89 £4,650,319 £41,463

POLCV £2,235,880 £1,806,680 £429,200 £506,539 £675,385.84 £1,866,601 £369,279

Total £9,509,273 £8,697,585 £811,688 £2,263,417 £3,017,889 £8,767,055 £742,217

Financial Impact QIPP ( prescribing)

Original Budget 2015/16 Budget QIPP 1st Quarter Spend YTD Spend at August Forecast Spend Forecast Saving

£52,089,081 £49,112,081 £2,977,000 £12,326,563 £20,690,978 £49,649,944 £2,439,137

Personally administered items may not be factored in as yet, and may represent approximately £1m of the forecast saving.

Key messages

Key messages

• There has been good progress in the first 6 months

• KPIs are not all or nothing

• % achievements will be rounded down

• Further discussion with Joint Committee needed re non-compliance with mandatory standards

• KPIs will be calculated in June / July 2016 when all data is available

• Final KPI achievement payment to be made in July 2016

CCG Support

Ongoing support available: • Specialist nurses • Medicines optimisation team • Prescribing technicians • Primary care development team • Practice visits • Review of progress reports • Education sessions

What’s next?

What’s next?

• Joint committee discussions

• Ongoing membership engagement

• Board decision – December 2015

• Continued monitoring

• Continued CCG support & practice visits

• Development of Bolton Quality Contract 2016/17 if agreed

Documents

AGENDA JOINT COMMISSIONING COMMITTEE · Verbal for Approval, Discussion or information By Whom 1. 3.30pm Apologies for absence. Verbal All 2. 3.35pm 5 mins Declarations of Interest