Prime Minister’s Challenge Fund: Improving Access to ...socialsolihull.org.uk/healthandwellbeing/wp... · visiting (Telemedicine) module of the bid, aiming to improve primary and

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Prime Minister’s Challenge Fund: Improving Access to General Practice

Wave Two Application Form

Gateway reference: 02356

Section A. About you Information about the area, providers and commissioners involved. 1. Pilot project title:

Solihull 8 to 8 seven days a week

2. Are you a member of the existing Challenge Fund Associate Network?

Please tick

3. Lead contact details:

Proposal on behalf of: General Practice Solihull (GPS)

Project Lead: Dr Mike Baker

Job title: Medical Director

GP Practice/Organisation: GPS

Email: [email protected]

Telephone: 07875 575 999 / 0121 742 5666

4. Practices involved:

Please indicate which GP practices are covered, where they are located and

approximate population size for each.

Practice name Practice code Post code List size

Blythe Practice M89006 B93 9LE 6,195

Meadowside Family Health

Centre M89003 B92 8PJ 8,322

Tanworth Lane Surgery M89020 B90 4DD 6,470

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Park Surgery M89011 B90 3AF 6,864

Village Surgery M89609 B90 4JA 4,062

Yew Tree Medical Centre M89023 B91 2RA 7,627

Total population covered 39,540

The orange stars on the map below indicate the approximate location of each

practice and give an indication of the practice area. The green circles show other

practices in the Solihull area. The new merged practice area will cover an area

which should be coterminous with Solihull Metropolitan Borough Council.

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5. Other providers involved:

Please give details of any other providers with whom you will be collaborating (eg

community services, pharmacies, 111, etc).

Key providers with whom we will collaborate include:

Heart of England Foundation Trust – particularly in respect to the care they

provide for people to stay independently in a community setting, such as on

Solihull’s Integrated Community Teams, providing community nursing and

support in a crisis. This includes the rapid response nursing team, hospice at

home and intermediate care teams. We will also collaborate with the Trust-led

Integrated Care Partnership which aims to develop services that:

Supports patients to stay healthy and well

Provides personalised care in patients’ own homes and community settings

Prevents unplanned admission to hospital and provide rapid access to

diagnostic and expert services when needed

(See Appendix C Letter of support)

Solihull Metropolitan Borough Council – who provide a wide range of public

health services, particularly helping people to choose healthy lifestyles, providing

services that support the elderly and have plans for innovative development of IT

solutions for health monitoring and promoting independence. The council is also

an integral member of the Integrated Care and Support Solihull ( ICASS) program

and are closely working with the CCG and primary care to develop an integrated

public sector offering for Solihull in line with the recent 2015/16 Forward Planning

documentation including looking at developing Multispecialty Community

Providers ( MCPs).

(See Appendix C Letter of support)

111 – who provide medical help or advice when it's not a life-threatening situation

and who are key to reducing demand on A & E services

West Midlands Ambulance Service – with respect to altering patient flow

diverting flow from secondary care where appropriate.

Third Sector – Through the Integrated Care and Support Solihull (ICASS)

program we will involve third sector organisations to support both our virtual

visiting model and also look at providing a transport network for vulnerable

patients in need of primary care assessments.

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Care homes within Solihull – These will be identified by stratifying those homes

with the greatest secondary care non-elective activity in order to pilot the virtual

visiting (Telemedicine) module of the bid, aiming to improve primary and

secondary care support to these homes.

Healthwatch Solihull – who is the independent consumer champion for health

and social care in the borough. They give a powerful voice to patients to make

sure that their views and experiences are heard so that they can be designed

better

Pharmacies – who can dispense medications and simple advice which is often

the reason for people to contact health services when traditional GP services are

closed

6. CCGs covered:

Please indicate which CCGs are involved in this application.

Solihull CCG

7. NHS England Area Team:

Please indicate your NHS England Area Team.

Birmingham, Solihull and the Black Country

8. Patient satisfaction:

Latest position on patient experience of access1 across your proposed pilot area.

Our patient experience statistics from the GP Patient Survey Results are given in the

table below. We have also colour coded the results for ease of interpretation. A

green result denotes that our practices are amongst the best performers, orange in

the middle range, and red amongst the worst. In broad terms we perform in line with

our peers in most areas. However, our aim is to perform at a green level within all

areas within six months of embarking on the PMCF process.

1 See breakdown of access related questions from the latest GP Patient Survey results (by practice)

in the supporting documents section on the PMCF web page.

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For comparison purposes, the position for Solihull as a whole is shown below. This

shows that there are far too few practices in the “amongst the best” range, and far

too many in the “Amongst the worst range”.

Solihull as a whole – The patient experience

Pra

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M89003 Meadowside 89.3% - In the middle range54.7% - In the middle range73.9% - As expected63.7% - Among the worst72.1% - In the middle range88.9% - Among the best

M89006 The Blythe Practice 87.4% - In the middle range51.4% - In the middle range57.8% - Worse than expected81.3% - In the middle range72.6% - In the middle range78.6% - In the middle range

M89011 Park Surgery 83.5% - In the middle range56.4% - In the middle range78.0% - As expected84.5% - In the middle range78.3% - In the middle range74.3% - In the middle range

M89020 Tanworth Lane 93.9% - Among the best51.5% - In the middle range83.4% - As expected86.9% - In the middle range86.1% - Among the best87.5% - Among the best

M89023 Yew Tree 77.9% - Among the worst32.4% - Among the worst74.6% - As expected79.4% - In the middle range61.2% - Among the worst71.1% - In the middle range

M89609 The Village 90.0% - In the middle range77.7% - Among the best79.3% - As expected85.4% - In the middle range83.6% - In the middle range88.9% - Among the best

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Section B. What you propose to deliver Information about the proposed service innovations. 9. Project overview - Please give an overview of the proposed project. Please focus

on what changes will be made to services.

Max 1000 words:

Extended Access

Our project will offer a minimum of 471 (ten minute) extended hour appointments

every week. Our doors will be open for an additional 28 hours per week.

