rccg/gb/18/036...to drive the principia programme forward, work was organised into ten delivery...

1. Introduction

Since its inception in April 2015, Principia Multi-Specialty Community Provider (MCP) has worked in

Rushcliffe to establish a new care model to change the way local health and social care services are

delivered locally. The purpose of this paper is to enable discussion around the future commissioning

intentions for Principia MCP’s work beyond the end of the national New Models of Care vanguard

programme on 31 March 2018, within the strategic context of Rushcliffe, Greater Nottingham, and the

Nottingham and Nottinghamshire STP.

2. Context

Rushcliffe was chosen by NHS England as one of the 50 vanguard sites identified by NHS England to

receive national funding over a three-year period to lead significant changes in the way local health and

social care services are delivered. Through this, Principia MCP has worked to provide a better quality of

care for patients within Rushcliffe through an innovative, more coordinated system via a partnership

between general practice, community and local nursing and mental health services, social care, third sector

organisations, pharmacy, and hospital services.

The vision at the core of the Principia MCP, as set out in the February 2016 Value Proposition, is:

“To provide a better quality of care for the people of Rushcliffe through an innovative, patient-

centred, coordinated care delivery system, which is designed to improve our communities’ health

outcomes, increase our clinician and staff satisfaction, and at the same time moderate the cost of

delivering that care.”

Principia MCP was the subject of an independent evaluation via Capita in 2017/18 to gauge progress and

impact of its work over the three years of the vanguard programme. From the evaluation report:

“Rushcliffe is demonstrating positive results for those projects being delivered in all workstreams. A

document review, interviews with the programme, clinical, and workstream service leads, and a GP

survey show that these results are being enabled by a long history of established community care

delivery coupled with strong cooperation across general practice. There is a real ‘can do’ mentality

within the GP community with a mind-set that is open to new ways of working rather than one of

cynicism. There is a notably higher level of trust and regard between clinicians across the system

than we have seen elsewhere and a forward thinking, responsive community provider in

Nottinghamshire Healthcare NHS Foundation Trust alongside the independent care sector providers

in the area.”

In the areas we have explored… the [Principia] MCP is delivering significant improvements in

patient outcomes and experience through excellent system relationships which are delivering more

integrated care closer to home. Savings are also being delivered in many instances.

RCCG/GB/18/036

Having proven these models in Rushcliffe, there is now significant potential to make even more

impact for patients and deliver even larger savings by applying the models at scale in Rushcliffe and

across Greater Nottingham.”

3. Overview of MCP transformation programme

To drive the Principia programme forward, work was organised into ten delivery workstreams, each led by a

clinical lead and a managerial lead, and an enabling workstream, led by the MCP programme management

team:

Each of the ten workstreams of the MCP is focused on a specific area of health and care, as outlined in the figure above, and is subsequently divided into schemes, as follows:

Workstream 1-2: Support to Self-Management and Primary Prevention, Clinical Lead -Dr Jeremy Griffiths

Let’s Live Well in Rushcliffe (LLWiR) social prescribing programme

-Identification of people in need (patients with low activation, high BMI and/or other lifestyle risk factors, poorly managed LTCs, etc.) -Investment in three Health Behaviour Advisors to asses patient activation level and refer to self-care and/or more intensive support -Investment in six Community Connectors to provide ongoing support for people

with higher or more complex needs -Identification of gaps in provision in community services and investment in community cafes and support for development of community groups where support can be accessed

Public outreach activity, including increased targeting of working-aged adults (e.g. One You)

-Promoting self-care and appropriate use of NHS services to Rushcliffe public -Distributing information about local preventative and healthy living resources -Linking in with local engagement work (such as Rushcliffe patient forums), national prevention/self-care events, Public Health England One You campaign, and NHSE events like #NHS70 -Spreading information about accessing the LLWiR programme

Self-Care and Health Education Media Streaming in Primary Care (and ongoing patient engagement)

-TV screens in all Rushcliffe GP practices, linked up to a central system via NuMed to communicate to patients in waiting rooms -Communications to include health promotion and self-care, including the national/local campaigns aligned with engagement activity, using GP and other services appropriately, and information about accessing the LLWiR programme

Workstream 3-4: Secondary Prevention and Management of Long Term Conditions (LTCs), Clinical Lead -Dr Neil Fraser

AF upskilling programme for GPs -GPs upskilled to increase the identification of AF and increase prescription of anticoagulants

AF case finding -GP practices equipped with AliveCor devices to perform opportunistic pulse checks on patients over 65 (such as during flu clinics)

