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NHS Ealing Clinical Commissioning Group
Commissioning Intentions 2015/16
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Contents 1 Introduction ......................................................................................................................................... 3
2 Strategic context .................................................................................................................................. 4
3 Approach to the contracting round ..................................................................................................... 5
4 Strategic Priorities for 2015/16 ............................................................................................................ 6
4.1 Patient Empowerment and self-management ............................................................................. 7
4.2 Primary Care Transformation...................................................................................................... 13
Out of Hospital Services ................................................................................................................ 14
4.3 Whole Systems Integrated Care ................................................................................................. 17
4.4 Service Reconfiguration (Shaping a Healthier Future) ................................................................ 20
4.4.1 Acute Services Transformation ............................................................................................ 23
4.4.2 Community Services Transformation ................................................................................... 27
4.4.3 Integrated Commissioning ................................................................................................... 29
4.4.4 Information Management and Technology ......................................................................... 35
5 Required performance and quality improvements ........................................................................... 38
Quality ............................................................................................................................................... 38
Safeguarding ..................................................................................................................................... 40
6 Procurement plans ............................................................................................................................. 41
7 Contracting Intentions ....................................................................................................................... 43
7.1 Acute Services Transformation ................................................................................................... 43
7.2 Community Services Transformation.......................................................................................... 47
7.3 Mental Health Transformation ................................................................................................... 50
7.4 Whole Systems Integrated Care (including Better Care Fund) ................................................... 53
7.5 Primary Care Transformation...................................................................................................... 54
7.6 Patient empowerment and self-management ........................................................................... 57
8 Finance and activity impact analysis by provider .............................................................................. 58
9 Equalities Impact ................................................................................................................................ 59
10 Conclusion ........................................................................................................................................ 61
Appendix 1 High level timeline for developing Commissioning Intentions .......................................... 62
Appendix 2 Service Alerts Report ......................................................................................................... 63
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1 Introduction
This document provides an overview of our plans to commission high quality health care to
improve health outcomes for Ealing registered patients for 2015/16 and beyond. It outlines
the commissioning intentions for NHS Ealing Clinical Commissioning Group (CCG) for
2015/16 and builds on the commissioning plans implemented in 2014/15. They reflect the
2014/15 implementation of the CCG’s longer term strategic vision and the medium term
financial strategy, and set out the areas where the CCG wishes to contract differently,
improve quality or transform service delivery. The contracting intentions section of this
document sets out for providers the priority contracting intentions for Ealing CCG for
2015/16, which will inform contract negotiations.
Our commissioning intentions have been formulated within the framework set by the Ealing
Health & Wellbeing Strategy 2013/16. This strategy was developed with the engagement of
key partners and stakeholders across the council, health and voluntary organisations and
Ealing LINks (Local Involvement Networks), including Ealing CCG. The Health & Wellbeing
Strategy 2013/16 was also informed by an extensive joint strategic needs assessment
(JSNA) update for 2012/13 and an agreed approach to focus on where joint working
between partners could add value.
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2 Strategic context
The 8 CCGs in North West London, with our local authorities and other partners, are in the
process of implementing wide scale changes to the way in which patients experience and
access health and social care. These plans are ambitious and transformational, and the
vision is set out below.
“We want to improve the quality of care for individuals, carers, and families, empowering and supporting people to maintain independence and to lead full lives as active participants in their community.” This vision is supported by 3 principles:
1. People and their families will be empowered to direct their care and support and to receive the care they need in their homes or local community
2. GPs will be at the centre of organising and coordinating people’s care
3. Our systems will enable and not hinder the provision of integrated care.
We started the implementation of this vision in 2013/14, and have been putting many of the
fundamental building blocks in place during 2014/15. Some of the key enablers have been:
Extended Intermediate Care Services in Ealing
7 day working in primary and social care
Commissioning of out of hospital contracts at Ealing GP Limited (GP practices in
Ealing are working together as Ealing GP Limited) level, which will replace practice
level local enhanced services and ensure wider population coverage from October
2014
Closure of Hammersmith Hospital Emergency Department A&E unit
Implementation of a single GP IT system(SystmOne)
Community Transport Service pilot
Establishment of whole system integrated care early adopters, with business cases
for implementation from April 2015 being developed
Contracts with all key NHS providers that incentivise the transformation of services
and the movement of services out of hospital
Joint Commissioning Board (LBE and Ealing CCG)
Development of Better Care Fund initiatives and planning
We intend to build on these further during 2015/16.
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3 Approach to the contracting round
Our approach to the contracting round will build on the approach taken in 2014/15. We will
be working closely with the other CCGs in CWHHE, and also with our colleagues in Brent,
Harrow and Hillingdon, to maintain strategic alignment. Our primary objective is the delivery
of our strategic vision, and we expect to negotiate contracts that will support us in the
delivery of that vision, with a focus on transformational change and service integration. We
will expect our providers to demonstrate how they are transforming their services to meet
that challenge and how they are moving towards the Shaping a Healthier Future (SaHF)
service standards. We will seek to ensure that the incentives and penalties within contracts
are aligned to ensure the delivery of the required transformation. All CCGs in NWL have
whole systems integrated care early adopters who are developing models of care, and we
expect to commission these during 2015/16, either in shadow or live form. We expect to
reflect this within our 2015/16 contracts with the relevant providers.
Patient empowerment, and putting the patient at the heart of all we do, is fundamental to our
vision. Generally providers are not doing this at present. We will seek to embed a
requirement for much greater patient focus within our contracts for 2015/16.
We intend to start our contract negotiations earlier for 2015/16, with the aim of agreeing the
baseline activity and many of the schedules before Christmas 2014, subject to any changes
that may be required as a result of the publication of planning guidance and 2015/16 tariffs
in late December 2014. This will give us the opportunity for better quality discussions and
earlier certainty regarding 2015/16, enabling better planning and therefore a greater chance
of delivery of the agreed changes. We expect all contracts to be signed by 31 March 2015.
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4 Strategic Priorities for 2015/16
Our vision is underpinned by the 4 key workstreams of
i) Patient Empowerment and self-management
ii) Primary Care Transformation
iii) Whole Systems Integrated Care;
iv) Service reconfiguration underpinned by Shaping a Healthier Future;
This is shown in the diagram below.
We are currently developing the 5 year roadmap that sets out all the key milestones over the
next 3-5 years. The following section sets out the delivery priorities and milestones for
2015/16 against each of these key programmes.
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4.1 Patient Empowerment and self-management
We have been working in partnership with patients, carers, wider public and voluntary
organisations to ensure that the services that are commissioned are responsive to the needs
of the population. More specifically, the CCGs are committed to ensuring both the
continuous improvement in patient experience and the overall quality of care that is provided
locally.
Our Patient and Carer Experience Strategy was co-designed with patients, carers and
stakeholders to ensure, it has identified key areas of priorities that the CCG has committed
to resourcing. These include
Ensuring that providers produce quarterly patient experience reports which
o incorporates qualitative as well as quantitative data
o compares feedback from weekday and weekend services
o captures feedback that reflects the diversity of their patient and carer
population.
o Includes actions to address gaps in satisfaction and experience
Working in collaboration with Health and Social Care organisations through the
Whole systems Integration and Transforming Primary Care Programmes embed
patient and carer experience at every stage of development and implementation.
More specifically to:
o Ensure that patients are actively involved in shared decision making and
supported by clear information that it appropriate to the patient and carer
needs
o Improve staff learning and Experience
o To address the needs Carers for People with Dementia.
o To improve experience of patients and carers at Transfer of Care point
Our patient empowerment programmes will be targeted at supporting people with long terms
conditions to take more control of their health and wellbeing. The outcome of engagement
has enabled us to identify voluntary and community sector partners, through whom we can
promote self-management messages to patients and the wider public. Through our
commissioning and service re-design projects, we have embedded an approach to working
with patients, service users, carers and stakeholders. Our approach is therefore:
Collaborative: bringing together clinicians, staff, patients, service users and the
community together as equal partners, for example, to develop and implement the
Better Care Fund programme
Evidence-based: engaging to co-design evidence based and locally appropriate
solutions to promote integrated health and social care, for example, the on-going
community healthcare transport pilot
Asset-based : developing the capacity of patients, service users and the community
to engage effectively in identifying needs, project planning and development,
procurement, implementation and evaluation. This year, we ran the first training
course in Ealing for potential patient representatives.
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Continuous and iterative: engaging to build and refine sustainable models for local
delivery that reflect the needs and aspirations of local people and frontline staff
What we are currently working on (2014/15):
Integrating and co-ordinating health services across north west London
Helping patients to take control of their own care and managing their own conditions
Self-care and education program for diabetics
Greater involvement of carers in care-planning
Training potential patient representatives to participate in commissioning projects
Commissioning Healthwatch to support the CCG in its duty to enable individual
participation
Developing the relationship between clinical commissioners and the voluntary sector
with a view to procuring third sector services, including those that promote self-
management and independence
Briefing the voluntary sector on personal health budgets so that this information can
be cascaded to the local public
Promoting health messages, including self-care, through the CCG’s patient
newsletters, website and community stakeholders
Our plans for next year (2015/16):
Ealing CCG’s plans for 201/16 in terms of Patient empowerment and self-management can
be summarised as follows:
What will enable us to empower patients?
Lay representatives’ role in championing patients’ voices
Commissioners working together with patients to ‘co-design’ services
Support and care for carers
The voluntary sector’s role in speaking up for patients
Helping patients to manage their own conditions and to stay independent in the
community, supported by care navigators
Patient education
Expert patient program – learning from our peers
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Making the best and most appropriate use of medicine
Improving access to pharmacy services, supported by IT
Community transport – helping patients get to appointments
Personal Health Budgets – empowering patients to make decisions about their own
care
Public Health agenda – helping the population to stay healthy
Pharmacists – making best use of this frontline service
Increasing patients’ access to their own records
Effective communication with patients
Community Transport Pilot in Ealing - During 2013/14, Ealing CCG’s Patient and Public
Engagement workstream identified a range of needs in relation to patient transport to
appointments in primary, community and secondary settings. Particular barriers were
identified for people who are elderly or frail, who have mobility or other health problems, or
who live in geographically isolated parts of the borough.
In addition, the CCG’s Out of Hospital Strategy and the Shaping a Healthier Future
programme is likely to shift a significant volume of activity from hospital-based care to a
range of new settings in primary care, community services and patients’ homes. It is
recognised that some cohorts of less mobile patients will require additional transport
services to reach local services. Therefore, Ealing CCG made a public commitment to
commission services that would respond to these identified needs in its Commissioning
Intentions for 2014/15.
The CCG has started a six-month pilot project, focusing initially on the north of the borough -
this being the area where the greatest access barriers have been identified - but with a view
to expanding to cover a wider area of the borough and to enable all Ealing practices to
participate and benefit from the service.
As there are information gaps in the demand map, the pilot will be used to test the demand
for and take-up of the service, as well as trialling how well the logistics work for practices,
patients and the transport provider. The pilot will be delivered by Ealing Community
Transport, a local voluntary organisation with a long track record to providing community
transport services.
In our Better Care Fund plans, Ealing CCG has identified that community transport service
will be a critical element of the GP Based integrated care and coordination model in 2015/16.
Working with Patient, Public and lay partners
Ealing CCG has made an on-going commitment to capturing public feedback and patient
experiences. This information is gathered through a number of conduits, including public
events, stakeholder meetings, the local community networks, local voluntary sector forums,
partnership boards, a range of patient and carer-led groups, Healthwatch, complaints,
Patient Participation Groups at local GP practices, and via patient representatives.
There were over 100 engagement interactions in the last quarter. These are collated into a
three monthly report, drawing out the key themes and patterns. This report is scrutinised by
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both Ealing CCG’s patient and public engagement committee and the quality and safety
committee, before it goes to the CCG's governing board to inform its commissioning,
decision-making and planning.
Many of the key issues identified through the engagement work described above have
directly informed our commissioning intentions 2015/16. Community transport, interpreting
services and support for carers have been frequently raised through our PPE work.
Consequently, these themes are all clearly referenced as areas for action in our
commissioning intentions.
The CCG’s top twenty community stakeholders have been identified and there is regular
communication with them to cascade messages and invite responses. Our approach to
consultation, engagement and communication will be to use existing community networks,
voluntary sector forums, self-help groups, patient forums, Healthwatch and partnership
boards in the borough.
Healthwatch, in particular, is key to our patient and public engagement work stream as it
enables us to identify patient and carer representatives to participate in our service re-design
and commissioning projects. There have been good examples of Healthwatch volunteers
helping to share service specifications and participating on steering groups and in
procurement exercises. We aim to continue this joint work with Healthwatch and ensure that
Healthwatch and local residents are involved in our contract negotiations with providers as
well as service redesigns.
Working with Local Authority
Ealing CGG is committed to working with the Health and Well Being Board and the Health
and Adult Services Scrutiny Panel to ensure good oversight of health and social care
services.
In 2013 the Health and Well Being Board was established with new statutory functions to
encourage integrated working to enhance the health and well-being of the local population,
based on a Joint Strategic Needs Assessment (JSNA) and a Joint Health and Well Being
Strategy (JHWBS). Over the past year we have contributed to the review of the JSNA and
the development of the Health and Well Being Strategy as well as supporting the
commencement of the strategy’s implementation.
