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KIRKLEES PRACTICE BASED COMMISSIONING FINANCIAL INCENTIVE SCHEME FOR 2010-11

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Version Control

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Comment First version Revision of many indicators based on initial feedback received Revision of peer review and meetings indicators and finance indicators following discussion at Commissioning College Revision of care planning indicator. Inclusion of templates as appendices Revision of care planning, A and E and predictive risk indicators Revision of care planning and finance indicators, some very minor wording changes to medicines management

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Since 2006 the Department of Health (DH) has required PCTs to put in place a local financial incentive scheme (FIS) for Practice Based Commissioning (PBC). Uptake of this Financial Incentive Scheme is assessed through the MORI survey, via a questionnaire sent to practices from the DH. The DH best practice guidance of March 2009 “Clinical Commissioning: Our Vision for Practice Based Commissioning” sets out that “every PCT should agree PBC incentive schemes that promote better health, better care and better value in specific areas”. Principles The principles agreed in designing the financial incentive scheme for 2010/11 are: • Base on “Quality, Innovation, Productivity and Prevention” (QIPP): All indicators can demonstrate clear QIPP outcomes and effectiveness • Include Identified Priorities: Includes targets from “vital signs” where appropriate and not already covered by QOF or enhanced services • Encourage participation: Provides a scheme that is attractive to practices • Have appropriate targets: Indicators are specific, measurable, achievable, realistic and time bound • Be equitable: Is fair and consistent across the PCT area • Support learning and development: Includes indicators for peer review and attendance at plenary/ forum meetings • Offer some local flexibility: Enables some indicators to be locally determined so that issues that are of particular relevance to specific consortia can be addressed • Payment reflects workload Where the work involved is proportionate to list size then a payment per patient is appropriate. Where workload is similar regardless of list size then a flat payment is appropriate • Provide feedback to practices Each indicator has a clearly identified method and timeline for provision of feedback to practices about the difference the indicator has made The eleven indicators within the incentive scheme are: Care planning Use of A and E Predictive risk Medicines management better care better value (two indicators) Finance Diabetic retinal screening registers Peer review Plenary attendance Local indicators (two indicators) The majority of indicators have standard and stretch levels. Version 6 - final version at 31.3.2010

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CARE PLANNING Description of the Indicator Undertake care planning with patients with diabetes and provide detail of types of goals agreed through diabetes care planning consultations. To review the patient and record progress against the chosen goal. Collate information to include: Description of goal agreed: E.g.: To exercise more to help reduce weight Goal Category [NHS Referral / Self Care Approach / Other]: E.g.: Self Care Approach – walking Goal Type [Maintenance/Improvement] E.g.: Improvement (due to weight loss) Any Unmet Needs identified [YES/NO]: E.g.: Join Salsa Class – no classes available locally Progress against goals E.g.: Goal achieved – walking 30 minutes daily, lost 1 stone Provide a return to the PCT. Why has this indicator been included? Care Planning is a target within the Vital Signs of the Operating Framework. Personalised care planning in general practice can ensure better outcomes for patients, reduced exacerbations of long term conditions, increased patient satisfaction and financial savings. Department of Health research and local evidence indicates the benefits of care planning include: • • • • • • •

Reduced emergency attendances and inpatient days Quality-of-life improvements Greater patient knowledge and confidence in being able to cope with their condition(s) Better use of medication Reduced costs Overall improved quality of care.

This is an extension to the previous Care Planning indicator in the 2009/10 FIS. Including Care Planning in the FIS for 2010/2011 will complement the care planning training to be delivered from April onwards and help embed care planning into normal diabetes care.

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What does the practice need to do to achieve this indicator? Training: Diabetes clinicians within each practice (GP and/or Practice Nurse[s] who will be undertaking Care Planning reviews) to attend a local Care Planning Training event of 1.5 days. This training is available during 2010. Practices who attended this training during April/May 2009 are exempt from this condition. Reviews: Undertake an initial care planning review with 25% of patients on the diabetes register setting goals, with a further follow up 6 months later to review and record their progress against goals. Complete the excel spreadsheet, providing 1 x return [March 2011] detailing the goals agreed for the relevant percentage of care planning consultations and their review outcome. This is a new 25% with effect 1st April 2010 and reviews undertaken previous to this date cannot be counted towards the 25%. How and when will feedback be given to practices? Feedback will be given Spring 2011 following analysis of data received via the PCT’s PBC newsletter and also at PBC Plenary and Forum meetings. Who should practices contact for support? Julie Wood Diabetes and Renal Programme Manager Tel: 07720 463 006 Julie.Wood@kirklees.nhs.uk