Heart Failure and Pulmonary Rehab

-Combined pulmonary and heart failure rehab courses offered in Rushcliffe offering educational and exercise components, with back-to-back and rolling programme courses in place to allow patients to more easily re-join if needed -Reduction of exacerbation/re-admission for patients who have completed the joint rehab programme

Cardiology Lead GP (Scheme closed due to lack of interest from GPs and role no longer needed)

Update of carer registers and ongoing support in GP Practices

-Scoping exercise/report by Age UK to look at how carers are identified and supported in Rushcliffe, with suggestions of where to join up/improve

Frailty Pathway

-Integration of care for frail elderly and people with multiple LTCs in Rushcliffe -Redesign of assessment and care planning process -Case identification and risk stratification -Joined-up patient pathways between different elements of community care -Agreed thresholds for case management and different clinical interventions -Implementation of new MDT guidelines, including care coordinator roles -Establishment and training of Frailty GPwSIs

COPD upskilling in primary care, including introducing micro-spirometers into practices

-Implementation of micro-spirometry in practices to identify cases of COPD earlier and free up clinicians' time to better manage these patients -Upskilling of GPs, practice nurses, and HCAs on diagnosis and management of COPD and opportunistic testing

Standardisation of long-term conditions

-Standardised templates on F12 Pathfinder: diabetes, heart failure, COPD, AF -GPs asked to set goals and provide personalised patient-centred care planning approach with reviews -Scoping exercise in Rushcliffe around diabetes (consistency of management across practices and to inform further development)

Workstream 5: Mental Health and Parity of Esteem, Clinical Lead -Dr Nick Page

Primary Care Psychological Medicine (PCPM)

-Specialist liaison psychiatry service within primary care for patients with mixed medical/psychiatric morbidity or frequent admissions where clear diagnosis has not been made -Initial internal evaluation shows improvement in clinician- and patient-reported outcomes for patients in this cohort who have attended the PCPM service

Data sharing project (getting -Migration of the mental health data set into the core primary care data

Mental Health into systems modelling)

warehouse at Notts Healthcare Trust (GPRCC), creating a core infrastructure to be utilised in modelling and demand management -Checking, cleaning, and assessing for validity of imported Mental Health data

Reducing inappropriate emergency utilisation in patients w/ selective LTCs (enhanced IAPT and other psychological interventions)

-Identification of patients with selected LTCs (COPD, CCF, angina, diabetes) at risk of mental health effects via primary care and GPRCC -Identified patients to be offered enhanced access to IAPT and/or other psychological support

Reducing inappropriate emergency utilisations in patients with severe mental illness (maximising preventative cardiometabolic interventions)

-Shared interventions in place between GP practices, general healthcare community services, and specialist mental health workers -Joined-up integrated planned care and enhanced management of mental illness alongside careful LTC disease management, using existing protocols of care and increased engagement of patients and carers -Recovery College models to support patient education and sustainability -Aim for 25% reduction in utilisation within first year from affected cohort

Developing an Optimal Value pathway (RightCare) for treatment-resistant depression

-Local application of RightCare approach to address challenges of treating depression that does not respond to first-line treatment -Analysis of the current pattern of care using RightCare Data Pack for Rushcliffe CCG; identification of priority areas and extrapolation of the modelling to healthcare population system-wide -Changes proposed to care models/system implementation to ensure clinical teams can readily access comparable intelligence to assess/improve care

Suicide prevention (SAFETool)

-Evening sessions training GPs to engage in dialogue around suicide risk factors, detect signs of suicidal tendencies in patients, create management plans, and connect them with resources and interventions -Personality Disorders training for GPs using the same evening training model

Depression Advice/ Review Clinic (DAC)

-DAC established and run by psychiatric fellow to provide psychiatric outreach for patients with depression via a biopsychosocial approach -Patients attending the DAC clinic receive a 90 minute consultation with follow-up appointment if necessary, and then are discussed with a psychiatric consultant; this ensures patients have the correct mental health condition diagnosis and a fully biopsychosocial management plan in primary care -Depression patients are better managed to improve quality of life, reduce exacerbation/other symptoms, and reduce emergency admissions

Workstream 6-7: Integrating Health and Social Care, Clinical Lead -Lynn Hallam

Integrated health and social care

-Integration of Occupational Therapy team across health and social care in partnership with Notts County Council -Investment in integration managers (Mental Health and Occupational Therapy) -Integration of single point of access and trusted assessor model across health and social care -Integration of assistive technology strategy across health and social care