The Health and Social Care integration agenda, as it affects a range of services for Children,
Young People, and Adults, brought new responsibilities for the Health and Wellbeing Board
and the need for a robust framework to ensure transparency, democratic and financial
accountability overseeing these jointly delivered services. The membership of the Health and
Wellbeing Board has subsequently been reviewed during the summer of 2014 to align with
the changing priorities and responsibilities for health and integrated service delivery.
Ealing CCG is required to present its commissioning plan for 2015/16 and seek the
governing board’s opinion as to whether the plan takes proper account of the JSNA and the
Joint Health and Well Being Strategy. This document forms part of that process and will be
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adapted according to the feedback received. Further links will be made with the Health and
Well Being Board as the CCG’s commissioning intentions are rolled out.
This document is due to be presented to Health and Adult Services Scrutiny Panel at its
meeting in November 2014, providing a formal opportunity to review and scrutinise the
proposals. Similarly there will be on-going involvement in scrutiny going forward, particularly
in key areas of change. Where ever possible it is our intention to engage scrutiny in the early
stages of service development to maximise opportunities for co-production.
Ealing CCG’s whole systems care and better care fund plans recognise the need to increase
efforts in prevention and health maintenance, supporting and empowering people to care for
themselves. The Public Health Department is a key stakeholder and fully engaged in
developing integrated care as well as being represented on the HWBB. Our plans are
aligned to the joint Health and Wellbeing Strategy and Joint Strategic Needs Assessment
(JSNA).
The Public Health Department commissions activities to encourage the promotion of self-
care as well as prevention of long-term conditions, and have undertaken significant primary
care prevention interventions around diabetes.
Other innovative interventions, put in place in collaboration with the ECN and local VCS
groups, include initiatives such as:
‘Change for life’ programmes such as “Eat Less – Move More”, and “Eat well on a
tight budget” sessions in community venues
‘Make every contact matter’ programmes, using motivational interviewing techniques
to embed healthy lifestyles
Projects to reduce social isolation for older people
Outreach health checks on estates and in community hubs (provided by trained NHS
staff)
We will continue to work proactively with Public Health during 2014/15 to seek to align
budgets and contracts and to assess how services commissioned by public health are
supporting our jointly agreed Health and Social Care plans. We will review opportunities to
work with public health commissioners and providers on shaping the specification of services
in scope for our integration work, particularly in relation to Third Sector commissioning, the
promotion of self-care, care coordination & navigation and in supporting the Council to meet
statutory duties to promote wellbeing as part of the Care Act.
Working with Member Practices
GPs practices in Ealing are invited to report any concerns they have about services
commissioned by the CCG, using the service alert process. The process enables us to have
an overview of how well our commissioned services are meeting the needs of patients and
member practices, to identify themes that need to be raised with providers and to feed into
the CCG commissioning intentions. Our commissioning intentions respond to the themes
raised by the service alerts in a number of ways, including:
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Care navigator and care co-ordination roles and the move towards seven-day
working will support care-planning and joint working between providers and
practices. This will respond to frequent concerns about inappropriate referrals and
discharge planning raised in service alerts.
There is an expectation of our commissioned providers to improve diagnostic
services, which will address some of the concerns regarding delays for patients when
accessing treatment.
The CCG’s continued commitment to the Shifting Settings of Care workstream will
respond to service alerts relating to mental health by strengthening joint working
between specialists and primary care.
The intention to roll out SystmOne will improve the two-way exchange of information
and clinical correspondence between practices and providers. This addresses the
many concerns relating to communication, one of the most common themes arising
from service alerts.
The review of community health services will also improve communication and co-
ordination between practices and providers, linking community providers with primary
care.
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4.2 Primary Care Transformation A number of drivers have combined to create a pressing need to transform access to General
Practice in NW London:
Patient expectations: in a recent survey of NWL patient priorities for primary care,
seven of the top ten issues related to improved access.
Implementation of the Shaping a Healthier Future reconfiguration programme: The
Independent Reconfiguration Panel (IRP) report on NWL’s Shaping a Healthier Future
(SaHF) programme requires GP practices in NW London to move towards a ‘seven
day’ model of care to support the agreed changes to acute services.
Contractual drivers: With effect from April 2014, GMS contractual arrangements have
been amended to reflect an increased emphasis on improved access to General
Practice.
Financial drivers: A consistent, system-wide access model has the potential to reduce
costs for both commissioners (reduced service duplication) and providers (more
efficient use of resources).
Though it may be part of the solution, expanding capacity alone will not improve access to
General Practice. There are several reasons for this:
Funding: It is financially unsustainable for every GP practice in NW London to operate
8am – 8pm, 7 days a week.
Workforce: There are not enough GPs and nurses in NW London for every GP practice
to operate 8am – 8pm, 7 days a week.
New demand: Likely that increasing the number of appointments would cater for unmet
need instead of re-distributing existing demand.
More of the same: Still wouldn’t give the public the type of appointments they want
(e.g. doesn’t make use of new technology to offer different types of appointment and
make booking appointments more convenient).
Any strategy for widening access to General Practice must therefore comply with four
overarching goals:
1. System-wide reconfiguration of access to all ‘General Practice’-type services: the
provision of additional urgent appointments outside of core hours is unlikely to lead to
sustainable improvements to access. In order to ensure that we are able to deliver
services that genuinely reflect patient needs and preferences, we need to be thinking
about seven day working across General Practice in its totality
2. Financially and operationally sustainable: a new model must be affordable and
deliverable. In the long-term this probably means no net increase in cost or workforce
3. Meets patient expectations: a new model must deliver the type of appointments
patients want, when they want them.
4. Reconfigures both supply and demand such that both are mapped more closely to
clinical need: Though patient choice should be respected, every effort should be made
to ensure that patients receive care appropriate to their clinical condition. This means
mapping capacity more closely to clinical need.
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NW London were awarded funding through a successful application to the Prime Minister’s
Challenge Fund. This is now a significant enabler to delivery of NW London’s vision for a
transformed primary care landscape in allowing, through a combination of NWL and NHSE
funding:
Extending GP access and continuity in the short term (by the end of 2014/15)
Putting in the right support in place to nurture and grow GP networks (in 2014/15 and
beyond)
Developing detailed plans with primary care to ensure the model is sustainable for
15/16 onwards
The Challenge Fund will focus on outcomes around Urgent, Continuity and Convenient Care
to ensure that patients have access to General Practice services at times, locations and via
channels that suit them seven days a week
Ealing CCG’s plans for 201/16 in terms of Primary Care Transformation can be summarised
as follows:
Out of Hospital Services Central London, West London, Ealing, Hounslow and Ealing CCGs are working together to
enable transformation within primary care across the CWHHE collaborative. Each CCG has
an Out of Hospital (‘OOH’) strategy that describes keeping the patient at the centre of their
own care, with the GP as a key provider and coordinator of services. In addition, key
strategic priorities for the CCGs are to improve quality, reduce variation within primary care
and ensure all patients within the CCG have equity of access to commissioned services. The
CWHHE collaborative has therefore agreed to realign services to support the delivery of the
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OOH strategies, including the commissioning of a consistent range of services – an OOH
portfolio - from GP networks.
Implementation of the OOHS portfolio with the new GP provider organisations will
commence during 2014/15; in 2015/16, the roll-out of the service portfolio will be completed
with the aim to have full population coverage by 2016/17. Secondary care providers will be
assisted in supporting the expected shift of activity into primary care settings.
Ealing CCG is commissioning the following OOHS:
i. ABPM service that delivers a safe and timely Ambulatory Blood Pressure
Monitoring service
ii. Anticoagulation service that Improves patient access to safe and clinically
effective anticoagulation initiation and monitoring to patients on warfarin therapy
iii. A case finding, care planning and case management service ensuring patients at
high risk of admission and/or with complex health and social care needs have a
care plan in place, supported by proactive case management as appropriate
iv. General practice to use the Coordinate My Care system to support the
management of palliative care patients
v. A complex wound care service to improve the quality of life for people requiring
management of their wounds, through the delivery of clinically effective care and
advice which reduces the risk of recurrent infection and promotes independence.
vi. A diabetes service that supports and enables primary care clinicians to provide
patient care in a seamless and integrated way through supported diabetes
education, improving the proactive care of patients at high risk of diabetes,
reducing variations in diabetes care and outcomes across network populations,
enabling better self-management of diabetes through care planning
vii. Service providers to deliver an EGG recording and interpretation service. The
services will detect common cardiology conditions such as, but not limited to,
arrhythmias and heart block
viii. A service for homeless people to ensure this group has patient access to the
appropriate services
ix. A near patient monitoring that means the service provider will undertake the
necessary monitoring required for certain defined drugs, ensure that the service
to the patient is convenient; review the need for continuation of therapy on a
regular basis
x. Delivery of a timely and safe phlebotomy service
xi. A ring pessary service that delivers a timely, effective and personalised ring
pessary service in a safe environment and provides appropriate patient education
xii. A safe and timely spirometry testing service
xiii. A service for enhanced engagement for those patients with serious and enduring
mental illness (SEMI) where responsibilities for care are transferred between
secondary care and primary care
xiv. Management of common mental health problems service that aims at increasing
diagnosis of complex common Mental Illness and case management of people
with moderate to severe complex common mental illness.
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At this stage, the impact on individual acute, community and mental health providers is yet to
be confirmed, as the new GP networks are in the process of confirming contracted services
and activity levels. It is also recognised that the implementation of these services will have
varying impact as some are new, whilst others represent an extension of existing services,
both in terms of specification and population coverage. In 2015/16, the roll-out of the service
portfolio will be completed with the aim to have full population coverage by 2016/17.
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4.3 Whole Systems Integrated Care In the summer of 2013, along with partner organisations across North West London (NWL),
we committed to a vision to create “better coordinated care and support, empowering people
to maintain independence and lead full lives as active participants in their community.” The
Whole Systems Integrated Care (WSIC) programme was established to achieve this shared
vision. As indicated in our commissioning intentions last year, an extensive programme of
co-design ran through 13/14, which included partners from health and social care
organisations across NWL, service users and carers.
NWL is one of fourteen national integrated care ‘Pioneers’. We are currently developing
detailed local plans in order to begin implementation in 15/16 and will continue our
commitment to collaboration and co-production with our partners. We anticipate that our
transition to full Whole Systems Integrated Care will take three to five years, at which point
we will be:
Commissioning fully integrated models of care based on the holistic needs of different
population groups, encompassing both health and social care
Jointly commissioning for each population group a set of outcomes across health and social
care, with a single, combined, capitated budget to achieve them. Through capitation, we will
support service users to access a personal budget for health and social care needs as
agreed through the development of a personalised care plan
Commissioning a group of providers to offer an integrated care service to the population
groups. We anticipate that these providers will work together as an accountable care
partnership (ACP) and be held collectively accountable for achieving the commissioned
outcomes and managing the associated financial risk for the population groups.
In 15/16, we will begin to move towards Whole Systems by implementing elements of a new
model of care, employing a joint commissioning approach and continuing to work
collaboratively with providers to support the development of accountable care partnerships.
Our Whole Systems Integrated Care will involve the following:
Co-commissioning arrangements
o LA, CCG and NHSE agree a co-commissioning governance model
o Social, mental health, acute, community and primary care budgets that are spent on
a particular group of people are grouped
o Where people would benefit from integrated care, they explore what a pool of
associated social, mental health, acute, community and primary care budgets may
look like in a shadow form for those people
o During the year explore what a risk sharing and/or gain sharing agreement may look
like under these joint provider arrangements
Contracting
Commissioners explore how best to jointly commission these services to deliver
improved outcomes for the population as a whole rather than by service
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o Set measurable outcomes that an Accountable Care Partnership (ACP) must
deliver, both clinical targets, financial savings targets and personal goals of the
people
o Commission care at a scale to fit with coherence to a population health approach and
the commissioning strategy of LAs and CCGs
o Assure that ACPs are formed from existing providers in a geography such that
system is not destabilised and choice is maintained
o Establish contractual frameworks for provider services outside the ACP scope (e.g.,
A&E, elective surgery, rehabilitation services) and allow flexibility for ACP to procure
services directly when needed
Accountable Care Partnership
o Relevant provider leaders come together in an Accountable Care Partnership (ACP)
around a GP registered population.
o The ACP is representative of all member provider’s views and ensures they work in a
co-ordinated and collaborative way to shared objectives
o Governance arrangements are agreed for new ACP, including how decisions are
made
o Delegation of decision rights from the parent organisations is agreed
o The ACP board decides how to reallocate the capitated budget into the composition
of the new care team (i.e., proportion invested in social care/community/mental
health/specialist interventions/self-care/personal budget)
o Rules are established in advance for how financial risk is repatriated to parent
organisations or reinvested in the ACP
o Binding performance management targets are agreed for the integrated care team
o An integrated administrative support and management function is created, including
a joint CFO
o An integrated operations director is established to help manage team to deliver
clinical and financial objectives
o Providers currently working with the population groups in each local geography
respond to this vision
New model of care
o Health and Social care staff are brought together from their parent organisations into
a single, integrated care team
o The team is a named list of professionals, who are accountable for a named list of
people
o People take control of their own personal health budgets that they direct in order to
achieve their care goals
o The team is able to purchase services from providers that are not part of the
Accountable care Partnership (ACP) if needed, though larger ACPs will be more able
to provide a wide range of services themselves
o Self-care, community capital and the third sector are core parts of the model
o The team has one point of accountability and shared clinical and financial objectives
based on the person’s own needs
o They are co-ordinated and managed by an integrated management function
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o The GP holds ultimate clinical responsibility but delegates delivery to the team where
ever possible
o There are clear performance objectives that the team is managed against week-on-
week, with peer to peer GP review
o They are co-located - or at minimum have high levels of in person and virtual
communication
o The model of care is tailored to meet different people’s different needs, not a one-
size-fits all
All providers will continue to have the opportunity to participate in the development of WSIC
through a collaborative, iterative process. Through on-going co-production with both our
partners and service users, we will continue to build towards a model of integrated care that
best meets the needs of our residents. We expect providers currently working with
population groups in our local area to respond to these intentions.
