Transcript PCPCS new Care Planning Service

CCG Clinical Commissioning Forum
Thursday 2nd April 2015
GP IT Update April 2015
Niifio Addy
Clinical Lead for IT
 Recap on IT funding and the operating
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framework
What has the CCG done to mitigate the effects
of funding changes?
What local initiatives are being introduced?
Update on National IT programmes
Docman
IT Funding
 NE London CSU core contract price £561,00
 £160,000 for additional services
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Core IT services- what’s in?
 IT support staff costs (NELCSU)
 Helpdesk and engineers (IT support)
 GP SoC (EMIS, Vision)
 Project management (National IT programmes)
 Management and reporting on IT service
 Strategic management support
 Asset management, IT procurement, software
licensing
 Overheads (e.g hardware upgrades, servers,
printers, network security)
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Non-core services
 Tape validation for hosted clinical systems
 Out of scope services associated with practice
business e.g. automated patient check in
notification screens
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Additional services
 Enhanced N3 network project costs (e.g. COIN
upgrade)
 Management of local data centres
 Remote access to EMIS web
 Network management and monitoring
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What are the cost pressures?
 BT COIN (N3) £202k p.a
 Leased PCs (850 on 3 year contract) £158k p.a
 MIG license(HIE project) 46k for 2 years
 CEG £72k p.a
 Patient automated check-in screens £22k p.a
 T Quest £13k p.a
 Interxion data hosting £10k
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CCG financial planning
The projected shortfall in funding in 2015/16 is
£150k
What have we done to manage costs in light of
reduced funding?
 Transitional funds available for 2 years. £433k in
2014/15 and £406k in 2015/16
 Re-negotiated NELCSU service price (from
£750k in 2013/14)
 CEG costs moved from IT to general budget
 Capital bids to reduce revenue costs
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CCG financial planning (cont)
What were the capital bids?
 PCs: £630k for 2015/16 and £50k p.a up to
2019/20. Would release £52k savings p.a in
2015/16 and 2016/17 and £158k p.a from
2017/18.
 BT COIN upgrade: £260k to upgrade from
current service to NGA network. Would release
£42k from COIN network costs in 2016/17
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Local Initiatives
 HIE
 DXS
 EMIS mobile
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Docman
 Accredited under GPSoC as a core service item
 Previously funded by PCT
 Will now be funded centrally by NHSE
 NELCSU (rather than individual practices) has
the admin rights for managing the software
under IT operating framework rules
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Docman (cont)
What do practices need to do?
 Upgrade to the latest version of Docman (v75)
 Upgrade requires admin rights so NELCSU has
to do this for most licenses (but not all)
 Practices with the correct version will be added
to GP IT tracking database allowing Docman to
claim its costs directly from NHSE
 Practices not on v75 should ask Docman to
upgrade them first then NELCSU if needed
 Claim a refund from Docman for paid invoices
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Docman (cont)
There are some risks and potential costs when
switching from Docman to EMIS document
management
 Potential data loss
i.e. documents held in Docman not being filed in
EMIS (normally admin related)
If practices have used Vision previously then EMIS
will only migrate documents created whilst using
EMIS
 DDE (dynamic data exchange) costs
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Docman (cont)
DDE costs:
 Docman produces a file extract . NB there is no
longer a £1500 charge for this as it is covered
under the GPSoC framework
 EMIS imports the file to its documents system
for a £1500 fee (not covered under GP SoC
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Questions?
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END
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Maternity Programme Board Update to the
Clinical Commissioning Forum
Referring Women to Maternity Services
Dr. Balvinder Duggal
2nd April 2015
New Referral Form for GPs
First Name:
Date of birth
Address
Family Name:
NHS Number:
GP Name:
Postcode
GP Address:
Preferred title: Mrs/ Miss/ Ms
Mobile Number :
GP telephone:
OK to send texts to mobile phone?