End of life pathway

-100% of Rushcliffe residents supported to understand their choices for end of life (EoL) care and achieve their preferred place of care -Personal and consistent EoL care delivered by local integrated care team, a workforce trained, skilled, and clinically supervised to manage their needs at home (linked in with MDTs; pathway carers attending MDT meetings)

Integrated nursing workforce project -pilot

-Proof of concept of a new approach to more integrated working across practice nursing and community nursing, developing nursing staff -GPNs in pilot to be in practice two days/week, in community two days/week, and in the De Montfort University GPN programme one day/week; community nurses to spend two days/week in community and two days/week in general practice. -Encouragement of application and retention of nursing staff in Rushcliffe

-Ensuring a pipeline of nurses into primary care and piloting a "way in" to primary care nursing to address future workforce/skills needs

Workstream 8: Medicines Optimisation, Clinical Lead-Dr Richard Stratton

Practice pharmacy support

-Five-month pilot of practice pharmacist within Rushcliffe practice -Practice pharmacist conducted medication reviews leading to medicines optimisation, cost-effective switches, and reduced waste and -Release of GP time as practice pharmacist is an independent prescribers and could see/advise patients when appropriate, relieving GPs’ prescribing burden

Managed repeats hub

-Pilot repeat prescribing POD model -Centralised function for repeat prescriptions involving support documents, screening tool for repeat prescriptions, standardised polices/processes within practices for repeat prescriptions/use of screening tool, and plans for centralisation of service within a hub in one of the Rushcliffe practices -Screening tool piloted in three practices July-Oct 2017 with positive results -Phased rollout of screening tool and scoping centralised hub ongoing

OptimiseRx prescribing tool -Tool in SystmOne/EMIS at the point of prescribing to enable GPs to make the most clinically and financially appropriate choice when prescribing

Medicines Safety Officer (Scheme closed; absorbed within existing Medicines Management team)

eMAR (electronic medication administration records) pilot in Rushcliffe care homes

-Trial of eMAR systems within four Rushcliffe care homes, allowing care home staff to keep an electronic record of all residents’ medications and medication administration -Results included reduced medication waste in care homes (through monitoring of stock and ordering accuracy), increased medication safety (ensuring medicines are monitored and given at appropriate times/ways), providing an audit trail, and increasing confidence and time savings for care home staff

Care Home Pharmacist -Care home pharmacist performing functions such as medication optimisation reviews

Community pharmacy

-Support for self-care agenda and links to social prescribing -Targeted MURs to support medicines optimisation -Out of hours/urgent care support via front-line advice to patients and OTC medicines knowledge to decrease reliance on A&E services -Signposting to services

Pre-reg places in primary care (including teacher practitioner)

-Pre-registration pharmacy students on six-week programme to gain experience in primary care within Rushcliffe

Workstream 9: Elective Care, Clinical Lead -Dr Matt Jelpke

Gynaecology community clinic

-Consultant-led community clinic, supported by GPs, providing assessment, diagnosis, and treatment in the community -Referrals are triaged, standardised, and managed, with patients only referred to secondary care when specifically needed -Reduction in referral variations and first to follow-up appointment ratio in secondary care

Gastro pre-assessment pathway

-Triage of all Gastro referrals (excluding 2ww) via links between primary and secondary care -Minimum data set completed within each referral -Diagnostic tests ordered and interpreted within primary care -Reduction in referral variations and first to follow-up appointment ratio in secondary care

Respiratory pre-assessment pathway

(Scheme closed; Respiratory pathway to be included in Urgent Care workstream at Greater Nottingham level)

Extension of Fracture Liaison Service

-Patients who have experienced or are at risk for a fragility fracture are identified via casefinding and assessed/monitored via a secondary care consultant within a virtual clinic the community

-Eligible patients are given IV Zolendrate in the community via the Band 7 Fracture Liaison Nurse, leading to increased medication tolerance and decrease in fractures/fracture-related acute activity

Service redesign and implementation of GP/nurse-led community Dermatology pathways (Triage and Treatment)

-Community Dermatology clinic including establishment of GPwSI triage/advice system and BCC triage clinic/teledermatology -Reduction in referral variations and first to follow-up appointment ratio in secondary care

Design and implementation of a community ENT service

-Consultant-led community clinic, supported by GPs, including assessment, diagnosis, and treatment where possible -Referrals triaged, standardised, and managed -Reduction in referral variations and first to follow-up appointment ratio in secondary care

"F12 project" -Development and roll-out of standardised approach to accessing guidance and making referrals within general practice

