Prim

ary Integrated Community Ser

vicesAnnual Report 2017/18Excellence in patient and primary care

Primary Integrated Community ServicesLimited Registered Offi ce: Unit H4, Ash Tree Court, Nottingham Business Park, Nottingham NG8 6PY

Tel: 03000 830000 enquiries@picsnhs.org.uk www.picsnhs.org.ukRegistered in England & Wales Company Registration Number 8763136

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3Diabetes team Pat & Karen

ForewordPrimary Integrated Community Services (PICS) presents our fourth Annual Report.The report highlights our achievements and progress over the last year, includinga summary of our accounts and current fi nancial position.

PICS was established in 2013 as a supplier of local health services, provided by local clinical staff and owned by local clinical staff. PICS has increased in sizefrom a very small organisation employing less than 20 people to now employing over 100 staff with an annual turnover of over £5 million.

‘For Profi t’The organisation is a company limited by shares and (nominally)“For Profi t” We take pride in ensuring each service we provide covers the cost of the service with the income it receives for that service. Any surplus above cost we do achieve goes towards further service improvement. Our board consists of a small group of Directors;

Dr Kelvin Lim (Chair), Dr Andrew Parkin, Dr. Paul Skullardand Dr Junaid Dar and the Managing Director Mrs Alison Rounce.

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“We Care”“We Care” about our patients, carers and families, our partners and all the people we work with, underpinned by our core values and our “can do” approach. We regularly review our values and ensure these are integralat all levels of the organisation.

Our ValuesAll PICS services are provided free at the point of service and are part of NHS services. PICS services can be accessed in a number of ways including referrals from GP practices and self-referrals in certain cases.

The PICS values below are integral at every level of the organisation:

■ Family and patient need is central to our decision making.

■ We have a “can do” approach that is responsive, creative and innovative.

■ We are non-judgmental, open and transparent with a no blame culture.

■ We are inclusive and collaborative inside and outside the organisation.

■ We are professional and passionate about our care for patients and one another.

■ We protect and support General Practice and our clinicians.

■ Our care is evidence based, safe and effective.

■ We put safety fi rst in everything we do.

■ Our care is evidence based, safe and effective.

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Message from Alison RounceManaging Director

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It is my pleasure to introduce the 2017/2018 Annual Report for Primary Integrated Community Services Limited.

2017/2018 has been a year of developments and a prelude to the forthcoming changes within the local health economy. The fi rst and most obvious success has been the successful implementation of the community pain contract for South Nottinghamshire County.

In addition to this, we have strengthened our management team to put us in a stronger position to build upon the work already undertaken for the next 12 months.

We are developing internal communication improvements including a staff newsletter, Managing Director regular monthly blog and looking at an intranet for late 2018.

We have also initiated a series of ‘Open Conversations’ across the organisation, giving staff the chance to speak to the senior team about the issues that are important to them in their working life.

■ Staff well-being sessions ■ Staff well-being programme

I am very proud of the expertise, passion and skills of our staff with a strong ethos to provide quality care that supports general practice. Our next 12 months will focus upon working with primary care clinical networks to collaborate in developing innovative ways of providing primary care services at scale.

I would also like to thank all the partners we work with in secondary and primary care and the third sector who help us to work together to give our patients the good care they deserve.

There is so much to be proud of and look forward to. I hope you enjoy reading our achievements and I very much look forward to working with you in the coming year.

Message from Dr Kelvin LimMedical Director

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Our organisation has grown considerably over the last year and PICS provide an increasing number of services in a wide geographical area and in partnership with many different providers. Retaining a positive caring culture, patient safety and a high standard of clinical care is paramount.

The Medical Director is accountable for continuously improving the quality of services and safe guarding high standards of care by creating an environment in which clinical care can fl ourish.

The Clinical Governance committee (CGC) has monthly meetings and has been successful in ensuring that PICS as an organisation is able to care for patients safely. We have reviewed all complaints, safeguarding reports, audits and signifi cant events that have occurred in the last year.

Having one process has allowed us to analyse trends, ensure learning across all parts of the organisation and feedback toall staff.

The CGC is multi-disciplinary with representatives from Nursing, General Practice, Pharmacists and Management. It is chaired by the Medical Director and should it be necessary representatives from different disciplines are invited.

All components of clinical governance are subject to scrutiny and challenge through the Board of Directors. These include; risk management, clinical audit, education and training and professional development, evidence based care, patient and carer experience and staffi ng.

All reporting and risk registers are presented to the board for assurance with any action plans that are required giving an opportunity for both challenge and support from non-executive Directors.

Acute Home Visiting Service April 2017In April 2017, PICS became the provider of a new acute home visiting service (AVS) in Newark. The service was expanded in November 2017 to include Sherwood practices, including Ollerton, Blidworth and Clipstone.

A small team of Advanced Nurse Practitioners (ANPs) and Emergency Care Practitioners (ECPs) provide acute visits to patients in their own homes or care homes. The aim of the service is to reduce inappropriate hospital admissions and enable patients to be cared for at home when it is clinically safe to do so.

GP Practices Working Together April 2017PICS actively supported the establishment of the Newark practices. In March 2018, PICS began to actively support the establishment of GP Federations in both Nottingham West and Nottingham North and East CCGs.

