Thursday 2nd April 2015

CCG Clinical Commissioning Forum

GP IT Update April 2015

Niifio Addy

Clinical Lead for IT

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Recap on IT funding and the operating framework

What has the CCG done to mitigate the effects of funding changes?

What local initiatives are being introduced? Update on National IT programmes Docman

IT Funding

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NE London CSU core contract price £561,00 £160,000 for additional services

Core IT services- what’s in?

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IT support staff costs (NELCSU) Helpdesk and engineers (IT support) GP SoC (EMIS, Vision) Project management (National IT programmes) Management and reporting on IT service Strategic management support Asset management, IT procurement, software

licensing Overheads (e.g hardware upgrades, servers,

printers, network security)

Non-core services

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Tape validation for hosted clinical systems Out of scope services associated with practice

business e.g. automated patient check in notification screens

Additional services

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Enhanced N3 network project costs (e.g. COIN upgrade)

Management of local data centres Remote access to EMIS web Network management and monitoring

What are the cost pressures?

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BT COIN (N3) £202k p.a Leased PCs (850 on 3 year contract) £158k p.a MIG license(HIE project) 46k for 2 years CEG £72k p.a Patient automated check-in screens £22k p.a T Quest £13k p.a Interxion data hosting £10k

CCG financial planning

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The projected shortfall in funding in 2015/16 is £150k

What have we done to manage costs in light of reduced funding?

Transitional funds available for 2 years. £433k in 2014/15 and £406k in 2015/16

Re-negotiated NELCSU service price (from £750k in 2013/14)

CEG costs moved from IT to general budget Capital bids to reduce revenue costs

CCG financial planning (cont)

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What were the capital bids? PCs: £630k for 2015/16 and £50k p.a up to

2019/20. Would release £52k savings p.a in 2015/16 and 2016/17 and £158k p.a from 2017/18.

BT COIN upgrade: £260k to upgrade from current service to NGA network. Would release £42k from COIN network costs in 2016/17

Local Initiatives

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HIE DXS EMIS mobile

Docman

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Accredited under GPSoC as a core service item Previously funded by PCT Will now be funded centrally by NHSE NELCSU (rather than individual practices) has

the admin rights for managing the software under IT operating framework rules

Docman (cont)

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What do practices need to do? Upgrade to the latest version of Docman (v75) Upgrade requires admin rights so NELCSU has

to do this for most licenses (but not all) Practices with the correct version will be added

to GP IT tracking database allowing Docman to claim its costs directly from NHSE

Practices not on v75 should ask Docman to upgrade them first then NELCSU if needed

Claim a refund from Docman for paid invoices

Docman (cont)

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There are some risks and potential costs when switching from Docman to EMIS document management

Potential data loss

i.e. documents held in Docman not being filed in EMIS (normally admin related)

If practices have used Vision previously then EMIS will only migrate documents created whilst using EMIS DDE (dynamic data exchange) costs

Docman (cont)

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DDE costs: Docman produces a file extract . NB there is no

longer a £1500 charge for this as it is covered under the GPSoC framework

EMIS imports the file to its documents system for a £1500 fee (not covered under GP SoC

Questions?

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END

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Maternity Programme Board Update to the Clinical Commissioning Forum

Referring Women to Maternity Services

Dr. Balvinder Duggal2nd April 2015

New Referral Form for GPs

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First Name: Family Name:Date of birth NHS Number:Address

 Postcode

GP Name:

GP Address:

 Preferred title: Mrs/ Miss/ Ms GP telephone:Mobile Number :

Other number :

OK to send texts to mobile phone? YES/ NO

Interpreter Needed? YES/ NO

Preferred Language:

Blood Pressure: /Height-Weight-BMI-

First Day of Last Period:

EDD by dates-

Gestation age at referral-

Number of previous deliveries:

Reasons if Booking after 12 weeks pregnant:

PregnanciesHaving First baby □ Other pregnancies normal IVF for current pregnancy- □ OrCaesarean Section □ Premature Baby □ Previous Womb Surgery □ Pre-Eclampsia /Eclampsia Postnatal depression □ 3 or more miscarriages □ Miscarriage after 13 weeks □ Baby born with abnormality □ Shoulder Dystocia □ Placenta Accreta □ Stillbirth □ Neonatal death □ Other Maternity Problems:  

History None □   Or  High Blood Pressure □ Diabetes □ Other Hormone disorder □ Epilepsy □ Heart disease □ Kidney disease □ Liver disease □ Severe Asthma □ Blood Clotting Disorder □ Autoimmune Disease □ Deep Vein Thrombosis □ Tuberculosis □ Haemoglobin disorder □ Psychiatric illness including depression □ Other Medical/Surgical problems:

InformationNone □  Or □   Smoker □ Alcohol/ Substance Misuse □ Domestic Violence □ Learning Disability □ FGM □ Children on protection register □ Has a Social Worker □ Social Worker name if known……………………………………………. Other relevant social/ domestic circumstances:  Current Medication:    Allergies:

Previous History – Information to help maternity services plan care ( where relevant):

New Referral Process

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1. Women presents as pregnant at GP.2. Discussion on choice of hospital and referral form completed (some

elements of form can be pre-populated on EMIS). Please do not advise women to self refer.