-F12 Pathfinder tool in place and in use by all GPs (and other primary care staff where appropriate), including features such as pathways and referral guidance, Minimum Data Sets, templates and forms, tools and helpers (protocols), patient Information, and other useful information (PLCV, contacts etc.) -Results include reduction in referral variation and inappropriate referrals, improved referral quality (minimum data set), and improved GP confidence when referring

Primary Care Community Services Clinic Co-ordinator

-Clinic co-ordinator, performing functions including attending clinics to trouble shoot and ensure delivered as intended, providing centralised booking facility, ordering consumables, ensuring accurate recording/reporting, and performing ad-hoc tasks -0.2 WTE operations manager to mobilise new services/developments and line manage the clinic co-ordinator -Mobilised via PartnersHealth

Workstream 10: Non-Elective Care, Clinical Lead -Dr Jonathan Ashton

Strengthening the EMAS 10 minute call back protocol and EMAS Community Car pilot

-Ten-minute protocol implemented; paramedics contact patients’ GPs before conveyance for guidance -Community Cars pilot (two EMAS ambulance technicians) accessing calls from rural areas of Rushcliffe faster and reducing conveyance -Use of Mangar Elk cushions to lift patients who have fallen and stabilise them to reduce need for conveyance to ED after a fall

Enhanced Dietetics support to care homes

-Band 7 dietician employed to work with care homes to ensure residents are accurately screened for malnutrition, residents’ malnutrition rates decrease, and oral nutrition supplement prescriptions are reviewed and reduced where necessary. -Implementation of a “Food First” strategy within care homes, with guidance for optimal food preparation -Reduction in admissions due to aspirate pneumonia, dehydration, and gastroenteritis, increased strength and wellbeing, and decrease in frailty/fall risk for care home residents

Case Management of Very High Service Users (VHSU)

-Band 3 administrative support for identification of and written contact to patients across Greater Nottingham who contact EMAS >4 times per month or 10 calls per 3 months -Band 7 mental health nurse to manage Rushcliffe VHSU patients, including via care plans with comprehensive management through an MDT approach to ensure they no longer need to call 999

Integrated Personal Care Manager -IPC case manager recruited, supporting and coordinating Continuing Healthcare patients from the hospital to assessment and long-term care needs

Multi-Disciplinary Falls Clinic (Note: Now included within the Rushcliffe Frailty Pathway)

-Identification of patients who are at risk of falls and implementation of personalised falls prevention strategies -Wider patient education of basic falls prevention strategies

-Work with local pharmacies to increase awareness around medications that could potentially cause falls -Greater identification of patients for Fracture Liaison Service

Respiratory work to manage interstitial lung disease

-Implementation of additional nursing resource to provide case management patients with interstitial lung diseases, reduce non-elective admissions in these patients, improve ILD patients’ quality of life, and ensure oxygen support is provided in a timely and efficient manner

The Rushcliffe CCG Governing Body is asked to:

1. Note the progress and activity of the MCP transformation programme.

2. Discuss and note the future proposed commissioning intentions of the transformation schemes.

4. Future commissioning intentions per workstream

Work ongoing; pending evaluation

Commissioned by Rushcliffe CCG

Spread to Greater Nottingham

Potential to spread STP-wide

Comments

Workstream 1-2 Support to Self-Management and Primary Prevention Clinical Lead – Dr Jeremy Griffiths

Let’s Live Well in Rushcliffe (LLWiR) social prescribing programme

-Pilot programme launched 1 Oct 2017, with six link workers and three health coaches (tethered to CDG localities) managed by ImROC; target of 60 referrals per week to provide sufficient activity for statistical relevance. -Task and finish group at Greater Nottingham level to commence at end of March 2018 to ensure swift procurement and avoid gap after finish of pilots in Rushcliffe and Nottingham City.

Expand implementation of public outreach activity, including increased targeting of working-aged adults (e.g. One You)

-Communication and engagement 2017/18 One You activity. -Plan previously contained funding for a self-care app; now to be pursued in Greater Nottingham

Self-Care and Health Education Media Streaming in Primary Care (and ongoing patient engagement)

-Non- recurrent funding; ongoing costs to be picked up by practices (with agreement with PartnersHealth and CCG to support content); not currently being aggregated to Greater Notts, but with potential for replicability.

