Upload
others
View
1
Download
0
Embed Size (px)
Citation preview
Circle Clinical Services Limited
Quality Account (‘Circle
Integrated Care’)
June 2019
Contents
2
Part One
Introduction Page 3
Statement from the Registered Manager (Director of Operations)
Circle Integrated Care (CIC)
Page 4
Circle Integrated Care’s Vision Page 6
The Circle Credo Page 7
What are Circle Integrated Care Services? Page 8
CIC Bedfordshire Achievements 2018/19 Page 10
CIC Greenwich Achievements 2018/19 Page 11
The MSK Teams Page 13
The CIC Operational model Page 19
CIC Facilities Page 21
Core services Provided at CIC Hubs Page 22
CIC Bedfordshire Community and Secondary Care Providers Page 25
CIC Greenwich Community and Secondary Care Providers Page 27
Ensuring the Quality of Providers Page 29
Part Two
Bedfordshire Achievements against Quality Improvement
Priorities for 2018/19
Page 32
Greenwich Achievements against Quality Improvement Priorities
for 2018/19
Page 34
Best Clinical Outcomes Page 36
Clinical Innovation Page 39
Best Patient Experience Page42
Staff Engagement Page 49
Operational Updates Page 50
Staff Engagement Page 51
Quality Improvement Priorities for Bedfordshire 2019/20 Page 53
Quality Improvement Priorities for Greenwich 2019/20 Page 54
Mandatory Statements Page 55
Acronyms in the Quality Account Page 63
Comments from:
Bedfordshire Clinical Commissioning Group Page 64
HealthWatch Bedford Borough (HBB) Page 65
HealthWatch Central Bedfordshire Page 66
HealthWatch Greenwich Page 67
The Health Act 2009 requires all providers of healthcare services to NHS patients to publish
an annual report about the quality of their services; this report is called a Quality Account.
Amendments were made in 2012, such as the inclusion of quality indicators according to
the Health and Social Care Act 2012. The primary purpose of a Quality Account is to
enhance organisational accountability to the public, to engage Boards and leaders of
organisations in fully understanding the importance of quality across all of the healthcare
services they provide, and to promote continuous improvements on behalf of their
patients. The quality of the services is measured by looking at patient safety, the
effectiveness of treatments that patients receive and patient feedback about the care
provided.
This report summarises the quality of the service Circle Clinical Services Limited (CCSL)
have delivered in the financial year 2018/19. To do this, it uses the quality improvement
targets set during the previous year as a measure for patient experience, clinical outcomes
and engaged staff.
The key requirements of this Quality Account include:
1.A statement summarising the Registered Manager’s view of the quality of services
provided to NHS patients
2.A review of the quality of services provided over the previous financial year (2018/19)
3.The quality priorities for the forthcoming financial year (2019/20)
We have used the Department of Health’s Quality Accounts Toolkit as a guide for our
Quality Account.
To supplement all the mandatory elements of the account, we have also worked closely
with our patients, clinicians, commissioners and other partners including local providers
and Healthwatch to ensure this account truly reflects the quality measures in place and
provides readers with an accurate and comprehensive insight into the organisation.
CCSL is known locally as Circle Integrated Care and will be referred to as CIC throughout
this report.
Introduction
3
Statement from the Registered Manager (Director of
Operations)
Circle Integrated Care (CIC) is responsible for and dedicated to the care of adults with
musculoskeletal (MSK) conditions, coordinating a patient’s journey from their initial
referral to their final follow-up appointment. It is our mission to ensure patients see the
right person first time, and to work with our community and secondary care providers to
provide outstanding treatment and support. As a provider of musculoskeletal healthcare
services to NHS patients in Bedfordshire and Greenwich our Quality Account is an annual
report published about the quality of the services we provide.
This Quality Account reports on the services CIC provide to the NHS which were delivered
in 2018/19.
CIC began providing these services in Bedfordshire in 2014 and Greenwich in 2017. We also
deliver electronic referral triage services for Northamptonshire and Rushcliffe,
Nottinghamshire which commenced in 2018. As CIC are not responsible for seeing these
patients this account concentrates on Bedfordshire and Greenwich.
At a time when demand is growing and it is important to provide value for money we
continue to maintain excellent standards of patient care offering a range of quality patient
focused services in locations close to patient’s homes.
4
Statement from the Registered Manager (Director of
Operations) continued
CIC achieve continuous improvement by having a well defined clinical governance
structure in place. This means that we have strong clinical leaders holding clear
responsibilities and systems and processes to ensure we operate safely and monitor the
quality of care we offer to our patients.
Over the last few years CIC have found that successful partnerships with NHS services and
independent sector services allow an integrator service such as ours to streamline patient
pathways in collaboration with local stakeholders.
CIC had a CQC inspection on 20th September 2018. In summary they found that CIC are
delivering safe, effective, caring, responsive and well led services in accordance with the
relevant regulations. The CQC believe that we are delivering:
“a service that has vision and values and is set to provide a quality service with the
leadership in place to achieve the vision”
Our staff are the backbone of our business and our services have grown over the reporting
time period. This has led to a new site being sourced for the Greenwich service to provide
more locations for patients. The Bedfordshire service staffing levels have increased and a
hub move for administration staff occurred on 29th April 2019.
CIC have already achieved much in the time we have been providing these services, in this
document we will present an overview of the services provided so far. Primarily though, we
will tell you about what we are working on in the year to come.
In putting together this publication we have sought feedback from colleagues,
Bedfordshire and Greenwich CCG’s and Healthwatch and I would like to take this
opportunity to thank them for their input into the process.
I can confirm that to the best of my knowledge, the data and information in Part 2 of this
report reflect both the success and the areas we have identified for improvement over the
next 12 months.
Amanda Phillips
Director of Integrated Care Operations
5
Circle Integrated Care’s Vision
6
The Circle Credo
Our purpose
To build a great organisation dedicated to
our patients
Our parameters
We focus our efforts exclusively on:
What we are passionate about;
What we can become best at;
What drives our economic sustainability
Our principles
We are above all the agents of our
patients
We empower our people to do their best
We are unrelenting in the pursuit of
excellence
What this means for patients
• Fast access to MSK specialists
• One-to-one discussions and tailored
treatment plans
• Options to talk about treatment over the
phone
• Shared decision making so patients are
involved in their care
• Choice of hospital or local service
• Choice of appointments in the community,
closer to home
• Opportunity to give feedback and shape the
service
• A co-ordinated journey through the
healthcare system for treatment of their MSK
condition
7
What are Circle Integrated Care Services?
Circle Clinical Services Limited (CCSL) is the CQC registered entity. This was known
locally as Circle MSK. We rebranded at the end of 2018 to Circle Integrated Care (known
as ‘CIC’). CIC deliver MSK services in Bedfordshire and Greenwich and deliver triage
services in Northampton and Rushcliffe and is part of a group of companies owned by
Circle Health. CIC has a dedicated team of experienced healthcare professionals, as well
as support staff, and our purpose is to provide patients with high quality, best value,
outcomes focused care. Circle’s approach is based on the premise that clinicians are best
placed to decide how to deliver the best care for patients and our Credo commits us to
being ‘above all the agents of our patients’.
CIC have been commissioned by the local Clinical Commissioning Groups (CCGs) to
manage all NHS musculoskeletal (MSK) problems (apart from emergencies) for the
populations of Bedfordshire and Greenwich and deliver triage services for Northampton
and Rushcliffe. This includes conditions involving muscles, joints, bones, tendons,
ligaments, some nerve-related conditions and associated pain. CIC Bedfordshire was the
first service of its kind in the United Kingdom and has been operational since April 2014.
CIC Greenwich has been operational since April 2017 and uses the same model.
CIC provide streamlined triage and treatment services for patients with MSK conditions.
Combining the expertise of multiple clinicians ensures patients receive the right
treatment, at the right time, in the right place, with the right person. CIC have contracts
with local NHS and private providers covering the whole range of services needed to
manage MSK conditions, so that we can provide an integrated, efficient, high-quality NHS
service.
Scope of CIC Services
The scope of our MSK services in Bedfordshire and Greenwich include:
• MSK related Physiotherapy
• MSK related Podiatry
• Community Triage Clinics (Advanced Practice Physiotherapist -APPs & MSK Physicians)
• Orthopaedics
• Rheumatology
• Pain Services
• Fracture clinic follow-ups (Greenwich)
8
Rationale for Integrated MSK Services
CIC was commissioned to streamline patient pathways and ensure best practice national
guidelines were followed for MSK conditions.
This was important as rising numbers of patients presenting with MSK conditions, driven by
demographic growth, was causing financial pressures for local health economies.
The community model adopted by CIC allows for appropriate activity to be delivered in
community settings near patient’s homes. This relieves the burden on local hospitals.
The NHS Long Term Plan
On 7th January 2019, NHS England published the NHS Long Term Plan, setting out its
priorities for healthcare over the next ten years and showing how the NHS funding
settlement will be used. The areas covered are:
How the NHS will move to a new service model in which patients get more options, better
support, and properly joined-up care at the right time in the optimal care setting.
Action the NHS will take to strengthen its contribution to prevention and health
inequalities.
The NHS’s priorities for care quality and outcomes improvement for the decade ahead.
How current workforce pressures will be tackled and staff supported.
A wide-ranging and funded programme to upgrade technology and digitally enabled care
across the NHS.
How the 3.4% five year NHS funding settlement will help put the NHS back onto a
sustainable financial path.
9
CIC Bedfordshire Achievements 2018/19
CIC Bedfordshire has managed a 14.2% referral growth on a capitated budget saving the
CCG over £19m to date. A single point of access has been set up with all referrals triaged
within 24 hours. In 2018/19 48,187 referrals were received through the hub and over 100%
of referrals into the hub are electronic.
Activity has increased from 33% of activity in the community in 2013 to 64% in 2018/9.
We have provided self-management tools and CIC website to empower patients; and
PhysioLine for early telephone access to physiotherapy advice and treatment.