Ealing CCG’s plans for 2015/16 in terms of Whole Systems Integrated Care can be
summarised as follows:
The Better Care Fund (BCF) is a key enabler for Whole Systems Integrated Care. Two major
schemes within the BCF that are particularly significant are described later in the document.
These schemes represent a continuation of the direction we set out in our commissioning
intentions for 2014/15; they are aimed at addressing increased demand and complexity of
need amongst older people as well as improving efficiency and reducing duplication, the
schemes are:
Healthy at Home (Virtual Ward)
GP-based integrated care and coordination
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4.4 Service Reconfiguration (Shaping a Healthier Future)
Shaping a Healthier Future (SaHF), the acute reconfiguration programme in NW London, will
centralise the majority of emergency and specialist services (including A&E, Maternity,
Paediatrics, Emergency and Non-elective care) to deliver improved clinical outcomes and
safer services for our patients. Agreed acute reconfiguration changes will result in a new
hospital landscape for NW London. The SaHF Reconfiguration programme will oversee:
The existing hospital landscape of nine hospitals reconfigured to provide five Major
Acute Hospitals;
Ealing and Charing Cross sites redeveloped, in partnership with patients and
stakeholders, into Local Hospitals;
Hammersmith Hospital established as a specialist hospital; and
Central Middlesex Hospital will be redeveloped as a Local and Elective Hospital.
2014/15 service changes
Following the ‘full’ support of the Secretary of State in October 2013 following the review of
the Independent Reconfiguration Panel, priority service changes are being delivered in
2014/15:
Transition of services from the Emergency Unit at Hammersmith Hospital
Transition of services from the A&E at Central Middlesex Hospital
All Urgent Care Centres (UCCs) moved to a common operating specification, including
a 24/7 service
The programme has also been undertaking contingency planning for the potential transition
of Maternity and Paediatrics services at Ealing Hospital.
Contracts for 2015/16 will reflect the full year effect of the changes above.
OBC development
Outline Business Cases (OBCs) will be developed and centrally reviewed for all sites in
2014/15 (major and local hospitals). Additionally, the programme is also developing an
Implementation Business Case (ImBC) to ensure that the refined solution for NW London
remains affordable and aligned with the clinical vision. OBCs for Major and Local Hospitals
are expected to be approved by NHSE, NTDA, DH and HMT in 2015/16, and following this
Full Business Cases will be developed to allow the redevelopment of sites to continue.
Clinical Standards
The programme supports the achievement of enhanced clinical standards. As part of the
original development of NW London’s vision, NW London’s clinicians developed a set of
clinical standards for Maternity, Paediatrics, and Urgent and Emergency Care, in order to
drive improvements in clinical quality and reduce variation across NW London’s acute trusts.
During 2015/16, all Acute Trusts will be required to meet the following standards:
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Time to first consultant review: All emergency admissions must be seen and have a
thorough clinical assessment by a suitable consultant as soon as possible but at the
latest within 14 hours of arrival at hospital.
On-going review: All patients on the AMU, SAU, ICU and other high dependency
areas must be seen and reviewed by a consultant twice daily, including all acutely ill
patients directly transferred, or others who deteriorate.
Diagnostics: Hospital inpatients must have scheduled seven-day access to
diagnostic services such as x-ray, ultrasound, computerised tomography (CT),
magnetic resonance imaging (MRI), echocardiography, endoscopy, bronchoscopy
and pathology. Consultant-directed diagnostic tests and completed reporting will be
available seven days a week: within 1 hour for critical patients; within 12 hours for
urgent patients; within 24 hours for non-urgent patients
In addition, Acute Trusts will be expected to produce quarterly patient experience reports
that compare feedback from weekday and weekend services.
These clinical standards, along with the London Quality Standards and the national Seven
Day Services Standards, will underpin quality within the future configuration of acute
services, including along the urgent and emergency care pathway. North West London is
committed to delivering seven day services across the non-elective pathway by March 2017,
based on the national clinical standards, in order to improve the quality and safety of
services and to support emergency care flow.
Over the course of 2015/16, Acute Trusts will work towards achieving the following 7 day
standards:
Multi-disciplinary Team review: All emergency inpatients must be assessed for
complex or on-going needs within 14 hours by a multi-professional team, overseen
by a competent decision-maker, unless deemed unnecessary by the responsible
consultant. An integrated management plan with estimated discharge date and
physiological and functional criteria for discharge must be in place along with
completed medicines reconciliation within 24 hours.
Shift handover: Handovers must be led by a competent senior decision maker and
take place at a designated time and place, with multi-professional participation from
the relevant in-coming and out-going shifts. Handover processes, including
communication and documentation, must be reflected in hospital policy and
standardised across seven days of the week.
All providers across primary, community and social care will work towards 7 day discharge
pathways – i.e. that support services, both in the hospital and in primary, community and
mental health settings must be available seven days a week to ensure that the next steps in
the patient’s care pathway, as determined by the daily consultant-led review, can be taken.
Ealing CCG’s plans for 201/16 in terms of Service Reconfiguration can be summarised as
follows:
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4.4.1 Acute Services Transformation
The acute reconfiguration is dependent on significant take-up of existing and new out of
hospital services being delivered locally by all CCGs to ensure that patients only go to
hospital when they need to.
As part of a common commitment across NW London, CCGs will commission services from
Acute Trusts that meet the agreed clinical standards, including those defined by the Shaping
a Healthier Future programme, London Quality Standards, and national Seven Day services
standards. In 2014/15 the baseline of delivery against the Seven Day standards has been
established, and a NWL prioritisation has been agreed to guide the sequencing of Seven
Day standard achievement through until March 2017.
Service changes as defined by the SaHF Programme are expected to proceed as planned
and advised following the endorsement from the Secretary of State in 2013. Detailed timings
for service changes will be communicated to the public as they become available. Within
acute services, the CCG intends that the following service changes and improvements will
be achieved in the 2015/16:
Emergency Admissions and A&E attendances
A minimum reduction in avoided emergency admissions and A&E attendances of 3.5%
The CCG will implement the whole systems integrated Healthy at Home Service
incorporating the revised model of ICE (Intermediate Care Ealing) service, inclusive
of the new model of care based on the “Virtual Ward” concept. This is in line with the
CCG’s Whole Systems Integration Strategy, BCF Programme and Out of Hospital
Strategy. The key components of the service will be Rapid Response, Short Term
Rehabilitation and Enhanced Supported Discharge from acute hospitals for all Ealing
registered patients, Reablement Support. In order to reduce and avoid emergency
admissions, referrals pathways straight into the new Integrated Healthy at Home
Service will be established via a Single Point of Access, from GPs, London
Ambulance Service, A&E departments, District Nursing Service, Practice Nurses, GP
Out of Hours, Urgent Care Centres, and others as appropriate.
The new service will be available from 1st July 2015.
Cardiology Services
Decommissioning of the elements of existing outpatients services and non-electives. New
service provider and clinical pathways will be in place in 2015/16 following the service
redesign and procurement during 2014/15. The new service will commence from July 2015.
Respiratory Services
Respiratory service redesign is in progress impacting elements of respiratory outpatients and
emergency inpatients. New community service provider and clinical pathways will be in place
in 2015/16 following the service redesign and commissioning. Anticipated start date Q3
2015/16
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Older Persons Services
Re-commissioning of the community pathway so that its combines frailty, falls and fracture
services, which will reduce admissions of the elderly. See Community service contracting
intentions table on the following pages. Expected to impact on both level of admissions and
length of stay for patients under Care of Elderly specialty. Anticipated start date Q3 2015/16
Gynaecology.
Gynae service redesign leading to the establishment of a new community service to cover
conditions/treatments including infertility, menorrhagia, menopause, ring pessary. Expected
to impact outpatient attendances and related procedures. Anticipated start date Q3 2015/16
Cancer Services
Cancer is one of the four priority areas for improvement identified by NHS England (London)
to transform the health, wellbeing and lives of Londoners.
Cancer services will be commissioned in line with a number of national and regional cancer
priorities and quality standards. The Five-year Cancer Commissioning Strategy for London
was launched in February 2014. The strategy was developed collaboratively by NHS
England with significant input from cancer clinicians, representatives from the Integrated
Cancer Systems linking into the clinical pathway groups, CCG clinical commissioners as well
as commissioners from Public Health England and NHS England.
The approach taken for 2015/16 is to refine last year’s commissioning intentions as they will
not all have been delivered by April 2015 and only to add limited additional areas. In
2015/16 quality requirements for cancer have been refined to provide clarity on actions to
reduce variation. The KPIs have been aligned to the Model of Care and the work
programmes of the integrated cancer systems. Commissioning intentions for 2015/16 are
summarised below.
All cancer services will be commissioned in line with the requirements of NICE Improving Outcomes Guidance and NICE quality standards (QS), the London Model of Care for cancer services and the National Cancer Survivorship Initiative (NCSI). Where there is new guidance or QS these will be identified below.
To support delivery of national CWT standards, services will be commissioned against timed tumour level pathways commencing with lung, colorectal, breast and prostate cancers in 2015/16 .Each timed pathway will be required to have clear escalation points and an agreed inter-trust referral policy.
A number of services will be commissioned to support the earlier diagnosis of cancer in line with the Pan London Early Detection pathways.
Some services will be commissioned to manage the consequences of anti-cancer treatment (late effects).
Earlier detection of cancer
GP direct access to diagnostics (chest x-ray (same day chest x-ray for high suspicion of cancer), non-obstetric ultrasound)
Services will be required to comply with NICE guidance for smoking cessation(2013) and for staff to complete e-learning in relation to “every contact counts”
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GP direct access to flexible sigmoidoscopy, colonoscopy via a diagnostic triage service that will assign the most appropriate diagnostic test. There will be no minimum age requirements for referral for low risk, but not no risk of cancer cases (previously there was a minimum age restriction of 55 years)
In order to promote the earlier diagnosis of ovarian cancer, services will be commissioned to support US and CA125 concurrently
In order to support the reduction of the risk of delayed diagnosis, all commissioned services will be required to formally report A&E, Urgent care centres and inpatient chest x-rays(CxR)
JAG accreditation for endoscopy services
Reducing variation in secondary care
All services will participate in national cancer peer review or other assurance
programme defined by commissioners. All cancer MDT’s are quorate for 95% of
meetings and individual members attend 66% of meetings (in order to support
improved MDT decision making)
Endo-bronchial US (EBUS) services are commissioned to an agreed service specification and tariff.
Best practice timed pathway for lung cancer
Best practice timed pathway for breast cancer – all to provide a one stop diagnostic service. All surgeons to have a minimum caseload of 50 per annum.
Best practice timed pathway for colorectal cancer – all teams completing 60 new surgical cases with curative intent. All people who need emergency treatment should be treated by a colorectal cancer team
Note: All timed pathways will be required to have clear escalation points and an agreed
inter-trust referral policy.
Prostate cancer services commissioned in line with NICE guidance (2014)
Providers to agree and implement service consolidation plans
Services will be commissioned to provide pathways for the management of treatment related fertility issues (NICE Guidance 2013)
Services will be commissioned for the management of those with a family history of moderate risk breast cancer to a Pan London specification (NICE Guidance 2013)
Services for the provision of Metastatic spinal cord compression will be commissioned in line with NICE QS56 (Feb 2014).
Living with and beyond cancer - recovery package (NCSI)
All cancer services commissioned to deliver the recovery package (holistic needs assessments and care plans, treatment summaries; health and well-being events)
Stratified pathways (breast, colorectal and prostate)
Pathways for the consequences of treatment of pelvic radiotherapy, lymphedema and treatment related sexual dysfunction
These commissioning intentions were signed off by the Pan London Cancer Commissioning
Board (CCB) on the 23rd September 2014.
In addition, during 2014/15 London CCGs and NHSE commissioners have been in
discussion regarding the realignment of cervical screening commissioning in line with the
national requirement. The London Cervical Cancer Screening Commissioning Task and
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Finish Group is currently working through realignment options and there may be an impact in
year 2015/16 which will be managed via the contract variation process as required.
GP Pathology Services
Service to be changes to maintain the adult walk-in phlebotomy service, but discontinue the
consultant interpretation and GP advice line.
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4.4.2 Community Services Transformation In line with CCGs’ Out of Hospital Strategies; Ealing Integrated Care Organisation (EICO),
and, NHS Brent CCG and NHS Ealing CCG (ECCG) with EICO agreed to work on a
comprehensive commissioner-led review of community services in 2014. This review will
inform our decisions that need to be made to create community services which are fit for
purpose for adults and children in Ealing over the next 5-10 years. The review’s key question
is ‘How are we going to develop a plan for Ealing’s community services that ensures we
increase capacity in community and intermediate care services effectively across the
transforming system, balancing resources’. The focus is on getting to the best integrated
model of care across social care and GP practices / practice networks.