Workstream 3-4 Secondary Prevention and Management of Long Term Conditions Clinical Lead – Dr Neil Fraser

AF upskilling Programme for GPs -Non-recurrent funding; training delivered to Rushcliffe GPs (with ongoing wider education programme within the MCP)

AF case finding -AliveCor pulse-checking devices provided to practices. Approximately 32,000 pulse checks will have been completed April 2017-March 2018. It is proposed that this incorporated as a quality indicator within the Greater Nottingham Enhanced Service GP Specification.

Heart Failure and Pulmonary Rehab

-Scheme originally funded via MRET, currently, HF rehab incorporated into existing GP core contract. -Additional business case for £45k to additional HF nurse capacity to support rehab and service development opportunities under development.





Comments

Cardiology Lead GP -Scheme closed

Update of carer registers and ongoing support in GP Practices

-Initiative completed and report received from AgeUK, identifying Rushcliffe’s current carers offer and any gaps. Recommendations from the report will be taken forward via the Carers Federation contract within South Nottinghamshire. Plan is to standardise recommendations and action plans across Greater Nottingham and the STP.

Frailty Pathway

-Case-finding and care planning in GP practices is now part of the new GP contract and discussions are ongoing about inclusion in the Greater Nottingham Enhanced Service GP Specification. -Frailty Pathway pilot rolled out across Greater Nottingham -Care co-ordinators will be funded via MCP until December 2018 (first 12 months FYE), with second year approved via BCF funding. -Discussions ongoing re: clinical support structure (Frailty GPwSIs and/or Frailty GP leads within each practice) and payment -Communications and engagement – PLT session completed; practice visits to commence once all care co-ordinators are in post.

COPD upskilling in primary care, including introducing micro-spirometers into practices

-Non-recurrent funding; practices have been provided with micro-spirometers and training

Standardisation of long-term conditions

-Diabetes, HF, COPD, AF, and LTC personal care plan indicator processes all live and standardised as part of F12 Pathfinder. -Work ongoing specifically around diabetes care across Greater Nottingham. Scoping in Rushcliffe will inform any recommendations across Greater Nottingham (with no funding implications)





Comments

Workstream 5 – Mental Health and Parity of Esteem Clinical Lead – Dr Nick Page

Primary Care Psychological Medicine (PCPM)

-Pilot ongoing until September 2018 (two band 6 psychiatric liaison nurses and one session with consultant liaison psychiatrist two sessions per week). -Independent evaluation has been commissioned from the Centre for Mental Health, evaluation of a similar model in West Yorkshire has identified direct physical health secondary care savings of £64k over one year by seeing 27 cases. If this rate of savings is aggregated to the 154 cases seen in Rushcliffe, this would result in £486k savings. GP-based primary care savings in West Yorkshire averaged £1300/patient. - Potential replication at STP level is being explored.

Data sharing project (getting Mental Health into systems modelling)

-Non recurrent funding to enable RIO data flowing into the General Practice Repository of Clinical Care (GPRCC) system. -Potential for scaling up to Greater Nottingham level.

Reducing inappropriate emergency utilisation in patients w/ selective LTCs (enhanced IAPT and other psychological interventions)

-Clinical lead is in post (Ian Bowns, consultant in Public Health) one day/week, from Aug 2017-Oct 2018 providing data analysis, clinical leadership, links to the Public Health and support for work on SMI and RightCare depression pathways. -Funded until October 2018 - Funding committed in 2018/19 for 0.1 Band 7 CBT therapist to work with COPD, angina, and heart failure patients in the cardiorespiratory team, delivering education session within the cardiac and pulmonary rehabilitation sessions, signposting patients to IAPT, upskilling the team, and seeing people who drop out of the rehab programmes due to anxiety or depression. -Ongoing development of Greater Nottingham model, to operationalise the progress Rushcliffe and other South Nottinghamshire CCGs have made alongside national and local evidence from elsewhere regarding integrated IAPT.

Work Commissioned Spread to Potential Comments

ongoing; pending evaluation

by Rushcliffe CCG

Greater Nottingham

to spread STP-wide

Reducing inappropriate emergency utilisations in patients with severe mental illness (maximising preventative cardio metabolic interventions)

-Additional clinicians to support this scheme to be in place in 2018/19, including additional clinical support for practices and NHS providers at local level (such as one WTE band 7 nurse). -Possible links being investigated with other work around long-term conditions in Rushcliffe. -Delays in start of scheme; currently looking at the relevant skill mix and support staff to deliver. Scheme will be evaluated and once in place will potentially be aggregated up as part of the avoiding admissions pathway.