Physitrack® has been introduced for our PhysioLine patients, allowing videos of exercises
to be sent to patients rather than sheets of exercises, also allows interaction with their
physiotherapist if questions or further advice is needed.
Patients have true choice for every part of the system and are empowered through shared
decision making to be involved in their care.
The patients have had the choice of non-surgical options for hip and knee conditions
including Ossur braces and APOS Therapy.
The patients have had the choice of options for spinal rehabilitation with Nordic
rehabilitation equipment.
Introduction of Synertec, a technology which enables us to send letters to patients which
meet their accessible information standard needs e.g. in a particular font size.
We have created a referral and treatment pathway in collaboration with the Bedfordshire
Wellbeing service to ensure patients receive the most appropriate treatment within the
relevant service.
96% of patients would recommend the Circle run community hubs, with complaints less
than 0.1%. Patient representatives are involved in the service and we have developed links
with Healthwatch to support patient events, obtain feedback on the system and we have
commissioned them to undertake independent reviews.
Continual GP engagement in the system through practice visits, locality meetings, GP
surveys, and participation in MSK forums to support service re-design.
Visits to GP locality boards have been undertaken to update on the service and answer
questions about any issues.
Worked with Bedfordshire Clinical Commissioning Group to roll out the First Contact
Practitioner trial which is a nationwide programme. This is an extension to the MSK
Practitioner roles we have offered to GPs for the last 3 years.
10
CIC Bedfordshire Achievements 2018/19 continued
Engagement of clinicians from providers occurs on alternate months through the clinical
steering group (participants include GPs from each locality, Orthopaedic, Rheumatology &
Pain Consultants, Physiotherapists from different providers, APPs, and MSK Physicians).
Operational relationships have been built in the nine community hubs as well as local
provider sites (see Appendix for details).
Integration of the MSK system has occurred through operational, contractual, and clinical
engagement as well as development of technology to support tracking of patients and
system analysis.
National PROMS (Patient Reported Outcome Measures) following Hip and Knee surgery are
better than national average for Bedfordshire patients.
Evidence based pathways ‘The Circle 6’ have been developed from national guidance to
ensure all patients with particular conditions are offered the most appropriate options
according to the current evidence base.
Developed ‘one stop shop’ clinics for particular conditions to make patient treatment
pathways more effective and efficient.
Significant capture of outcome measures (>239,793) not previously collected to drive up
clinical quality and support clinicians development.
CIC Greenwich Achievements 2018/19
CIC Greenwich has managed an increased population growth on a capitated budget saving
the CCG £1.9m to date. A single point of access has been set up with all referrals triaged
within 24 hours. 24,627 referrals have been received over the year 2018/19 (an average
2,052 per month) and 100% of referrals into the hub are electronic.
Activity has increased from 41.15% of activity in the community in 2017/18 to 73%
in 2018/19.
A new clinic in Woolwich (Grabadoc) offering an additional location to the existing Eltham
Community Hospital for patients to access CIC services.
A self-management web based tool called ‘Physitrack®’ has been implemented to assist
patients with self-management of their MSK condition.
PhysioLine for early telephone access to physiotherapy has increased as well as
implementation of self-referrals which is a new initiative in Greenwich.
Patients have true choice for every part of the system and are empowered through shared
decision making to be involved in their care.
11
CIC Greenwich Achievements 2018/19 continued
The patients have had the choice of non-surgical options for hip and knee conditions
including Ossur braces and APOS Therapy.
On average 98.5% of patients in 2018 would recommend the Community Clinics; 6 total
complaints received in 2018, on average 1 every other month which is 0.02% of all
referrals.
Healthwatch Greenwich undertook an independent review of the service in June 2018.
Continued GP engagement in the system through practice visits, syndicate meetings, GP
engagement and training events, and participation in MSK forums to support service re-
design.
Dedicated GP support and advice line/emails have been set up and free resource (First
Contact Practitioners) has been provided to surgeries to support GPs workload and provide
early access to an MSK clinician in primary care for patients. GPs feedback as a result of
these are they welcome the support and rapid access to advice.
Engagement of clinicians from providers occurred at alternate months through the clinical
steering group (participants include local GPs, Orthopaedic, Rheumatology & Pain
Consultants, Physiotherapists from different providers, APPs, and MSK Physicians).
Waiting times have decreased significantly for the Borough.
CIC captured Community based outcome measures for every patient to drive clinical
quality and support pathway development.
Making Every Contact Count Questionnaires are embedded into our initial clinical
consultation which enables us to signpost patients to services which support healthier
lifestyles.
CIC Greenwich’s progress with the MSK service KPIs are as follows:
• 89% of patients treated in the community hub have had an improvement in pain and/or
function
• 88% of Patients being referred to Secondary Care have had a dedicated shared decision
making (SDM) consultation
• Choice of provider for further treatment – 100% patients offered choice; 96% had a
dedicated patient choice telephone conversation
• Local GP training and support for MSK care –GP visits and Education events held
• All patients over 65 are asked if their condition is a result of a fall
12
The MSK Teams
Across our sites, the CIC team consists of:
• Physiotherapists
• Advanced Practice Physiotherapists (APP’s)
• Specialist Podiatrist (CIC Greenwich)
• MSK Physicians
• Pain, Orthopaedic and Rheumatology Consultants
• Clinical Psychologist (CIC Bedfordshire)
• Specialist Pain Nurses (CIC Bedfordshire)
• Specialist Hand Occupational Therapist (CIC Bedfordshire)
• Shared Decision Makers
• Health Care Assistants (HCA’s)
• MSK (First Contact) Practitioners
They provide specialist MSK clinical triage, assessment, and treatment within the
CIC run community MSK hubs across Bedfordshire and Greenwich and triage for
Northampton and Rushcliffe (electronic review and signposting of referrals).
Advanced Practice Physiotherapists (APP) are experienced physiotherapists who
have undertaken further postgraduate training to provide an advanced practice.
Advanced practice is a combination of advanced skills, knowledge and attitudes
together with the core set of physiotherapy skills and knowledge, tailored to
individual patients and local environments. For example, they can request
investigations such as ultrasounds or MRIs, interpret the results of investigations to
plan management with patients, and many are trained in the administration of
steroid injections; some can also prescribe medications, and some are able to carry
out advanced treatments such as ultrasound-guided injections, diagnostic
ultrasounds and shockwave therapy.
MSK Physicians are doctors that have undertaken further training and
assessment to develop the expertise to deliver a high quality clinical service to
patients with musculoskeletal problems, beyond the scope of their core
professional role. They can also carry out advanced treatments such as
ultrasound-guided injections and shockwave therapy.
13
“Appointment was on time and consultant very friendly and explained everything -
nothing could be improved”
CIC Bedfordshire
CIC Bedfordshire has:
One Clinical and Governance Lead
Two Triage and Audit Leads
Twenty two APPs
One Physiotherapy Lead
Five Physiotherapists
Five MSK Practitioners (Senior Physiotherapists)
Six MSK Physicians
One Clinical Psychologist
Four Healthcare Assistants
One Rehabilitation Assistant
Three Pain Consultants
Two Spinal/ Neurosurgery Orthopaedic Consultants
One Upper Limb Consultant
Three Lower Limb Consultants
Two Rheumatology Consultants
Two Pain Nurses who work within the MSK hubs
These Consultants are linked to three contracted secondary care providers.
They provide outpatient appointments in the Circle community hubs and direct
list to their hospital of employment for surgery as appropriate
14
CIC Greenwich
CIC Greenwich has:
One Clinical and Governance Lead
One Triage and Audit Lead
Six APPs
Clinical Chair
One Physiotherapy Lead
Five Physiotherapists
Two MSK Practitioners (Senior Physiotherapists)
Three MSK Physicians
One Clinical Psychologist
Four Healthcare Assistants
One Rehabilitation Assistant
Two Pain Consultants
Two Upper Limb Consultant
Five Lower Limb Consultants
Two Rheumatology Consultants
The Consultants are sourced from Lewisham & Greenwich Trust as a result of a
tripartite agreement with the trust and CCG and Dartford & Gravesham Trust.
15
16
Supporting Members
17
CIC are supported by:
Director of Integrated Care
Director of Operations
Head of Clinical Services
Head of Finance and Contracts
Head of Operations
Head of Service Transformation
Two Quality and Contracts Managers
One MSK Service Manager
One Service Coordinator
A patient choice team
An 18 Week team
Two Quality and Assurance Facilitators
A Service Transformation team
An administrative team who are responsible for referral management, co-ordinating
patient appointments in the community setting, managing the flow of patients to our
providers and importantly act as a point of contact for patient and GP queries at any point
in the clinical pathway.
Amanda Phillips
Director of Integrated Care
Julie Yanni
Head of Clinical Services
Ben Millard
Head of Finance and Contracts
Supporting Members- Executive Board
18
CIC has a team of seven Executives who meet monthly at the Executive Board. The
purpose of the Executive Board is to implement the strategic direction and group policies
and objectives set by the Circle Health Executive Team. The Executives that sit on the
Board include:
Director of CIC
Director of Operations
Clinical Chair
Head of Clinical Services
Head of Finance and Contracts
Head of Service Transformation
Head of Operations
The Clinical and Governance Risk Management Committee (CGRMC) which is responsible
for overseeing and delivery of both reactive risk management, including complaints
handling and incident reporting, analysis and learning, and proactive risk management,
including clinical audits, risks on the risk register and research governance.
The CIC Operational Model
The model is centred on an integrated provider hub (IPH) which:
• Provides a single triage hub for all MSK referrals
• Ensures patients are directed to the right treatment first time
• Ensures patients are given choice over secondary care
• Reduces inappropriate surgery
• Outcomes can be measured
GP’s and patients refer into the Integrated Provider Hub (IPH) which manages all referrals
and provides multidisciplinary care for patients utilising our team of clinicians. All referrals
are triaged within 24 hours of receipt of the referral. Patients are then guided to the most
appropriate part of the system. This includes PhysioLine (early access to assessment and
advice over the phone), physiotherapy or podiatry in the community; and Secondary Care
hospital treatment for those patients requiring surgery or Consultant expertise. Community
clinics provide expert MSK assessment, further investigations and additional treatments,
such as ultrasound guided injections.