Ealing CCG is currently completing an open book review of community services and is on a
pathway to consider the re-commissioning of this contract. The timeline of this pathway is yet
to be developed and although seen as a key step in the delivery of our out of hospital
services & whole systems agenda. In view of the complexity of change in Ealing, we are
unable to determine a finalised timeline at this point.
The CCG wishes to work with the ICO to implement the findings and recommendations of the Community Services Review:
Improvements in visibility of the community nursing team within the multi-disciplinary team wrapped around the GP practice;
Revisions to community nursing to align with the “Whole Systems” model of care including the “Healthy at Home Service (Virtual Ward)”;
Improvement in recruitment & vacancy rates.
Improvements to the podiatry, ophthalmology and tissue viability services as per findings of the Community Services Review.
Intermediate Care Services in Ealing
The CCG wishes to commission a new integrated whole systems Healthy at Home Service, incorporating the current ICE (Intermediate Care Ealing) service and the “Virtual Ward” model. The new service will take account of the recommendations from the 2014/15 ICE Review. The key components of Healthy at Home will include:
Rapid Response,
Short Term Rehabilitation,
Enhanced Supported Discharge
Single Point of Access.
Social Care
Links with WLMHT for Dementia and mental health patients, embedding improvements from 2014/15 Dementia and mental health CQUIN into the service. Linked to the psychiatric liaison service, dementia and mental health services
Musculo-skeletal Services
Ealing CCG is working with the CWHHE CCG Musculoskeletal Services Review
Collaborative to ratify a model core pathway, clinical pathways and service specification that
should ensure patients across this area of North West London will have access to a
community MSK service that is equitable regardless of which CCG they are registered with.
Eight high volume clinical pathways for orthopaedic, musculoskeletal and rheumatological
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conditions will be implemented to ensure a common approach to clinical management
including investigations and referral thresholds. The keys areas for service redesign for
Ealing arising from the CWHEE review are:
to continue supporting primary care management of common musculoskeletal conditions through a robust education programme
develop a single point of access for the community and hospital musculoskeletal, orthopaedic and rheumatology services with embedded clinical triage to ensure patients are seen in the most appropriate setting of care
improve the efficiency and clinical effectiveness of the community-based musculoskeletal physiotherapy and interface services by reducing waiting times and DNAs, and providing adequate and appropriate numbers of treatments per patient
continue the clinically and cost-effective access to MRI scanning and other diagnostics through the Musculo-Skeletal interface service
develop a community musculoskeletal pain service
develop community based rheumatology input to the Musculo-Skeletal interface service to allow care closer to home for patients with long term conditions
adhere to clinical standards for discharge from Musculo-Skeletal services
access post-operative care and rehabilitation in a coordinated way through the single point of access
clinical integration and identifying the resources to enable musculoskeletal services provision within the whole systems integration programme for defined populations (e.g. frail elderly)
Ealing CCG will explore with the CWHHE CCG Musculoskeletal Services Review
Collaborative about funding and procurement options for the redesigned services across the
cluster. Ealing CCG is keen to explore the early adoption of a pathway funding model for
services not covered by the whole systems integration programme, to promote clinical,
financial and organisational integration of musculoskeletal services along common clinical
pathways, to provide seamless services across organisation boundaries Service
development will adhere to the published NICE Quality Standards for osteoarthritis, low back
pain and rheumatoid arthritis and will contribute to the achievement of outcomes in the
health, social care and public health outcomes frameworks, with particular reference to long
term conditions.
Other QIPPs (not inclusive list): The CCG will expect to include provision for other QIPP
schemes in the 2015/16 contract, including their associated impacts on activity. These
include Diabetes, Anti-Coagulation, Tele-dermatology, and Referral Facilitation Services,
which all impact relevant outpatient specialties. Providers will only accept referrals that have
been approved through the Ealing RFS service (subject to defined exceptions). QIPPs also
include Enhanced Primary Care for Nursing Homes, affecting A&E and emergency
admissions.
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4.4.3 Integrated Commissioning This section has been prepared by both Ealing CCG and Ealing Council. They set out the
commissioning intentions of both organisations in respect of all the areas of commissioning
where the two organisations collaborate and have integrated commissioning arrangements
in place.
4.4.3.1 Better Care Fund
The Better Care Fund (BCF) is a key enabler for Whole Systems Integrated Care. Two major
schemes within the BCF that are particularly significant are described below. These
schemes represent a continuation of the direction we set out in our commissioning intentions
for 2014/15; they are aimed at addressing increased demand and complexity of need
amongst older people as well as improving efficiency and reducing duplication, the schemes
are:
Healthy at Home (Virtual Ward)
GP-based integrated care and coordination
Healthy at Home model in Ealing
Healthy at Home model in Ealing aims to create a wholly integrated pathway of services and
care for the older persons in Ealing, and help individuals remain at home and receive any
care required in a home or community setting.
Figure: Healthy at Home Model in Ealing
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Ealing’s Intermediate Care service will be expanded, developed and re-commissioned, to
establish the Healthy at Home service. We will create Healthy at Home Service in the
community, comprised of integrated care community and social care teams. The Healthy at
Home Service will connect GP practices, occupational therapists, intermediate care and
community nursing teams. They will build upon the multi-disciplinary integrated teams that
already meet and work together in Ealing.
The key aims of the service will be to:
Reduce urgent hospital attendances where possible by providing high quality clinical
care at home to patients;
Reduce the length of stay in hospital;
Improve integrated coordinated care – high quality rapid response care that is patient
centred, coordinated and offers continuity of care to high need patients.
The central elements of the model are:
Rapid Response Services, which provides crisis response
Inreach/Supported Discharge, providing support in A&E to direct patients to more appropriate community services rather than hospital admission
Rehabilitation, providing therapies for people particularly with co-morbidities, where such rehab has the potential to improve the outcomes for people with multiple conditions
Reablement, providing support in the community to maximise independence and reduce reliance on healthcare professionals
GP-based integrated care and coordination – Whole Systems Model of Care
Following a series of workshops and engagement events with commissioners, provider partners, voluntary sector partners and lay partners a vision for an Integrated Model of Care is emerging.
This model of care comprises of 6 core components. These are:
Figure: Elements of care coordination model
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Care Planning & Case Management
Screening through individualised care plans developed in partnership with patients,
ensuring holistic, proactive screening and advice in order to prevent deterioration
and / or unnecessary emergency admissions.
Care co-ordination
Support for patients to get proactive, co-ordinated, responsive care close to home,
without having to repeat themselves.
Care navigation
Support patients to navigate their way through the complex health and care system.
Joint care team (JCT)
A multi-disciplinary team wrapped around a network of practices, supporting primary care to deliver the best, most responsive care possible. The JCT would comprise of a number of staff groups, including mental health, social workers, community nursing teams, community pharmacists and the voluntary sector.
Self-Care
Supporting patients to feel empowered to manage themselves but know when to reach out for help and where.
Community Transport
In order to support patients to access community sites, a pilot to explore how a community transport service may work is being developed.
4.4.3.2 Children’s Services
In 2014, an analysis was undertaken of Paediatric hospital activity. Following on from this,
we will focus on following key priorities:
The development of Connecting Care for Children in two pilot sites. The business
model is being developed with a view to implementation in 2015/16. The aim of this
approach is to improve the primary care response to paediatric cases and to reduce,
where possible, the use of hospital services especially outpatient services.
Anticipated start date: quarter 2 or 3 of 2015/16
To set up an atopic conditions service for children, working in community settings
and with families in their own homes. The business model, with options for
procurement, is under development with the aim of setting up the service in 2015/16.
Anticipated start date: quarter 2 or 3 of 2015/16
Subject to decision by the CCG executive, a new service model for CAMH out of
hours service delivery will be put in place providing more comprehensive coverage
and helping to reduce avoidable admissions. This new approach is being developed,
following a review of the current service and options for change, across 8 CCGs.
Integrated services for children aged to 0 to 5 (known as Early Start Ealing) – the
plan is, subject to final decision by CCG, jointly commission this service with LBE.
The service will comprise health visiting, SLT and OT, social worker support, family
support and be based in three administrative centres. Anticipated start date: Oct
2015.
Integrated services for children with SEN/disabilities – the plan is to renew the joint
commissioning arrangement with LBE for these services and to review specialist
health services in light of new legislation.
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4.4.3.3 Mental Health Transformation
In June 2014, the Collaboration Board supported the need for co-ordinated, system-wide
change in NWL as the best way to achieve our vision for mental health and wellbeing
services, ensuring mental health has an equal priority with physical health, and that those
with mental health needs get the right support at the right time. It agreed that a programme
of work should be delivered to address the strategic challenges and opportunities facing
mental health and wellbeing services in NWL. Since then, engagement has been undertaken
with a wide group of stakeholders to gauge their interest in the programme and their views
regarding its scope and the timescales within which each stage of the programme could be
achieved. Stakeholders include all NWL CCGs and Local Authorities, WLMH, CNWL,
Directors of Public Health, members of the Mental Health Programme Board, Lay Partners
and Imperial College Health Partners.
Overall enthusiasm and commitment has been high whilst recognising the need to ensure
alignment with existing local programmes and priorities and national initiatives. In September
the Collaboration Board noted progress on development of the NWL Whole System Mental
Health and Wellbeing Strategic Plan and endorsed a Programme Initiation Document setting
out the governance arrangements, overall timetable and the resourcing requirements to
deliver this exciting and important piece of work. The programme will likely commence in
November 2014, with a case for continuity and change produced six months afterwards, and
options for change six months after that. There may be a need for public consultation
depending on which options are developed.
In 2015/16, CCGs wish to see continued implementation of the Shaping Healthier Lives
2012-15 core initiatives including:
o Urgent Care: roll out of the SPA and 24/7/365 access to urgent assessment and
initial crisis resolution work closer to home (or at home as appropriate)
o Liaison Psychiatry: further benchmarking of services to drive increased
standardisation of investment, activity, impact and return on investment.
o Whole Systems/Shifting Settings: building on work to date to implement primary
care plus, to test, refine and roll out a new model of ‘community staying well’ services
for people with long-term mental health needs, providing the GP (as accountable
clinician) with a range of care navigation, expert primary mental health and social
integration/recovery support services to deliver care closest to home and prevent
avoidable referral to secondary.
In 2014/15, the Transformation Programme Board has sponsored development work
streams in Dementia, Learning Disability, Perinatal Mental Health and IAPT. Ealing CCG will
expect providers of service to implement the key pathway, models of care and quality
standards that emerge from these work programmes. Regarding CAMHS OOH, CCGs will
be commissioning a new provider of service, following that service review, due to be
complete early Autumn 2014.
Subject to decision by the CCG executive, a new service model for CAMH out of hours
service delivery will be put in place providing more comprehensive coverage and helping to
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reduce avoidable admissions. This new approach is being developed, following a review of
the current service and options for change, across 8 CCGs.
In summary, Ealing CCG intends that the following will be achieved in 2015/16:
Urgent Access and Care: Ensure that the needs of a range of currently under-served
groups are met (including, but not limited to: the needs of those in transition from
CAMHS and those with a Learning Disability meet national expectations and those of
the emerging pathway work streams under MHPB, and those with Personality
Disorder and severe behavioural disorders). Implement expediently any remaining
performance improvement to deliver the NWL MH access standards.
Liaison Psychiatry Services: Secure full roll out of, and reporting against, the
developmental measures being piloted by WLMHT under the 2014/15 quality
dashboard relating to patient experience, clinical outcomes and referrer experience.
Implement further commissioning and delivery clarity on the nature of services across
the 10 sites and, where there is a significant on-going psychological therapy provided
for those with Long Term Conditions, ensure synergy with IAPT commissioning and
delivery.
Liaison Psychiatry Services: Achieve greater core standardisation of services across
all sites in terms of workforce skills mix, costs, activity, impact and productivity in line
with contractual requirements.
CAMHS: Deliver equitable access to sustainable, high quality, productive and
efficient CAMHS services, wherever a service user resides in North West London.
Jointly commission Behavioural Support Teams for children and adolescents with
learning disabilities. Jointly commission training and public education programmes
with public health partners and safeguarding boards.
CAMHS: Through multiagency collaboration, streamline the pathway for looked-after
children in mental health and establish continuity of care.
CAMHS: Improve out-of-hours crisis response times and service provision.
Dementia: Commissioning intentions for Dementia Services will be informed via the
process of a strategic review across all 8 CCGs, which commences in Quarter 2
2014/15.
Dementia: Providers to sustain Dementia Diagnosis target of 67%
IAPT: Significant transformation and increased capacity in IAPT services. Implement
the recommendations from the pan-London work led by the Anna Freud Centre on
the coordination of children and young people’s IAPT specifically in relation to
building capacity in Voluntary and Community Sector Organisations (VCSOs) to
deliver early intervention mental health support for children and young people.
IAPT: Providers to sustain ‘access rates’ at/or above 15% of the target population of
patients with common mental health problems and, deliver improvements in recovery
rates by over 50%.