YES/ NO
Other number :
Interpreter Needed? YES/ Blood Pressure:
/
NO
HeightWeightPreferred Language:
BMIFirst Day of Last Period:
Number of
Reasons if Booking
previous
after 12 weeks
EDD by datesdeliveries:
pregnant:
Gestation age at referral-
Previous History – Information to help maternity services plan care ( where relevant):
Pregnancies
History
Information
Having First baby
□
None
□
None
□
Other pregnancies normal
Or
Or
□
IVF for current pregnancy- □
Or
High Blood Pressure
□
Smoker
□
Caesarean Section
□
Diabetes
□
Alcohol/ Substance Misuse
□
Premature Baby
□
Other Hormone disorder
□
Domestic Violence
□
Previous Womb Surgery
□
Epilepsy
□
Learning Disability
□
Pre-Eclampsia /Eclampsia
Heart disease
□
FGM
□
Postnatal depression
□
Kidney disease
□
Children on protection register □
3 or more miscarriages
□
Liver disease
□
Has a Social Worker
□
Miscarriage after 13 weeks □
Severe Asthma
□
Social Worker name if known
Baby born with abnormality □
Blood Clotting Disorder
□
…………………………………………….
Shoulder Dystocia
□
Autoimmune Disease
□
Other relevant social/ domestic circumstances:
Placenta Accreta
□
Deep Vein Thrombosis
□
Stillbirth
□
Tuberculosis
□
Current Medication:
Neonatal death
□
Haemoglobin disorder
□
Other Maternity Problems:
Psychiatric illness including
Allergies:
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depression
□
Other Medical/Surgical problems:
New Referral Process
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7.
Women presents as pregnant at GP.
Discussion on choice of hospital and referral form completed (some
elements of form can be pre-populated on EMIS). Please do not advise
women to self refer.
Referral emailed by GP to [email protected] (sent from generic
practice email, not faxed or sent via choose and book, or sent by admin)
Email acknowledgement of referral from Homerton to GP.
Homerton introducing 48hr turnaround target for referrals.
Letter sent to women with Homerton first appointment date, time, venue – if
appointment within 48hrs will be telephoned.
Above letter will also be copied to GPs – for information and also to aid
booking of 16 week GP appointment. This will also apply for self referrals.
Aim now is for Homerton to see women by 8-10 weeks. Late bookers will get
expedited appointment, usually with public health midwife.
Pathway to be further discussed and finessed at a Friday GP & Maternity
education session.
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Rationale for Approach
GPs know their patients and so it is best practice for GPs to refer women
to maternity services:
• It ensures social needs are identified and shared – particularly
critical for vulnerable women (DV, MH, LD)
• It provides information on past medical history including past
obstetric history.
• It specifies the details of any medications.
• It helps prevent complications being missed and helps them to be
identified and supported early by maternity services.
• A lack of information sharing has been identified as an issue in
Serious Incidents (SIs) and in one maternal death.
*Advocating a whole practice approach to enquiries (GPs, nurses,
receptionists) to support referrals from Practices.*
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END
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Children’s Programme Board
1) Vulnerable Children’s Contract
• The Key changes to previous versions
2) How do we want to work with the Health
Visiting team?
LTC Requirements:
•Consistent with previous versions:
•New
•
Development of disease registers at each practice
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Improve the management of childhood asthma
•Delivery of ‘care review’ contact with patients with
epilepsy* £35 per contact
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Embed the ‘paediatric asthma review’ template and
the ‘at risk of asthma’ templates developed by the
Children’s Programme Board
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Agree personalised written asthma action plans
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Proactive (within 2 working days) post discharge
reviews
•Delivery of ‘care review’ contact with patients with
Diabetes* £35 per contact
•An audit of patients with epilepsy to inform development
of, and enable referral to, the transition pathway £7k total
Mental Health Requirements:
Consistent with previous versions:
New:
Carers:
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Identification (via register) of children with caring
responsibilities
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A register must be established at every practice
Offer referral of child carer to specified support
Vulnerable Children Requirements:
•Consistent with previous versions:
•New:
•Vulnerable Children
• Practice led MDT review of children in order to establish
an agreed register of vulnerable children (0-5 years)
This to be achieved by June 2015
• Agreed joint action plan for all children categorized as
universal partnership plus
•Payment per plan - £64
•Minimum to be completed – 1 per practice
•Maximum plans to be funded in the 6 months - 1200
• Patient checks
• New patient checks – no changes
• 16th Birthday checks
 All practices to evidence that patients are invited
You’re Welcome Quality Criteria
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This is now included in the 6 month VCC April –October 2015
•
Funding (remains the same) is £26k for 100% practice compliance with the quality standards
•
Minimum 75% practice compliance required for incremental payment
Part 2: Health Visiting - How do we want to work with the Health Visiting team?