Currently we are six separate traditional GP practices which open between 8am

and 6.30pm daily from Mondays to Fridays, with two practices closing over the

lunchtime period and three practices closing for a half day on a Wednesday. The

six practices also offer some 11¼ hours a week (“doors open” time) of Extended

Hours funded as an Enhanced GMS service. We are currently unable to offer video

consultations, and there are no special arrangements over and above the GMS

contract requirements for treating our more vulnerable patients who live in nursing

homes.

As can be seen from our response to question 8 above, we are aware that patients

are not entirely satisfied with these arrangements, and there is increasing pressure

on urgent care services in the area. Thus, our intention with effect from the 1 April

2015, is to:

Become a fully merged organisation (to be called “GPS”) offering a full seven-

day 8am to 8pm service. We will be a unified single contract holder - fully

accredited for CQC, Information Governance and N3 compliance.

Offer a far more integrated approach to providing general practice and wider

out-of-hospital services, including “wrap-around” community services including

community nursing, community pharmacy, diagnostic services and voluntary

sector provision

Offer an integrated approach to the provision of urgent care services by

including “virtual visiting” (see below), and better use of modern information

technology arrangements.

Provide the opportunity for all patients to consult at any of our six sites,

significantly improving access

Provide access to our GPs with special interests (GPSIs) across sites i.e. in-

house care rather than referring to secondary care

Provide a transport service for patients at greatest need to our practice sites at

weekends. This will be procured through voluntary sector organisations.

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For the seven days a week service we will ensure that two sites are open for the full

60 hour a week period, and at weekends one site - our state of the art facility on

Tanworth Lane located in the middle of Solihull MBC area as shown on the map

above. GPS will be open both for appointments and “drop in” services, and we will

far more closely with our community teams to (for example) facilitate discharges

from hospital and to provide services to reduce the risk of readmissions.

Virtual Visiting (Telemedicine) and Secure Video Consultations:

GPS will offer two new modalities for accessing primary care advice digitally –

virtual visiting and secure video consultations.

We will provide a new form of access to people who find it difficult or impossible to

visit our surgeries. This could be due to physical disability, caring responsibilities or

general frailty including those within care home settings. This service will be offered

through utilisation of TV boxes and webcam consultations.

The TV box element of this initiative has been designed in partnership with the

Council. Together we will provide TV boxes for individual patients and care homes

which will allow users to talk to their doctor or care professional through a web-cam

link. Currently we know that some 200 patients living in their own homes and some

550 care home residents within Solihull would benefit from this service. These

numbers are expected to rise by at least 10% annually.

We will establish a secure web portal at each of our six sites and portals (with

additional mobile webcam devices for bed bound patients) for ten care homes

serviced by the practices. We will also pilot the use of twenty TV boxes for

individuals with a very high level of need.

The pilot will also establish further portals in the local acute medical unit at Solihull

Hospital, the community health headquarters (both run by Heart of England

Foundation Trust) and social care. By working with our acute trust we will be able to

work through pathways of care that will avoid non-essential admissions to hospital.

Previous deployment in community settings (as for example by Airedale NHS

Foundation Trust)2 of a similar form of remote support has resulted in a 53%

reduction in A&E attendances from care homes one year after deployment, and a

58% reduction in acute bed days. Telecare services not only enable patients to

access care professionals more easily, but also enables professionals to take part

in virtual consultations and multidisciplinary meetings.

2 See www.airedale-trust.nhs.uk/services/telemedicine/ for further details

http://www.airedale-trust.nhs.uk/services/telemedicine/

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We have trialled the available equipment with a number of providers and have

found it to be simple to set up and effective. With the right consent, patients can

also be connected to form support groups, and the service facilitates social support.

For the population as a whole, patients will be able to access video consulting

services with a clinician using a secure video service solution (NHS One) and will

also be able to dial in to any of our six surgeries for web cam consultations at pre-

agreed times.

The ease of use of this technology, and its availability across a wide range of

devices (such as tablets, PCs or even mobile phones) means that friends, family

and carers can see and talk to each other as often as they wish. This can give vital

reassurance for a wide range of carers who cannot be there all the time.

Through these the new arrangements, day time routine access to their GP surgery

for our 40,000 patients will increase from an average of 55 hours a week, to an

average of 76 hours per week. An increase of some 28%. The range of ways to

consult will also increase with, for example, the availability of web-cam

consultations, and the quality and continuity of care for many of our most vulnerable

patients will significantly improve. Because of the concentration of services into

fewer buildings it will also become easier for a wider range of services to be offered

at these locations by other providers as we will be able to co-locate key services.

996/1000 words

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10. Project outputs - Please describe the expected benefits for patients as a result

of the project. Include expected service benefits and how this will support practices

in delivery of core primary care3.

Max 1000 words

Patient Benefits

The benefits to patients from the service will be:

Easy to use and understand

o It is simply an extension of traditional general practice to a seven days a

week model

o No new numbers to find or remember, patients just call their GP Practice

number as usual

o Sites are conveniently located for face-to-face access

Consistent care

o Use of SystmOne means clinicians will have access to patient notes

across all sites and thus patients will get the care they need and expect.

o Better management of long-term conditions with patients managed

consistently in primary care with clinicians having full access to patient

notes and thus being able to provide the care they need

Equality of access – regardless of the contract of their GP Practice (i.e. GMS or

PMS), patients will receive the same level of access

Patients will be seen and directed to the right clinician in the right service at the

right time releasing resources from services designed for more urgent services

toward primary care. The potential impact on urgent care services could

generate savings of between £0.5 million and £0.75 million annually as detailed

further in our response to Question 12 below.

Reduced pressure on appointment slots during normal surgery hours and on

out-of-hours services means that more time can be spent providing a better

clinical service for the elderly and those with more complex needs

Easy access means earlier access, earlier diagnosis and intervention which

results in better health outcomes

Young and low paid workers will not need to take time out of work for a

consultation unless really necessary

Reduced waiting times in surgeries due to the wider available access

3 We would expect successful applications to also make reference to how the proposed scheme will

achieve the wider range of benefits given in Section 6 of the wave two invitation.