Learning Disabilities: For those with learning disabilities and their families, following
on from the Winterbourne View Concordat, implement recommendations from the
national guidance from the recently established Joint Improvement Programme and
NHS England National Expert and Advisory Group.
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Learning Disabilities: Commission services to best support people with learning
disabilities at home and in their communities.
Learning Disabilities: Commission a service model that covers health, social care,
housing, education/employment, based on findings from joint LA/NHS needs
assessment.
Perinatal: Commissioning intentions for Perinatal Services, as with Dementia
Services will be informed via the process of a strategic review across all 8 CCGs
which also commences in Q2 2014/15
The Recovery Houses need to be in place with clear monitoring mechanisms to
measure the number of patients which are expected to be transferred within the year;
number of patients to be discharged into the recovery houses; WLMHT to
demonstrate that it is proactively rehabilitating the patients and working closely with
voluntary sector.
Implementation of findings from Inpatient Demand and Capacity review.
Implementation of step-up and step-down rehab pathway review
Shifting Settings of Care: To stimulate new ways of working that allows a remodelling
of the workforce, and to enable the shifting of care closer to home to be achieved on
a larger scale and in a consistent way, a range of resources, incentives and
information will be proactively deployed and monitored to establish how Providers
impact directly or indirectly on quality outcomes and system flows.
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4.4.4 Information Management and Technology The CCG will continue to establish information technology across its commissioned services
to ensure integrated and fit for purpose solutions that link primary care with other settings of
care. For the coming year the intention is to build on the established programmes. Business
Intelligence is a key enabler in all aspects of the CCGs commissioning programmes and
providers will be asked to align their IT offering to achieve the overarching principle of
achieving one actual or virtual electronic patient record across all settings of care.
The objective is to implement three layers of clinical information exchange where at least
one of the following is in place in any setting of care:
Level 1 - There is access to and two way information exchange as well as associated
workflow within a common clinical IT system and a shared record between the GP
and the care provider.
Level 2 - Where the above is not possible due to technical, operational or financial
constraints that as a minimum, the respective IT systems in primary care and
elsewhere are interoperable and in full conformance with the current Interoperability
Toolkit (ITK) standards (or other common messaging standards) as defined by the
Health and Social Care Information Centre (HSCIC).
Level 3 - Where neither of the above is relevant or feasible then the Summary Care
Record is enabled, available and accessible particularly where patients are receiving
care out of area.
The CCG will work towards the sharing of clinical records in different settings of care within
robust information governance frameworks and processes across the health and social care
community. Providers will be expected to actively consent patients when sharing their
records.
The CCG has made considerable investment in ensuring a unified primary care IT platform.
Current and future providers will be required to work within the frameworks and opportunities
that a single IT system across primary care can offer. This will be translated into more
granular service specifications, service improvement plans and/or CQUINs where relevant.
Explicitly, the CCG will expect all staff working in community settings to use SystmOne as
default clinical system and will expect providers delivering ambulatory urgent care to use
SystmOne.
The overriding objective is to improve standards of care facilitated by the accurate, timely
and appropriate information exchange. However, at the core will be the principle of the
primacy of the primary care record and the objective to directly or indirectly achieve the
outcome of one patient one integrated record.
The technology currently in place and due to be implemented during 2015/16 will bring about
a turning point in how different organisations work together to provide patient centric care.
The CCGs will encourage all existing and future providers to:
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Fully exploit the opportunities by the standardised and common technology
platforms, engaging staff to collaboratively design and implement solutions that bring
about improvements in diagnosis, treatment and longer term care.
Implement work and information flows that will reduce the administrative and
processing burden on clinical and administrative staff across different organisations.
Ensure that information exchange is in real time, processed within native IT systems
of the organisation, accurate in content, structure and coding at the point of data
entry.
Inform and enable patients to improve their understanding and access to their
medical records and take a proactive role in their own care through the use of
technology solutions that will improve access to their own records and interaction
with care providers. In effect, enabling self-care planning tools and solutions where
appropriate and particularly targeted at patients with long term conditions.
It is a key objective to enable patient access to a suite of online services as well as their own
records within a robust and secure environment. Under the Prime Ministers Challenge fund
programme GP practices have been and will continue to provide patients access to their
online services. Providers outside of primary care will also be asked to develop or link with
existing systems so that patients have greater access to wider online services and records.
The CCG will in addition focus on these areas :
Continue working to improve the timeliness and quality of information sent to or
accessible by providers from GP practices via clinical IT systems and to ensure the
most up to date, relevant and accurate information is always sent.
Continue working with providers to enable safer and more efficient electronic
methods of communication between them and primary care, building on the previous
work and solutions around CQUINs with a greater emphasis on structured coding
and integrated workflow.
Extending the diagnostic cloud across the NW London health economy, ensuring the
principle of one patient, one diagnostic record across NW London. Embedding the
access to pathology and radiology results across all settings of care. Ensuring that
ordering tests and receiving results across NW London are exclusively done
electronically with minimal manual or paper based processes.
Within the better care fund programme work with social services to develop an
interface between IT systems and more robust information exchange within common
information governance frameworks. Principally that all non-healthcare providers use
the NHS number as the unique identifier of the patient for all services in order to
integrate records.
Developing tools for GP clinical IT systems to provide integrated services and
processes such as in common clinical templates, status alerts and searches that will
highlight key patients requiring further attention. Providing a patient risk stratification
tool within (rather than outside) GP clinical systems, integrating more closely with
other IT systems where the patient may have a record.
37
In addition the CCG will seek to implement (or make better use of) during 2014/15 and the
following years, national and regional strategic IT systems such as:
Choose and Book and its replacement system e-Referrals
Ensuring high utilisation of the Electronic Prescribing System
Close integration and information flows with Coordinate my Care system
Maintain the high availability of accurate and timely Summary Care Record
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5 Required performance and quality improvements
Quality Ealing CCG expects all providers to achieve the following:
Improved discharging: Proactive multi-agency/multi professional management of
complex discharges in timely manner.
7 day services: Integrated 7 day multi professional discharges, improved post
discharge care, and meeting the NHS Services Seven Days a Week - Clinical
Standards
A&E: Improvement in specialities response times to A&E and UCC referrals. Jointly
improve pathways and sustain management of late referrals from UCC to A&E and
specialities. Reduction admissions made due to diagnostic waits.
Assured sustainability of 18 week RTT performance
Assured sustainability of cancer waiting targets, including where patients are
transferred between providers.
Implementation of the cancer commissioning intentions as published by the
Transforming Cancer Services Team, and as applicable.
Sustainable improvement to ensure the required standards are met in the areas
identified during 2014/15 raised through CQG/PCEs
Cross Border Issues: Ealing CCG will be exploring the options to resolve some of the
cross-border issues that our patients face when accessing services as they are
resident in a borough outside of Ealing, but registered with an Ealing Practice.
Partners are expected to work with Ealing CCG to come up with options to resolve
these concerns and ensure equity of access.
In addition, the CCG has identified priority areas for quality improvement for its main
providers. These are detailed below.
Provider
Organisation
Quality Improvements identified Possible Stretch targets
Imperial
College
Healthcare
Trust
Choose & Book: Ensure sufficient appointment
slots are available (–2% 14/15)
Percentage of last minute
cancellations by the hospital for non-
clinical reasons - 0.6%
Percentage of complaints agreed to within
agreed targets
Percentage of women experiencing
3rd degree tear - 4%
Decrease the percentage of cancellations by
hospital for non-clinical reasons
Decreased number of C-Diff cases
West London Percentage of complaints agreed to within
39
Mental
Health Trust
agreed targets
% of patients on enhanced CPA who were
discharged from psychiatric in-patient care
during the month
Decreased number of violent and aggressive
incidents
Ealing
Integrated
Care
Organisation
Choose & Book: Ensure sufficient appointment
slots are available above 2% threshold
Decrease the percentage of
cancellations by hospital for non-
clinical reasons
Delayed Transfer of Care Increase VTE risk assessment target
Re-admissions within 30 days
Percentage of women that have elective
sections less than 15%
Reduce C-Diff target
LAC Initial Health Assessments (IHA)
conducted within 20 operational days including
late notifications (>5 days)
LAC Review Health Assessments (RHA)
completed by the due date
LAC Review Health Assessments (RHAs) by
the due date for BAAF's received no later than
6 weeks before the due date
Referrals responded to during the day, twilight
or night periods within 24 hours
Pre-booked appointments DNA or UTA rate
Patients with venous leg ulcers healed within
12 weeks
Palliative care patients who died in their
preferred place of death
North West
London
Hospitals
Trust
Percentage of complaints agreed to within
agreed targets
Decrease the percentage of
cancellations by hospital for non-
clinical reasons
Reduce number of C-Diff cases Increase VTE risk assessment target
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Safeguarding All services commissioned by the CWHHE CCGs must comply with the current legislation
and, multi-agency and NHS assurance systems covering safeguarding children and adults.
In respect of safeguarding children, services must comply with Section 11 (Children Act
2014), Working together to Safeguard Children (2013) and current London Child
Protection Procedures. Within the contracting period, services will also be required to
effectively respond to emerging initiatives and work practices, in order to safeguard and
promote the welfare of children and young people.
In respect of safeguarding adults, services must comply with the current London multi-
agency policy and procedures to safeguard adults from abuse Safeguarding Policy and
Procedures, the Mental Capacity Act (including the Deprivation of Liberty Safeguards) and
the Prevent Agenda. It is expected that Services be compliant with the Care Act 2014 ahead
of its implementation in April 2015.
Services must provide quarterly reports completed in a framework agreed with the
designated nurses and adult leads and be prepared to report on their compliance with any
additional statutory frameworks published during the period of the contract.
Quarterly reports must include safeguarding training data, safeguarding supervision
provision, activity utilising partnership working, as well as a summary of learning from local
and national case reviews or reports. The quality schedule is cross referenced to these
points.
An annual safeguarding report must be submitted to the CCG by August 1st.
Referrals to the LADO in relation to allegations against staff working with children or
vulnerable adults must be reported to the Designated Nurse Safeguarding Children and
Commissioner within one working day. The tables below set out how we will improve quality
across NWL through our contracting intentions.
Child Protection Information Sharing Project (CPIS)
The Child Protection Information Sharing Project (CPIS) is a national multi-agency
safeguarding initiative; focussing on the identification and protection of vulnerable and at risk
children attending unscheduled care centres. CWHHE/Ealing CCG will require the
unscheduled care services it commissions to work collaboratively as part of local
development and implementation of this national system.
Female Genital Mutilation
Female Genital Mutilation (FGM) is a national safeguarding priority. CWHHE/Ealing CCG
intends to commission services in an integrated way to ensure effective implementation of
national legislation and policies; identifying, treating and supporting women and girls who
have been subjected to FGM or who are at risk of this abuse.
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6 Procurement plans
The purpose of this section is to highlight for providers those service areas where we intend
to undertake procurements for services. This includes both existing services where current
contracts are due to expire, and new investment areas where we anticipate that we can best
deliver improvements for patients through an open procurement. The service areas and
indicative timings for when the procurement process will commence are shown below. We
are publishing this list to enable providers to best respond to our commissioning intentions
but reserve the right to add or remove services or amend timetables should this be in the
best interests of patients.
Contract Provider Existing
Contract End
Date
Procurement: 2015/16
Urgent Care Centre Care UK Jul 2015 Full competitive procurement during
2015/16. Must be completed at least
three months prior to current contract
end date
111 Service Care UK Jul 2015 Full competitive procurement during
2015/16. Must be completed at least
three months prior to current contract
end date
AQP Audiology Specsavers &
Ealing ICO
Nov 2015 New AQP process during Apr-Sep
2015. Existing AQP contracts cannot
be extended
AQP TOPs BPAS, MSI and
Fraterdrive Ltd
Mar 2016 New AQP process during Oct 2015-
Mar 2016. Existing AQP contracts
cannot be extended
Community Services EHT-ICO ECCG sponsored procurement
running throughout 2015/16 leading to
new provision from April 2016
WSIC Care
Coordination Services
N/A ECCG sponsored procurement
running from Q1 2015. Could either
be linked to Adult Nursing Services
procurement, or run separately.
Elements of this service will be linked
to the integrated Healthy at Home.
42
Integrated Healthy at
Home Service
Incorporating ICE and
“Virtual Ward”
Community Falls
Services
EHT-ICO(ICE)
EHT- ICO
ECCG sponsored procurement
running from January 2015
ECCG sponsored procurement
running from November 2014, as per
the outcome of the Falls Review (Aug-
Oct 14).
Community Transport
Services
EHT-ICO ECCG sponsored procurement
running from December 2014,
following the Transport Review.
Implementation of learnings in 2015
CAMHS Out of Hours CNWL March 2015 Service development by CNWL and
WLMHT across 8 CCGs
Atopic conditions
service for children
EHT-ICO Either procurement or service
redesign within current provider or
competition within GP federation
Voluntary sector
grants
Various voluntary
organisations in
Ealing
March 2015 Grant process led by LBE
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7 Contracting Intentions
The tables below summarises the specific contracting intentions we have developed for each of these overarching strategic priority areas.