 L.A. to tender service – draft spec by May 2015, award Sept 2015, start April 2016
 Primary Care invited to state how it would like to work with service in the future
 Communication
• Information sharing protocols between Health Visitors and GPs
• Children’s Leads
• Joint child health clinics (CHCs) in primary care
• CHCs in Children’s Centres (how does information reach GP?)
• Expand use of Red Book
• Electronic transmission – eRedBook
 Joint Decision Making & Accountability
• Templates for vulnerable children discussions
• Recording on EMIS/RiO
• Monthly meetings re vulnerable children (is monthly adequate for every practice?)
• Joint child health clinics in primary care (GPs to work in Children’s Centres?)
Part 2: Health Visiting - How do we want to work with the Health Visiting team?
 Service Development
• Interprofessional learning and working
• Community minor ailment clinics? (link to primary care)
• Joint child health clinics in Children’s Centres (with Health Visitors and GPs)
• Immunisations
• Liaison with Social Services/Safeguarding (joint training for Health Visitors and Social
Workers)
• Set up Health Visiting and GP forum (Quarterly?)
 Accessibility
• Increased hours evenings and weekends
• Communication by telephone or fax
 Knowledge of Health Visiting Service
• Improve knowledge of parents and professionals
END
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Breastfeeding Support in City and
Hackney
Anna Lucas: Early Years Transition Lead, Public Health, LBH
What we know about Breastfeeding in
Hackney and City
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Initiation is very high. In 2013/14, 92% of mothers initiated
breastfeeding compared with the England average of 74%.
Mothers still breastfeeding around 6-8 weeks is 83%. 51% are being
exclusively breastfed.
The rate of mothers not breastfeeding at all was 15% in 2012/13 and
16% in 2013/14.
Mothers exclusively breastfeeding at 6-8 weeks in 2013/14 :
 cluster B 32%
 cluster A 24%
 Other clusters range 9% - 14%
 HIGH MIXED FEEDING RATES AT 6-8 WEEKS
We know most mothers stop
breastfeeding before they plan to….
1. Mothers who run into breastfeeding problems sometimes
feel that they have been given unrealistic expectations in
antenatal classes.
2. Many mothers who might benefit from it do not access the
available breastfeeding support.
3. Mothers receive conflicting advice from professionals
Breastfeeding Welcome Scheme
• Launched January 2013, the scheme engages health professionals,
parents, volunteers and venues to encourage women to breastfeed
more widely in public.
• 87 venues signed up to the scheme in hackney
• Some breastfeeding welcome venues provide money off vouchers for
new parents i.e. a free coffee when they buy a sandwich
Breastfeeding support
groups
There are 11 active breastfeeding drop-in sessions
running on a weekly basis across Hackney provided
by community midwives, health visitors and
Breastfeeding Network (BfN) supporters
Antenatal health promoting
visit by Health Visitor
• Universal antenatal visit will begin shortly at 28+ weeks
• Focus on emotional preparation for birth, carer–infant
relationship, care of the baby, parenting and attachment, using
techniques such as promotional interviewing
• Opportunity to discuss the mother’s breastfeeding, what
she perceives the obstacles and pressures to be.
