City and Hackney Clinical Commissioning Forum Thursday 8

City and Hackney Clinical Commissioning Forum Thursday 8 th 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 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 (Save. Lives) 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 • • 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 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: • • 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

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JOINT WORKING WITH IIT AND PARADOC • IIT – multidisciplinary (Nursing, OT, PT, SW) Rapid Response assessments – – • Para. Doc – GP and Paramedic. 12 midday to 12 midnight. – – • • 9 am to 10 pm Mon-Fri 10 am to 6 pm Saturday/Sunday/Bank Holidays Referrals accepted from all Health Care Professionals as an alternative to using 999. Para. Doc leaves 90% of patients at home compared to 20 -30% by LAS. Increasing joint working (joint visits) and referrals between teams Information sharing (EPR, Ri. O, Social Services) Follow up support – medication management & monitoring IIT to Para. Doc – OOH borderline admission patients needing medical Ax +/- medications Peer support with OOH clinical decision making Post IIT clinical support (eg after 6 pm weekend) Alternative to LAS used by IIT Reablement care workers Case Example • • 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 Para. Doc 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?

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Homerton Pathology IT UPDATE TO CCF September 2016

Homerton Pathology – Concerns raised so far • - 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. • - 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 • 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 • When using T Quest, we get a reply saying ‘no sample received’ - this is the case with multiple samples • Patient’s results were high risk but the practice was not alerted • 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: huh-tr. qualityandrisk@nhs. net 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 huh-tr. qualityandrisk@nhs. net 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 huh-tr. qualityandrisk@nhs. net 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 huh-tr. qualityandrisk@nhs. net

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City & Hackney CCG Clinical Commissioning Forum GP Forward View Presentation 8 th Sep 2016 Dr Mark Rickets

GP Forward View 5 themes: 1. Investment 2. Workforce 3. Workload 4. Practice infrastructure 5. Care redesign 19

1. New Investments • £ 2. 4 billion to go into core GP contract - indemnity cover, winter pressure funding – further details awaited… • £ 40 m available for practice provider development/resilience – approx. £ 136 for C&H (by population) but… • £ 10 m support for practices in CQC special measures (currently nil in C&H) • £ 30 m ‘Time to Care’ programme – application made • £ 45 m training/supporting practice staff to sign-post - £ 26, 000 received for C&H • £ 16 m for initiatives to manage burnout - details expected towards the end of 2016. • £ 6 m earmarked for practice manager development - details awaited… • £ 6 / patient access funding, but… • £ 171 m practice transformation support AND £ 126 M releasing GP capacity AND £ 45 m additional investment in on-line consultations - details awaited… 20

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. 4 m NR funding from CCG) 21

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 £ 30 m for Time to Care (embedding priority HIA) NHS Standard contract - impact on managing increasing non-patient generated workload (Local pathway review and development – priorities? ) 22

4. Infrastructure Up to £ 900 m for Estates and Technology Transformation Fund – application made… 23

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) 24

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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 ? £ 130 m overspent? ? , didn’t receive their Q 1 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 28

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. . 29

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