19
The IPH manages the patient from referral to discharge so if the first treatment
pathway is unsuccessful, the hub co-ordinates care to another appropriate part of
the system (eliminating the need for patients to be referred back to their GP, saving
both patients and GP’s time). The IPH also has Consultants from a range of hospitals
so patients can see a consultant closer to home and then be referred into a hospital
for surgery if required. Their follow up care can also be undertaken in one of our
community hubs and closer to home.
Patient choice is offered at all stages, however patients being referred to Secondary
Care are spoken to by Patient Choice Advisors, to enable patients to understand
their options. Patient Choice advisors provide links to all the hospitals operational
teams and have non-clinical conversations regarding information on Consultants,
travel and current waiting times, which may influence patients’ choice and enables
waiting times to be more controlled. Similarly, although Shared Decision Making
(empowering patients to be involved in their care) is part of our ethos, we have
dedicated Shared Decision Makers (Senior Physiotherapists) who speak to patients
before major surgery (such as total hip and total knee replacements). They enable
patients to understand the implications of surgery, ensure conservative measures
have been optimised, surgical thresholds are met and that patients want surgery.
Where appropriate we do offer non- surgical alternatives and these will be
discussed with patients who meet the criteria. This ensures that the patient needs
and wants surgery and is more prepared for it.
In addition we work collaboratively with all our providers to streamline pathways,
create innovative services and manage the quality of all the providers in the
system. We do this through having a dedicated Quality and Contracts Manager,
monthly contract meetings with quality reporting; clinical pathway meetings and a
bi-monthly clinical steering group with GPs, Physiotherapists, APP’s, MSK Physicians
and Consultants to gain feedback about performance and discuss best practice
pathways and service changes. We have also worked with the Bedfordshire CCG to
be able to provide MRI, Ultrasound and Nerve Conduction Studies in the Integrated
Hubs, closer to patients’ home, which streamlines pathways and reduce waiting
times. In Greenwich we have worked with the CCG to source MRI and Nerve
Conduction Studies through other providers which has reduced waiting times.
20
“Very clear explanation and friendly. Didn’t feel rushed.
Left feeling there was a plan in place- thank you”
CIC Facilities
At the end of 2018/19, CIC Bedfordshire provided Services from the following
facilities:
• The Enhanced Services Centre – 3 Kimbolton Road, Bedford MK402NT
• Bedford Consulting Rooms – 4 Goldington Road, Bedford, MK403NF
• Church Lane Surgery – 147a Church Lane, Bedford, MK410PW
• Flitwick Surgery – Highlands, Flitwick, MK451DW
• Ivel Medical Centre, ChestnutAvenue, Biggleswade, SG18 0RA
• Toddington Surgery – Luton Road, Toddington, LU5 6DE
• Salisbury House Surgery – Lake Street, Leighton Buzzard, LU71RS
• Bassett Road Surgery – 29 Bassett Road, Leighton Buzzard, LU71AR
• Greenfields (Aldwyck Housing Group), Leighton Buzzard, LU7 9SP
• Rothesay Clinic Rooms, 14 Rothsay Place, Bedford, MK40 3PX
At the end of 2018/19, CIC Greenwich provided Services from the following
facilities:
• Eltham Community Hospital, 30 Passey Place, London, SE9 5DQ
• Grabadoc, 394 Shooters Hills Road, London, SE9 5DQ
21
Core Services Provided at CIC Hubs include:
22
Lower Limb
Service Bedfordshire Greenwich What it is
Ossur Knee
Brace
Ossur is a brace offered as biomechanical
device for treating Osteoarthritis of the
knee
APOS therapy
– Hip & Knee
APOS is a boot-like device for patients
with chronic pain from osteoarthritis of
the knee or hip.
Consultant in
the Hub Hip
and Knee
A consultant that holds outpatient
appointments in Circle CIC clinics and
direct lists patients to their hospital as
appropriate.
Shockwave
therapy Focused sound waves which work by
increasing blood flow to the injured area.
Non-specific
Service Bedfordshire Greenwich What it is
Ultrasound
guided
injection
Injections are given with ultrasound
guidance.
In-house
physiotherapy Wide range of treatment options, most
often a programme of specific exercises
targeted to help a particular condition.
In-house
Rheumatology
A consultant that holds outpatient
appointments in Circle MSK Hubs and
direct lists patients to their hospital if
required.
In-house
Podiatry
A specialist podiatrist who provides
expert assessment and treatment of foot
and ankle related conditions.
Pain
Service Bedfordshire Greenwich What it is
PMP (Pain
management
programme) /
LEAP (Lifestyle,
education,
activity and pain
management)
The Pain Management Program (PMP)
is a group intervention for people
with long-term musculoskeletal pain.
There is strong evidence that this
type of help is effective for those
affected by persistent pain
Pain MDT drop in
clinic
A clinic with a pain nurse and pain
APP so the patient can see multiple
clinicians in one visit
Clinical
Psychologist
A psychologist who undertakes
individual appointments with
patients to empower them to self
manage their pain symptoms and to
facilitate their progression along a
treatment pathway
Pain Consultant in
the Hub
A consultant that holds outpatient
appointments in Circle MSK Hubs and
direct lists patients to their hospital
for procedures as appropriate.
23
Spinal
Service Bedfordshire Greenwich What it is
iBest (Back
skills
training)
A bio-psychosocial approach where
patients would benefit from a CBT type
approach with combined exercise
Nordic Health
Nordic Health are a range of
rehabilitation machines used
specifically for treating spinal pain and
improving outcomes.
Consultant in
the Hub
A consultant that holds outpatient
appointments in Circle MSK Hubs and
direct lists patients to their hospital as
appropriate.
24
Upper Limb
Service Bedfords
hire
Greenwich What it is
Barbotage
An ultrasound guided needle is injected
into a deposit of calcium which has
occurred within a tendon. The needle is
used to break up the calcium and help the
body to remove it naturally (usually in the
shoulder).
Hydrodilatation
This is an image guided injection
procedure, whereby a needle is inserted in
to the shoulder joint under direct
ultrasound vision to allow the injection of
between 20-30mls of fluid.
It is performed as part of the treatment of
Frozen Shoulder, a condition where the
shoulder becomes very stiff and painful.
High volume injection is considered when
the pain and stiffness hasn’t settled with
rest, painkillers, exercises or a previous
unguided steroid injection.
Consultant in the
Hub Upper Limb
A consultant that holds outpatient
appointments in Circle MSK Hubs and
direct lists patients to their hospital as
appropriate.
CIC Bedfordshire Community Therapy
Via the CIC Bedfordshire service we have access to physiotherapy, podiatry (together with
podiatric surgery) and hand therapy across Bedfordshire as demonstrated below:
25
• Essex Partnership University NHS
Foundation Trust
• Gilbert Hitchcock House Bedford
• Gilbert Hitchcock House Biggleswade
• ICE Ampthill
• Ampthill & Flitwick Chartered
Physiotherapy Clinic
• Asplands Medical Centre
• Bedford Physiotherapy Centre
• ICE Olney
• Luton & Dunstable Hospital Trust
• Luton & Dunstable Outpatient
Physiotherapy and Hand Therapy
Department
• Parks Therapy Centre, Biggleswade
• Parks Therapy Centre, Church Lane
• Parks Therapy Centre, Elstow
• Parks Therapy Centre, St Neots
• Woodside Clinic, Leighton Buzzard
• Woodside Clinic, Dunstable
• The Physiotherapy Clinic, Stotfold
For Secondary Care the CIC Bedfordshire service has access to a range of hospitals in and
around Bedfordshire as demonstrated below:
26
• BMI Three Shires Hospital
• BMI The Manor Hospital
• BMI The Saxon Clinic
• Ramsay Blakelands Hospital
• Ramsay Woodlands Hospital
• Ramsay Pinehill Hospital
• Spire Harpenden Hospital
• Spire Cambridge Lea Hospital
• Northampton General Hospital NHS Trust
• Milton Keynes University Hospital
• Stoke Mandeville Hospital
• North West Anglia Foundation Trust
• Bedford Hospital NHS Trust
• Luton and Dunstable University Hospital
• East and North Hertfordshire NHS Trust
• Addenbrooke’s Hospital
CIC Bedfordshire Secondary Care Providers
CIC Greenwich Community Therapy
• Oxleas NHS Foundation Trust - Manor
Brook Medical Centre
• Oxleas NHS Foundation Trust - Eltham
Community Hospital
• Oxleas NHS Foundation Trust - Clover
Health Centre
• Oxleas NHS Foundation Trust - The
Greenwich Centre
• Oxleas NHS Foundation Trust - Kidbrooke
Village Centre
• Lewisham & Greenwich Trust - Manor
Brook Medical Centre
• Lewisham & Greenwich Trust - Gallions
Reach Health Centre
• Lewisham & Greenwich Trust - South
Street Medical Centre
• Lewisham & Greenwich Trust - Queen
Elizabeth Hospital
• Vanbrugh Group Practice
27
CIC Greenwich also has access to both community and secondary care providers for
therapy:
28
For Secondary Care the Circle MSK Greenwich service has access to a range of hospitals
in and around the borough as demonstrated below:
CIC Greenwich Secondary Care Providers
• Queen Elizabeth Hospital
• University Hospital Lewisham
• BMI The Blackheath Hospital
• Darent Valley Hospital
• King's College Hospital NHS Foundation
Trust
• Guy's and St Thomas' NHS Foundation
Trust
• Royal National Orthopaedic Hospital
• Oxleas NHS Foundation Trust
• BMI The Sloane Hospital
• BMI Shirley Oaks Hospital
• Queen Mary’s Hospital
Ensuring the Quality of Providers
29
Quality Management
CIC believes it is important to monitor the quality of the sub-contracted providers to
ensure all patients receive the best care. CIC’s approach to quality management adopts a
number of approaches. CIC requires a formal submission of quality metrics but also places
great value on maintaining good relationships with contracted providers. CIC use a monthly
Service Quality Performance Report (SQPR), a Quarterly Quality Report, and a combination
of CQUIN schemes and SDIPs (Service Delivery Improvement Plans) to improve the quality of
the service that our sub-contracted providers deliver on our behalf.
