City & Hackney Clinical Commissioning Forum

Thursday 8th January 2015St Joseph’s Hospice

13:00-15:00

EPS Release 2

City & Hackney Clinical Commissioning Forum

8th January 2015

Ashik Rai

EPS enables prescriptions to be sent electronically from the GP to the dispenser of the patient’s choice.

It makes the prescribing and dispensing process easier and more convenient.

Electronic Prescription Service

@EPSnhs

Electronic Signatures

Electronic repeatdispensing

Electronic cancellation

Nomination

Electronic claims

EPS overview

GP practice key process changes

• Approach to capturing nominations

• Preparing a repeat prescription

• Signing electronic prescriptions

• Electronic repeat dispensing

• Split prescriptions.

• Electronic Cancellation

• Business continuity (when things don’t quite work as expected …)

Pharmacy key process changes

• Approach to capturing nominations• Dispensing and downloading electronic

prescriptions• Dispensing tokens• Electronic cancellation• Electronic endorsement and patient declarations• Electronic claims• End of month processes• Business continuity (when things don’t quite work as

expected …)

New prescription tracker

https://nww.spine2.ncrs.nhs.uk/prescriptionsadmin/ - available from August 24th 2014The old tracker URL will re-direct to the new URL above.

Future of EPS – in progress

• Controlled Drugs in EPS • EPS “Phase 4”• Dispensing System supplier relationships• Spine 2

– New prescription tracker

– Claim amendment

– Message Acknowledgement

• EPS Release 3 …

Future of EPS – EPS Release 3

An example of the options being considered:•Enhancement of repeat dispensing functionality •More comprehensive dm+d drug mapping / adherence•Eliminate the need for paper dispensing tokens •Multiple nominations for patients •Self-service access for patients, to allow them to view, adds, change or remove their nomination•Instalment prescribing/dispensing•Ability for patients to manage their own medication via a mobile device (e.g. electronic tokens, prescription re-ordering, booking of appointments)•Sharing of prescribing /dispensing information with SCR.•Improvements to the management of larger prescriptions (more than four items) •‘Push’ delivery of prescriptions•EPS in other health care settings

EPS London Deployment Map

EPS London Update

• Total 1,443 Practices• 1065 Live (74%)• 122 Planned (8%)• 256 No Plan (18%)

• Total 1,874 Pharmacies• 1818 Live (97%)• 8 Planned (0.5%)• 48 No Plan (2.5%)

EPS Deployment in City & Hackney

EPS Training & go-live planned

Queensbridge Group Practice 14/01/15

Kingsmead Medical Centre 22/01/15

Rosewood Practice 28/01/15

Heron Practice 11/03/15

Healy Medical Centre 17/03/15

EPS go-live to be booked

• Abney House Medical Centre• Brooke Road Surgery• Cranwich Road Surgery• Dalston Practice• De Beavoir Surgery• Lower Clapton Health Centre • Somerford Grove Health Centre • Sorsby Health Centre • Statham Grove Surgery• Tollgate Lodge Healthcare Centre

EPS Utilisation in City & Hackney How much is it used?

At the end of December 2014:

• 28 practices were using EPS Release 2• 22 practices are using EPS for over 25% of

prescriptions• of which 12 practices are using EPS for over 40% of

prescriptions and 6 over 50%.

• National Average Usage = 35%• Target for March 2015 = 40%

EPSr2 Data taken from NHS BSA cliams for August and compared the total prescriptions in May 2014

Contact details

Annette Breslin

GP IT Project Officer (NEL CSU)

Annette.Breslin@nelcsu.nhs.uk

07961 077038

Charlette Appleton

Emis seconded Trainer (EMIS)

Charlette.Appleton@e-mis.com

07436 273588

Questions?