Developing an Optimal Value pathway (RightCare) for treatment-resistant depression

-Clinical lead is in post (Ian Bowns, consultant in Public Health, also supporting on the enhanced IAPT scheme above) Aug 2017-Oct 2018. -Practice level support, patient group work, roll-out of pathway, and launch event to take place in 2018/19. -Currently a Rushcliffe scheme with potential to be aggregated to Greater Notts and/or STP level following evaluation.

Suicide prevention (SAFETool)

-Non-recurrent funding; Rushcliffe suicide prevention training completed, ongoing review of the SAFE tool and how it is being used. -Informing ongoing study at Greater Notts level around suicide prevention tools for GPs. -Personality disorder training for GPs to be completed May 2018 in Rushcliffe

Depression Advice/ Review Clinic

-Depression Advice Clinic (DAC) ongoing until end of Sept 2018 -Findings from the DAC to inform the Optimal Value (RightCare) Pathway at STP level.

Work ongoing;

Commissioned by Rushcliffe

Spread to Greater

Potential to spread

Comments

pending evaluation

CCG Nottingham STP-wide

Workstream 6-7 Integrating Health and Social Care Clinical Lead - Lynn Hallam

Integrated health and social care

-Integrated Occupational Therapy (OT): Ongoing development of scope of project with discussions in South Notts CCGs, with key areas around OT, re-ablement, and social care. No further Rushcliffe funding required as this involves existing workforce coming together and links in with the five year plan. -Single Point of Access (SPIA): Lead identified within Notts Healthcare Trust to develop a project plan to identify costs, efficiency, and potential streamlining of SPIAs across South Notts, Mid Notts, and Bassetlaw. -Workforce: In planning stages, linked to team redesign; possible synergies in workforce planning and other enablers and links into STP. -Housing: Four posts in place until Oct 2018, three within the community and one as a shared Greater Notts post (shared with NUH IDT team); six months funding through MCP, and additional three months via BCF to match timescale of equivalent Nottingham City team. Programme will be evaluated at six months to inform ongoing commissioning intentions for model for Greater Notts. -Trusted assessor (TA) model: Two TAs for care homes have been recruited for a six-month period within the Integrated Discharge team, focusing on care homes, re-ablement, pathways and fast track discharge. Bespoke competencies are being developed to deliver training to TAs to have full TA programme running by April 2018 within the South Notts CCGs (to inform Nottingham City). TA model will inform what is taken forward as a system, and mostly funded by the BCF. -Assistive technology: Strategy being approved at A&E Delivery board





Comments

End of life pathway -Pilot of pathway due to conclude June 2018, deep dive evaluation by Capita

-Pathway also currently being evaluated by County Health Partnerships (CHP) task and finish group across the South Notts CCGs, strengthening initial evaluation data. -Dedicated End of Life Matron who drove initial year of pilot and assisted quick discharge of Rushcliffe end of life patients from acute to community care now in place in a complex case manager post in the Integrated Discharge team at Greater Notts level.

Integrated nursing workforce project -pilot

- 4 x GPNs in place in practices for 12 months during the pilot. -Non recurrent funding -All four nurses will collate their experience of gaps, overlaps and areas that could be improved. -Learnings and evaluation to inform future workforce and educational requirements; De Montfort University have been commissioned to evaluate the pilot commencing February 2018.

Workstream 8 – Medicines Optimisation Clinical Lead – Dr Richard Stratton

Practice pharmacy support -Practice pharmacists providing sessions with GPs and with patients; ROI was evidenced from pilot -Further exploration of progressing this model is needed

Managed repeats hub

-3 month pilot of screening tool in 3 practices showed positive ROI and quality and safety improvements; screening tool now rolling out in phased process across Rushcliffe -Scoping of centralisation of services in Rushcliffe is ongoing 2018/19, with spread to Greater Notts. Discussions ongoing around location of hub.





Comments

OptimiseRx prescribing tool -Spread to Greater Nottingham level (ongoing licensing fee) -To be evaluated yearly to ensure continued ROI.

Medicines Safety Officer -Absorbed within existing Medicines Management team

eMAR -eMAR requirement potentially to be added to care home contracts via Local Authority based on MCP learning; Local Authority can stipulate requirement to put eMAR systems in

place based on safety benefits evidenced during MCP pilot. Ongoing discussions between Medicines Management team and Local Authority.

Care Home Pharmacist -To be put forward as a business case for Greater Nottingham as part of the care homes PID in 2018/19; Rushcliffe Prescribing Lead and clinical lead are discussing how to move forward.

Community pharmacy -Still in development; no MCP funds currently required. To be put forward as a business case to Rushcliffe once developed.