The SQPR metrics are collated into a county wide dashboard for sub-contracted providers,
and is presented to both CIC’s internal CGRMC (Clinical Governance and Risk Management
Committee) and the local CCG at the monthly contract meetings.
Due to all reporting reviewing activity that is two months in arrears, CIC also asks sub-
contractors to make them aware of any incidents that have happened in the interim, or
give a “lag report” covering the time from the reported metrics to the date of the
meeting. All sub-contractors are also required to report in line with NHS national timelines
any Serious Incidents or other reportable incidents as defined by the CQC.
Sub-contractors are also required to submit a Quarterly Quality Report as a platform for
service providers to give more narrative and context to the quarter’s activity. These
submissions are then collated into a county-wide report that is submitted to the CIC’s
CGRMC and relevant CCG on a quarterly basis. These quality reports and documents are
monitored through a monthly Contract Meeting forum.
The attendees for the meeting will depend on which hospital/Trust the meeting is with,
however there must be at least the following for the meeting to be of value:
• Quality and Contracts Manager (Circle)
• Hospital Director/Executive Director/General Manager (PrivateHospitals)
• General Manager / Service Lead (NHSprovider)
• Finance (both parties)
• Quality representative (both parties – usually Quality & Contracts Manager from Circle)
• 18 week/patient choice/Operations Lead from CIC asrequired
During the month of submission of the report, each sub-provider has a Quality meeting in
addition to the Contract meeting in order for CIC to fully understand the content of the
report. All submitted quality metrics are reviewed on a monthly basis at the Quality
Performance Committee, a sub-committee of the CGRMC. CIC also undertake quality
visits at the sub-contracted provider’s location, often in conjunction with the local CCG.
Ensuring the Quality of Providers
30
Quality Improvement
Selected sub-contractors have Quality Improvement Schemes in their contracts,
which follow the same mechanisms as a CQUIN scheme on a Standard Acute NHS
Contract i.e. 2.5% of quarterly activity that the sub-contractors can earn back
dependent on achievement of pre-agreed quality improvement criteria. These are
submitted on a quarterly basis, and reviewed in line with the NHS contractual
mechanism i.e. submission to CIC, request for additional information sent from
CIC, final submission.
Outside of this contractual mechanism, CIC also reviews existing pathways on a
regular basis as required, and promotes a culture of continuous improvement with
the contracted relationships, and with the CCGs. Sub-contractors are aware of the
methodology that CIC employs, and that new approaches to patient pathways are
always welcomed.
The standard approach that CIC also employs with sub-contracted providers is one of
collaborative working if a challenge arises. Once an area of concern is raised, CIC
will work with sub-contracted providers in order to resolve any issues and ensure the
best outcome for patients.
Approach to feedback to drive improvement
Patients are at the heart of everything CIC do and the service seeks to develop
strong relationships with patients, carers and the public to create a responsive
service which empowers patients, improves health outcomes and drives quality.
Patient outcome and experience measures are the foundation blocks of CIC’s
continuous improvement methodology and forms a key component of the Circle
Operating System.
CIC actively seeks patient feedback, inviting patients to share their comments and
views using feedback cards, telephone, SMS and face to face meetings. Patient
representatives have participated in our partnership sessions for all staff. This
provided valuable and powerful insight into the experience of a service user.
Patient comments and suggestions are reported via Quality dashboards and
interrogated in the various clinical and governance meetings.
A range of forums enable staff to discuss patient focussed service and take
collective responsibility for their delivery, tracking and reviewing progress in
subsequent meetings.
“Appointment wasn’t
rushed, symptoms
discussed.
Examination given and
discussed and
diagnosis given and
explained well, no
improvement needed
with my
appointment”
Bedfordshire Achievements against Quality Improvement
Priorities for 2018/19
32
Quality
Domain
Our Quality
Priorities
for 2018/19
Success Measures for
2018/19
2018/19
Progress
Status
Best Patient
Experience 98% of
patients
‘would
recommend’
in the friends
and family
test feedback
Continual improvement of
communication, data quality
and adherence to processes to
ensure effective patient
experience as evidenced by
reduction in volume & themes
on Datix.
95% of patients ‘would
recommend’ consistently from
May 2017
The average for
2018/19 was 96%
for ‘would
recommend’.
There has been a
reduction in
number of issues
with ‘accessing
the service’
themes on Datix
Partially
achieved
Consistently
over 50%
response rates
for our
feedback in all
hubs
Consistently >50% response
rate in all hubs for every
month.
The response
rates have not
reached over
50% for
feedback. A plan
is in place to
improve this for
next year
Not
achieved
Best Clinical
Outcome
100% of all
audits
undertaken
being captured
within a
dashboard
Audit tool to be set up from
May 2017 to present all audits.
We have an
audit tool that
captures all of
the mandatory
audits, clinical
audits are
captured
separately
Partially
achieved
Bedfordshire Achievements against Quality Improvement
Priorities for 2017/18
33
Quality
Domain
Our Quality
Priorities
for 2018/19
Success
Measures for
2018/19
2018/19 Progress Status
Best
Clinical
Outcome
100%
utilisation of
all clinic slots
within hubs
Monitor usage of
clinic slots
weekly.
Clinic utilisation is reviewed on a
weekly basis in the Ops Pack. This
has helped monitor utilisation to
ensure efficiency
Achieved
The
organisation
identifies
safety risks
inherent in its
patient
population
increase of
holistic
assessments to
cover physical
and
psychological
impact of
chronic pain and
its challenges for
patients
CIC have collaborated with the
Lifestyle hub to provide clinics for
CIC patients within our hubs.
Our one to one appointments with
the Clinical Psychologist are well
embedded as part of our pain
pathway.
Achieved
Improve
effectiveness
of
communicatio
n amongst
caregivers
Report critical
results of tests
and diagnostic
procedures on a
timely basis
Ensuring clinic usage is optimised
has improved the communication of
test results to patients and
caregivers. There is ongoing
monitoring on a weekly basis of
clinic usage.
Partially
achieved
Most
engaged
staff
To create a
feedback
board
including what
challenges we
faced that day
as a company
and how we
overcame
them
Monitor usage of
board, feedback
from staff on
effect of board
on engagement.
A staff feedback board has been in
use for 2018/19, also our Circle
Operating System (COS) champions
have a feedback box which is
reviewed at the fortnightly COS
meetings.
Achieved
Cross
shadowing
between
different
members of
the team
To encourage
and support all
staff to develop
core skills and
create
opportunities to
help progress job
role/satisfaction
(evidenced by
working at Circle
survey and 1-2-1
documentation).
As part of our induction process
staff spend time with different
members of the team to gain an
understanding of the different roles
within the service. There is a
programme of rolling this out to
existing staff members.
Partially
achieved
Greenwich Achievements against Quality Improvement
Priorities for 2018/19
34
Quality
Domain
Our Quality
Priorities
for 2018/19
Success Measures
for 2018/192018/19 Progress Status
Best Patient
Experience
98% of patients
‘would
recommend’ in
the friends and
family test
feedback
Continual
improvement of
communication,
data quality and
adherence to
processes to ensure
effective patient
experience as
evidenced by
reduction in volume
& themes on Datix.
96% of patients
‘would recommend’
consistently from
June 2017.
The average ‘would
recommend’ score for
Greenwich over 2018/19
was 98%.
There has been a
reduction in number of
issues with ‘accessing the
service’ themes on Datix
Achieved
Consistently over
40% response
rates for our
feedback in all
hubs
Consistently >40%
response rate in all
hubs for every
month.
Response rates have not
been consistently over
40%. A plan is in place to
improve this for next
year.
Not
achieved
Best
Clinical
Outcome
100% of all audits
undertaken being
captured within a
dashboard
Audit tool to be set
up from December
2017 to present all
audits.
We have an audit tool
that captures all of the
mandatory audits, clinical
audits are captured
separately
Partially
achieved
Greenwich Achievements against Quality Improvement
Priorities for 2017/18
35
Quality
Domain
Our Quality
Priorities
for 2018/19
Success Measures
for 2018/192018/19 Progress
Status
Best
Clinical
Outcome100% utilisation
of all clinic
slots within
hubs
Monitor usage of
clinic slots weekly.
Clinic utilisation is reviewed on
a weekly basis in the Ops Pack.
This has helped monitor
utilisation to ensure efficiency
Achieved
Review patient
pathways for
best practice
Annually clinical
staff to meet to
review all triage
pathways.
Triage guidance and surgical
thresholds were update to
reflect new national guidance in
2018/19
Achieved
Most
engaged
staff
To create a
feedback board
including what
challenges we
faced that day
as a company
and how we
overcame them
Monitor usage of
board, feedback
from staff on effect
of board on
engagement.
At Eltham facilities do not allow
boards to be put up. Feedback
is sent to staff on a monthly
basis and raised at meetings
with all staff. COS sessions have
also been set up to monitor
staff feedback
Partially
achieved
Cross
shadowing
between
different
members of
the team
To encourage and
support all staff to
develop core skills
and create
opportunities to
help progress job
role/satisfaction
(evidenced by
working at Circle
survey and 1-2-1
documentation).
All staff meet once a month at a
meeting. New staff shadow
other staff as part of their
induction. A programme of all
staff shadowing is being rolled
out
Partially
achieved
Best Clinical Outcomes
CIC recognises that in order to have both a positive and informative reporting
system, it is necessary to maintain a culture where staff feel able to report
incidents without fear of reprisal or blame.
