Rural Locality Network Meeting 2-5pm on Tuesday 13 … · Tanya Jefcoat-Malam . 3. Declarations of Interests Nil : 4. Admission Avoidance . ... Suzanne Fennah, Cath Kitching, Dr Kausik

Rural Locality Network Meeting 2-5pm on Tuesday 13 October 2015 at Cheshire View, Chester

Chair – Steve Pomfret APPROVED MINUTES

Attendants: (see the embedded attendance list at the end of this document)

In attendance: Philippa Robinson Interim Director of Operations (WCCCG) Sarah Murray Programme Lead Primary Care and Membership Engagement (WCCCG) Diane Taska Locality Support Manager for Rural (WCCCG) Suzanne Fennah Commissioning Manager, West Cheshire Clinical Commissioning Group John Hodgson Hospital @ Home Dr Kausik Chatterjee Countess of Chester Hospital Diane Taska Locality Support Manager (WCCCG) Nick Thompson Membership Support Officer (Minutes), (WCCCG)

Practices not represented by a GP: Frodsham Medical Practice, Kelsall

Key Points to Communicate to your Practice Admission Avoidance See below for further details – Item 4. Membership Council Review See below for further details – Item 5. Admission Avoidance See below for further details – Item 4. Membership Council Review See below for further details – Item 5. CCG Update See below for further details – Item 6.

Agenda No

heshire Action

1. Welcome & Introductions The Chair welcomed members to the Network meeting..

2. Apologies Tanya Jefcoat-Malam

3.

Declarations of Interests Nil

4.

Admission Avoidance

Minutes of Rural GP Network by 1 NHS West Cheshire Clinical Commissioning Group Date: 14/07/2015

Suzanne Fennah, Cath Kitching, Dr Kausik Chatterjee and Dr John Hodgson attended the meeting to discuss some new schemes and advances in existing schemes aimed at providing alternatives to admission. • Single Point of Access Suzanne Fennah explained that Single Point of Access has been piloted in six care homes in the area and now rolled out to all care homes, nursing homes and residential homes. Based on a criteria of conditions (attached), Single Point of Access aims to give those working in care home settings an alternative to a 999 call. Based on the condition and needs of the patient in question, Single Point of Access would then signpost the caller to appropriate services as opposed to a default admission following a 999 call. Suzanne asked that the group promote the service as much as possible to help the service grow. • Clinician2Clinician Pilot Dr Kausik Chatterjee attended the meeting to tell the Network about a pilot he and some colleagues from the Countess of Chester Hospital had been involved with. He showed a presentation (attached) detailing the scheme which involved GPs being given a phone number that led directly to the Clinican2Clinican service. A GP preparing to organise a medical admission would call this number, the call would then move between the mobile phones of Dr Chatterjee and a number of his colleagues until the call is answered, and the GP could then discuss the case with the consultant in order to ascertain whether admission is necessary. The Network enquired as to whether Dr Chatterjee’s data was able to be broken down per Locality Network in order to understand the difference between call rates across the area. It was explained that this has been done and there is in actual fact only small differences from one Locality to the next. The Network wondered whether it was necessary to call SPA, give a full clinical background in order to have the call directed to the Clinician 2 Clinican pilot and have to repeat the clinical background all over again. The Network heard how a similar point was raised at Network meetings prior to this one, and as a result slight amendments have been made to the SPA > Clinician 2 Clinician pathway. GPs can now ask to be directed straight through to Clinician 2 Clinician and thus only having to give the clinical background once. The Network asked whether the Clinician 2 Clinician outcome data could be slightly skewed by calls from GPs seeking only ‘expert opinion’ rather than admission. The Network heard that such calls had already been filtered out before the data was presented. The Network also wondered whether the outcome data reflected patients who may have been admitted later, just not at the point of the initial call. It was explained that the data only reflects patients whose initial issue had been dealt with by a means other than admission and as such would not be expected the be admitted at a later date. The Network enquired as to whether the clinicians involved in the pilot have access to other services if admission is decided to be unnecessary. The Network heard that the clinicians can book directly into Countess of Chester Hospital outpatient clinics. The Network stated that it is equally important that the data from the pilot not only reflect a reduction in admission, but also highlight training opportunities; they would be interested to know if there common themes, things that could be avoided in the future.It could also therefore be used as a commissioning tool by highlighting gaps in services provided in the community/alternative to admission. The discussion referred to an example of blood transfusion patients. Such patients are