7.1 Acute Services Transformation
Key deliverable Contracting intention Joint
commissioners Sectors
impacted Achieve agreed priority 7-day
clinical standards for 15/16,
including those included
within the national acute
contracts
Respiratory Pathway Design
Dementia Pathway
Urgent Care Strategy
Ealing Local Hospital Full
Business Case
Hubs Business Case
Healthy at Home Service
(Virtual Ward), incorporating
ICE, Virtual Wards and Older
Person Pathway (Frailty,
Falls, Fractures)
Implementation of Cardiology
pathway design
Joined up clinics for LTCs
MSK
Diabetes
UCC/ 111 service
Within acute services, the CCG intends that the following items be addressed in the 2015/16 Contract:
Service Changes and Improvements:
SaHF: Service changes as defined by the SaHF Programme are expected to proceed as planned and advised following the endorsement from the Secretary of State in 2013. Detailed timings for service changes will be communicated to the public as they become available.
Better Care Fund: The expected impact on our acute providers as a result of the BCF schemes in 2015/16 is as follows:
o Ealing Hospital Trust:
o Expected impact on NEL Admissions (587 less NEL admissions), with a resultant contract reduction by £723,387.
o Expected impact on A&E Attendances (587 less A&E attendances), with a resultant contract reduction by £72,504.
o NW London Hospitals Trust: o Expected impact on NEL Admissions (134 less NEL admissions), with a resultant contract
reduction by £183,972. o Expected impact on A&E Attendances (134 less A&E attendances), with a resultant contract
reduction by £16,536. o Imperial Hospitals Trust: o Expected impact on NEL Admissions (168 less NEL admissions), with a resultant contract
reduction by £204,453. o Expected impact on A&E Attendances (168 less A&E attendances), with a resultant contract
reduction by £20,806. o Hillingdon Hospitals Trust: o Expected impact on NEL Admissions (146 less NEL admissions), with a resultant contract
reduction by £191,343. o Expected impact on A&E Attendances (146 less A&E attendances), with a resultant contract
Other CCGs in
NWL as relevant
Acute,
Community
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OOHS
Children's Services -
Implementation of findings
from Paediatric Pathway
Review, Connecting Care for
Children Pilot, 0-5 integrated
services, Community
Paediatric Services
Improvement in the quality of
diagnostic and cancer care
pathways
reduction by £17,977.
Cardiology: Decommissioning of the elements of existing outpatients services and non-electives. New service provider and clinical pathways will be in place in 2015/16 following the service redesign and procurement during 2014/15. The new service will commence from July 2015. The expected impact for
o Ealing Hospital Trust: o Expected impact on Outpatient activity (3507 less appointments), with a resultant contract
reduction by £544,784. o NW London Hospitals Trust: o Expected impact on Outpatient activity (459 less appointments), with a resultant contract
reduction by £76,043. o Imperial Hospitals Trust:
o Expected impact on Outpatient activity (1204 less appointments), with a resultant contract reduction by £196,868.
Emergency Admissions and A&E attendances. o A minimum reduction in avoided emergency admissions and A&E attendances of 3.5% o The CCG will implement the whole systems integrated Healthy at Home Service
incorporating the revised model of ICE(Intermediate Care Ealing) service, inclusive of the new model of care based on the “Virtual Ward” concept. This is in line with the CCGs Whole Systems Integration Strategy, BCF Programme and Out of Hospital Strategy. The key components of the service will be Rapid Response, Short Term Rehabilitation and Enhanced Supported Discharge from acute hospitals for all Ealing registered patients, Reablement Support. In order to reduce and avoid emergency admissions, referrals pathways straight into the new Integrated Healthy at Home Service will be established via a Single Point of Access, from GPs, London Ambulance Service, A&E departments, District Nursing Service, Practice Nurses, GP OOHrs, Urgent Care Centres, and others as appropriate.
o The new service will be available from 1st July 2015.
A&E: Pathway for patients to be referred directly into A&E by 111 service.
Respiratory: Respiratory service redesign is in progress impacting elements of respiratory outpatients and emergency inpatients. New community service provider and clinical pathways will be in place in 2015/16 following the service redesign and commissioning. Anticipated start date Q3 2015/16
Older Persons Services: Re-commissioning of the community pathway so that its combines frailty, falls and fracture services, which will reduce admissions of the elderly. See Community service contracting intentions table on the following pages. Expected to impact on both level of admissions and length of stay for patients under Care of Elderly specialty. Anticipated start date Q3 2015/16
Paediatrics: Paediatric service redesign for both atopic and respiratory conditions is in progress. In addition, the CCG will be looking to implement the findings from the Connecting Care for Children pilot. Expected to reduce paediatric outpatients. Anticipated start date Q3 2015/16
Gynaecology. Gynae service redesign leading to the establishment of a new community service to
45
cover conditions/treatments including infertility, menorrhagia, menopause, ring pessary. Expected to impact outpatient attendances and related procedures. Anticipated start date Q3 2015/16
Other QIPPs (not inclusive list): The CCG will expect to include provision for other QIPP schemes in the 2014/15 contract, including their associated impacts on activity. These include MSK, Diabetes, Anti-Coagulation, Tele-dermatology, and Referral Facilitation Services, which all impact relevant outpatient specialties. Providers will only accept referrals that have been approved through the Ealing RFS service (subject to defined exceptions). QIPPs also include Enhanced Primary Care for Nursing Homes, affecting A&E and emergency admissions.
GP Path: Service to be changes to maintain the adult walk-in phlebotomy service, but discontinue the consultant interpretation and GP advice line. Letter to Dr William Lynn dates 14 August 2014 refers.
Community Services forward plan. From 2016-17, the CCG intends to re-commission a Virtual Ward
service, potentially via a competitive procurement during 2015/16.
Quality Improvements:
Improved discharging: Proactive multi-agency/multi professional management of complex discharges in timely manner.
7day services: Integrated 7 day multi professional discharges, improved post discharge care, and meeting the NHS Services Seven Days a Week - Clinical Standards
A:E. Improvement in specialities response times to A&E and UCC referrals. Jointly improve pathways and sustain management of late referrals from UCC to A&E and specialities. Reduction admissions made due to diagnostic waits.
Assured sustainability of 18 week RTT performance
Assured sustainability of cancer waiting targets, including where patients are transferred between providers.
Implementation of the cancer commissioning intentions as published by the Transforming Cancer Services Team, and as applicable.
CQUINs:
Continued implementation of Single Patient Record and principles of intra-operability
Other CQUINs to be defined and agreed. Possibilities include discharges from acute, enhanced discharged planning and others.
External quality assurance mechanism to all CQUINS Finance and efficiency: Implementation of all agreed changes to Non-PbR tariffs effective from 1st April following the review to
be completed in Q3 2014/15.
For the avoidance of doubt, nurse anti-coagulation services will be paid at equivalent nurse lead tariffs.
Local tariff for Ambulatory Care Pathway, commissioned to be consistent and not overlapping with the Intermediate Care Service.
A range of performance efficiency KPIs. To include all existing KPIs with incremental stretch, plus
46
additional metrics that address focus areas of improvement or change. Examples will include internally generated referrals, discharging/DTOC amongst others.
Inclusion of high cost drugs risk share.
Liaison Psychiatry Service in mainstream acute ward settings (not A&E) will be fully funded through the PbR Tariff.
High Cost Drugs. HCD reimbursed at cost only, and not to exceed NICE published template tariffs. No funding for high cost drug administration.
A single contract with the merged EHT/NWLHT Trust, but with separate plans and schedules to reflect the focus on local issues and priorities.
National priorities and planning guidance for 2015/16 is not expected until later in the year. It would be our intention to reflect national guidance and priorities in our agreed contracts for 2015/16. Contracts to fully reflect 2015/16 PbR Guidance.
Data sharing/ reporting:
Strict adherence to all provisions of the Information Schedule with incentive scheme to ensure full
compliance; covering (but not limited to) areas of non-compliance in the past..
DTOC be reported by the Trust by the number of bed days
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7.2 Community Services Transformation
Key deliverable Contracting intention Joint commissioners Sectors
impacted Implement
Community Services
Review outcomes
Implement ICE
Review Outcomes
Respiratory Pathway
Design
Older Person
Pathway
Review Community
Patient Transport
pilot and implement
recommendations
Create roles for
District nurses
Good, patient
friendly sign posting
Ealing CCG is currently completing an open book review of community services and is on a pathway to consider the re-commissioning of this contract. The timeline of this pathway is yet to be developed and although seen as a key step in the delivery of our out of hospital services & whole systems agenda. In view of the complexity of change in Ealing, we are unable to determine a finalised timeline at this point.
Within community services, the CCG intends that the following items be addressed in the 2015/16 Contract:
Service Changes and Improvements:
Community Services Review outcomes: The CCG wishes to work with the ICO to implement the findings and recommendations of the Community Services Review:
o Improvements in visibility of the community nursing team within the multi-disciplinary team wrapped around the GP practice;
o Revisions to community nursing to align with the “Whole Systems” model of care including the “Healthy at Home Service (Virtual Ward)”;
o Improvement in recruitment & vacancy rates. o Improvements to the podiatry, ophthalmology and tissue viability services as per
findings of the Community Services Review. o See also the Finance and Efficiency section below
ICE: The CCG wishes to work with the ICO to implement the findings and recommendations from the 2014/15 ICE Review.
o Following procurement, the CCG wishes to provide the new integrated whole systems Healthy at Home Service, incorporating the current ICE (Intermediate Care Ealing) service and the “Virtual Ward” model. This will incorporate the recommendations from the 2014/15 ICE Review. The key components will be as follows:
o The CCG wishes to work with the ICO to implement the findings and recommendations from the 2014/15 ICE Review.
o Rapid Response, Short Term Rehabilitation, Enhanced Supported Discharge via Single Point of Access.
o The Enhanced Supported Discharge Service will be for all Ealing registered patients from acute hospitals.
o Links with WLMHT for Dementia and mental health patients, embedding improvements from 2014/15 Dementia and mental health CQUIN into the service.
o Clinical criteria for acceptance into ICE to be as per the original business case,
Other CCGs in NWL and
London Borough of Ealing
as appropriate
Community
48
and stated in the service specification o From 2015/16, the CCG intends to re-commission the ICE/Virtual Ward service
(Healthy at Home Service), via a competitive procurement commenced during 2014/15.
o CCG therefore gives notice of termination of the ICE service from 31st March 201.
o .
Older Person Services: Re-commissioning of the pathway so that its combines frailty, falls and fracture services from April 2015.
MSK service: Amendments to ensure waiting time’s targets are maintain, activity plans as per the service specification are met and introduction of pathway based tariffs.
MSK service: Implementation of service changes related to MSK Phase IV. Implementation of review of the Interface Service from April 2015. Impact on consultant referrals and Rheumatology outpatients.
Diabetes: Revision of Diabetes Service in line with the Out of Hospital services in Primary Care
Respiratory Services: Revisions to the Pulmonary Rehabilitation Service in line with the outcomes of the Review scheduled in October 2014. This may lead to a wider review of the respiratory pathway in year and a potential service redesign.
Booking: Community services to introduce bookable appointments available on Choose and Book
Interoperability: Assurances on the SystmOne deployment project and achievement of full interoperability with GP systems. Achievement of interoperability with mental health and social services systems in line with Whole Systems programme. Continued implementation of Single Patient Record.
EHT acute and EHT-ICO provides integrated care across acute and community. Trust to
be held to account for required changes between the two parts of the organisation.
Quality Improvements:
Sustainable improvement to ensure the required standards are met in the areas identified during 2014/15 raised through CQG/PCEs
Key performance issues (including Delayed Transfer of Care - DTOC)
Quality issues as highlight in 2014/15 KPI measures
Cross Border Issues: Ealing CCG will be exploring the options to resolve some of the cross-border issues that our patients face when accessing services as they are resident in a borough outside of Ealing, but registered with an Ealing Practice. Partners are expected to work with Ealing CCG to come up with options to resolve these concerns and ensure equity of access.
CQUINs:
49
Continuation of the Interoperability CQUIN to achieve future state goals.
Other CQUINs to be defined and agreed.
External quality assurance mechanism to all CQUINS Finance and efficiency:
Adjustment to the block charges for community services in line with the service line benchmarking form the Community Service Review.
Bring all exiting contract variations into main contract and service schedule
Assurance that CCG investment in the EICO contract is fully and properly spent on Ealing services
Scheme to ensure that Activity Plan targets are achieved.
Continued improvement in efficiency and productivity improvement above the national requirements.
Integration of delivery of QIPP between acute and community services. Data sharing/ reporting:
Strict adherence to all provisions of the Information Schedule with incentive scheme to ensure full compliance; covering (but not limited to) areas of non-compliance in the past.
DTOC to be reported by the Trust by the number of bed days
Performance Incentive Scheme
Inclusion of a performance incentive scheme focussed on key outcomes, building on 2014/15 scheme.