An organisation with high incident reporting is a mark of a ‘high reliability’
organisation. Research shows that organisations with significantly higher levels of
incident reporting are more likely to demonstrate other features of a stronger
safety culture, such as a high patient satisfaction rate, positive peer review
assessments and a low number of clinical negligence claims. The commitment to
reporting demonstrates a commitment to our patients and their safety. This is
recognised by the Care Quality Commission Fundamental Standards of Quality &
Safety and further reinforced by the Report of the Mid Staffordshire NHS
Foundation Trust chaired by Robert Francis QC (February 2013). An organisation
with a high reporting rate of no harm incidents is a safe place to be.
Staff at CIC Bedfordshire reported a total of 449 incidents in 2018/19 as opposed to
497 incidents in 2017/18;
1a. Graph showing number of incidents by reported date per month from 1st April
2018 to 31st March 2019 for CIC Bedfordshire
Staff at CIC Greenwich reported 404 incidents in the year 2018. All staff have been trained
in the importance of reporting incidents to ensure we monitor the themes in relation to
incidents and use this to continuously improve the service
36`
35
22
40
51
37
31
46
57
34
28
46
22
0
10
20
30
40
50
60
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1b. Graph showing number of incidents by reported date per month from 1st April 2018 to
31st March 2019 for Circle Integrated Care Greenwich
37
257
66
38
2517
Access, Appointment,Admission, Transfer,Discharge
Patient Information(records, documents,test results, scans)
Clinical assessment(investigations, imagesand lab tests)
Consent, Confidentialityor Communication
The top five incident categories for 2018/19 for CIC are detailed below and
divided between our Bedfordshire and Greenwich services. Altogether there were
449 Incidents for Bedfordshire and 404 Incidents for Greenwich, all of which
were ‘No harm to staff and patients’. As graphs 1c and 1d demonstrate, the main
categories of incidents provide problems with the administrative processes in
relation to the patients’ pathway. As a result, a full review on the administrative
processes and supporting operating procedures has been undertaken in an effort
to minimise the number of incidents associated with process errors.
We have used this information to inform our Quality Improvement Priorities for 2019/20.
1c. Graph showing top 5 incidents from 1st April 2018 to 31st March 2019 for CIC
Bedfordshire
1d. Graph showing top 5 incidents from 1st April 2018 to 31st March 2019 for CIC
Greenwich
Serious Incidents and Never Events
• Serious Incidents are defined as ‘incidents where care management failures are
suspected, which result in serious neglect, serious injury, major permanent harm or
death (or the risk of) to a patient as a result of NHS funded health care’
• Never Events are defined as ‘serious, largely preventable patient safety incidents that
should not occur if the available preventative measures have been implemented’
Safety Alerts
Alerts issued via the Central Alerting System (CAS) relate to key safety issues that have the
potential to cause harm if not acted upon promptly. Safety alerts are an important source
of information which enables CIC to ensure that safety of clinical services is our first
priority.
Timely and effective implementation of safety alerts form part of the CQC (Care Quality
Commission) Fundamental Standards. Failure to implement safety alerts could result in
incidents, complaints, claims and/or inquests and have a significant impact on both staff
morale and patient confidence.
CIC received 74 safety alerts during 2018/19, 4 of which were applicable for Medical
Devices and 1 for the Estates & Facilities services.
Incidents and events Total
Serious Incidents 0
Never Events 0
38
271
48
22
2018
Access,Appointment,Admission,Transfer, Discharge
Patient Information(records,documents, testresults, scans)
Consent,Confidentiality orCommunication
Clinical Innovation
39
Rheumatology
CIC is now running twelve consultant clinics per month with short waiting times. In
Greenwich CIC we have a rheumatologist who specialises in osteoporosis who assesses this
cohort of patients. This will reduce pressure on secondary care, reduce waiting times and
consequently benefit patients care.
Pain Psychology
A total of 588 individual psychology appointments were booked between April 2017 and
31st January 2019. Main diagnoses were depression, anxiety and post-traumatic stress
disorder.
The majority of patients were either referred on to our in-house CIC Pain Management
Programme (PMP) or signposted to Bedfordshire Wellbeing Service (BWS).
228 indirect psychology consultations with other clinicians about patients occurred May
2017-31 Jan 2019. This included discussions about potential risk and a management plan;
where to signpost, advice regarding complex psychological/mental health issues, and
whether a referral to Pain Psychology would be appropriate.
Previously these 816 patients would have been referred to Secondary Care Pain Clinics.
Outcome measures consisting of the PHQ-9 (depression scale), GAD-7 (anxiety scale),
Sickness Impact Profile (SIP), Pain Coping Strategies Questionnaire (PCQ) and Self-Efficacy
Scale (SES) are collected at pre-assessment and post-therapy stages. 160 completed
questionnaires have been collected for completed episodes of care demonstrating
• 81% of patients improve on the depression scale PHQ-9
• 75% of patients improve on the anxiety scale GAD7
• 69% improvement on the Sickness impact profiles and Self efficacy profile
Coping strategies scoring demonstrated 57% of patients improved in their ability to re-
interpret pain; 63% of patients showed improvements in not catastrophising pain and 57%
were able to think positively about coping by themselves.
Given these patients are the most complex pain patients we see, these outcomes are
positive.
Clinical Developments
40
41
LEAP Programme
LEAP is a group environment that offers motivational interviewing and a 6 week pain
management programme. In our Quality Account for 2017/18 we announced the
commencement of the LEAP groups. This year we are reporting on the outcomes for
patients following the group sessions.
Psychology metrics have been measured post these groups.
128 questionnaires for depression showed 35% of patients improved post pain
management classes. 116 questionnaires for anxiety showed 50% of these patients
improved. As these classes are designed to empower patients to self-manage pain and
are not directed at reducing anxiety and depression per say, these results show a wider
impact for these classes.
Clinical Innovation
Best Patient Experience
Patient Surveys
CIC believes that patient feedback is essential as it provides a rich source of
information about the quality of the services we provided. As an organisation we
have set out the key principles in our Credo to ensure we listen and act upon what
our patients tell us. The most effective way has been through the collection of
rapid response feedback, which provides real time information which is promptly
acted upon by the teams.
CIC participates in the ‘Friends and Family Test (FFT)’ using paper based collection
cards. This is supplemented with the use of text message and electronic collection
through an iPad. This enables patients to provide feedback through different
methods.
The ‘would recommend’ score is the number of responses recommending the
service over the total number of response cards received. A score of 95% or above is
considered high. During 2018/19, our average recommendation for CIC Greenwich
‘would recommend’ was 98.5%. For CIC Bedfordshire, our average ‘would
recommend’ for 2018/19 was 96%. CIC fell below the target of 40% response rate for
feedback. We recognise this may be a result of a change in methods of capturing
patient feedback as we have also promoted patients to give feedback via PALS and
NHS Choices. Subsequently, our MSK Team will be promoting patient feedback
through all methods used to capture feedback, including a new emphasis on
feedback cards to improve response rate.
In taking patient feedback seriously we have recruited a Patient Representative to
build the connections with patients, the local community and staff. The role of the
Patient Representative involves being an active member of the patient community
by attending borough-wide GP Surgery Patient Participation Groups (PPGs) and
providing feedback to CIC, being a portal of communication between patients and
the MSK service, and assisting the recruitment of members of the CIC PPG. The
Patient Representative is also involved in staff events such as our Quarterly
Partnership Sessions where we discuss performance, patient feedback and service
improvements, to truly embed that link between patients and the service.
42
CIC have strengthened our relationship with our local Healthwatch groups, working with
them to undertake patient focus groups and surveys and supporting some of their events to
meet more of the local community and hear their views. A dedicated team from CIC
Bedfordshire regularly have meetings with Bedford Borough Healthwatch and Central
Bedfordshire Healthwatch. These meetings facilitate conversations regarding patient
experience and ways in which the service can improve its relationship with the community.
Following the Central Bedfordshire independent review of CIC Bedfordshire, the service
presented updates to the suggested action points in the review to the open board meeting
of the Central Bedfordshire Healthwatch.
CIC Greenwich has been working with Healthwatch Greenwich since April 2017 to
proactively seek feedback. Healthwatch have visited the Greenwich Hub on several
occasions in 2017 and 2018. Both Greenwich and Bedfordshire Healthwatch’s have taken a
patient survey on CIC’s behalf to provide knowledge on patient experience and patient
perception of the service.
Senior staff have attended CCG Patient Participation Groups to report on the service and
discuss any issues, they have also attended locality boards for GP’s and Practice Manager
forums.
43
“Lots of relevant questions asked and time to explain given.
Nothing to improve next time.”
“Really good service felt he took plenty of time to go through
everything with me”
“Appointment on time ,excellent clinician, everything explained,
further appointment made. First class service. Thankyou”
Complaints, Concerns, Comments, Compliments (4Cs) & PALS
Circle Integrated Care places feedback from our patients at the very heart of the
service and utilise this feedback to ensure that we are maintaining high standards of
care. We operate a complaints process that responds flexibly, promptly and
effectively to the justifiable concerns of complainants, which therefore enables CIC
to address unacceptable practices promptly, support complainants effectively and
promote public confidence in our services.
CIC Bedfordshire received 499 pieces of feedback during 2018/19 which comprised of:
• 57 complaints
• 29 concerns
• 19 comments
• 394 PALS (Patient Advice & Liaison Service) enquiries
• 12 compliments
Patients who complained represent only 0.1% of the referrals CIC Bedfordshire
received.
1e. Chart showing types of feedback from 1st April 2018 to 31st March 2019 for CIC
Bedfordshire
44
57
29 12
19
394
Complaints by Type
Complaint
Concern
Compliment
Comment
PALS
Complaints, Concerns, Comments, Compliments (4Cs) & PALS continued
CIC Greenwich received 102 pieces of feedback in 2018/19 which comprised of:
• 6 complaints
• 8 concerns
• 2 comments
• 73 PALS (Patient Advice & Liaison Service) enquiries
• 13 compliments.