Contact Details

Ashik RaiSenior Implementation Manager

Email: ashik.rai@hscic.gov.uk

Web: http://systems.hscic.gov.uk/eps

END

PRIMARY CARE

TAKING ON COMMISSIONING

FROM APRIL 2015

WHAT ARE WE GOING FORPrimary Care Function

 Greater involvement Joint Commissioning Delegation

General practice commissioning

Involvement in discussions but no decision making role

Jointly with area teams CCG does it

Design and implementation of local incentive schemes

No Subject to joint agreement with the area team

CCG does it

Budget management No Jointly with area teams CCG does it

Complaints management No Jointly with area teams CCG does it

Managing practice contract Opportunity for involvement Jointly with area teams CCG does it

Medical performers’ list, appraisal, revalidation

No No – stays with NHSE No – stays with NHSE

Pharmacy, eye health & dental commissioning

Stays with NHSECCG can fund and contract

for additional services

Stays with NHSECCG can fund and contract

for additional services

Stays with NHSECCG can fund and contract

for additional services

Commissioning of prevention remains with LA Public HealthCommissioning of screening remains with NHSE

MONEYStill work in progress….•Sufficient money to carry on with contracts √ •Central budgets – TBC

Review again end of January

OUR STRATEGY REMAINS

OUR PLANS• Access• Early years• LTC and cancer• Mental Health• Social prescribing, prevention and support• Care plans/PBIC• Equity of provision via the Confederation• Understand outcomes and ££s

NEXT YEAR• PBs to look at turning DESs in local contracts? - LD, Access, Minor Surgery

• PBs to consider more enhancements to “core” and QOF • Other than early years no new things – revise specs for 15/16• Keep on with additional investment to recognise work in primary care • Keep on working with Confederation to turn into additional manpower

and support

• Understand and share current spend and outcomes by practice• How do we assess• How do we level up

• How can we streamline core and additional

• Strategy only works if we remain “productive” – i.e. minimising hospital spend – CCLES behaviours are critical.

Clinically led Boards bringing together commissioners and providers to

develop clinical plans

Primary Care Quality Board

CCG Primary Care

Oversight of core contract ££s and outcomes

- contracts would remain with individual practices

Define what we want to commission from practices to deliver our service models (and align delivery across

providers)

All plans subject to member and LMC consultation

Additional services/local “DES”/local CCG contracts – via the Confederation if

list based

CCG Programme Boards

HOW WE PLAN TO DO IT

Chaired by Mark Rickets LMC; Consortia; Confederation; Public

Health; NHSE

Coordination of Programme Board plans

Proposals to deliver equity

Chaired by Jamie Bishop (lay member)Board Consultant and Nurse;

Healthwatch x 2, Two Lay members, CO & CFO

 Supported by Independent GP Adviser, DPH,

HWBBs in attendance

Delegated responsibility from CCG Board for primary care contracts

 

Scrutinises and approves all contract proposals for practices/the

Confederation/ OOH provider

Scrutinises all payments toConfederation/ practices/

OOH provider

OTHER STUFF• New conflicts of interest guidance

• Refresh CCG policy• Declarations, openness• Fine balance…..

• Constitution changes • Reflecting responsibility for primary care• New conflicts policy• Meeting in public• Lay member roles

END

Planned Care Programme Update

Dr Nikhil Katiyar

8th January 2015

GP first referred activity • GP first referred Outpatient activity: is increasing. Based on our

referrals year to date, we will have increased our referrals as much as 18% by the end of this financial year. It could equate to almost £2m and this is before the possible impact on elective admissions and day cases.

• We are concerned because this can affect our financial stability, our ability to invest in primary care and other new services.

• The analysis shows an overall increase across all practices

• The Top five specialities across all practices are: gynae, general surgery, T&O, dermatology and ENT.

• Acute Paediatric referrals also feature highly in the practices which are 2STD above the CCG average

Evidence from the King’s Fund• Firstly – what not to do.

• In the current financial climate there is a danger of becoming preoccupied with reducing the volume of referrals. An unsophisticated approach to this, for example setting target referral rates, could do more harm than good.