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7.3 Mental Health Transformation
Key deliverable Contracting intention Joint
commissioners Sectors
impacted Dementia and IAPT: improve integrated
care pathways - work closer with
voluntary sector
IAPT: achieve ‘access rates’ at/or above 15% of the target population of patients with common mental health problems and, deliver improvements in recovery rates by over 50%
CAMHS Out of Hours new service model
Outcome of Dementia review across the
8 NWL CCGs will identify local
commissioning gaps and inform
Commissioning Intentions
CCG specific Learning Disabilities plan,
aligned with the green light toolkit review
Outcome of Perinatal services review
across the 8 (Hammersmith and Fulham
CCG is leading on it) NWL CCGs will
identify pathways to be implemented
locally and commissioning gaps
Ealing CCG is working across the collaboration of eight CCGs in NWL in line with the partnership board (MHPB) transformational programme. Within Mental Health services, the
CCG intends that the following items be addressed in the 2015/16 Contract: Service Changes and Improvements:
Urgent Access and Care: Ensure that the needs of a range of currently under-served groups are met (including, but not limited to: the needs of those in transition from CAMHS and those with a Learning Disability meet national expectations and those of the emerging pathway work streams under MHPB, and those with Personality Disorder and severe behavioural disorders). Implement expediently any remaining performance improvement to deliver the NWL MH access standards.
Liaison Psychiatry Services: Secure full roll out of, and reporting against, the developmental measures being piloted by WLMHT under the 2014/15 quality dashboard relating to patient experience, clinical outcomes and referrer experience. Implement further commissioning and delivery clarity on the nature of services across the 10 sites and, where there is a significant on-going psychological therapy provided for those with Long Term Conditions, ensure synergy with IAPT commissioning and delivery.
CAMHS: Deliver equitable access to sustainable, high quality, productive and efficient CAMHS services, wherever a service user resides in North West London. Jointly commission Behavioural Support Teams for children and adolescents with learning disabilities. Jointly commission training and public education programmes with public health partners and safeguarding boards.
CAMHS: Through multiagency collaboration, streamline the pathway for looked-after children in mental health and establish continuity of care.
Dementia: Commissioning intentions for Dementia Services will be informed via the process of a strategic review across all 8 CCGs, which commences in Quarter 2 2014/15.
IAPT: Significant transformation and increased capacity in IAPT services. Implement the recommendations from the pan-London work led by the Anna Freud Centre on the coordination of children and young people’s IAPT specifically in relation to building capacity in Voluntary and Community Sector Organisations (VCSOs) to deliver early intervention mental health support for children and young people.
Learning Disabilities: For those with learning disabilities and their families, following on from the Winterbourne View Concordat, implement recommendations from the national guidance from the recently established Joint Improvement Programme and NHS
Other CCGs in
NWL as relevant
Mental
Health
Voluntary
sector
51
England National Expert and Advisory Group.
Learning Disabilities: Commission services to best support people with learning disabilities at home and in their communities.
Learning Disabilities: Commission a service model that covers health, social care, housing, education/employment , based on findings from joint LA/NHS needs assessment.
Perinatal: Commissioning intentions for Perinatal Services, as with Dementia Services will be informed via the process of a strategic review across all 8 CCGs which also commences in Q2 2014/15’
Shifting Settings of Care: Commission additional capacity for young people, long-term conditions, medically unexplained symptoms and severe and enduring mental health problems by looking to Providers to relieve pressure on general practice; enhance patient choice; and assist in reaching as many people as possible within their target population.
The Recovery Houses need to be in place with a clear monitoring mechanisms to measure the number of patients which are expected to be transferred within the year; number of patients to be discharged into the recovery houses; WLMHT to demonstrate that it is proactively rehabilitating the patients and working closely with voluntary sector.
Shifting Settings of Care: To stimulate new ways of working that allows a remodelling of the workforce, and to enable the shifting of care closer to home to be achieved on a larger scale and in a consistent way, a range of resources, incentives and information will be proactively deployed and monitored to establish how Providers impact directly or indirectly on quality outcomes and system flows.
Quality Improvements:
Improved discharging: Proactive multi-agency/multi professional management of complex discharges in timely manner.
7day services: Integrated 7 day multi professional discharges and improved post discharge care.
Urgent Access and Care: Continue any quality improvement trajectory in terms of key Shared Care communication paperwork
Liaison Psychiatry Services: Achieve greater core standardisation of services across all sites in terms of workforce skills mix, costs, activity, impact and productivity in line with contractual requirements.
CAMHS: Improve out-of-hours crisis response times and service provision.
IAPT: Providers to sustain ‘access rates’ at/or above 15% of the target population of patients with common mental health problems and, deliver improvements in recovery rates by over 50%.
CQUINs:
Continued implementation of Single Patient Record and principles of intra-operability
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Other CQUINs to be defined and agreed. Possibilities include discharges from acute, enhanced discharged planning and others.
External quality assurance mechanism to all CQUINS Finance and efficiency:
Implementation of all agreed changes to Non-PbR tariffs effective from 1st April following the review to be completed in Q3 2014/15.
A range of performance efficiency KPIs. To include all existing KPIs with incremental stretch, plus additional metrics that address focus areas of improvement or change. Examples will include discharging/DTOC amongst others.
Inclusion of High cost drugs risk share.
Transformation incentive to implement recommendations arising from the Demand and Capacity review i.e.: resource and cash releasing efficiencies ( Transformation of Rehab and Community Services)
Delivery of Shifting Settings of Care QIPP Data sharing/ reporting:
Strict adherence to all provisions of the Information Schedule with incentive scheme to ensure full compliance; covering (but not limited to) areas of non-compliance in the past.
DTOC be reported by the Trust by the number of bed days
Urgent Access and Care: Utilize developments in electronic e-referral systems and ‘intelligence sharing’ to enable trusted assessment across teams, improved access to treatment, faster response times and ‘improved local health record self -ownership’
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7.4 Whole Systems Integrated Care (including Better Care Fund)
Key deliverable Contracting intention Joint
commissioners Sectors
impacted New models of care in place
7-day services in operation
Health and social care commissioners holding multi-provider ‘accountable care partnerships’ to account for delivery of population health outcomes
New payment model in operation
Enablement rather than reablement – focus on proactive management
Linked reablement, rapid response & ICE services
Utilising SystmOne to full potential and link community IT system
Use of formal/informal commissioning capital – voluntary sector, carers
Integrated Discharge Teams
Healthy at Home Service (Virtual Ward)s developed via BCF
Ealing Local Hospital Full Business Case
Hubs Business Case
Better Care Fund The Better Care Fund in Ealing has been submitted for final approval with a reduction of 3.5%
NEL across the borough. Provider partners will be expected to proactively engage with the schemes being developed to achieve this and any other outcomes as described in the Better Care Fund and raise any risks to delivery at an early stage. The changes to the baseline have already been communicated and will be reflected in the contracts.
Patient empowerment including Healthwatch into the contracting meetings Partners are expected to regularly engage with local residents and Healthwatch in any service
redesign programme, taking their views into account. To note, Ealing Healthwatch will be a part of the contracting meetings for Ealing, Data Sharing for BI and Interoperability Partners will be expected to fully engage with the data sharing requests to feed into any
Business Intelligence Tool developed for Ealing or across NWL. Community Transport - review as part of our Out Of Hospital strategy Ealing CCG has begun a pilot for Community Transport. This will be reviewed on a regular
basis and if successful may be commissioned more formally. Cross Border Issues Ealing CCG will be exploring the options to resolve some of the cross-border issues that our
patients face when accessing services as they are resident in a borough outside of Ealing, but registered with an Ealing Practice. Partners are expected to work with Ealing CCG to come up with options to resolve these concerns and ensure equity of access.
WSIC Central Ealing Pilot and then shared learning Partners will be expected to fully engage with the NWL Whole Systems Integrated Care
programme as well as the local Whole Systems Integrated Care Programme and support the delivery of the Central Ealing Pilot and then across the borough as the model expands
Provider partners will be expected to work with commissioners and each other to develop some form of provider partnership (still to be determined) to explore opportunities to align provision to become more integrated and coordinated and proactively reduce any barriers to patient care.
Partners will be expected to share the learning from the Pilot with colleagues around the
hospital, bringing all front line teams up to speed on progress on a regular basis, to ensure
continuity of messaging across the borough.
Other CCGs in
NWL and London
Borough of Ealing
as relevant
Acute,
Community,
Mental Health,
Social Services
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7.5 Primary Care Transformation
Key deliverable Contracting intention Joint commissioners Sectors
impacted 7 day/ week primary care
services in operation at
practices within networks
A range of consultation methods
available to patients (telephone/
email/ video conference)
Primary care appointments
tailored to patient’s needs (e.g.
urgent, continuity and
convenience appointment
standards met)
Model of care - aligned with joint
care team - Joint assessments
Education & workforce
development
Care planning
WSIC & integrated care
Commission GP Ealing GP Limited (GP practices in Ealing are working together as Ealing GP Limited)s to deliver population based services against targets
Out of Hospital bid for services via networks
Pooling of workforce to increase access (8am to 8pm in the weekdays and 6 hours on weekends)
Access provided within the network
Ensure specialised skills within the networks is harnessed to deliver enhanced care in primary care
Community nurses and district nurses to work within the networks
Increase email or phone triage services for patients
Patient empowerment system in each network/Ealing GP Limited (GP practices in Ealing are working together as Ealing GP Limited) though Patient Participation Groups, Care Planning
Clinical educations sessions within networks to decrease GP downtime and increase specific training for specialised skills
Understand role of Primary care in providing integrated care
Work more closely with provider partners as a multi-disciplinary group
Explore co-commissioning with NHS England
Ensure the required standards are met in the following areas
Key performance indicators ( Prescribing, Access, Out of hours access for patients, Onwards referrals, Equality)
Quality metrics
Finance , costing and QIPP metrics (including delivery of SSOC QIPP)
Data sharing/ reporting requirements
Other CCGs as
appropriate
Co-commission
primary care with
NHS England
Primary
Care
Deliver a range of Out of
Hospital Services (OOHS)
through Ealing GP Limited (GP
practices in Ealing are working
together as Ealing GP Limited)s
Implementation of the OOHS portfolio with the new GP provider organisations will commence during 2014/15; in 2015/16, the roll-out of the service portfolio will be completed with the aim to have full population coverage by 2016/17. CCG is commissioning
ABPM service that delivers a safe and timely Ambulatory Blood Pressure Monitoring service
Anticoagulation service that Improves patient access to safe and clinically effective anticoagulation initiation and monitoring to patients on warfarin therapy
A case finding, care planning and case management service ensuring patients at high
Other CCGs as
appropriate
Co-commission primary
care with NHS England
Primary Care
Secondary
Care
providers
55
risk of admission and/or with complex health and social care needs have a care plan in place, supported by proactive case management as appropriate
General practice to use the CMC system to support the management of palliative care patients
A complex wound care service to improve the quality of life for people requiring management of their wounds, through the delivery of clinically effective care and advice which reduces the risk of recurrent infection and promotes independence.
A diabetes service that supports and enables primary care clinicians to provide patient care in a seamless and integrated way through supported diabetes education, improving the proactive care of patients at high risk of diabetes, reducing variations in diabetes care and outcomes across network populations, enabling better self-management of diabetes through care planning
Service providers to deliver an EGG recording and interpretation service. The services will detect common cardiology conditions such as, but not limited to, arrhythmias and heart block
A service for homeless people to ensure this group has patient access to the appropriate services
A near patient monitoring that means the service provider will undertake the necessary
monitoring required for certain defined drugs, ensure that the service to the patient is
convenient; review the need for continuation of therapy on a regular basis
Delivery of a timely and safe phlebotomy service
A ring pessary service that delivers a timely, effective and personalised ring pessary service in a safe environment and provides appropriate patient education
A safe and timely spirometry testing service
A service for enhanced engagement for those patients with serious and enduring mental illness (SEMI) where responsibilities for care are transferred between secondary care and primary care
Management of common mental health problems service that aims at increasing diagnosis of complex common Mental Illness and case management of people with moderate to severe complex common mental illness.
The table below describes the services to be commissioned through the Out of Hospital Services commissioning programme. The unit construction method, indicative current service impacted, and total expected activity volumes for a full year for the CCG are shown. Please note that we do not expect a full year of activity to be transferred in 2015/16 as we will be phasing roll out. We will work with providers over the next three months to define how each provider will be impacted. Where services are predicted to meet 100% population coverage, decommissioning notices will be issued to current providers, as appropriate.
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Ealing
OOH Services
Activity Forecast:
100% coverage
Activity Type
(contact or
package)
Acute Point of
Delivery
(POD)
ABPM 8,120 Per test Cardio OPD
Anticoagulation Monitoring 4,006 Package p.pt p.a (FA+12FU)
Clin Haem OPD
Anticoagulation Initiation 1,717 Package p.pt p.a (FA+8FU)
Clin Haem OPD
Case Finding, Care Planning & Case
Management
8,175 Per patient N/A
Complex Common Mental Health Management
4,523 Package p.pt p.a (FA+7FU)
N/A
Complex Wound Care 431 Per contact Various
Diabetes (Level1) 19,701 Package p.pt p.a (FA+2/3FU)
Diabetes OPD
Diabetes (High Risk) 7,421 Package p.pt p.a (+2appts)
Diabetes OPD
Diabetes (Level2) 591 Package p.pt p.a (FA+2FU*)
Diabetes OPD
ECG 9,237 Per test Cardio OPD
Homeless 368 Package p.pt p.a (FA+11FU)
A&E/ NEL
Near Patient Monitoring 1,880 p.pt p.a Rheum OPD
Phlebotomy 133,490 Per venepuncture
Ring Pessary 842 Per ring p.pt p.a Gynae OPD
Simple Wound Care 4,305 Per contact Various
Spirometry Testing 6,744 Per test Respiratory OPD
Transfer of Care: Severe and Enduring
Mental Illness
430 Package p.pt p.a
N/A
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7.6 Patient empowerment and self-management
Key deliverable Contracting intention Joint commissioners Sectors impacted
Use of voluntary sector
Third sector
commissioning
Advocacy for patients
Focus on patient
education through care
planning
Voluntary patient
support groups
Enablement rather than
reablement
Self-care & self-
management – Care
navigators
Re-commission voluntary sector grants to deliver a stronger patient empowerment program and self-care programs
Re-commission reablement pathways to provide a more proactive response to care rather than at the point of discharge only
Commission primary care to ensure that care plans are done in partnership with patients and carers, encouraging more ownership of the care plans
Involve carers and families in decision making where appropriate, including decisions on end of life care
Review patient education program that are locally commissioned such as Diabetes Right Start Program and Type 1 Diabetes Program
Patient access to their own records
Ealing CCG has begun a pilot for Community Transport. This will be reviewed on a regular basis and if successful may be commissioned more formally.