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GP Practice Benefits

GP practices will benefit through the service from:

Investment in training to provide telephone, secure video & telecare

consultations, opening up further possibilities for the future

Better management of patient lists through patients staying within primary care

wherever possible, instead of accessing urgent care

Involvement in the design, delivery and future of the service, also helping

influence other pathways within the borough, particularly urgent care

Wider access times resulting in reduced waiting times at surgeries, improving

patient satisfaction results and reducing activity spike pressures

Wider Benefits

Further expected wider benefits that our service will bring include:

Alternative access for people who currently utilise the local Walk-in-Centre,

which is working at full capacity. Patients will be seen by clinicians who have a

patients’ full record and ability to fully investigate and care for that patient on an

ongoing basis

Reduction in reliance on the out of hours service before 8pm for minor ailments

Increased referrals to the patient’s own GP from other service providers e.g.

NHS111

A significant reduction of A&E activity

A fit with the Urgent Care Strategy ensuring patients are seen by the right

clinician, in the right service, at the right time.

Future Benefits

As well as producing immediate benefits, the service has the potential to produce

wider benefits to healthcare in Solihull in the future. These include:

Integration of primary care with other services in Solihull including other

out-of hospital services – GPs in the GPS member practices already have a

good working relationship with the community services provider. This service

will build on that with the potential to provide access to some of their services

through the extended hours service, both through the telephone and face-to-

face services. Seven day a week working will enhance the role of the primary

care in working with community services and urgent care to obtain timely clinical

advice and enable safer discharges as well as reduce readmissions. This will

be further enhanced with the Telecare being an enabler for professional face-to-

face dialogues.

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Further innovation in access to general practice – our use of Secure Video

Consultations and Telecare within the service will provide an innovative way to

work with children and young people. We will look to build on this through

exploring the use of video consultations during core GP hours (8am-6.30pm) as

well.

Safeguarding – through integrated records being shared and primary care

access available seven days a week there is an opportunity to enhance

safeguarding working for the practice’s population.

In terms of appointments provided (which is what patients normally refer to as the

key benefit they are looking for), the table given in our response to Question 11

below shows that in raw numbers, the new service will increase the number of

routine appointments being offered by some 471 per week4. From our own

experience though we know that both telephone and web consultations are often

completed in less than 10 minutes, so substantial amounts of clinical time can be

saved by using these methods for consultations. If consultations are of less than 10

minutes as the evidence from elsewhere would suggest, we will be able to provide

proportionally more consultations.

Importantly by working more closely with other providers there will be improvements

in continuity of care and in chronic disease management especially with respect of

care to frail, elderly and patients who have dementia. This technology will also

facilitate conference calling enabling improved multidisciplinary team

communications and potentially more timely and effective reviews.

The virtual visiting (Telecare) strand of this project goes hand in hand with an

integrated care strategy adopted by major providers in Solihull within the Integrated

Care and Support Solihull (ICASS) program jointly led by Solihull CCG and SMBC.

Key stakeholders in the ICASS program are SMBC, all GPs in Solihull, mental

health services, community services and Heart of England Foundation Trust. All

are working together through various work streams to improve care coordination for

vulnerable and hard-to-reach populations to improve out-of-hospital care.

959/1000

4 Our calculations assume a mix of 375 additional GP appointments and 96 practice nurse

appointments weekly at this stage.

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11. Describe how patients will receive some form of extended access outside of

core opening hours above what is already provided. Please specify how many extra

hours by practice the pilot will offer on weekdays and weekends (and number of

consultations if available). Demonstrate that patients will be able to access general

practice services from 8-8 on weekdays (or equivalent) and improved access at

weekends. This will be a minimum condition for receipt of funding.

Max 1000 words:

It is intended that the patients of the GPS partnership will be able to access general

practice services from 8am to 8pm, seven days a week.

A table showing our current extended access hours is shown below along with a

calculation of the extra hours and appointments by practice the pilot will offer on

weekdays and weekends. Two sites in the GPS partnership will be open for the

6.30pm to 8pm period on weekdays, and one site (at Tanworth Lane) will be open

from 8am to 8pm on Saturdays and Sundays.

The actual mix of appointments to be offered is currently under discussion but the

table below assumes that all the available extended access time will be used to

create 10 minute GP appointments. We will, however, also offer secure video and

telephone consultations, and from our experience and the evidence from others, we

should be able to consult with 10 -12 patients per hour, rather than the normal six

which is possible during normal face-to-face consultations.

Blythe Meadow Park Tanworth Village

Yew Tree

Current extended hours provision (outside 8am to 6.30pm)

Total current offering

GPS Proposed Total Extended Offering

Per Week

"Doors open" in hours 1.5 3 1.5 1.5 0 3.75 11.25

Doors open in hours 39

Clinical hours 4.5 4.5 4.5 3 0 5.75 22.25 Clinical hours 204

GP appts per week now 18 18 18 16 0 23 93

GP appts offered 468

Nurse appointments 0 0 0 0 0 0 0

Nurse appts offered 96

In summary this table shows that our “doors open” time will increase from 11.25 to

39 hours every week, our clinical hours available will increase from 22.25 to 204

each week, our GP appointments during non-core GMS hours will increase from 93

to 468, and nursing appointments during non-core GMS hours will increase from

zero to 96.

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This equates to a projected minimum of 30,000 appointments offered per year in

non-core GMS hours.

The open sites will also offer access to patients for queries, prescription collection,

and simple administrative tasks. The partnership are intending to put in place an

integrated telephone system with non-geographical routing technology to ensure all

patients are able to access an open site seven days a week, between 8am and

8pm.

With GPs and other health professionals on site we will also be able to offer “sit and

wait” services, be available to community staff such as community nurses and via

the virtual visiting service as described in response to Question 8 above.

418/1000

12. Sustainability - Describe how your project will lead to sustainable improvements

once the non-recurrent funding is no longer available (including whether your CCG

will support the scheme with supporting funding).

Max 1000 words:

We have had detailed discussions with Doug Middleton, Chief Operating Officer at

our CCG, and together we have identified the following sustainable improvements

once the non-recurrent funding is no longer available. These are:

More personalised services and better continuity of care as patients will receive

more care from their own GP practice, rather than at the local Walk-In Centre

(WiC), out-of-hours centre (OOH) or A & E department.