NT/DT ALL


offered sent for admission by GPs in lieu of being able to make alternative arrangements. These patients are then not considered to be needing admission and outpatient blood transfusion is arranged instead. The suggestion therefore would be an ‘open access’ blood transfusion service available to GPs would address this issue. The Network noted that the pilot does not provide a solution for the gap between an admission and an (approximately) six week wait for a regular outpatient appointment. • Hospital at Home Dr John Hodgson attended the meeting to remind the Network about the Hospital at Home service. He explained that Hospital at Home is consistently below capacity and could be utilised much more in the aim of avoiding unneccesary admissions. The Network heard the benefits of the service as opposed to hospital admission, explaining that as the service tends to be used by vulnerable older people, Hospital at Home can sometimes provide better longterm prognoses to avoidable admission to hospital for these patients, risking further hospital acquired illnesses lengthening their stay and detracting from their quality of life on discharge. He explained that as the majority of vulnerable older people if admitted to hospital tend not to be admitted to high dependency or intensive care units, they can receive the same level of care at home through Hospital at Home providing them with better prospects for meaningful recovery and quality of life upon discharge. It was suggested by the Network that Hospital at Home could be included in a patient’s management at the diagnosis stage to avoid ‘catch-all’ terms such as UTI, which will often result in admission to hospital but could equally be managed in the home by Hospital at Home. It was explained that Hospital at Home would much prefer to see a patient ‘sooner rather than later.’ It was suggested by the Network that a flowchart illustrating the referral process for sending a patient to Hospital at Home could be compiled and provided to care and nursing homes to avoid the common trap of patients being admitted via ambulance during the evening by care staff in the absence of GP advice. Work is underway on this document already. It was stressed that a plan to utilise Hospital at Home more thoroughly must be decided, both because the current financial pressures on the CCG mean that existing assets must be fully utilised, and because the stretched capacity at the Countess of Chester Hospital will struggle to cope with the winter months. The Network commented that a sizeable influence on admitting elderly patients is often the relatives. It was explained that although a patient might be admitted to a hospital ward, they may only see a clinician three or four times a day on ward rounds so they will not necessarily receive any closer care than through Hospital at Home. The Network requested that a quarterly Hospital at Home update be circulated to keep GPs abreast of changes to the service.

5. Membership Council Review

The Chair explained to the Network that he and a cohort of Practice Managers, GPs, CCG staff and the Head of the Patient Participation Group took part in a visit to the


Bromley-By-bow Centre in the Tower Hamlets borough of London. The centre is part of a somewhat unique community focused and community led approach to health and social care. It was felt that by visiting the centre and experiencing the methods and outcomes, the representatives from West Cheshire may find useful things to consider in relation to the West Cheshire Clinical Commissioning Group.

The Network heard that the centre grew out of a need for community activities and facilities. Various clubs and groups from within the community began to be based at what original a disused church and over time the number of services offered at the centre, and the number of people using using them, grew. The centre now houses primary care and social care within the same complex and maintain the same focus on community needs. A full report by those in attendance is attached.

The Network raised a few points cautioning against considering the way the Bromley-By-Bow Centre has set itself up as completely applicable to West Cheshire. It was noted that they must have a larger budget that WCCCG considering the denser population. It was also noted that given the denser population, Clusters (referred to as ‘Networks’ by The Bromley-By-Bow Centre) are geographically positioned to all function from one centre whereas West Cheshire are very dispersed. It was also noted that the three Locality Networks within West Cheshire Clinical Commissioning Group represent three significantly demographically different groups of patients and so it would be very difficult to provide a service from one central point that catered equally to the needs of all the patients of the three Locality Networks.