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ACCIDENT AND EMERGENCY Description of the Indicator This indicator is designed to identify patients who attend A & E in surgery opening hours and could appropriately have attended the practice or another primary care resource. Collate information about avoidable attendances (defined as those not requiring either an admission or any hospital follow up or any treatment that can only be carried out in a hospital setting), describe why the attendance was inappropriate, take action to advise, educate and inform the patient on alternative(s) and provide a quarterly return to the PCT. Why has this indicator been included? A&E attendances continue to increase; this indicator will help to identify patients who might otherwise have sought treatment from an alternative, community or primary care resource. It supports current drivers i.e. better care, better value; care closer to home; patient choice. It also ensures that patients are educated upon and directed to the most appropriate service (GP practice, 8-8 centre, self care etc). This is an area where financial savings may be apparent that will help practices to achieve the savings levels in the Finance Indicator. What does the practice need to do to achieve stretch level? To achieve stretch level the practice needs to note on the supplied proforma; 1. 2. 3. 4.

5. 6.

The patients name (to be removed prior to submission) The complaint with which the patient attended A&E The date and time of the attendance If, in the opinion of the person completing the proforma, the A&E attendance was appropriate or inappropriate and why (e.g. on-going health problem and could have been seen in surgery). This is a subjective decision and will be based on local knowledge i.e. of the patient, their circumstances, family circumstances, other health conditions etc. What alternative service (8-8 centre; visit to pharmacist etc) may have been appropriate. Any action taken. a. The practice will decide on the appropriate action (no action for a ‘first offence’ may be an acceptable decision) b. The practice may take a variety of actions dependant upon the patient and his/her circumstances e.g. write a letter, send information, invite into the surgery, refer to Community Matrons etc.

What does the practice need to do to achieve standard level? 1-5 above

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How and when will feedback be given to practices? Feedback will be given at Consortia executive meetings and Plenaries/forums in Autumn 2010. Feedback will also be in the PCT’s PBC newsletter on a six monthly basis. Who should practices contact for support? Designated PBC Facilitator and/or Pat Andrewartha, Programme Manager for Urgent Care.

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PREDICTIVE RISK Description of the Indicator; Evidence shows that improvements in both efficiency and quality of care can be made by providing care locally instead of admitting patients to hospital. NHS Kirklees as part of the Predictive Risk Programme has purchased on behalf of GPs the Integrated Care Manager. This Tool is currently being made available to all GPs (wave 1 data available April 2010 and wave 2 data available June 2010) and will sit on a practice machine. Why has this indicator been included? Reducing length of stay along with managing and reducing emergency admissions is a key indicator in Better Care Better Value and the Vital signs indicators. The NHS operating Framework for 2010 -11, highlights the importance of achieving care closer to home, fewer acute beds, more standardised pathways, early and more upstream intervention and individuals taking greater ownership for their health. The Integrated Care Manager provides us with Predictive Risk scores for each patient in the practice indicating those most likely to require secondary care utilisation in the coming 12 months. This data when used as part of a case management process will help us achieve reduced admissions to secondary care. The process described therefore starts with a focus on those patients most at risk of future hospital admission. What does the practice need to do to achieve this indicator? Practices need to complete all actions detailed below to fulfil this indicator and achieve payment. From April 2010 – August 2010 A Practices need to sign up for the Predictive risk program and send the lead GP for predictive risk plus a Practice manager (or equivalent) on the training program (4 hours) before end August 2010. Between April 2010 – March 2011 (once training complete) GP’s will then use the Integrated Care Manager on a monthly basis to identify their patients with a high risk of inpatient admission in the coming year and case manage these. B Run report from the Integrated Care Manager and validate the top 0.5% of the practice population – these are the patients that evidence shows you are likely to be working with already. Take any appropriate action you believe necessary. C Using the “0.5 to 5%” category run a report and conduct at least 7 monthly review meetings during which you review a minimum of 5 patients.