The table below illustrates how this could happen with the WiC for example.

Currently an average of 103 of our patients per week uses the WiC service. As

we will be offering an additional 471 appointments (plus a sit & wait clinic) each

week, we could eliminate the need for our patients to attend WiC by offering a

service from their ‘usual practice’.

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Meadow Blythe Park Tanworth Yew Tree Village

Total for GPS

Group

Capitation 8375 6256 6886 6578 7577 4071 39743

Walk-in Centre Registration notifications

April/May 311 129 193 141 220

994

Jun/Jly 240 125 179 116 254

914

Aug/Sept 246 117 143 129 257

892

Oct/Nov 261 98 160 115 192

826

Dec 123 49 72 58 101

403

Total 1181 518 747 559 1024 0 4029

Average per week (39 weeks) 30 13 19 14 26 0 103

The current review of urgent care across Solihull aims to develop links between

secondary and primary care. Reductions in activity in total urgent care (be it

WIC, A+E or the proposed new Urgent Care Centre) will be analysed to

establish the impact of the Solihull seven day a week service on reducing

demand on hospital activity and identify funds available to secure continuing

service.

Furthermore, analysis of non-elective care activity has been provided to GPS for

this bid by Solihull CCG. It is estimated by the practice merging and sharing

good practice through the sites that by harmonising non-elective activity rates

could achieve savings of some £870,000 for the local health economy.

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A table showing this is shown below:

Weekdays Saturday Sunday TOTALS

3,461 582 760 4,803

Nett change from 14/15 forecast outturn 217- 45- 67- 329-

3,306 532 756 4,594

372- 95- 71- 538-

£5,538,742 £960,090 £1,241,072 £7,739,904

-£347,266 -£74,233 -£109,413 -£530,912

£5,290,691 £877,608 £1,234,540 £7,402,840

-£595,317 -£156,715 -£115,945 -£867,976

Rates per 1,000 list sizeList size

(April 2014)

Weekdays

forecast rate

per 1,000

Saturday

forecast rate

per 1,000

Sunday

forecast rate

per 1,000

TOTALS

M89003-MEADOWSIDE FAMILY HEALTH CENTRE 8,345 116.72 19.77 27.68 164.17

M89006-THE BLYTHE PRACTICE 6,213 95.61 11.75 22.37 129.73

M89011-PARK SURGERY 6,880 88.66 14.24 18.46 121.37

M89020-TANWORTH LANE SURGERY 6,490 78.74 14.48 17.72 110.94

M89023-YEW TREE MEDICAL CENTRE 7,629 80.74 17.04 16.91 114.69

M89609-THE VILLAGE SURGERY 4,082 91.38 16.41 21.07 128.86

Other Solihull practices 200,174 83.91 13.31 20.65 117.87

Practice group rates 39,639 92.79 15.82 20.86 129.47

Solihull rates 239,813 85.38 13.73 20.68 119.79

Weekdays

2014/15

forecast total

Saturdays

2014/15

forecast total

Sundays

2014/15

forecast total

TOTALS

974 165 231 1,370

M89006-THE BLYTHE PRACTICE 594 73 139 806

M89011-PARK SURGERY 610 98 127 835

M89020-TANWORTH LANE SURGERY 511 94 115 720

M89023-YEW TREE MEDICAL CENTRE 616 130 129 875

M89609-THE VILLAGE SURGERY 373 67 86 526

Other Solihull practices 16,797 2,665 4,133 23,595

Practice group - activity 3,678 627 827 5,132

All practices - activity 20,475 3,292 4,960 28,727

Practice group - costs £5,886,008 £1,034,323 £1,350,485 £8,270,816

All practices - costs £32,851,420 £5,591,642 £7,418,366 £45,861,428

Weekdays

2014/15 to

November

Saturdays

2014/15 to

November

Sundays

2014/15 to

November

TOTALS

M89003-MEADOWSIDE FAMILY HEALTH CENTRE 637 108 147 892


M89011-PARK SURGERY 404 65 87 556





Practice group - activity 2,406 392 540 3,338

All practices - activity 13,505 2,120 3,135 18,760

Practice group - costs £3,883,223 £666,698 £852,974 £5,402,895

All practices - costs £21,673,329 £3,604,229 £4,685,482 £29,963,040

Weekdays

2013/14

Saturdays

2013/14

Sundays

2013/14

Totals

M89003-MEADOWSIDE FAMILY HEALTH CENTRE 855 159 176 1,190


M89011-PARK SURGERY 433 103 86 622





All practices 18,089 3,078 3,936 25,103

Weekdays

2013/14 to

November

Saturdays

2013/14 to

November

Sundays

2013/14 to

November

Totals

M89003-MEADOWSIDE FAMILY HEALTH CENTRE 559 104 112 775


M89011-PARK SURGERY 287 68 59 414





All practices 11,934 1,984 2,486 16,404

Forecast costs for merged practices

Forecast activity for merged practices

All practices achieve current practice group rates

All practices achieve current Solihull rates

Nett change from 14/15 forecast outturn

Actual emergency admissions full year forecasts

Actual emergency admissions year to date

Actual emergency admissions full year

Actual emergency admissions year to date

All practices achieve current practice group rates


All practices achieve current Solihull average rates


COMMENTARY: the table immediately below forecasts the potential impact of the group of practices achieving either their current rate if they are already below the standard or the standard rate if theuy are currently above the standard. Generally the practices are achieving rates above the Solihull average and might generate a saving of around £870k if they were to reduce admissions accordingly. However, care should be taken in using these figures as the readmissions data is a subset of this activity so any the data on this tab already i ncludes

readmissions activity.

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It has been agreed that by examining the activity levels and trends over the year the

CCG will look to reinvest savings made from the group back into continuing funding

of seven day week working and community liaison services.

Also:

Solihull CCG is applying for joint commissioning status for primary medical

services and through this will use extended hours DES resources to support our

PMCF arrangements

Our commissioners have made a commitment to incorporate “Operational

Resilience” funding (including winter surge as 365 day year Extended Hours

Services), and this new service will be in a position to support a surge response

and winter pressure initiatives.