• Commissioners should not introduce financial incentives to drive blanket reductions in referral numbers.

• Several areas have established referral management centres which check all GP referral letters before directing them to the most appropriate destination, or rejecting them as unnecessary. These centres may have had some benefits but do not appear to be cost-effective and in some cases undermine referral quality.

• Instead, an approach based on peer review and audit of referral patterns among groups of GPs, coupled with a system for harnessing feedback from hospital consultants, holds the greatest promise for improving the quality of referrals while also controlling costs.

• Decision-making around referral is a complicated process, balancing several competing concerns and sources of information. There are many different reasons why a GP might make a referral, including the patient's need for reassurance or simply to 'do something’.

• There is wide variation in referral rates between practices. At least some of the variation is accounted for by non-clinical factors such as GPs' willingness to tolerate risk and uncertainty, sensitivity towards patient pressure, or fear of accusations of malpractice.

• A whole systems strategy will be required to manage demand, with active collaboration between primary, secondary and community care services.

Your support • We recognise the pressure we are all under but we need to

understand this and gather insight• Things we would like to consider with you:

• How do we work more collaboratively with secondary care to ensure our referrals are appropriate?

• The higher referring practices would provide the richest source of insights and examples of comparison with other practices• Gary Marlowe, Planned Care Lead would like to meet with the top 7 referring practices

with their consortia lead to explore the referrals in more depth during the next month. We will provide support to these practices in case finding.

• Consider providing an C&H induction programme on our pathways and culture for new and salaried GPs

• We want to think about new ways of supporting practices as well as through the CCLES – prioritising specialities in our education events, more consultant outreach to practices/consortia

END

City and Hackney CCG Clinical Commissioning Forum 8th January 2015

Children’s Programme Board

Consultation with GPs on a strategy for Early Years

(0-5 year olds)

What currently existsNHS England

•Pre-conception advice (GMS)•Post natal 6- 8 week checks (GMS)•Health Visitors, including developmental checks •Specialised services

CCG

•Perinatal mental health•Ante and post natal CCG Contract•Community Services •Vulnerable Children’s Contract•Acute Services

LA Public Health

•Children’s Centres•Health Visitors (from October 2015)•School Nursing•Family Nurse Partnership

Local Authority

•Social Services

Voluntary sector: Innovation Fund Bonding with Baby Programme

So there are many contracts with multiple commissioners and providers

Public Health England

•Immunisations•Screening

How can we improve on thisWe want to see an integrated offer from pre- birth to 5 years, with onward links to School Nursing.

The outcomes we would want to contract for are:

An integrated pathway from pre-conception to 5 years

Accessible and strengthened multidisciplinary Child Health Clinics

Improved communication and joint action, agreed and monitored, across health and social care when vulnerability is identified

Improved immunisation rates

A key question is

Do we want GPs to continue to offer Child Health Clinics from practices

or

Do we focus on developing Child Health Clinics in Children’s Centres?

Child Health ClinicsIf we contract for practice based clinics

What would good look like?

If we contract for Children’s Centres

•How do we enable professionals to work together, share information and support children and their families at the right time and place?

What do you think about …• How and to whom should we best deliver pre-conception advice?

• Should we / how can we incentivise increased rates of immunisations?

• How can we work with non-engaging families?

• Should we / could we develop the red book so it is a hand held record of all needs and interventions?

• Would a Children’s Service Directory, with referral forms, be useful on GP systems?

• What else have we not considered?

Next steps Consultation with CCF, review of GP questionnaire responses Development of draft strategy Consultation with Children’s Programme Board and LBH Early Years working group Consultation with public and patient engagement including the Children’s Disability

Forum, Maternity Services Liaison Committee and PPI Committee Consultation with CEC and initiate application for non recurrent funding

Please get involved -

we need interested GPs to help us achieve great things for children in City and Hackney