Pre-reg places in primary care (teacher practitioner)

-Non recurrent funding. -Decision at Greater Nottingham level whether other CCGs will adopt model

Workstream 9 Elective Care Clinical Lead – Dr Matt Jelpke

Gynaecology community clinic

-Current contract to finish 15 May 2018 - ongoing support to be at Greater Nottingham level via a business case. -Evaluation evidences strong ROI (including net savings of approx. £200k via reduction in secondary care spend year-on-year) -Included within PMO Planned Care workstream for Greater Nottingham

Gastro pre-assessment pathway

-Scheme spread across Greater Nottingham 1 Jan 2018; commissioned as part of main NUH contract. -Evaluation evidences strong ROI (delivering net savings of approx.. £50k in Rushcliffe and approx. anticipated £350k net savings at a Greater Nottingham level)





Comments

Respiratory pre-assessment pathway

Respiratory pathway to be included in Urgent Care workstream at Greater Nottingham level

Extension of Fracture Liaison Service

-Rushcliffe model expanded across south Nottinghamshire (Nott. North and East, Nott. West, Rushcliffe) -Coverage of approach across Greater Nottinghamshire, but with a different model in

Nottingham City; learning to be shared moving forward.

Service redesign and implementation of GP/nurse-led community Dermatology pathways (Triage and Treatment) – 10 months

-Ten months’ funding initially agreed through MCP, running 1 Dec 2017-30 Sept 2018; further funding for Oct/Nov 2018 via CCG Pathways budget, with business case needed for Dec 2018 onward. -Currently in place in Rushcliffe, including teledermatology and BCC triage in community pathway, but future opportunity across Greater Nottingham within the Planned Care workstream -Evaluation pending

Design and implementation of a community ENT service

-Taken up by Greater Nottingham Planned Care workstream; still at explorative phase, planning to expand to Greater Nottingham foo -Discussions ongoing around procurement process and interlinking into secondary care

"F12 project" -Development and roll-out of standardised approach to accessing guidance and making referrals within general practice

-F12 Pathfinder tool rolled out successfully in Greater Nottingham, with appetite at STP level - Posts included to support further development of the F12 Pathfinder tool proposed to the Greater Notts Exec Team as part of new structure, including additional posts to provide necessary resource to support continued delivery of F12 across the STP





Comments

Primary Care Community Services Clinic Co-ordinator

To be managed by PartnersHealth post March 2018

Workstream 10 Non-Elective Care Clinical Lead – Dr Jonathan Ashton Strengthening the EMAS 10 minute call back protocol and EMAS Community Car pilot

EMAS Community Cars technicians will end 31 March 2018. Meetings ongoing with other potential providers to further develop/scope potential future Community Cars model

(Rushcliffe Urgent Care clinical leads currently working on further development of model) -Ongoing work is needed as part of the development of wider hub-and-spoke urgent care model -Reinforcement of the Ten-minute call-back protocol to be spread Greater Nottingham with potential to be spread across the East Midlands

Enhanced Dietetics support to care homes

-ROI evidenced with current work (reduction in ONS prescriptions, etc.), with work still to be done in care homes and potential expansion into other areas -Current care homes dietician will not be continuing after 31 March 2018 but scheme potentially could go forward as part of the STP plan

Case Management of Very High Service Users (VHSU)

-Extension of administrative support within EMAS agreed at MCP Governance Group until 31 Oct 2018 for Greater Nottingham (to match Rushcliffe VHSU Mental Health Nurse contract length) -VHSU model to be scaled up to incorporate Rushcliffe element of alcohol-related LTC care and VHSU work within Care Delivery Groups

Integrated Personal Care Manager

-IPC manager in post with 12 months funding -Still ongoing in Rushcliffe with potential interest at STP level; discussions ongoing with STP team and within structural changes

Multi-Disciplinary Falls Clinic -Scheme is now included within Rushcliffe Frailty Pathway

Respiratory work to manage interstitial lung disease

-Post started 15 Jan 2018 to address Rushcliffe’s need for additional support in Respiratory team for ILD patients; position permanently recruited with first 12 months funding from MCP

Appendix - Principia Local Integrated Care Partnership (ICP) High-Level Delivery Plan Principia Local Integrated Care Partnership (ICP) Delivery Plan Overview This high level plan sets out the key milestones for the phased development of the Principia Local Integrated Care Partnership. The detailed work programme will be fleshed out early during Q1 2018/19. The main phases of the plan are:

Jan to March 2018: Pre-mobilisation phase - concluding the formal overall evaluation; confirming future commissioning intention; seeking legal advice; finalising the future service model and ‘prospectus’