We will be able to use some of the diverted funds saved from secondary care

(A&E/ED) as a result of plans to stream patients away from A&E

Perhaps most importantly there will be a significant reduction in more traditional

secondary care activity for our elderly patients as our remote monitoring of people

at high risk of illness will enable people, normally considered not fit enough, to

remain in their own place of residence. Through the Telecare model patients will be

supported by primary care, community, voluntary and social care.

Additionally:

1. Our six member practices who will form GPS will develop fully integrated

systems, allowing standardisation of high quality patient care, realising benefits

of integrated work at scale. Our vision is that patients will benefit by accessing

any practice within the group, making all of the skill sets and enhancing the

specialisms in the group available.

2. The evaluation of the Telecare service for vulnerable patients is currently being

supported through ICASS and Solihull Council. The council is committed to

supporting Telecare models and rigorous evaluation of the Virtual Visiting model

will inform the further roll out and continuing funding of the service to other

residents within the borough. After the evaluation has been completed by SMBC

and provider partners, funding routes will be sought through The Better Care

Fund, governed by the ICASS program under the guidance of the Health and

Well Being Board.

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3. Education and training for clinical staff – standardised enhanced training to a

wide group of staff has clear enduring benefits for the long term.

4. The network of practices will have size and capacity to support further in-house

training and specialisms in long term conditions and they will ‘cross cover’

practices through the integrated clinical systems. This aligns with the 5 year

forward view of developing Multispecialty Community Provider (MCP) models in

the local care economy.

The project offers choice and improves accessibility for the practices’ population

over an extended period of time. The ability to cross cover each practice, combined

with an increased pool of clinical expertise, will improve patient access to a diverse

range of specialisms that are present in a number of individual practices.

The holistic model will increase patients’ confidence in contacting local services and

reduces the potential for inappropriate access to other emergency services. There

will also be a reduction in duplication of patients having to tell their story to different

professionals.

835/1000

13. How does the project link to the local strategy for the health and care system

including its contribution to improving care for older people, promoting continuity of

care, improving overall quality and productivity of local NHS services, and reducing

health inequalities?

Max 500 words:

GPS is working closely with colleagues in the CCG, LAT, Health and Wellbeing

Board, SMBC and community services; ensuring that the proposed project links

closely to the local strategy for the health and care system. GPS will align itself with

local initiatives with respect to the 5 year Forward View; Solihull is exploring models

around Multispecialty Community Providers.

The project aligns with aspects of the three key local healthcare strategies:

LAT’s Five Year Primary Care Strategy

o Identifies strong evidence that a significant proportion of urgent GP

consultations can be handled over the phone.

o Identifies that the NHS must do better to help patients with urgent care

needs to get the right advice in the right place and avoid attendance at

A&E wherever possible.

18

o Stresses the need to provide proactive co-ordination of care that is

planned together with people..

o Identifies how fast, responsive access to primary care is crucial in

preventing avoidable emergency admissions / A&E attendances.

Health and Wellbeing Board’s strategy

o Identifies the need to support people to live independently, including

through increased appropriate access to telecare.

o Identifies the need to improve care management and access to intensive

home support.

CCG Operating Plan 2014–2016 The project will contribute to the achievement of

the following CCG objectives (and national ambitions):

o Improving the health related quality of life of people with one or more

long-term conditions, including mental health;

o Reducing the amount of time people spend avoidably in hospital through

better, more integrated care in the community;

o Increasing the proportion of older people living independently at home

following discharge from hospital;

The aims of the project are consistent with the objectives of the following CCG

Programmes (included within the Operating Plan):

o High Quality General Practice

o Out of Hospital

o Planned Care

Additionally the project contributes to the following, wider priorities:

Improving Care for Older People

Supporting older people to use Telehealth and Assistive technology. GPS

expects the project to reduce the need for older people to travel to their practice

for minor queries and monitoring. In addition, improved opening hours,

particularly on weekends will provide older people with the option to use primary

instead of urgent care; benefiting their long-term health needs in a proactive, as

opposed to reactive way.

Promoting Continuity of Care

The service will encourage using non-face-to-face consultations with a GP. The

use of SystmOne ensures that all clinicians within the service (and across

Solihull Community Services) will have access to patient records, leading to

better informed treatment

19

Improving Overall Quality and Productivity of Local NHS Services

Through supporting a shift from urgent to primary care throughout Solihull.

Reducing Health Inequalities

The service helps reduce health inequalities through providing a wider range of

more accessible services for all GPS patients. There is a disparity in health

outcomes due to differing demographics / deprivation across the GPS area. This

will provide more equitable access to primary care for all helping to reduce

health inequalities in the long-term.

500/500

14. How do you think your pilot might influence current patient pathways out of

hours, linking to 111, GP out of hours and diverting people from A&E?

Max 500 words:

As mentioned in our response to Question 12 above, more accessible general

practice will mean that the walk in service will no longer be needed by this

significant cohort within Solihull. By offering appointments over the weekend it will

be much easier for patients to be diverted from A&E, via the developing integrated

community teams within Solihull Community Services which is currently being

commissioned and this project will be one of the places where the integrated teams

will be able to refer GPS patients.

It is recognised there is a need to educate / alter patient behavior with respect to

urgent care and the CCG is keen work with GPS to further this behavioral change.

We will establish an awareness program for the patients of GPS to emphasis the

change in local service offering.

In working with the voluntary sector to offer a patient transport service we will be

able to develop closer links which is important in developing a stronger support

network for frail and vulnerable patients. Significant amounts of clinical time will be

saved by transporting patients to our surgeries, rather than having to make home

visits.

The out-of-hours (OOH) will have reduced demand on weekdays between 6.30 and

8pm, and in the daytime on Saturdays and Sundays.

20

As part of the mobilisation process our medical director will meet with senior clinical

staff and managers from the 111, OOH and A&E services to ensure that this project

becomes part of their Directory of Services, and that there is a clear patient

pathway for GPS patients to be referred to their own practice when this is

appropriate.