Patients who complained represent only 0.02% of the referrals CIC Greenwich
received. The Quality & Assurance Facilitators manage the 4Cs and PALs process (as
well as the wider governance agenda). The Facilitators support staff to ensure that all
feedback is captured on the Circle’s Risk Management System to ensure full visibility
and reporting, and to enable learning from this feedback.
1f. Chart showing types of feedback from 1st April 2018 to 31st March 2019 for Circle
Integrated Care Greenwich
45
68
13
2
73
Complaints by Type
Complaint
Concern
Compliment
Comment
PALS
Complaints, Concerns, Comments, Compliments (4Cs) & PALS continued
46
Complaints and concerns represent 17% of the feedback received for the CIC Bedfordshire
during 2018/19 as opposed to 61% during 2017/18.
There has been an increase in PALS from 19 in 2017/18 to 394 in 2018/19.
Complaints and concerns represent 13% of the feedback received for the CIC Greenwich
during 2018/19 as opposed to 62% during 2017/18.
There has been an increase in PALS from 6 in 2017/18 to 73 in 2018/19.
CIC strive to provide support for all patients who feel they have not had a positive
experience in the service and want to learn from their concerns to improve services as
appropriate. CIC services are guided by the patient as to how they want to proceed with
their concerns or raise complaints. Most importantly patients have the opportunity to feel
heard, this helps CIC deliver a great service.
Over the past year we have further strengthened our feedback processes through inviting
patients who have made a complaint into the service to meet some of the team members
and have a face to face discussion so we can understand their concerns in more detail and
take further action as appropriate. Complainants are identified by the Quality & Assurance
Facilitators upon raising their complaint, and are then invited in to CIC to have a meeting
with a senior clinician, Operations Lead and the Quality & Assurance Facilitator.
During the meeting, patients have the opportunity to discuss their individual complaint, as
well as identify ways in which CIC could improve the service. This is advantageous to CIC’s
development and integration in the community, as well as for improvement to patient
pathways.
“Very friendly person on the phone. Clear questions.
Appreciated being able to speak to someone. Can't think of
anything that could be done differently”
The top 5 themes from complaints and concerns during 2018/19 for CIC
Bedfordshire are as follows. We have used this information to feed into our
Quality Improvement Priorities for 2019/20.
1g. Chart showing top 5 themes of complaints and concerns from 1st April 2018 to
31st March 2019 for CIC Bedfordshire
1h. Chart showing top 5 themes of complaints and concerns from 1st April 2018 to
31st March 2019 for CIC Greenwich
47
30
21
8
7
5
Complaints by Subject
Communication (oral)
Appointment
Communication(written)
Attitude and behavior
Clinical treatment
5
3
2
1
1
Complaints by Subject
Communication (oral)
Appointment
Attitude and behavior
Clinical treatment
Communication(written)
As these themes demonstrate, patients raise concerns around appointments,
communication and explanations about their pathway. In response to these themes we
have already provided customer service training to the team and amended our phone
system to enable people to get to the right person to help with their query. We are in the
process of installing a more sophisticated phone system. CIC reviews our waiting times in
the hub weekly with the aim of ensuring they are as low as possible. All patient feedback is
shared with our clinicians to support learning where inappropriate behaviour has been
identified. This is managed through one-to-one meetings with line managers to encourage
staff to reflect and learn from feedback.
48
“I feel confident that my condition is being taken seriously and that there is a
plan in place to help treat it. I can't think of how you could improve things. I
think the system works well for me.”
Staff Engagement
Circle Operating Systems (COS) Partnership Afternoon
Clinical and non-clinical staff members of CIC regularly come together at quarterly Circle Operating
System (COS) Partnership Afternoons. These afternoons consist of ‘Team Updates’ where we review the
opportunities for the team and discuss where we are in terms of performance and feedback. These
sessions are interactive where staff are encouraged to participate in activities that re-iterates what
Circle stands for and our six behaviours (Passion, Disruption, Agility, Humanity, Partnership and
Resilience). Speakers are invited to cover relevant topics to support continuous learning and service
improvement. They may be internal or external including Patient Representatives, local Healthwatch
and Security Management specialists. These sessions are well attended by both Bedfordshire and
Greenwich teams, as well as those from other Circle hospital sites and Circle Head Office. The 9 CIC
COS Champions run the session. COS Champions are recruited on the basis of enthusiasm and dedication
to the service and its patients. COS Champions regularly instil this into the everyday working
environment alongside the COS Partnership Afternoons in order to ensure we have our culture of being
agents of our patients, empowering staff and continuous learning is maintained.
The COS team covered the following topics to reinforce our Circle Behaviours in the last year:
Q1 – SWARM & Stop the Line (problem solving approach and ability for any member of the
team to ask for a halt to activity if they see something unsafe)
Q2 –Updating on the Governance structure and decision making hierarchy)
Q3 – Improvement projects (plan, do, check, act).
Q4 – Partner Empowerment –how do we live the credo and our behaviours?
49
Operational Updates
50
Hub relocation
In 2018/19 CIC took on two triage services, as well as increased more MSK activity into the
community. This meant an increase in the number of administration staff. In order to
accommodate these staff and provide suitable space for meetings and an optimal work
environment it was decided to relocate the staff who were based on the second floor of
the Enhanced Services Centre in Bedford to premises in Regent House on the Woburn Road
industrial estate. This move happened on 29th April 2019. The first floor of the Enhanced
Services remains the main clinical location for the service.
Telephone system
In 2019 Circle moved telephone platforms to UCONE successfully. This cloud based
platform bring greater flexibility in allocating call handlers to meet incoming demand and
provided patients with clearer routes to deal with their enquiries. Alongside this we have
gained greater visibility of call volumes and reason for call. With this greater visibility we
are now responding to this information to maximise patient experience as well as that for
our sub contracted providers.
Synertec
In February 2019 CIC introduced an IT solution to automate the printing of patient letters
including postage. This solution provides a great way for ensuring patients receive timely
communication by letter when needed, it also allows reporting on letters sent therefore
quickly identifying any potential issues. We are in the process of maximising this
technology to incorporate enhanced features such as braille and large print. This ensures
compliance with the Accessible Information Standard.
Staff survey
In 2018/19 the staff survey was undertaken. There was a change in the levels of
satisfaction shown compared to the previous year. CIC acknowledges that the survey was
undertaken at a time of considerable change during the hub move and will be redoing the
survey a few months after the move. Any issues still being raised in the second survey will
be addressed by the service.
Staff Engagement
MSK Academy
The MSK Academy has been embedded in CIC Bedfordshire in 2017/18 and is being rolled
out in CIC Greenwich in 2018/19. Alongside the Academy a new career pathway has been
introduced which links with the Academy competencies. This gives clinical staff a clear
and structured pathway to further their career in CIC.
Employee Assist Scheme
Circle Health initiated a group wide change to the scheme provided for staff. This
Employee Assist scheme is independent of CIC and offers advice on many issues e.g.
stress, financial issues. Staff access this scheme individually and in confidence. This
allows CIC to provide appropriate support to ensure staff wellbeing.
Circle Operating System Partnership days
CIC Bedfordshire have embedded the partnership days in 2018/19 and CIC Greenwich have
held their first partnership days. These partnership days ensure staff are empowered to
get involved in the evolution of the service.
51
Staff Engagement
Salutations (Greetings)
CIC has embedded call salutations for administrative teams to ensure patients receive the
same consistent and high calibre care each time they interact with the service. This has
also given administration teams increased confidence on the telephones.
Awards and Conferences
CIC were shortlisted for two awards in 2018/19, Laing Buisson and Health Investor Best
Public-Private Partnership Awards. CIC have been awarded a 2 year extension in our
Bedfordshire contract . This has given us a stronger platform to continue to innovate
across the Community. CIC were asked to present at the Heath + Care Conference in June
2018 and HSJ Integrated Care Summit in September 2018.
Staff Safety and Wellbeing
CIC strongly promote an environment free from abuse and bullying. We operate a Zero
Tolerance Policy that means no member of staff will be accepting of any act of
aggression, violence or intimidation, both physical and non-physical from any member of
staff, patient or member of the public.
52
Quality Improvement Priorities for Bedfordshire 2019/20
53
CQC
Domain
Our Quality
Priorities
for 2019/20
Success Measures for 2019/20
Monitoring &
Reporting
Responsibilities
Responsive
Caring
Well Led
Feedback from
service users to be
collected across a
variety of sources
Feedback form service users to be
collected by methods to include
HealthWatch surveys, focus groups
and patient champions in addition
to cards and texts
Executive Board
Patient education
sessions to be held
around the county,
increasing on the
number held in the
previous year
An increase in the number of
sessions and the locations they are
held atExecutive Board
Safe
Effective
Ensure evidence
based treatment
pathways are
embedded using the
‘Circle 6’
Audits of pathways to show
compliance with evidence based
pathways and treatments offeredExecutive Board
Review of current
Patient Related
Outcome
Measures(PROMs) to
ensure most effective
are being used
Embedding any recommendations
within the assessment templatesExecutive Board
Caring
Responsive
Well Led
Implement a review
of the staff wellbeing
strategy
Staff survey results to be analysed
and an action plan to be put in
placeExecutive Board
Offer an ‘In Your
Shoes’ opportunity to
all staff to shadow
other staff members
All staff survey results to be
analysed to ensure compliance Executive Board
Quality Improvement Priorities for Greenwich 2019/20
54
CQC
Domain
Our Quality
Priorities
for 2019/20
Success Measures for 2019/20
Monitoring &
Reporting
Responsibilities
Responsive
Caring
Well Led
Feedback from
service users to be
collected across a
variety of sources
Feedback form service users to be
collected by methods to include
HealthWatch surveys, focus groups
and patient champions in addition
to cards and texts
Executive Board
Patient education
sessions to be held
around the county,
increasing on the
number held in the
previous year
An increase in the number of
sessions and the locations they are
held atExecutive Board
Safe
Effective
Ensure evidence
based treatment
pathways are
embedded using
the ‘Circle 6’
Audits of pathways to show
compliance with evidence based
pathways and treatments offeredExecutive Board
Review of current
Patient Related
Outcome
Measures(PROMs)
to ensure most
effective are being
used
Embedding any recommendations
within the assessment templatesExecutive Board
Caring
Responsive
Well Led
Implement a
review of the staff
wellbeing strategy
Staff survey results to be analysed
and an action plan to be put in
placeExecutive Board
Offer an ‘In Your
Shoes’ opportunity
to all staff to
shadow other staff
members
All staff survey results to be
analysed to ensure complianceExecutive Board
Mandatory Statements
Review of Services
During 2018/19 CIC Bedfordshire provided and/or sub-contracted a number of NHS services
including MSK related physiotherapy, MSK related podiatry, community triage clinics
(Advanced Practice Physiotherapists -APPs & MSK Physicians), Orthopaedic Surgery, Pain
Management and Psychology, Rheumatology and Chronic Pain; with some associated
diagnostic procedures.