• Parents need realistic expectations - insufficient milk most
common reason for stopping
• Wider family targeted with breastfeeding messages
Wider support
• Peer supporters can provide ongoing support and follow-up – this
works best when close integration of services and referrals
• Shared outcomes for breastfeeding across partners – UNICEF
Baby Friendly scheme
• Fathers not routinely receiving information about the health
benefits of breastfeeding, advice and encouragement to be
supportive about breastfeeding – the father’s involvement is a key
predictor of breastfeeding initiation and maintenance.
• Early years settings
• Breastfeeding cafes – good evidence – empowers mothers
• Antenatal Breastfeeding workshop – preparation for how to
overcome difficulties
Welcome Hackney Babies
1. Baby pack – given to new parents at children’s
centre
2. Baby ceremony – introducing new parents to
Hackney services and welcoming babies as new
citizens
Healthy Start for All: Free vitamin
scheme
Very low uptake amongst pregnant women and
new mothers
END
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PAIN SERVICE PATHWAY
GP Referral
Physio
Referral
Screening
Introductory
Session
MDT Session
(Psychologist, Physio, Prescriber)
1:1
PMP
UPP
Pain Consultant
OT
Psychology
Pain Physio
Locomotor Pain Service referral form
Please note: The Pain Service is an interdisciplinary service based predominantly on a self-management
and biopsychosocial model for persistent pain. If physiotherapy or further investigations are required
please refer directly to the Locomotor Service
Referral date
1. Patient Information
Name
Date of Birth
Current
Address
Home Phone
/
Male
Female
Mobile Phone
Ethnicity
NHS Number
Advocate
required?
(If yes please write
Post Code
Email
address
language spoken)
2. Referrer Information
GP Name
Surgery
Address
Phone Number
Fax Number
Email address
3. History
Duration of pain
Diagnosis if known
Current symptoms
Pain characteristics e.g. cramping/
dull ache/tingling/burning/stabbing
Other factors contributing to the patients
mobility difficulties or pain presentation
e.g. Dizziness, diabetic neuropathy,
4 Impact of pain
How does the pain impact on day to day
activities (e.g. self-care, leisure, work,
caring for others)
Physical function (e.g. work, caring for self,
others, activity etc.)
Mood (e.g. anxiety, depression, anger
etc.)
/
Usual GP (if different
from referrer)
5
Reason for referral
What does this person hope to gain from being
referred to the Pain Service?
Please detail any potential obstacles to
engagement with self-management or being in a
group setting (from referrer or patient perspective)
6
Investigations
Please detail findings of investigations carried out
relevant to this condition and attach reports as
appropriate e.g. blood tests, X-rays, MRI scans,
etc.
7 Previous Interventions or onward specialist referrals already made for this & other relevant conditions
(please provide details of the condition treated, outcome & include copies of related correspondence)
Surgical or injection intervention
Psychology intervention (also including for other
trauma, or psychological issues)
Physical therapy interventions for this condition
e.g.physiotherapy/acupuncture/
osteopathy/chiropractic
Other interventions and/or agencies involved e.g.
ACRT/ Housing/Social Services
8
Other Medical History
Please list all past and current significant
conditions of physical and mental health
9 Medications
Please list current medication taken for physical
and mental health conditions. Please note any
compliance issues/mis-use/addiction history.
Identify allergies & significant side effects of
medication (incl. previous analgesia tried)
10 Relevant employment & social history
Please detail employment status and issues
relating to employment
Please detail any other relevant issues including
housing, isolation, financial, benefit, immigration
related or legal action
11 Any other relevant info
THANK YOU FOR YOUR REFERRAL
PHQ-9
Depression
2
17
none-minimal
6
mild
10
7
moderate
moderatesevere
81% moderate - severe levels of depression at point of
entry
GAD-7
Generalised Anxiety
0
6
25
11
none-minimal
mild
moderate
severe
86% moderate and severe anxiety at point of entry
END
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