The Virtual Visiting Model will allow much easier contact between vulnerable people

at home and in nursing homes with their GP, which will help to divert these patients

from visiting A&E. As this service will be available with both links to each of our six

GP practices and also within the local urgent care department and community

settings, we would hope to be able to set up an on-call arrangement which again

will help to reduce unnecessary visits to A&E and the OOH service at weekends.

Overall however, we very much see the PMCF funding as an opportunity for us to

make time to coordinate services much more effectively than we are able to at the

moment. By opening for longer and implementing the virtual visiting service, we are

certain than many new opportunities for influencing pathways will arise.

407/500

21

Section C. How will it happen

Information about your strategy for leading this programme.

15. Engagement - Describe how local people and practices have been involved so

far in designing this programme. Outline the methods by which organisations and

professionals involved will continue to be engaged.

Max 300 words

The six founding practices of GPS have been working on a federated basis for over two years and so we have got to know one another well. Each practice has an active patient participation group (PPG) and as part of the PMCF project we plan to invite representatives from each of these to help guide this project.

In order to continue to be engaged with patients, other organisations and professionals to address local needs, we will:

Set up an Expert Patient Group to identify needs and seek views

Provide all patients and professionals with ample opportunities to feedback on the services they provide or receive

Develop a targeted patient survey concerning the PMCF

Have in place an efficient system for dealing with suggestions and complaints

Take part in the National Patient Survey

Ensure that information collected through the above methods will be reported to and regularly reviewed by the GPS Board

Have a user-friendly web site with an area for patients, staff and professionals to give feedback

Ask the merged PPG for advice and guidance as changes are proposed

These initiatives will all be managed by a PMCF service manager who we will appoint to coordinate all the various strands of the project, and who will be the point of contact for all other organisations and professionals involved.

We have always encouraged staff to have an open relationship with patients and others by (for example) providing information and feedback from engagement exercises. We will publish the outcomes of our audits on the GPS website, and we will have a standing agenda item at our team meetings to review patient satisfaction and complaints and to agree actions for service changes.

Two of our GP partners are also members of the CCG Board.

296/300

22

16. Demonstrate that you have the capacity and capability for rapid

implementation and technical deliverability, with tangible benefits for patients being

demonstrated during 2015/16.

Max 300 words:

The organisational structure chart below shows our capacity and capability for

rapid implementation. We have CQC accreditation in place and we are IG

compliant at all sites. We have a medical director in post.

The posts highlighted in red are staff members who will be dedicated to this

project. The Board of GPS has been operating in shadow form since June 2014

and our merged partnership agreement is in place. We have submitted our formal

application for merger to our Area Team, who have agreed in principle the various

administrative changes that are needed to ensure that we can operate as a

merged practice from 1 April 2015. Our IT, GMS contract arrangements, premises

and staffing matters (i.e. TUPE) have all been addressed. Therefore we do not

envisage any difficulty in the technical deliverability of this project as part of our

overall merger programme. In fact a key driver for this merger was so that we

would be able to take advantage of such initiatives.

As a fully merged practice with one GMS contract we will have strong cohesive

governance arrangements. We will be able to make substantial economies of

scale within our administrative teams and some of this freed up resource will be

used for the mobilisation of this project.

Our Board is supported by professional advisers. These include accountants, legal advisers, and a healthcare planner. Other specialist advisers will be commissioned as required. The Operational Management Team has been purposely designed to be small so that day-to-day operational decisions can be made quickly. The service manager from this team will need to be appointed during March 2015.

Two of our Board members are Solihull CCG Governing Board Members and

have a great deal of experience of managing change and leadership of innovative

primary care led projects.

298/300

23

Professional advisors

Ballards accountants

HR/payroll specialists

The Primary Care

Partnership

Operational Management Team

Organisational Medical Director

Medical Director – GMS Services

Medical Director – PMCF project

PPG Representative

Executive Business Manager

Nursing Lead

Partnership Board

Chair (elected annually)

5 x (former practice) representative GP partners

Organisational Medical Director

Executive Business Manager

Bly

the

Pra

ctic

e

Serv

ice

del

iver

y te

am

Mea

do

wsi

de

Fam

ily

Hea

lth

Cen

tre

Serv

ice

del

iver

y te

am

Par

k Su

rger

y

Serv

ice

del

iver

y te

am

Tan

wo

rth

Lan

e Su

rger

y

Serv

ice

del

iver

y te

am

Business Manager

Business

Manager

(Admin

Hub lead)

Business Manager Business Manager

Cen

tral

ser

vice

del

iver

y

team

Ye

w T

ree

Med

ical

Cen

tre

Serv

ice

del

iver

y te

am

The

Vill

age

Surg

ery

Serv

ice

del

iver

y te

am

Business

Manager

– PMCF

and

Finance

24

17. Leadership - Can you demonstrate both clear leadership for the proposed work

programme and strong commitment from all the practices involved (eg signatures of

support).

Max 300 words:

The project will be led by our medical director Dr Mike Baker who is a CCG

Governing Board Member. He has been given dedicated time to lead this project.

He is supported by a strong team of twenty experienced GPs and six business

managers.

Our business plan for the merger states the following “core values” of GPS to

which all the GPs are committed. These core values have also been shared with

our patients are staff. We feel that these link very well with the PMCF aims and

objectives. A letter confirming each of our six practices commitment to this PMCF

application is also attached as Appendix A.

Patient-

centred

Treating patients, carers and the public with respect and

dignity. Actively listening to patients and addressing their

needs. Delivering patient focused pathways of care which

will deliver safe, high quality care within the financial

envelope provided.

Partnership

Working

Working with partners across both health and social care

to reduce fragmentation, increase efficiency and to

ensure effective lines of communication.

Respect Respect the differing views and working practices of

stakeholders by working together to build a common

purpose and culture to guide decision making and service

development.

Efficient To act as responsible stewards of the resources and

funding received. To develop an organisation which

makes the best use of the resources and expertise

available.

Inclusive Ensuring that all constituent practices and their patients

are included and valued.

Team

working

Working as a single team across the former practices to

reduce fragmentation, increase efficiency and to ensure

that there are effective lines of communication

Transparent Being clear on decisions made and their rationale.