Partners are expected to regularly engage with local residents and Healthwatch in any service redesign programme, taking their views into account. Ealing Healthwatch will be a part of the contracting meetings for Ealing,
Other CCGs in NWL and London
Borough of Ealing as appropriate
Acute, Community,
Mental Health, Social
Services
58
8 Finance and activity impact analysis by provider
The CCG circulated its contracting intentions for 2015/16 as detailed in Section 7 above to
the provider organisations on 30th September 2014. In addition, the CCG is providing
separate advice to providers on the anticipated impact on funding levels in 2015/16 as a
result of these Commissioning Intentions. We have estimated the impact levels form both
current QIPP schemes, and from new schemes that are in an advanced stage of
development and due to go live prior to or during 2015/16. These estimates are provisional,
and are subject the outcome of more detailed analysis presently in progress.
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9 Equalities Impact
Duty to Involve
Our CCG is mindful of its individual participation duty to ensure that we commission services
which promote the involvement of patients across the full spectrum of prevention or
diagnosis, care planning, treatment and care management when discharging its duty. We
have been working in partnership with patients, carers, the wider public and local partners to
ensure that commissioned services are responsive to the needs of our population.
Our Patient and Carer Experience Strategy was co-designed with patients, carers and
stakeholders to identify the key priority areas. It requires commissioned providers to ensure
that patients, service users and carers are provided with opportunities to get involved in
shaping and influencing services and the organisations as a whole.
We therefore expect that providers will provide evidence of engagement of their service
users and carers in the planning, development and delivery of services, more specifically, we
expect that providers:
Train and support service users and carers to be effectively engaged in the design
and delivery of services as well as in shaping and influencing the organisation as a
whole
Work with local voluntary organisations and patient groups to deliver a programme of
staff training and capacity development relating to understanding the experience of
specific groups and communities
Feedback on services reflects the diversity of the patient and service user population.
Work in partnership with local health and social care organisations to capture
experience of integrated care
Promoting Equalities and Improving Patient Experience and Access
We expect providers to measure patients, service user and carers experience of accessing
and services and demonstrate that commissioned services are accessible by all. Evidence
of this will be demonstrated by the provision of evidence that:
Patient Experience data incorporates data relating to key equality groups, more
specifically; data should include ONS categories plus sub-categories in order to
reflect the diversity of the local population. The data should be analysed to assess
whether:
o There is a difference in outcomes of experience by patients, service users
and carers
o There is a difference in the perception of treatment and care between
patients, service users and carers from different equality groups
o Action has taken place to address gaps in relation to point 1 and 2
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Uptake and Use of services. To assess whether:
o There are differences in the frequency of usage by different equalities groups
e.g. A&E and UCCs
o The services are delivered to meet the needs of the diverse population
o There is anything the service can do to increase usage by those groups that
under-use the service
o Action has taken place to address gaps in relation to points 1, 2 and 3
Complaints and other feedback. To assess whether:
o There are differences in the complaint rates for different groups with different
needs or circumstances
o there are particular areas of the service that causes a problem for particular
groups of patients, service users and carers
o there is an underlying cause or barrier that means that certain groups are
receiving a better service than others and
o whether or not different groups have different expectations of the service
o For investigated complaints equalities monitoring is carried out on a sampling
basis by the Complaints Team and reported quarterly.
Children with disabilities. To ensure that providers have in place a range of facilities
and support available to children with disabilities and their carers, more specifically:
o Waiting areas are sensitive to the needs of disabled children
o Changing Places Toilets for complex needs children which incorporate the
right equipment with enough space
o Signposting to support groups and coping strategies offered at point of
diagnosis
o Facilities for complex needs children admitted to hospital wards include
adequate hoists and changing facilities as well as adequate food and nutrition
e.g. pureed food.
o That parents and GPs are copied in on all doctors and therapist reports
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10 Conclusion
This document has set out the commissioning intentions for Ealing CCG. They are intended
to drive major transformation across the services that we commission to ensure that patients
receive higher quality, more integrated care with an enhanced patient experience. We
expect all providers to respond proactively to our intentions and to work with us to ensure
our vision is realised.
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Appendix 1 High level timeline for developing Commissioning Intentions
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Appendix 2 Service Alerts Report
22nd October 2014
Quarterly PPE and service alert report to the Patient and Public Engagement and
Quality and Safety Committees
1. Background and purpose of report
This report is part of a series of quarterly reports made to Ealing CCG’s PPE and Quality
and Safety Committees, in which the main themes and outcomes of the CCG’s engagement
and communications workstreams are summarised. The report also includes feedback
received through the service alert process, which enables the CCG to have an overview of
how well local health services are meeting the needs of patients.
The purposes of this report are to highlight patient and public issues in order to inform the
CCG’s commissioning intentions and to provide an indication of the quality of commissioned
services from the patient’s perspective.
2. Engagement and communication conduits
This report covers the three-month period from July to September 2014. During this period
there were 120 different engagement and / or communication interactions, including 28
public queries and 19 service alerts from GP practices.
The different conduits, through which Ealing CCG received feedback and / or communicated
information, are set out below:
0
5
10
15
20
25
30
public queries(28) - 34%
voluntary sector(27) - 32%
NHS sources(24) - 29%
service alerts(19) - 23%
local authority(12) - 14%
individualpatients (10) -
12%
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3. Key themes of the engagement and communication workstreams
The main themes arising from the CCG’s patient and public engagement and communication
workstreams in this quarter were information and awareness-raising and empowering and
involving patients.
A thematic summary of patient and public feedback received during the last three months is
set out below:
The most common themes raised by GP service alerts concerned the direct treatment and
management of patients and poor communication between services, the patient and the
practice.
A thematic summary of the service alerts received in the last three months is set out below:
Information / awareness raising(42) - 45%
Empowering / involving patients(27) - 29%
Voluntary sector engagement (9)- 10%
Co-ordination issues betweenservices (9) - 10%
Local hospital (7) - 8%
Carers' issues (5) - 5%
Access issues / barriers toservices (5) - 5%
Membership engagement (4) - 4%
direct treatment of patients (5) -26%
communication issues (4) - 20%
clinical correspondence (3) - 16%
referral problems (3) - 16%
dignity and respect (2) - 11%
lack of co-ordination (2) - 11%
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The table below sets out the themes raised by the individual alerts, organised by provider,
showing that, in the case of our two largest providers – Ealing Hospital and Imperial Trusts –
a range of different concerns have been raised and there is no one over-arching theme.
Provider Number of
alerts Breakdown by Category
Ealing Hospital 8
3 Concerns about the direct treatment and management of patients
1 Clinical correspondence
1 Lack of co-ordination between services (e.g. poor discharge planning)
1 Communication issues
2 Problems with arranging an appointment or making referrals
Imperial 4
1 Concerns about whether the patient was treated with dignity and respect
2 Communication issues
1 Problems with arranging an appointment or making referrals
WLMHT 3 2 Clinical correspondence
1 Communication issues
Central Middlesex 1 1 Concerns about the direct treatment and
management of patients
District Nursing Team 1 1 Concerns about the direct treatment and
management of patients
Hillingdon Hospital 1 1 Concerns about the direct treatment and
management of patients
Northwick Park 1 1 Lack of co-ordination between services (e.g. poor
discharge planning)
Total 19
Most public queries received in this quarter were from individual patients concerning their
individual care, or from politicians, writing on behalf of individuals about their care.
4. Key outcomes of the communications and engagement workstreams:
The most common direct outcomes of the CCG’s patient and public engagement and
communication workstreams in this quarter were, as follows:
Key messages have been communicated through a number of community and voluntary
sector routes, as well as through our local stakeholders. In the last three months, this
has included cascading information about the development of the CCG’s commissioning
intentions for 2015-16, raising awareness of the care navigator and care co-ordinator
posts, and reporting the CCG’s progress against its four-year equality objectives.
Individual patient and carer representatives have been identified and recruited to
participate in CCG projects and wider initiatives. In this quarter, this has included the
delivery of the CCG’s first patient training programme, which was jointly commissioned
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across CWHHE, encouraging practices to make use of volunteers and voluntary sector
resources, and inviting patient participation on the CCG’s community healthcare
transport pilot.
Strategic planning and joint working with the local authority, Healthwatch, Ealing
Community Network and other CCGs in the collaborative has also continued as part of
the engagement and communication workstreams.
A summary of key engagement and communication outcomes during the last three months
is set out below:
Of the nineteen service alerts received in the last quarter, six have been closed with the
following outcomes:
Providers have reviewed their processes, including a consultant review, and made
changes to double check and safeguard against future errors or recommendations for
improvement.
In two cases involving clinical correspondence, human error was acknowledged.
In one case, the provider undertook a data reconciliation exercise to correct errors in
information that has been communicated to a GP practice.
At a strategic level, the CCG’s draft commissioning intentions can be seen to respond to the
themes raised by the engagement and communication workstreams in a number of ways,
including:
Route established through whichCCG can cascade info (31) - 27%
Reps sought / identified for futureinvolvement (17) - 15%
Strategic planning / joint workingestablished (12) - 11%
Briefing and engagement on localhospital (8) - 7%
Briefing and enagagement on CIs(7) - 6%
Briefing and engagement onintegration (5) - 4%
Communication and feedbackconduits established with memberpractices (4) - 4%Public scrutiny of clinicalcommissioning (4) - 4%
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Care navigator and care co-ordination roles and the move towards seven-day working
will support improved care-planning for the most vulnerable patients and joint working
between providers and practices. This will respond to the frequently-raised concerns
about inappropriate referrals, poor co-ordination and communication between services,
and inadequate discharge planning.
Commissioning intentions include an expectation of our commissioned providers to
improve diagnostic services, which will address some of the concerns regarding delays
for patients when accessing treatment.
The CCG’s continued commitment to the Shifting Settings of Care workstream will
respond to some of the issues raised relating to mental health by strengthening joint
working between specialists and primary care.
The intention to roll out SystmOne will improve the two-way exchange of information and
clinical correspondence between practices and providers. This addresses the many
concerns relating to communication between primary and secondary care, one of the
most common themes arising from service alerts.
The review of community health services will also improve communication and co-
ordination between practices and providers, linking community providers with primary
care and moving towards a more integrated service for patients. This responds to
concerns and issues raised by both practices and patients.
5. Recommendations for the CCG
In light of the patient and public feedback received in quarter 2, the PPE Committee is asked
to endorse the following recommendations for the CCG:
i) Given the strongly worded comments received at the CCG AGM and at the recent
Commissioning Intentions event for PPG chairs, it is recommended that the CCG makes
a commitment to producing easy read materials in advance of public briefings or
meetings. This will require improved forward planning in order to make use of the
engagement, communications and Healthwatch resources available. This would also be
in line with our four-year equality objectives.
ii) Given the high volume of feedback from and communication through voluntary sector
partners over the last two quarters, it is recommended that the CCG makes an on-going
commitment to an annual meeting between clinical leads and the voluntary sector. This
is next due to take place on 19th November at the Health Summit.
iii) This report now combines intelligence gleaned through both public engagement (as part
of the CCG’s public participation duty, informing commissioning intentions) and patient
experiences (as part of the individual duty, which informs quality and safety actions).
Therefore, it is recommended that the CCG reviews the resources available to cover
both duties, both locally and at collaborative level, and takes a view on how they can be
co-ordinated in order to avoid duplication.
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iv) In light of the free, bespoke leadership training on engagement on offer from South
London CSU, funded by NHS England, it is recommended that the CCG’s Governing
Board prioritises time to take up this training.
6. On-going work
Future engagement and communication work will be determined by the PPE Committee’s
discussion and decision on the CCG’s corporate approach at its meeting on 22nd October
2014. This approach has been approved by the CCG executive and is now ready to be
implemented through the PPE Committee.
Over the next three months, it is anticipated that there will be further work on communicating
the CCG’s commissioning intentions to the community and reporting on progress against the
CCG’s various pilot projects (carers’ healthcare co-ordination, community healthcare
transport and care navigation and care co-ordinator). The annual reporting deadline for the
CCG’s equalities objectives is also due shortly and, therefore, the CCG will continue to
engage with ECN’s equality reference group to scrutinise this workstream.
The next quarterly report to the PPE and Quality and Safety Committees will cover the
engagement, communication and service alert activity in October, November and December
2014 and will be made to the committees’ meetings in January 2015.