3. Referral emailed by GP to homerton.antenatal@nhs.net (sent from generic practice email, not faxed or sent via choose and book, or sent by admin)

4. Email acknowledgement of referral from Homerton to GP. 5. Homerton introducing 48hr turnaround target for referrals.6. Letter sent to women with Homerton first appointment date, time, venue – if

appointment within 48hrs will be telephoned. 7. Above letter will also be copied to GPs – for information and also to aid

booking of 16 week GP appointment. This will also apply for self referrals.

Aim now is for Homerton to see women by 8-10 weeks. Late bookers will get expedited appointment, usually with public health midwife.

Pathway to be further discussed and finessed at a Friday GP & Maternity education session.

Rationale for Approach

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GPs know their patients and so it is best practice for GPs to refer women to maternity services: • It ensures social needs are identified and shared – particularly

critical for vulnerable women (DV, MH, LD)• It provides information on past medical history including past

obstetric history. • It specifies the details of any medications. • It helps prevent complications being missed and helps them to be

identified and supported early by maternity services.• A lack of information sharing has been identified as an issue in

Serious Incidents (SIs) and in one maternal death.

*Advocating a whole practice approach to enquiries (GPs, nurses, receptionists) to support referrals from Practices.*

END

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Children’s Programme Board

1) Vulnerable Children’s Contract• The Key changes to previous versions

2) How do we want to work with the Health Visiting team?

LTC Requirements:•Consistent with previous versions:

• Development of disease registers at each practice

• Improve the management of childhood asthma

Embed the ‘paediatric asthma review’ template and the ‘at risk of asthma’ templates developed by the Children’s Programme Board

Agree personalised written asthma action plans

Proactive (within 2 working days) post discharge reviews

•New

•Delivery of ‘care review’ contact with patients with epilepsy* £35 per contact

•Delivery of ‘care review’ contact with patients with Diabetes* £35 per contact

•An audit of patients with epilepsy to inform development of, and enable referral to, the transition pathway £7k total

Mental Health Requirements:Consistent with previous versions:

Carers:

• Identification (via register) of children with caring responsibilities

• A register must be established at every practice

New:

• Offer referral of child carer to specified support

Vulnerable Children Requirements:•Consistent with previous versions:

•Vulnerable Children

• Practice led MDT review of children in order to establish an agreed register of vulnerable children (0-5 years) This to be achieved by June 2015

• Agreed joint action plan for all children categorized as universal partnership plus

• Patient checks

• New patient checks – no changes

• 16th Birthday checks

All practices to evidence that patients are invited

•New:

•Payment per plan - £64

•Minimum to be completed – 1 per practice

•Maximum plans to be funded in the 6 months - 1200

You’re Welcome Quality Criteria• This is now included in the 6 month VCC April –October 2015

• Funding (remains the same) is £26k for 100% practice compliance with the quality standards

• Minimum 75% practice compliance required for incremental payment

Part 2: Health Visiting - How do we want to work with the Health Visiting team?

L.A. to tender service – draft spec by May 2015, award Sept 2015, start April 2016 Primary Care invited to state how it would like to work with service in the future

Communication• Information sharing protocols between Health Visitors and GPs• Children’s Leads• Joint child health clinics (CHCs) in primary care• CHCs in Children’s Centres (how does information reach GP?)• Expand use of Red Book• Electronic transmission – eRedBook

Joint Decision Making & Accountability• Templates for vulnerable children discussions• Recording on EMIS/RiO• Monthly meetings re vulnerable children (is monthly adequate for every practice?)• Joint child health clinics in primary care (GPs to work in Children’s Centres?)

Service Development

• Interprofessional learning and working

• Community minor ailment clinics? (link to primary care)

• Joint child health clinics in Children’s Centres (with Health Visitors and GPs)

• Immunisations

• Liaison with Social Services/Safeguarding (joint training for Health Visitors and Social Workers)

• Set up Health Visiting and GP forum (Quarterly?)

Accessibility

• Increased hours evenings and weekends

• Communication by telephone or fax

Knowledge of Health Visiting Service

• Improve knowledge of parents and professionals

Part 2: Health Visiting - How do we want to work with the Health Visiting team?

END

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Breastfeeding Support in City and HackneyAnna Lucas: Early Years Transition Lead, Public Health, LBH

What we know about Breastfeeding in Hackney and City

• Initiation is very high. In 2013/14, 92% of mothers initiated breastfeeding compared with the England average of 74%.

• Mothers still breastfeeding around 6-8 weeks is 83%. 51% are being exclusively breastfed.

• The rate of mothers not breastfeeding at all was 15% in 2012/13 and 16% in 2013/14.