During 2018/19 CIC Greenwich provided and/or sub-contracted a number of NHS services
including MSK related physiotherapy, MSK related podiatry, community triage clinics
(Advanced Practice Physiotherapists -APPs & MSK Physicians), Orthopaedic Surgery,
Rheumatology and Chronic Pain; with some associated diagnostic procedures.
CIC has reviewed all the data available to them on the quality of care provided in all of
these NHS Services.
Registration and External Review
Circle Clinical Services Limited is required to register with the Care Quality Commission
and its current registration status is registered and has been inspected. This registration
covers both CIC Bedfordshire and Greenwich. The Care Quality Commission has not taken
enforcement action against Circle MSK services during 2018/19.
Site Regulated Activity
Registered Address –
Circle MSK Bedfordshire
Enhanced Services Centre
3 Kimbolton Road
Bedford
Bedfordshire
MK40 2NT
• Diagnostic and screening
procedures
• Surgical procedures
• Treatment of disease, disorder or
injury
Local Greenwich Satellite –
Circle MSK Greenwich
30 Passey Place
Eltham
London
SE9 5DQ
• Diagnostic and screening
procedures
• Surgical procedures
• Treatment of disease, disorder or
injury
55
CQC Inspection Area Ratings
The CQC inspected CIC on 20th September 2018. The inspection was carried out under
Section 60 of the Health and Social Care Act 2008 as part of the CQC regulatory functions.
The inspection team consisted of a lead CQC inspector, a GP specialist advisor and a nurse
specialist advisor to the CQC.
The summary of findings from the report were stated as :
Are services safe?
We found that this service was providing safe care in accordance with the
relevant regulations.
Are services effective?
We found that this service was providing effective care in accordance with
the relevant regulations.
Are services caring?
We found that this service was providing caring services in accordance with
the relevant regulations.
Are services responsive?
We found that this service was providing responsive care in accordance with
the relevant regulations.
Are services well-led?
We found that this service was providing well-led care in accordance with
the relevant regulations.
56
CQC Inspections and rating for specific services
The CQC inspection was undertaken under the Doctor/GP framework, at the time of
inspection this framework did not provide an overall rating. A link to the full CQC report
can be found at https://www.cqc.org.uk/location/1-2955328850.
Commissioning for Quality and Innovation (CQUIN) Payment Framework
A proportion of CICs income in 2018/19 was conditional on achieving quality improvement
and innovation goals agreed between CIC and their respective CCG’s, through the
Commissioning for Quality and Innovation payment framework. The Bedfordshire scheme
related to the setting up of a patient helpline, stakeholder engagement, falls prevention
and patient education. The Greenwich scheme related to improving staff health and
wellbeing, advice and guidance for GP’s, Preventing ill health by risky behaviours – alcohol
and tobacco, Improving the uptake of flu vaccinations for frontline clinical staff.
Data Quality
CIC maintains a high level of data quality and regularly reviews this to ensure we have a
robust view of the service performance in order to gain assurance that the data used to
manage the service and understand current performance is accurate. We do this through
reviewing metrics on a daily, weekly and monthly basis. This is supported by a suite of
reports generated from strategic reporting in SystmOne and our bespoke Data Warehouse.
This is further supported by a regular review of the data behind the reports to ensure
accuracy. Investigations are undertaken on ad hoc where data anomalies are identified
during our regular reviews of the data.
Secondary Uses Services
CIC services submitted records during 2018/19 to the Commissioning Data Set for inclusion
in the Hospital Episode Statistics which are included in the latest published data.
The percentage of records in the published data which included the patient’s valid NHS
Number was:
• 100% for outpatient care
57
Participation in Clinical Audits & National Confidential Enquiries
During 2017/18, there were no national clinical audits and no national confidential
enquiries that covered NHS Services that CIC provides.
The local clinical audits that CIC Bedfordshire and CIC Greenwich undertook in during
2017/18 are as follows:
Name of AuditAudit
CategoryComplete/Ongoing
When
measured
Referral to secondary care from clinic Internal Ongoing Daily
Referrals triaged to Secondary Care Internal Ongoing Daily
Reason for rejected referrals Internal Ongoing Monthly
‘Red flags’ notes audit Internal Ongoing Biannually
Medical Records (Clinical Notes Audit) Internal Ongoing Quarterly
Infection Prevention & Control Internal Ongoing Annual
Hand Hygiene Internal Ongoing Monthly
Environmental Audit Internal Ongoing Monthly
Fire Safety External Complete Annually
Compassion in Care Internal Ongoing Monthly
Resuscitation Equipment Internal Ongoing Weekly
Peer review of clinical assessments and
injection techniques
Internal Ongoing Biannually
Injection Clinical Outcomes Internal Complete Annually
Diagnostic request audit Internal Complete Annually
Fire Warden Audit Internal Ongoing Monthly
Out of Hours Audit Internal Complete Annually
ISO 27001 Internal Audit Report External Complete Annually
Health and Safety Audit Internal Ongoing Monthly
Health and Safety Audit Internal Complete Annual
Waste management audit (Greenwich
only)
Internal Ongoing Monthly
58
The aim is to take the following action to improve the quality of the healthcare provided:
• Share findings of audits at the CGRMC.
• Ensure dissemination of learned themes from audits.
• Give visibility to all team members of the audits that are planned for the year.
• Utilise the results of audits to improve clinical outcomes and improve patient
pathways.
Participation in Clinical Research
CIC is working in collaboration with Loughborough University to scope research projects
only with patients express consent and aligned to GDPR guidance..
Data Security and Protection Toolkit
A group-wide submission for the DSPT was submitted in March 2019.
Safeguarding
The Executive Board is accountable for and committed to ensuring the safeguarding of
children and all adults in their care. CIC also has a responsibility to liaise with other
agencies and provide information to them where necessary, to ensure the ongoing safety of
children and vulnerable adults once they leave our care.
Circle has a Safeguarding Policy that applies to all its facilities including CIC, the current
policy was issued in May 2018. CIC Bedfordshire adheres to the Bedford Central and
Bedford Borough Local Authority safeguarding procedures. CIC Greenwich adhere to the
Greenwich Borough Local Authority Safeguarding Procedures. All policies are available to
staff via the electronic policy library.
CIC provides all staff with Level 2 training in safeguarding. CIC has two dedicated
Safeguarding Leads who have Level 3 training (Clinical and Governance Leads). This has
been reviewed in line with the January 2019 intercollegiate document. The NHS
safeguarding app is available to all staff through the Circle Intranet and staff are
encouraged to download the app onto their mobile phone providing staff with the up to
date contact numbers and guidance where required.
The Corporate Quality and Assurance metrics reports safeguarding incidents and these are
discussed at the Clinical Governance and Risk Management Committee. The Executive
Board takes the issue of safeguarding extremely seriously and receives an annual report on
safeguarding.
59
Payment by Results
CIC was not subject to the Payment by Results clinical coding audit during 2018/19 by the
Audit Commission
Duty of Candour
Circle implements the statutory Duty of Candour Regulation of the Health and Social Care
Act 2008 (Regulated Activities) Regulations 2014 which came into legal force in 2015 and
builds on the requirements set out in the Being Open Framework 2009 “Being Open –
Saying Sorry When Things go Wrong” National Patient Safety Agency (NPSA), and Safety
Alert 2009
Circle has a Duty of Candour policy that applies to all facilities within Circle, this policy
was issued in November 2016. The aim of the policy is to help all health professionals to
apply Duty of Candour principles within their daily work. All incidents which involve Duty
of Candour are discussed within the Clinical Governance and Risk Management committee
meetings on a monthly basis, which are then taken to the Executive Board
There has been no statutory reporting to the CQC for Duty of Candour for CIC services
during 2018/19
Revalidation
CIC has embraced the process of revalidation for medical staff in 2018/19. This is fully
implemented and compliance is monitored quarterly by the Circle Integrated Governance
Committee
Freedom to Speak Up
Circle Health is committed to the principles of the Freedom to Speak Up review; listening
to our staff, learning lessons and improving patient care. Anyone who works (or has
worked) at Circle Health can raise concerns. This includes agency workers, temporary
workers, students and volunteers. Staff can speak up if they have concerns over risk,
malpractice or wrong doing. Examples of this may be regarding the quality of care, patient
safety or bullying and harassment within the organisation.
Circle has a Director who is the Freedom to Speak Up Guardian with board level
responsibility and each Circle site has Speak Up Guardian champions who staff can raise
concerns with. In addition, there is a non-executive Director with responsibility for
whistleblowing.
60
Freedom to Speak Up
Staff are encouraged where appropriate, to raise concerns formally or informally with
their line manager. Where they don’t think it is appropriate to do this, they are
encouraged to contact the Freedom to Speak Up champions or guardian. Concerns can be
raised in person, by telephone or in writing (including email).
Circle hopes that staff feel comfortable raising concerns openly, but we also appreciate
that they may want to raise it confidentially or anonymously. Where an individual wishes to
remain anonymous, Circle will keep their identity confidential unless required to disclose it
by law.
Any individual who raises concerns can expect to be treated with respect at all times.