The Chair acknowledged these points but also stressed that it was interesting to observe a widely spread shared goal and such ‘buy-in’ to the idea of cluster-working. It was argued that the CQUIN is taking important steps towards bolstering cluster working but the Chair went further and explained that all funds received by Bromley-By-Bow is paid into a cluster account which West Cheshire is not yet doing. It was argued that this would not be possible without a formal agreement in place, and it was acknowledged that each Bromley-By-Bow cluster had a senior manager figure being the lynch pins to the formal agreements in place.

The discussion moved to whether the Rural Network could make their own arrangements for applying to take on Sexual Health services under Primary Care Cheshire. It was felt that this was an appropriate opportunity to begin building and developing cluster-based tenders under Primary Care Cheshire. It was agreed that Lynn Suckley and Sam Jeffries would commence work on a plan and report back at the next meeting.

6. CCG updates CCG update document circulated with agenda and again with these minutes.

3. Key CCG Meetings Summary October 20

8. Minutes of the Last Meeting No issues raised Action Points

9. Future Agenda The Chair requested that a significant portion of the neet meeting agenda be spent


discussing the Sexual Health plan and resulting contractual discussions. The Network agreed to receive a ten minute presentation from James Duckers around Year of Care. It was requested that an item around CQUIN targets for 2016/17 be included on next month’s agenda.

10. Any Other Business Nil

Next Meeting: 10 November 2015: 2.00 – 5.00pm @ Cheshire View, Christleton City & E’Port Network Minutes – September 2015

City Network Meeting - September

EPort Neston Network 03 Septembe


Outstanding Actions NB: Actions will be taken off the table upon completion

Key:

Current Overdue Ongoing Date Initiated Action By

Whom Due Date

8 September SP to look into situation regarding Macmillan taking nursing resources from the community

SP October 2015





Rural Locality Network Meeting 2-5pm on Tuesday 10 November 2015 at Cheshire View, Chester

Chair – Steve Pomfret APPROVED MINUTES

Attendants: (see the embedded attendance list at the end of this document)

In attendance:

Philippa Robinson Interim Director of Operations (WCCCG)

Sarah Murray Programme Lead Primary Care and Membership Engagement (WCCCG)

Diane Taska Locality Support Manager for Rural (WCCCG)

Nick Thompson Membership Support Officer (Minutes), (WCCCG)

Present: Helen Black Alistair Adey Andrew Campbell

Melissa Siddorn Debbie Bailey Lynn Suckley

Sam Jeffery Paul Smith Trevor Ferrigno

Practices not represented by a GP: Frodsham Medical Practice, Kelsall

Key Points to Communicate to your Practice Turnaround Status See below for further details – Item 3.

Rural Co-ordinated Provider Review See below for further details – Item 4. Cheshire West and Chester Comissioning Intentions See below for further details – Item 5.

Prime Minister’s Challenge Fund Update

See below for further details – Item 6.

Agenda No

Action

1. Welcome & Introductions The Chair welcomed members to the Network meeting.

2. Previous Minutes Nil points raised Apologies Brian Yorke Declarations of Interests Nil


3.

Turnaround Status

Philippa Robinson, Turnaround Director for West Cheshire Clinical Commissioning

Group, attended the meeting to discuss the CCG’s the situation around NHS

England’s announcement that WCCCG has been placed in local turnaround.

The Network heard that following the CCG’s disclosure to NHS England that it

expects to be in a financial deficit as opposed to the surplus it initially projected. As

a result the CCG was asked to submit a financial recovery plan to bring it back into

balance and NHS England was not reassured that the submitted plan would deliver

this balance. As a result the CCG has been placed in a status of local turnaround

and Philippa Robinson has been appointed to lead a series of cost saving measures

to help bolster the financial recovery.

The Network heard that the initial focus will be on validating and maximising

current assets. It was argued that the CCG is currently funding a number of services

and initiatives that are either recurrently funded because historically they have

been but without fully understanding the benefits of these services, or potentially

beneficial services that are not currently being utilised to their full potential. This

includes a renewed emphasis on promoting and fully utilising existing services such

as Single Point of Access and Hospital @ Home, which are relatively expensive

services but which are not currently delivering the full benefit they are capable of.