• Mothers exclusively breastfeeding at 6-8 weeks in 2013/14 : cluster B 32% cluster A 24%

Other clusters range 9% - 14%

HIGH MIXED FEEDING RATES AT 6-8 WEEKS

We know most mothers stop breastfeeding before they plan to….

1. Mothers who run into breastfeeding problems sometimes feel that they have been given unrealistic expectations in antenatal classes.

2. Many mothers who might benefit from it do not access the available breastfeeding support.

3. Mothers receive conflicting advice from professionals

Breastfeeding Welcome Scheme• Launched January 2013, the scheme engages health professionals,

parents, volunteers and venues to encourage women to breastfeed more widely in public.

• 87 venues signed up to the scheme in hackney • Some breastfeeding welcome venues provide money off vouchers for

new parents i.e. a free coffee when they buy a sandwich

Breastfeeding support groups

There are 11 active breastfeeding drop-in sessions running on a weekly basis across Hackney provided by community midwives, health visitors and Breastfeeding Network (BfN) supporters

Antenatal health promoting visit by Health Visitor

• Universal antenatal visit will begin shortly at 28+ weeks• Focus on emotional preparation for birth, carer–infant

relationship, care of the baby, parenting and attachment, using techniques such as promotional interviewing

• Opportunity to discuss the mother’s breastfeeding, what she perceives the obstacles and pressures to be.

• Parents need realistic expectations - insufficient milk most common reason for stopping

• Wider family targeted with breastfeeding messages

Wider support• Peer supporters can provide ongoing support and follow-

up – this works best when close integration of services and referrals

• Shared outcomes for breastfeeding across partners – UNICEF Baby Friendly scheme

• Fathers not routinely receiving information about the health benefits of breastfeeding, advice and encouragement to be supportive about breastfeeding – the father’s involvement is a key predictor of breastfeeding initiation and maintenance.

• Early years settings • Breastfeeding cafes – good evidence – empowers

mothers• Antenatal Breastfeeding workshop – preparation for how

to overcome difficulties

1. Baby pack – given to new parents at children’s centre

2. Baby ceremony – introducing new parents to Hackney services and welcoming babies as new citizens

Welcome Hackney Babies

Very low uptake amongst pregnant women and new mothers

Healthy Start for All: Free vitamin scheme

END

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GP Referral

Physio Referral Screening

Introductory Session

MDT Session(Psychologist, Physio, Prescriber)

PMP UPP

1:1Pain Consultant

OTPsychologyPain Physio

PAIN SERVICE PATHWAY

Locomotor Pain Service referral form Please note: The Pain Service is an interdisciplinary service based predominantly on a self-management and biopsychosocial model for persistent pain. If physiotherapy or further investigations are required please refer directly to the Locomotor Service

Referral date

1. Patient Information

Name Date of Birth / / Male

Female

Current Address

Home Phone

Mobile Phone Ethnicity

Post Code

NHS Number

Advocate required?

(If yes please write language spoken)

Email address

2. Referrer Information

GP Name Surgery

Address

Phone Number

Fax Number

Email address Usual GP (if different from referrer)

3. History

Duration of pain

Diagnosis if known

Current symptoms

Pain characteristics e.g. cramping/ dull ache/tingling/burning/stabbing

Other factors contributing to the patients mobility difficulties or pain presentation

e.g. Dizziness, diabetic neuropathy,

4 Impact of pain

How does the pain impact on day to day activities (e.g. self-care, leisure, work, caring for others)

Physical function (e.g. work, caring for self, others, activity etc.)

Mood (e.g. anxiety, depression, anger etc.)

5 Reason for referral

What does this person hope to gain from being referred to the Pain Service?

Please detail any potential obstacles to engagement with self-management or being in a group setting (from referrer or patient perspective)

6 Investigations

Please detail findings of investigations carried out relevant to this condition and attach reports as appropriate e.g. blood tests, X-rays, MRI scans, etc.

7 Previous Interventions or onward specialist referrals already made for this & other relevant conditions (please provide details of the condition treated, outcome & include copies of related correspondence)

Surgical or injection intervention

Psychology intervention (also including for other trauma, or psychological issues)

Physical therapy interventions for this condition e.g.physiotherapy/acupuncture/ osteopathy/chiropractic

Other interventions and/or agencies involved e.g. ACRT/ Housing/Social Services

8 Other Medical History

Please list all past and current significant conditions of physical and mental health

9 Medications

Please list current medication taken for physical and mental health conditions. Please note any compliance issues/mis-use/addiction history.

Identify allergies & significant side effects of medication (incl. previous analgesia tried)

10 Relevant employment & social history

Please detail employment status and issues relating to employment

Please detail any other relevant issues including housing, isolation, financial, benefit, immigration related or legal action

11 Any other relevant info

THANK YOU FOR YOUR REFERRAL

2 6

10

7

17none-minimal mildmoderate moderate-

severesevere

PHQ-9 Depression

81% moderate - severe levels of depression at point of entry

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1125

none-minimalmildmoderatesevere

GAD-7 Generalised Anxiety

86% moderate and severe anxiety at point of entry

END

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