Communicating decisions clearly to patients.

25

We would be very happy to share our full Business Plan with PMCF which shows

in detail our commitment to the proposed work programme.

299/300

18. How will you develop your GP community to ensure sustainable leadership

after pilot funding ceases?

Max 300 words:

Although GPS is only becoming a fully merged organisation with effect from April

2015, the GP partners who lead these practices have been discussing the merger for

some years. We have therefore had some time to identify the most willing and able

leaders for our organisational development, including taking on the PMCF project.

The executive partners for GPS have been in post for many years, and we fully

expect them to remain in the future.

The advent of the 2012 Health and Social Care Act has been a major driver in

developing the leadership structure for the new practice, and the robustness of the

new organisational arrangements has been thoroughly tested as we have operated a

shadow leadership Board during 2014. We have been very encouraged that all six

practices have worked well together during this period, and we have every

confidence that this will continue after the full merger is formally in place from April

2015.

As can be seen from the organisational structure diagram given in our response to

Question 16 above, we have structured our leadership arrangements to include

representation from all six practices and reporting to the Board we have an

Operational Management Team to deal with day-to-day management issues.

Supporting the Board we have also appointed a number of professional advisers to

ensure that such matters as the TUPE transfer of staff, the new partnership

agreement, premises issues, and financial governance, are all correctly managed.

Two GPS Board members are also representatives on the CCG Board and have

experience and receive training in leadership. We also intend to arrange leadership

training to members of the GPS Board over the coming months. Other practices will

also be invited to join GPS. We therefore have no concerns about ensuring

sustainable leadership after the PMCF pilot ceases.

300/300

26

19. Improvement methodology - Outline the means by which you will redesign

services and undertake testing and refinement of innovation ideas.

Max 500 words

The redesign of our service under the PMCF project will be led by a service

manager who will be reporting to the GPS Board. This is shown diagrammatically

in the organisational structure given in our response to Question 16 above.

In terms of using the extended hours that GPS will be open to patients (6.30 – 8pm

on weekdays, and 8 to 8 at the weekends), this will initially be GP and nurse

appointments, but will be refined as we find out how well used the new service

becomes. The balance between face-to-face appointments, telephone

appointments, web and Virtual Visiting times for example will all be refined as the

service settles and is actively promoted.

Our expectation is that having longer opening times will reduce pressure during

the core GMS periods of 8 to 6.30 on Mondays to Fridays. This will mean that GP

and other staff resources can move their appointment sessions to different times to

meet the needs of patients. The management of this change will be the

responsibility of the Operational Management Team who will make

recommendations to the GPS Board.

As we redesign services we will need to consult regularly with our PPG and

analyse our patient survey results on a monthly basis to understand patient

preferences. We will also need to closely monitor both telephone usage (waiting

times to speak to a receptionist for example), and our SystmOne IT system for

consultation information. This will need to include the number of DNAs, waiting

times etc

For the Virtual Visiting aspect of this project, our service manager will once again

be responsible for mobilising the service under supervision from our medical

director. We have had detailed discussions with a company called V-Connect

(www.v-connect.co.uk) who offer the technology that is needed for this service.

Our intention is to test this at three nursing homes in the first instance, and with

three chronically unwell patients, and to learn from this experience before setting

up the service in full. We will, however, install the necessary hardware and

software in all six practices from April 2015 as from experience from elsewhere,

this system works extremely well.

353/500

http://www.v-connect.co.uk/

27

20. Measurement - The nine national metrics for wave one are:

A. Patient contact, as a direct result of the change in access

The change in hours offered for patient contact;

The change in modes of contacts;

The utilisation of additional hours offered; and

Impact on the ‘out of hours’ service.

B. Patient experience/satisfaction, including patient choice

Satisfaction with access arrangements; and

Satisfaction with modes of contact available.

C. Staff experience/satisfaction

Satisfaction with new arrangements.

D. Wider system change.

Impact on the wider system attendances; and

Impact on emergency admissions.

List any additional metrics you would like to see included as part of the

evaluation

Through our integrated SystmOne clinical system and utilising SUS Data we will

be able to collect and audit data in the following areas:

Access – appointment data

Reduction of External Out of Hours contact

Reduction in A & E attendances

Reduction in Unplanned admissions and re-admissions

Consultation methods – Video, telephone, face-to-face, virtual consulting

via Telecare

DNA rates

Agreed key success criteria with Solihull CCG to determine sustainability are

Improved patient experience

Increased use of general practice leading to reduced reliance on hospital

based services ( A&E, emergency admissions and outpatient activity)

Increased efficiency and productivity in general practice (including

improved use of technology)

28

Additional critical success factors we would like to see included as part of the

evaluation include:

Patient behaviour – are patients attending primary care rather than

urgent care as a result of the service? We will assess this by asking

patients about their satisfaction with access to the service. We will also look at

the number of extra appointments accessed and the proportion accessed

outside of “normal hours”.

Access to a GP within four hours of contacting the service

Percentage of remote (telephone and web consultations) vs face-to-face

consultations – We will also measure this to ensure that remote access is a

more productive and efficient use of GP time thereby freeing up more face to

face time for where it’s needed most. We will also measure patient

satisfaction with this

Monitoring of all Incidents (both minor and serious) – to ensure that the

extension of hours and introduction of new forms of consultation does not

increase the risks or reduce quality. A Serious Incidents and complaints

process is well established within all our practices. Outcomes from detailed

case review and lessons learned are used to improve and reshape services.

We will make use of this data to support us in our monitoring of the new

elements of the service.

Data collection plans (include costs in finance plans):

We have extensive experience in collecting data and reporting on performance

and quality. Reports are configured to meet the local needs of services and we

place great emphasis on the use of management information in providing full

transparency of our activity and the patients experience and journey in a timely

manner. We understand that quality information/data collection is vital in enabling

commissioners, clinicians and patients to make informed decisions about the

service.

