Transcript Primary Care MARAC Liaison Service aims to enable

City and Hackney
Clinical Commissioning Forum
Thursday 8th September 2016
St Joseph’s Hospice
Agenda items
1
Welcome
Led by
Clare Highton
Marcia Smikle | Jessica Woods
2
Primary Care MARAC Liaison Service
3
Paradoc/IIT
Wayne Gillon | Doug Green
4
Pathology IT Update
River Calveley
5
General Practice Forward View
Mark Rickets
6
Devolution & STP Update
Clare Highton | Paul Haigh
Primary Care MARAC Liaison
Service
Marcia Smikle- Head of Safeguarding
Children
Jessica Woods- MARAC Liaison Nurse
What we know about
Domestic Abuse
Nationally
• 2 women are killed every week in England and Wales by a current or
former partner
• Approximately 100,000 individuals are currently at high risk of
serious harm or murder as a result of domestic violence and
abuse.
• Research indicates that a victim is assaulted 35 times before
contacting the police (SaveLives)
Locally
• 506 cases were discussed at Hackney MARAC in 2015/16 – 22 cases
were referred by GPs.
• 41% of these cases involved 464 children
Primary Care MARAC Liaison
Service
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Historically information known to
GPs was not shared routinely and
did not inform risk
assessments/safety plans.
The safety plans agreed at MARAC
were not fed back back to GPs
Gap highlighted by GPs while
attending safeguarding training
events in 2015.
MLS aims to address this gap and
ensure important information is
shared with the MARAC and also
fed back to the GP’s.
Primary Care MARAC Liaison
Service aims to enable:
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Earlier identification of risks
Timely information sharing
Minimise risks to victims
Better case management robust risk assessments and
safety plans
Role of the MARAC Liaison
Nurse (MLN)
• Co-ordination: ensuring that information from GPs is gathered
and shared in a timely manner in line with information sharing
guidance
• Representation: GPs views at MARAC meetings.
• Ensure that GP’s are kept up to date with information discussed
at the MARAC regarding patients registered at their practice.
• Partnership working: with IRIS and support them in delivering
training to GP’s.
Notification and Feedback
Pathway
GP Engagement
• All correspondence will be sent
electronically by secure email
• Timely response to request for
information
• Ensure that ‘alerts’ are place on the
patient record
• Provide feedback on how the service is
working
End
JOINT WORKING
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AND
PARADOC
9am to 10pm Mon-Fri
10am to 6pm Saturday/Sunday/Bank Holidays
ParaDoc – GP and Paramedic. 12 midday to 12 midnight.
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IIT
IIT – multidisciplinary (Nursing, OT, PT, SW) Rapid Response assessments
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WITH
Referrals accepted from all Health Care Professionals as an alternative to using 999.
ParaDoc leaves 90% of patients at home compared to 20-30% by LAS.
Increasing joint working (joint visits) and referrals between teams
Information sharing (EPR, RiO, Social Services)
Follow up support – medication management & monitoring
IIT to ParaDoc – OOH borderline admission patients needing medical Ax +/medications
Peer support with OOH clinical decision making
Post IIT clinical support (eg after 6pm weekend)
Alternative to LAS used by IIT Reablement care workers
Case Example
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GP end of day (Friday) referral to IIT for increased leg swelling
HV - Wells Score and D-Dimer - Clexane prescription and injection until Doppler could be
completed on Monday.
HOW CAN IIT AND PARADOC SUPPORT
GP’S TO PREVENT ADMISSION?
Who do you refer to IIT or ParaDoc at present?
What would encourage you to refer more borderline admission
patients to IIT and Paradoc?
Who are the patients you send to ED where you thought they might
have been able to stay at home?
End
Homerton Pathology IT
UPDATE TO CCF
September 2016
Homerton Pathology – Concerns raised so far
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Duplication of results:
Patients’ blood test results were sent four times
Duplication of blood test results for same patients, has recently happened to 11 patients
A large number of duplicate/interim results are being sent out at the same time. Most FBC results for example come as 34 separate results all in the same batch, dealing with an inbox of results for 20 patient tests suddenly increases to 80
results.
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Results taking too long:
Results are taking up to 10 days - used to be 24 hours
Female patient attended with general malaise – it took over four weeks for the results to come back
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Mix up of results - A pregnant patient’s blood rest results came back attributed to her son – they had all of her son’s
details including NHS number - the practice is unsure how they got the sons details
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When using T Quest, we get a reply saying ‘no sample received’ - this is the case with multiple samples
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Patient’s results were high risk but the practice was not alerted
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Vitamin results are inconsistent
Homerton Pathology
Message from Pathology:
We are getting very little feedback from GP’s in relation to duplicate and missing results. A number of enquires ( 2) have
related to tests send to Bart’s Health , where the results are send directly back to GP’s by Bart’s and there have been delays.
Working with the provider of the IT system we have put in two changes to the system that have reduced problems but our
audit completed after the most recent change last week still shows some missing results. Our work continues until all the
results are posting correctly although this is proving difficult to completely resolve.
If practices have delays, duplicates etc., we are keen as ever to hear from them as it helps us in trying to resolve the problem.