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Meetings must include a GP, Practice manager and/or Practice Nurse and should be Multidisciplinary, ideally including a Community Matron, District Nurse or other significant members of the MDT team. If you hold existing clinical meetings you may want to synchronise this meeting with your existing ones. The patient review should consider • Any current key care plans in place • Next steps – eg possible referral to community teams or other potential interventions felt to be appropriate. • Lists to be updated monthly so that the 5 new patients reviewed are those with the highest risk flag, not reviewed previously. Evidence the above will be demonstrated by completion of a practice action plan (you will be provided with a specific practice link to this form) Complete the simple practice electronic record each month for a minimum of 7 months between April 2010 and March 2011. (i.e. a minimum of 35 patient reviews across the period). Practices can see the data they have previously submitted on their electronic forms by using the additional link provided. Please note that a link to the simple practice electronic record and your practice specific log on will be provided to you in due course by the Long Terms Conditions Development Facilitator. The NHS numbers of patients should not be recorded on this form. You should keep a list of the patients you review each month for your records or in case they are required for audit, but these do not need to be submitted routinely. The suggested template (enclosed) may be used if you wish. Seven monthly returns have been requested to allow time for GPs not trained until July/August to take part in the scheme and to make it equitable to all. How and when will feedback be given to practices? Feedback will be given at Consortia executive meetings and Plenary/Forums in autumn 2010. Practices can see the data they have previously submitted on their electronic forms. Feedback will also be in the PCT’s PBC newsletter on a six monthly basis. This will include the outcomes of any audit of the scheme that have been undertaken. Who should practices contact for support? Designated PBC Facilitators, Performance Information Analysts and Murray Forrest, LTC Development Facilitator - murray.forrest@kirklees.nhs.uk Please note – this is a separate indicator and is in addition to the peer review indicator, any local indicators developed by Consortia/Stand Alones or any other schemes where the Predictive Risk Tool may be used alongside other sources of information to support any activities undertaken.

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MEDICINES MANAGEMENT Better Care Better Value prescribing indicators (BCBV) Description of the Indicator Practices choose two of the BCBV indicators where they are not achieving the desired prescribing levels. The Medicines Management team will provide a “Red / Amber / Green” list for all three indicators. The practice may only choose to work on indicators that are showing as Red or Amber on the list. Where a practice is showing Red or Amber on only one indicator, then the practice may work on the “Patient register & medication review (Care Homes)” reserve indicator as it’s second medicines management indicator. Where a practice achieves well against all three BCBV indicators, the medicines management team may agree an additional local indicator. Where it is not possible to work on two medicines management indicators, the PCT will agree an alternative indicator that is relevant to the practice. The three Better Care Batter Value Indicators are: • Use of low cost Statins compared to all statin prescribing • Use of low cost Proton Pump Inhibitors (PPIs) compared to all PPI prescribing • Use of ACE inhibitors compared to all ACE/ARB prescribing. The indicators will use the national BCBV prescribing indicator set to allow easy comparison with other PCTs and national prescribing levels. Review prescribing of the drugs within the indicator/s selected, with support from the medicines management team. Assess which patients are suitable to change to alternative products within the same therapeutic class to improve the practice achievement vs the indicator/s (as per the individual BCBV indicator selected) and to improve prescribing cost efficiencies available. The practice with assistance of the medicines management team will collate information on the number of patients who have had treatments reviewed / changed (to provide an estimate of cost efficiencies achieved). Regular (3 monthly) update reports will be provided indicating where the practice is in relation to the national average and top quartile for each indicator. Why has this indicator been included? There are three Better Care Better Value prescribing indicators, one for low cost statin use, one for low cost proton pump Inhibitors, and one for ratio of ACE inhibitor use to all ACE/ARB prescribing. On all three national indicators, the PCT, and most practices within NHS Kirklees, are significantly below the national average, with NHS Kirklees being ranked between 110th and 128th out of 153 PCTs, giving considerable scope for efficiency savings through the prescribing of alternative drugs within the same therapeutic class, but with a lower acquisition cost. This is an area where

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financial savings may be apparent that will help practices to achieve the savings levels in the Finance Indicator What does the practice need to do to achieve stretch level? To achieve 2 points for each BCBV indicators worked on, the practice has to: a. move to the top 25% of practices (compared to the national indicator level – i.e. in the top quartile) with a minimum improvement from baseline of: 1. statins 8% 2. PPI’s 8% 3. ACE/ARB 6% (all these are absolute increases) b.