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Balderton Surgery

Pain Services July 2017In July 2017 PICS established an innovative community pathway across the Nottingham North and East, Nottingham West and Rushcliffe CCG areas where a co-ordinated multidisciplinary team of specialist clinicians help patients with spinal and other persistent pain conditions as well as patients with chronic fatigue syndrome (CFS) to get the right diagnosis and treatment, manage their symptoms better and improve their quality of life.

The service provides holistic patient centred care within a biopsychosocial framework, with individual treatment or group work depending on patient need.

It is the fi rst chronic pain service in the UK to employ a wellbeing practitioner to facilitate the self care part of the pathway. This enlarged service built upon the smaller service existing in Nottingham West and Newark and Sherwood. Extended GP Access

October 2017PICS started providing an extended access to GP practice services in the Mansfi eld and Ashfi eld CCG area in October 2017. Routine pre-bookable GP and nurse appointments can be booked in the evening, at weekends and over bank holidays using this PICS administered service.

PICS acts as the umbrella organisation providing governance, the necessary information systems and operational support to manage the service. The ongoing administration is undertaken by GP practice staff, working alongside PICS.

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Pain Team: Heidi, Alicia, Catherine & Maureen

24 hour ECG October 2017The Electrocardiology (ECG) 24 hour monitoring service was started in October 2017 for patients in the Newark CCG area.

It involves a small device (about the size of a mobile phone), that has 3 leads that are attached to the chest, which allow the device to monitor heart rate activity over a period of24 hours.

The ECG 24 hour monitoring service aims to improve the service and referrals for patients with Atrial Fibrillation (AF).

PICS Offi ce MoveNovember 2017The establishment of the new, enlarged pain service required an expansion of the premises for PICS staff. The pain clinical and administrative staff moved into a next door unit at Ash Tree Court, Strelley, Nottingham.

This enabled clinical and administrative staff to work closely together in providing the service.

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PICS H4 Offi ce

Pharmacy December 2017Since April 2016 PICS has been involved in NHS England’s Clinical Pharmacist pilots in Nottingham West and Ashfi eld areas. The scheme has been piloted over 4 years, enabling practices to access funding to support the employment of Clinical Pharmacists in General Practices.

The pilots were launched to help support the increasing demands in General Practice, by subsidising employmentof clinical pharmacists. During 2017-18 PICS expanded this service in the Nottingham City and mid-Nottinghamshire areas.

New PICS Website March 2018The website started from scratch and focused on■ What is PICS?■ Which services PICS provides.■ Who PICS provides services to.■ The latest news from PICS, including new jobs on offer.

The website can be found on picsnhs.org.uk/ The website is an easy way of fi nding out which services PICS provides.

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Clinical Pharmacist Training Session

Looking aheadPICS has changed signifi cantly over the past 12 months, as refl ected in the above highlights.

The next 12 months promise to see further signifi cant changes. The NHS is currently in the middle of a major reorganisation with the existing local “purchaser: provider” split between healthcare providers and commissioners likely to be changed, or even removed.

It is expected that local providers will need to work far more closely together, collaborating on future healthcare improvements and innovations. PICS is in a good position to take advantage of the expected changes, as we already work closely with other local providers and have been at the forefront of successful innovation in local healthcare.

The emerging changes will require GP practices to work closer together, coordinating service provision and cooperating on future developments. PICS is providing a keyrole in such requirements for many GP practices in Nottinghamshire and plans to further develop this role in the future.

This will give primary care a stronger more effective voice within local healthcare.

New Mid Notts EOL Team

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13Gynaecology clinical team

During this period, the accounts show an increase in turnover to £6,246,018 from £4,200,131 in 2017, with a surplus of £288,747 after taxation and extraordinary Items (2017£70,782). These fi gures include adjustments for the transfer of monies from the winding up of Nottingham West Health Ltd.

Overall the company has accrued net assets of £532,653 compared to £246,881 in 2017 and has a healthy cash position. The Directors consider the company has adequate resources to remain in operation for the foreseeable future and have adopted the going concern basis in preparing these statements.

There is no requirement to submit the accounts to independent audit at the level of activity during the year. During the period the turnover increase is largely attributable to the Greater Nottingham Pain Service contract which commenced in July 2017.

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Financial Report Year to March 2018The annual accounts reported for the 12 Months to 31 March 2018

Balance Sheet as at 31 March 2018

2018 2017 Fixed assets £ £ £ £ Tangable assets 48,185 36,824 Current assets Debtors 1,130,421 225,673 Cash at bank and in hand 3,113,673 1,416,748 4,244,094 1,642,421 Creditors: amounts falling due within one year (3,750,471) (1,424,999) Net current assets 493,623 217,422 Total assets less current liabilities 541 ,808 254,246 Provisions for liabilities (9,155) (7,365) Net assets 532 ,653 246,881

Capital and reserves Called up share capital 136 127 Share premium account 88,103 79,864 Capital redemption reserve 12 10 Profit and loss reserves 444,402 166,880

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Prim

ary Integrated Community Ser

vices

Primary Integrated Community ServicesLimited Registered Offi ce: Unit H4, Ash Tree Court, Nottingham Business Park, Nottingham NG8 6PY

Tel: 03000 830000 enquiries@picsnhs.org.uk www.picsnhs.org.ukRegistered in England & Wales Company Registration Number 8763136