It was also argued that the CCG should begin to employ ‘contractual levers’ to

ensure that services being paid for are actually delivering the agreed value.

The Network also heard that one area of specific attention is the CCG’s referral

rates. It was suggested that there is possibly work that can be done to maximise

the alternatives to admission based in the community. The Network enquired

about further discussions following the item on previous agendas around referral

support systems. It was explained that Amanda Lonsdale is now leading on this

matter and although nothing has been decided, there will be further information

coming soon.

It was also stressed that the CCG is open to any ideas or suggestions the Network

may have to improve cost efficiency. It was stressed that all ideas would be

considered as the situation the CCG in as now serious and changes to how things

are done are now necessary.

It was argued by the Network that secondary care rarely seems to be asked

to consider ‘the big picture’ and that the responsibility to alter processes

and protocols seems to fall to primary care.

It was also noted that GPs are not necessarily aware of the severity of

specific issues and therefore which need the most specially need the most

urgent attention to address. It was also noted that they are not sure where

best to direct any ideas or suggestions. The Network heard that the CCG will

welcome ideas of any kind and will be responsible for taking them forward.


4.

Rural Co-ordinated Provider Review Sam Jeffrey and Lynn Suckley updated the group on the decision from the previous meeting to investigate taking sexual health services forward within eastern Cheshire. They attended a recent event with a wide range of other providers potentially interested in delivering the service and learnt that sexual health forms

just a small part of a much bigger focus in the area on lifestyle. The outcome of the Cheshire East meeting was that they are offering these contracts for individual GP’s and others (Pharmacies, Weight Management services etc) to bid for, under their Integrated Lifestyle and Wellness Support System. This may give practices the opportunity to bid for other types of work, eg Smoking Cessation, Healthy Eating for the pre-diabetics etc. The Network heard that Primary Care Cheshire have been asked to bid for these contracts on behalf of the 4 practices. SJ will lead on the Sexual Health contract and LS will lead on the NHS Health Check contract. It was initially hoped that the same process could be used for the Cheshire West and Chester contract procurement, but the Network head that CWaC intend to extend their current sexual health plans for another year. There was then discussion around how LS and SJ could be compensated for their time spent working on behalf of the Network and while it was suggested that their work could be funded by PCC there needs to be discussion about establishing a a robust agreement to form the basis for this. Action: Issue to be discussed on next month’s agenda

5. Cheshire West and Chester Commissioning Intentions

Sarah Marshall and a numer of colleagues from Cheshire West and Chester Council attended the meeting to discuss, among other things, the opportunity to offer health checks through practices. Presentation attached.

The Network heard that Cheshire West and Chester Council would like to offer health checks for people in the area either through Brio Leisure, GP practices, or a combination of the two.

There was discussion around the aim of the health checks. It was argued that if Vrio delivers the service they should be able to signpost to help patients manage any conditions that may come to light. If a patient is just diverted straight back to GP then the GP may as well do the test.

It was also argued that any inconsistencies in Brio’s service should be diagnosed and remedied early. Members of the Network noted that some parts of Brio’s service that are free for some patients are not free for others, and it was also noted that previously practice data and council/Brio data have not always married up regarding payments.

The was also concern amongst the Network that if Brio deliver the service, it will still likely be be the GPs who have to follow the process through to the end with regards to blood tests, etc, as Brio do not have the clinical training to do that.

The Network heard that a decision about whether practices would like to deliver


this service by March 2016.

Joe Sheppard also attended the meeting to tell the Network about Turning Point, who provide the alcohol and substance misuse community service. They have less funding than the previous service and are proposing to operate under a shared care model from 14 November 2015. A handout was distributed amongst the Group detailing the stages of Turning Point’s ‘Recovery Academy.’ See attached copy. The Network asked the presenters whether the focus with regard to alcohol and substance misuse has shifted from ‘maintenance’ to ‘recovery. It was explained that it has to a degree but maintenance opiate prescribing will not be dropped entirely. It was further explained that the definition of ‘recovery’ is slightly different at Turning Point to how it is perhaps perceived outside the scheme, as to those involved with Turning Point ‘recovery’ means transitioning users of the service to a better place than they currently are and in some cases that might mean continuing maintenance prescribing.