April to Sep 2018: Establish the shadow Local ICP - develop the Integration Agreement; mobilise next stages of service improvement; focus on workforce development

Oct 2018 to March 2019: Formalise the Local ICP through appropriate contract framework; develop proposals for next phases of in-scope services; agree scope of tactical commissioning and associated support/resources

April 2019 onwards: Extend scope of services – this will include social care, third sector and specialist provision

Reference Objective Type

[Activity / Milestone]

Forecast Start Date

Forecast End Date

On track (RAG)

1 Pre-Mobilisation

1.1 Gain approval from MCP Governance Group to proceed with scoping of model

Milestone 17-Oct-17 Green

1.2 Discussions and initial legal advice around partnership options

Activity Green

1.3 Complete and sign off formal evaluation Activity 31 Jan 18 Green

1.4 Gain approval from CCG, PartnersHealth and NHCT Boards to progress with scoping the LICP

Activity 31 Jan 18 Green

1.5 Preparation for final NHSE Assurance meeting Activity 01-Jan-18 08-Mar-18 Green

1.6 Scope commissioning intentions through Confirm and Challenge process

Activity 01-Nov-17 15-Mar-18 Green

1.7 Formal close down of Principia MCP vanguard programme

Milestone 31-Mar-18 Amber

1.8 PartnersHealth approval of Integration Agreement Milestone 29-Mar-18

Amber

1.9 Notts Healthcare approval of Integration Agreement Milestone 26-Apr-18 Amber

1.10 Rushcliffe CCG Governing Body approval of LICP and work programme

Milestone 19 Apr 18 Amber

2 Establish Programme Governance and Leadership

2.1 Agree governance for the programme leadership and ToR Activity 29-Mar-18 Amber

2.2 Agree governance for programme management and ToR Activity 29-Mar-18 Amber

2.3 Take legal advice with regard to contracting arrangements Activity 01-Jan-18 28-Feb-18 Green

2.4 Draft Integration Agreement between PartnersHealth, CCG and Nottinghamshire Healthcare Foundation Trust (NCHT) produced

Activity 01-Jan-18 08-Mar-18 Green

2.5 Develop communication and stakeholder plan Activity 01-Jan-18 31-Mar-18 Amber

2.6 Agree resources necessary for programme mobilisation Activity 01-Jan-18 31-Mar-18 Amber

2.7 Develop Prospectus and description of model Activity 30-Mar-18

Amber

3 Mobilising Local Care Model

3.1 Set up LICP Joint Leadership Board Activity 12-Mar-18 30 Apr-18 Amber

3.2 Set up LICP Management Board Activity 12-Mar-18 30 Apr-18 Amber

3.3 Project Initiation Document produced and approved by LICP Joint Leadership Board

Activity 30-Apr-18 31-May-18

Amber

3.4 Delivery of LICP core components matched to workstream activity

Activity 12-Mar-18 31-May-18

Amber

3.5 Alignment of transformation areas and STP priorities with LICP

Activity 12-Mar-18 30-Apr-18 Amber

3.6 Prioritise clinical workplans for each priority areas – Planned Care, Primary Care, Mental Health and Urgent Care

Activity 12-Mar-18 01-May-18

Amber

3.7 Development of contractual mechanisms and relevant variations, associated legal frameworks with gain/risk sharing agreement and financial incentives

Activity 12-Mar-18 01-Oct-18 Amber

4 Outcomes Framework

4.1 Development of an Outcomes Framework of aligned phasing of in scope services to inform relevant contractual obligations

Milestone 01-Feb-18 30 Jun 18 Amber

4.2 Identification of budget lines to be included Milestone 01-Feb-18 30 Jun 18 Amber

5 Workforce Development

5.1 Taking recommendations from WSP analysis and developing a workforce plan

Activity 31-Jan-18 30 Jun 18 Amber

5.2 Engaging OD support for the transformation model Activity 31-Mar-18 01-May-18

Amber

5.3 Interface with tactical commissioning Activity 31 Mar 18 01 May 18

Amber

6 Communications and Engagement

6.1 Develop and produce materials/resources to communicate the LICP vision and model of care

Activity 12-Mar-18 30-Apr-18 Amber

6.2 Produce Staff Engagement Plan Activity 01-Jan-18 30-Apr-18 Amber

6.3 Produce Patient Engagement Plan Activity 01-Jan-18 30-Apr-18 Amber

rccg/gb/18/036...to drive the principia programme forward, work was organised into ten delivery...

Documents