29

How Data will be Collected

Data will be collected in a number of ways, including through:

SystmOne where all patient outcomes will be recorded

Patient satisfaction surveys

Friends & Family Test

SUS (Secondary Uses Service) Data

How it will be Used

All of the data will be collated for the GPS Board for National evaluation and

available to our commissioners (both national and local). Specifically for the GPS

Board, the data will be used to inform service development and redesign.

This transparency of information is important for all concerned parties to

understand how the project is progressing and whether it is being a success.

This is particularly important for our commissioners who would subsequently be

able to make plans for funding the project beyond 2015/16 if it is showing to be a

success.

Conclusion

Our data collection plans will ensure that all those that require it receive the

information they need. As well as this we will be constantly monitoring and

reviewing data internally to ensure that we respond quickly to any performance

issues and to continuously improve and develop the service.

21. Commitment from CCG(s) - Please attach a statement from your CCG setting

out their views on the proposals. Success and sustainability of new approaches to

primary care are partly dependent on the commitment of the CCG.

A statement from Dr Patrick Brooke, Accountable Officer for Solihull CCG is attached as Appendix B The CCG can be contacted through Doug Middleton,Chief Operating Officer Address and contact details below:

30

He can be contacted at: Friars Gate 1011 Stratford Road Shirley Solihull B90 4BN 0121 7138959 [email protected]

mailto:[email protected]

31

Section D. Programme planning

22. Estimate of funding needed - Please include an estimate of the funding that

you would need to support your proposal, including:

how the investment will be funded (clearly indicating what funding is coming

from PMCF and what from other sources – including matched /

supplementary funds from partner organisations, recognising that PMCF has

been identified as a revenue budget and funding is only available for the

15/16 financial year)

a breakdown of all capital and revenue costs of the proposed investment.

Please note: Final decisions on funding will depend on the number of pilots selected

and following dialogue between NHS England and applicants to help gauge the level

of financial support they require.

23. Please indicate the organisation to which you would wish funding to be awarded

(eg lead practice or registered CIC).

Meadowside/GPS M89003

24. Timetable - Please provide a high level programme plan, indicating key lines of

work, dependencies and milestones. Where possible, include this in both tabular and

graphical (Gantt) form. Please assume that funds will be available from 1 April 2015.

Please find our project plans attached in tabular and Gantt forms as Appendix D. 25. Attachments:

Attach map of geographic area covered – please see in our response to

Question 3 above

Attach letter setting out views of CCG(s)

Include (as a minimum) high level month by month programme plan

References:

Key documents used in the preparation of this document have included:

Solihull CCG’s Strategic Development Plan

The Health and Wellbeing Board’s Strategic Plan

NHSE’s 5 year Primary Care Strategy

32

Further information|: If you have any queries about the application process, please contact the relevant NHS England area team. Application submission: Please send your completed application to the following mailbox by 5pm on 16 January 2015 to: [email protected] and copy in your area team

mailto:[email protected]

33

Appendix A - Letter of commitment from GP partners

34

Appendix B – Letter of support from Solihull CCG

36

Appendix C – Letters of support from partner organisations

39

Appendix D – Implementation plan

Task Dependancies MILESTONES

Mar-

15

Ap

r-15

May-1

5

Ju

n-1

5

Ju

l-15

Au

g-1

5

Sep

-15

Oct-

15

No

v-1

5

Dec-1

5

Jan

-16

Feb

-16

Mar-

16

Ap

r-16

May-1

6

Ju

n-1

6

Ju

l-16

Au

g-1

6

Sep

-16

Personnel

Confirm role of Project Manager from existing team Person Appointed

Arrange administrative support from existing team Staff roles confirmed

Identify further support needed from member practices Support identified

Service Manager appointed Person Appointed

Employment / contractual issues for staff that will work for the service All issues sorted out

GPS Board responsibilities

Terms of Agreement with PMCF Terms agreed

Appoint Board Members with specific responsibility for PMCF project 12 Members appointed

Confirm dates for Board meetings for March-15 onwards 11, 12 Meeting dates confirmed

Regular monthly meetings of the Board 11, 12, 13 Monthly meetings happen

Systems

Virtual Consultation hardware installed at six practices and linkages set-up Skype operational at all hubs

Ensure all SystmOne links are in place and able to deal with the extended serviceSystmOne tested (and works) for

the service

Ensure all telephone links for telephone consultations are in place Telephone links in place

Training

Additional staff training for telephone consultations 9 Training Complete

Staff training for Skype/Virtual Consultations 9 Training Complete

Staff training to be able to direct / inform patients about the new extended service 9 Training Complete

Marketing

Website Website Live

Leaflet drops Leaflets created and handed-out

Posters in servicesPosters in place at primary,

urgent and community services

Data

Data gathering, methods, tools and systems approved Tools and systems approved

Patient survey created and approved (specifically for the extended access service) Survey approved

Template created tested to present the data to the GPS Board, Commissioners and for National Evaluation 28 and 29 Template approved

Tools and systems tested 28, 29 and 30 Testing works

Evaluate data 28, 29, 30 and 31 Data evaluated

Post Go-LiveImplementation

Go

liv

e d

ate

- f

irst

pati

en

t seen

Implementation Plan:

Solihull 8 to 8 seven days a week

40

Per

son

nel

Pro

ject

Te

amTr

ansp

ort

Dat

aM

arke

tin

gTr

ain

ing

Syst

ems

Implementation Start – March 2015

March – June 2015 July – September 2015 October – December 2015 January – March 2016

Project Manager and Support appointed / identified

Full service in place – October 2015

Employment and contractual issues sorted out

Terms of agreement and members appointed

Meeting dates diarised

Ongoing monthly Project Team Meetings

Web links Installed

Telephone links in place

SystmOne links in place

Telephone consultation training

Skype consultation training

Training to direct patients to new service

Website up and running

Leaflet drops

Posters in to healthcare services

Data tools approved

Patient survey approved Systems Tested

Collection templates created

Ongoing evaluation of data

Transport service in place (contract with local taxi firm)

First patient seen – June 2015

Documents

Prime Minister’s Challenge Fund: Improving Access to ...socialsolihull.org.uk/healthandwellbeing/wp... · visiting (Telemedicine) module of the bid, aiming to improve primary and