The Network also heard that CWaC will be continuining its current sexual health agreement until March 2017. The sexual health service has now moved into the Foutains building and is working with other services such as Brio, Body Positive and 5-19, and are hoping to begin work on upskilling school nurses to deliver some sexual health services.

6. Sarah Murray provided the Network with an update around Prime Minister’s Challenge Fund developments. The Network heard that Andy Muir and Simon Platt have now left the team and moved onto new roles elsewhere and Kevin Carbery has picked up their work on the Physio First and e-Consult projects. The Network also heard that Physio First is now up and running in Neston and Willaston and Ellesmere Port North clusters. The Network also heard that EMIS Web is expected to be in place within the Extended Hours Service from the end of the month with the aim of providing a complete service to patients. It was explained that in order to do this, patients who have previously opted out of Spine would not be able to use the Extended Hours Service as their opting out precludes Extended Hours Service GPs from using EMIS Web to access the patient records. Therefore the CCG has offered to put together a letter to be sent from each practice to opted-out patients explaining the situation and inviting them to opt back in. The CCG has offered to pay for the costs associated with this from the Prime Minister’s Challenge Fund and Primary Care Cheshire have offered administrative support to any practices who feel they may need it. The Network asked whether opted-out patients could use the Extended Hours Service without the GP having full access to their record and it was stated that they would not. It was explained that this is because the Extended Hours Service is not intended to be ‘urgent’ care rather an extension of routine practice services. The Network heard that arrangements for MPLS continue to progress. Issues regarding the change in procurement route and resulting significant increase have been accounted for. It is expected to begin rollout between February and May 2016. There are further discussions around using some of the funding originally allocated to the Virtual Desktop Infrastructure to fund EMIS Mobile as an interim arrangement to facilitate mobile working.


The Network also heard about the proposal to introduce e-Consult to practices, funded initially for the first year by the CCG. E-Consult is a system whereby patients can complete an online consultation questionnaire regarding an issue they might otherwise book a GP appointment for. The system is then able to help the GP manage the patient remotely, either through signposting and self-care advise, or collating all information submitted by the patient for the GP to review and decide whether to provide the patient with a prescription, or advise, or suggest that the patient does need an appointment. It was stressed that for the initiative to be as successful as possible it should be introduced across the whole CCG area and further information would be circulated after the meeting.

8. Future Agenda The Network requested that the End Of Life Framework be added to the next agenda. It was also suggested that The Cluster Leads Meeting be added to the next agenda as Primary Care Cheshire would like confirmation about the Networks position on the meeting.

10. Any Other Business The Network raised a point about CCG audits that they were expecting to take place regarding Do Not Rescucitate forms in the practice not having. Diane Taska will investigate this. Action: DT to investigate DNR form audit The Network asked for clarification around the selection process for the first wave

of e-Lloyd George digitisation. The Chair explained that he and the Chairs from

other Networks were given a scoring criteria with which to refer to when judging

applications. There was a points basis to this scoring criteria and the applications

with the highest points at the end of review were offered the service.

Next Meeting: 08 December 2015: 2.00 – 5.00pm @ Cheshire View, Christleton City & E’Port Network Minutes – October 2015

EP&N APPROVED Minutes 011015.pdf


Outstanding Actions NB: Actions will be taken off the table upon completion

Key:

Current

Overdue

Ongoing

Date Initiated Action By Whom

Due Date

8 September SP to look into situation regarding Macmillan taking

nursing resources from the community

SP October 2015

10 November DT to investigate CCG DNR audit process DT December 2015




Documents

Rural Locality Network Meeting 2-5pm on Tuesday 13 … · Tanya Jefcoat-Malam . 3. Declarations of Interests Nil : 4. Admission Avoidance . ... Suzanne Fennah, Cath Kitching, Dr Kausik