When a concern is raised, we discuss the concerns with the individual to understand
exactly what they are worried about. We confirm how long we expect the investigation to
take and agree how we will keep the individual up to date with its progress. Wherever
possible, we share the full investigation report with the individual who raised the concern.
Where an investigation identifies improvements that can be made, these are monitored by
the site executive board and lessons are shared with teams across the organisation through
the Integrated Governance Committee.
The Circle Group Operating Board has company wide responsibility and oversight for
quality and assurance. The Freedom to Speak Up Director provides the board with high
level information about all concerns raised by our staff through this policy and actions
taken to address any problems.
61
62
Getting in touch
Contacts
Comments and Complaints
Please speak to or address your correspondence to the Quality & Assurance
Facilitator.
Telephone: 01234 639089
In writing: Regent House, Wolseley Road, Woburn Road Industrial Estate, Kempston,
Bedford, MK42 7JY
Via email: [email protected]
Bedfordshire (CQC Registered address)
Enhanced Services Centre,
3 Kimbolton Road,
Bedford,
Bedfordshire,
MK40 2NT
01234 639000
Greenwich
Eltham Community Hospital
30 Passey Place,
London,
SE9 5DQ
0203 893 8382
Acronyms
A glossary of all acronyms in the Quality Account
CAS – Central Alerting System
CCSL – Circle Clinical Services Limited, or CIC for short.
COS – Circle Operating System
CQUIN - Commissioning for Quality and Innovation
APP – Advanced Practice Physiotherapist
FFT – Friends and Family Test
HCA – Health Care Assistant
IPH – Integrated Provider Hub
LEAP – Lifestyle, Education, Activity and Pain management Programme.
MDT – Multi-disciplinary team
MSK – Musculoskeletal
PPG – Patient Participation Group
SDIP – Service Development Improvement Plan
SQPR – Service Quality Performance Report
63
Comments
Bedfordshire Clinical Commissioning Group (BCCG)
Comments from Bedfordshire Clinical Commissioning Group on Circle Quality
Account 2018/19
Bedfordshire Clinical Commissioning Group (BCCG) acknowledges the receipt of Circles Quality
Accounts 2018/19, which has been shared for comments.
We have appraised the information provided within the Quality Account and cross referenced
data with information that is submitted to BCCG as part of Circles contractual obligation.
BCCG is pleased to note Circle Health’s CQC inspection in September 2018 and
recognise Circle Bedfordshire are reported by CQC as providing safe, effective, caring,
and responsive and well led services.
The Circle quality account reflects on priorities for 2018/19 and achievement and progress
against these. 2018/19 focussed on referral activity and implementing support for patients
using alternative treatments and videos instead of paper exercise sheets. We recognise
the demonstration of improvement that is outlined in these accounts
Circle’s quality priorities for 2019/20 are a continuation of the quality strategy priorities and
are based on the feedback received from patients in 2018/19.We note that a developed
structure is in place for measurement and reporting of performance against these
priorities.
Bedfordshire Clinical Commissioning Group welcomes the opportunity to comment on this
report and looks forward to a new year of working with colleagues at Circle to monitor the
continued Quality and Safety and increased service user input in the wide range of service
provision for patients in Bedfordshire.
Anne Murray Chief Nurse Bedfordshire, Luton & Milton Keynes Commissioning Collaborative
64
Comments
Healthwatch Bedford Borough (HBB)
65
Community Interest Company No 8385413
21 - 23 Gadsby Street Bedford MK40 3HP Telephone 01234 718018 Email:[email protected] Website: www.healthwatchbedfordborough.co.uk
Ms Amanda Phillips Director of Integrated Care Operations Circle Integrated Care
(by email)
Dear Amanda
Circle Integrated Care (CIC) Quality account 2018 - 2019
19th June 2019
Healthwatch Bedford Borough (HBB) is pleased to be requested to comment on this important document.
As you will be aware HBB has been supporting CIC in its desire to become “user” (Patient) driven.
It is pleasing to note on page 10 about the savings of over £19 million for the BCCG, which is hopefully being channelled into further improvements in patient care in Bedfordshire.
The CIC Operational Model shown on page 19 is to be commended, but it will rely on all elements of the Integrated Provider Hub being fully effective at all times.
On page 44 there is reference to 499 pieces of feedback during 2018/19 which comprised of complaints, concerns, comments and PALS (Patient Advice & Liaison Service) enquiries. It would be helpful to know whether the number of PALS enquiries shown includes complaints at all, or whether they are purely
“directional” enquiries.
HBB has looked at the processes for Concerns and Complaints as published on the CIC website – it is really not quite clear how a patient should distinguish between a “concern” and a “complaint”. Indeed it indicates that in respect of a concern “to confirm all the points you have raised which will be investigated. This gives you an opportunity to amend the points as appropriate and you will be moved to the complaints process”. Some clarification on these matters might be appropriate.
On page 50 there is the comment that “In 2019 Circle moved telephone platforms to UCONE successfully”. HBB is not quite clear as to whether this is the system referred to in the November 2018 letter from the Director of Operations.
In summary the Quality Account presents a positive position and HBB is pleased to see the Quality Improvement Priorities for Bedfordshire 2019/20.
Yours sincerely
Laurie Hurn Laurie Hurn Manager and Company Secretary
Comments
Healthwatch Central Bedfordshire
66
Circle Clinical Services Limited (‘Circle Integrated Care’) Quality
Account June 2019
Review by Healthwatch Central Bedfordshire
Circle Integrated Care are in the fifth year of delivering musculoskeletal (MSK) healthcare
in Bedfordshire.
Healthwatch Central Bedfordshire (HWCB) continue to have contact with patients from the
service, who have concerns or issues, ranging from: access, communication, treatment
issues and choice. We are encouraged by the prompt and thorough responses that we have
received from the PALS team.
HWCB are concerned to see that patient issues are often about similar themes, which the
service needs to consider and investigate further, as common themes often highlight
problems in the system, and if addressed, can drive improvements in practice. We will
continue to monitor the feedback we receive and communicate both individual cases and
thematic issues as appropriate.
In relation to sub-contracting provision, Circle has robust quality monitoring processes in
place, however it would be helpful to understand how much of the work is delivered under
these arrangements.
The quality improvement priorities table clearly sets out what Circle is looking to achieve
and HWCB would like to see more examples in the Quality Account on how these
achievements and other work have improved the patient experience.
In relation to patient feedback we note that there are four categories including enquiries,
complaints, concerns and compliments. It is encouraging to see that ‘Patients who
complained represented only 0.1% of the referrals’. It is, however, important to consider
that this is only representative of those who actually make contact to raise their concerns.
We are pleased to see that Circle continues to explore new ways to gain patient feedback.
HWCB also feel it is important that the range of staff, with differing job descriptions, should
communicate their roles and responsibilities more effectively to prospective patients. This
will help build patient confidence in non-clinical/less qualified staff.
Healthwatch Central Bedfordshire would welcome the opportunity to build on the patient
experience work undertaken in April 2018 to include an open dialogue with the Patient
Representative. HWCB are also keen to include Circle MSK in our public events, such as the
Festival for Older People in October, where their presence in the past has been valued by
visitors.
Healthwatch Central Bedfordshire Capability House, Wrest Park, Silsoe, MK45 4HR Email: [email protected] Tel: 0300 303 8554
www.healthwatch-centralbedfordshire.org.uk
Comments
Healthwatch Greenwich
67
Healthwatch Greenwich Response to Circle MSK 2018-2019 Quality Account
Healthwatch Greenwich welcomes the opportunity to comment on the quality of service provided by
Circle MSK as compiled in the 2018-2019 Quality Account.
General Comments
Healthwatch Greenwich would like to praise the wide range of improvements on quality of service and
patient experience in 2018/19 as compared with the previous year. In future reports, it would be useful
to see trends set out over a longer time period (three years) rather than from year to year.
We welcome the addition of the glossary, as suggested in our feedback to the 2017/18 Quality Account.
As suggested last year, the addition of a brief executive summary and an Easy Read version would
increase accessibility of this document and we are disappointed not to see them.
Service Progression
We are pleased to see all referrals triaged within 24 hours and a decrease in waiting times. We welcome
the new community location (Grabadoc) giving additional convenient access for Greenwich residents, a
significant increase in community activity and high patient satisfaction ratings for community clinics. Easy
access to services is of key importance to Greenwich residents and we are pleased with the progress CIC
has made to facilitate this.
Some Greenwich residents report difficulties getting through on telephone lines to the service and
needing to ‘chase’ appointments, suggesting there are administrative concerns that need to be
addressed. Our findings mirror the data provided by CIC in which the main categories of non-positive
feedback concern problems with administrative processes. We are pleased to see that a full review of
administrative processes has been undertaken.
The introduction of innovation in self-management (Physitrack and Physioline) are useful additional
tools, however without independent evaluation it is difficult to form a view on patient experience in the
use of these tools. Healthwatch Greenwich are keen to work with CIC to evaluate patient experience in
the use of these new tools as part of an annual independent review of the service (as we did in 2017/18).
Healthwatch is pleased to see that no serious incidents or ‘never events’ were recorded for 2018/19.
Patient Engagement
CIC carry out a broad range of internally led activity to gather patient feedback experiences, satisfaction
levels are high and complains and concerns have reduced significantly from 2017/18. However, response
rates for patient feedback have not met agreed targets. There is still some work to do to increase
response rates and analyse responses by protective characteristics to ensure all service users have a
Comments
Healthwatch Greenwich
68
positive experience. Overall, CIC would benefit from an annual, independent, review of patient
experience.
Quality Improvement Priorities for 2019/20
We are pleased to see an emphasis on patient experience and welcome the use of broader methods to
collect feedback. However, the priorities lack measurable success thresholds. This will make it difficult to
assess the extent to which these targets have been met in 2019/20.
Healthwatch Greenwich
June 2019
69
Enhanced Services Centre, 3 Kimbolton Road,
Bedford, Bedfordshire, MK40 2NT