They need specific feedback and may need someone to discuss with at the practice
Please Report pathology issues and concerns via the GP Alerts email and include a contact name at the practice:
Email Address: [email protected]
We will be raising any concerns next week with Homerton.
Patient safety is at the heart of everything we do and is a collective responsibility. If you come across a quality risk, ‘raising a concern’
(formerly duty of candour) is an essential part of improving care for patients in the future and could prevent immediate harm. In recent
months it has become clear there has been a lack of feedback received when patient concerns have been raised by GPs and your CCG has
been looking into how this process can be improved with the implementation of the ‘GP Alerts’ system.
The GP Alerts System will enable GPs to raise any quality concerns for individual patients arising from Provider services and can act as an
early warning system alerting City and Hackney CCG that further assurance may be needed from the Providers.
As Homerton is our main provider, the CCG Quality Team have been working with Homerton Hospital to set up the first in a series of
dedicated NHS.Net account for you to ‘raise concerns’ about your patients and receive feedback from Homerton Hospital. This will enable
you to give patient level information so the Homerton can investigate and report directly back to you.
How does it work?
1. Import Quality Issue form to EMIS Web document (download form http://www.cityandhackneyccg.nhs.uk/gp/Quality-Issues.htm)
2. Email form to [email protected]
3. The form is easy to use and can then be saved into the patient’s record if required
4. Alternatively just send an email to [email protected] with full details of the issue.
5. The Homerton will acknowledge your email within 3 working days and report back to you within 25 working days.
Homerton will send the CCG quarterly reports with your concerns and feedback provided
What type of concerns can I raise?
This email service is for individual patient concerns you want to be investigated by Homerton. So for example, if one of your patient’s
blood test results are delayed at Homerton Hospital, you would enter the patient’s NHS number and details about the concern onto the
EMIS document and email it to [email protected]
End
City & Hackney CCG
Clinical Commissioning Forum
GP Forward View Presentation
8th Sep 2016
Dr Mark Rickets
GP Forward View
5 themes:
1. Investment
2. Workforce
3. Workload
4. Practice infrastructure
5. Care redesign
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1. New Investments
• £2.4 billion to go into core GP contract - indemnity cover, winter pressure funding
– further details awaited…
• £40m available for practice provider development/resilience – approx. £136 for
C&H (by population) but…
• £10m support for practices in CQC special measures (currently nil in C&H)
• £30m ‘Time to Care’ programme – application made
• £45m training/supporting practice staff to sign-post - £26,000 received for C&H
• £16m for initiatives to manage burnout - details expected towards the end of
2016.
• £6m earmarked for practice manager development - details awaited…
• £6 / patient access funding, but…
• £171m practice transformation support AND £126M releasing GP capacity AND
£45m additional investment in on-line consultations - details awaited…
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2. Workforce
NHSE targets:
• 5,000 new GPs
• 3,000 MH therapists
• 1,000 Physician Associates
• 1,500 Clinical Pharmacists
(Local Community Education Provider Network
(CEPN) - local initiatives supported £170,000 HEE
Locality Fund and £1.4m NR funding from CCG)
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3. Workload
10 High Impact Actions (HIA):
1. Active signposting
2. New consultation types
3. Reduce DNAs
4. Develop the team
5. Productive work flows
6. Personal productivity
7. Partnership working
8. Social prescribing
9. Support self care
10. Develop QI expertise
£30m for Time to Care (embedding priority HIA)
NHS Standard contract - impact on managing increasing non-patient generated workload
(Local pathway review and development – priorities?)
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4. Infrastructure
Up to £900m for Estates and Technology
Transformation Fund – application made…
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5. Care redesign
London Transforming Primary Care Programme (HLP) and the STP process
Delivering the London Strategic commissioning framework:
• Proactive care specification
• Accessible care
• Coordinated care
• Co-commissioning
• New models of care (provider led)
• MCP alternative GP contract
Extended hours - access monies £6 per head, but…
Developing IT functionality:
(Local - Digital Roadmap – overseen by the Integrated Care Board)
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End
STP & DEVO
UPDATE TO CCF
FOR DEBATE
September 2016
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STP
• NEL STP submitted and feedback meeting in July
• Feedback letter attached which gives some idea of direction of travel
• STP Board meeting 24/8 attended by NHSE & NHSI
• Suggestion of a NEL control total – CCGs have the money; Trusts in deficit – therefore realign
the money so it “balances out”
• “Why wouldn’t you want to help each other?”
• Barts now in special financial measures – year end position unclear but ?£130m
overspent??, didn’t receive their Q1 STF money but Homerton did; BHR CCGs in deficit
• NEL governance unclear – seems to be growing move to everything done NEL wide and
everything has to fit within STP – eg estates, IT, new initiatives
• Suggestion of delegating decision making to STP Board
• First proposal - membership of Board mostly providers and executives – being redone and
Paul & Clare volunteered to participate
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DEVO
• 4 priority workstreams
• Early years; prevention; planned care; crisis/out of hospital
• Review current workplans and impact on outcomes
• Exploring integrated commissioning
• Pool all CCG, Public Health and other relevant SS budgets; align contracts;
pursue integration of delivery
• Joint governance with each Local Authority to oversee – CCG and Councillors
• Early discussions..
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End