If practice still below top 25% or below average (at 2010-11 year end)minimum improvement from baseline of at least: 1. statins 15% 2. PPI’s 15% 3. ACE/ARB 10% (all these are absolute increases) The reason for the larger increase required if the practice is below average is that it will be very much easier to achieve than a practice who is at “average” levels or better.

Baseline data will be based on BCBV indicator reports for quarter ending December 2009, with assessment for payment being based on BCBV indicator reports for quarter ending March 2011 reports. Payment will be made at the end of the year when the Q/E March 2011 reports are available. What does the practice need to do to achieve standard level? a.

The practice moves to average or better (compared to the national indicator set) – with a minimum improvement from baseline of: 1. statins 5% 2. PPI’s 5% 3. ACE/ARB 4% (all these are absolute increases)

b. If practice still below average (at 2010-11 year end) – minimum improvement from baseline of at least: 1. statins 10% 2. PPI’s 10% 3. ACE/ARB 7% (all these are absolute increases) The reason for the larger increase required if the practice is below average is that it will be very much easier to achieve than a practice who is at “average” levels or better.

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Baseline data will be based on BCBV indicator reports for quarter ending December 2009, with assessment for payment being based on BCBV indicator reports for quarter ending March 2011 reports. Payment will be made at the end of the year when the Q/E March 2011 reports are available. How and when will feedback be given to practices? Feedback will be provided at least quarterly, with regular feedback on progress with the Medicines Management Practice Support Team, and with quarterly prescribing reports to allow assessment of progress vs. targets. Baseline data using Q/E December 2009 prescribing, with quarterly update reports. Final assessment based on Q/E March 2011 data. Who should practices contact for support? The Medicines Management Practice Support team will work with practices to improve the practice achievement vs. the Better Care Better Value Indicator/s. For any issues which cannot be resolved with the Practice Support Pharmacist / technician please contact either Eric Power (Senior Medicines Management Advisor) or Neill McDonald (Assistant Director - Medicines management)

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Medicines Management Reserve Indicator Patient register & medication review (Care Homes) Description of the Indicator Practices will only be permitted to use this indicator within the PBC FIS if they are unable to work on 2 BCBV indicators (due to already being at the required levels of prescribing) – i.e. they have less than two BCBV indicators shown as Red / Amber on the assessment list (provided by Medicines Management). The practice will have available a register of all patients in care homes, and will undertake at least two full medication reviews (level 3) on these patients annually, and review the processes for repeat prescription requests for care home patients. Availability of up to date patient care home register, plus clear evidence of medication reviews having been undertaken for all patients on the register (including details within the clinical records of the reviews including read code – use of “medication review” read code only is not acceptable) It is recommended that the following areas are considered in relation to medication reviews and processing of repeat prescriptions for patients in care home settings (this is not exhaustive) in relation to this indicator: • Over ordering of repeat medicines (i.e. standardise to 28 day repeats) • Quantity of “when required medicines” (and / or continued need) • Sip / enteral feed requests • Dressings • Continence products • Antipsychotic use (particularly in dementia) • Topical products • Liaison with care home staff to reduce the practice of discarding medicines automatically every month even where the drug supplied will last for considerably longer (e.g. inhalers, PRN medicines, feeds, continence products, dressings) and / or stockpiling. The register and reviews undertaken will be reviewed by the medicines management team for verification purposes. Why has this indicator been included? Medicines use / management of patients in care homes has been identified by the Care Quality Commission in a recent report as a major concern and priority group, where significant improvement in patient care needs to be made. There is also significant scope for cost efficiencies to be released though more critical review of patients and their medication (medication review level 3) of this patient cohort. This indicator has been developed to assist in addressing issues highlighted in the Care Quality Commission report.

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What does the practice need to do to achieve stretch level? Patient register in place (which can be searched easily on the GP clinical system) plus one full mediation review (level 3 review – patient present and with access to medical records) for patients on the register in both the first and second six months of the financial year. Clear evidence of medication reviews having been undertaken for all patients on the register (including details within the clinical records of the reviews and any changes to treatment / monitoring including read codes needs to be made – use of “medication review” read code only is not acceptable evidence). Review of repeat prescribing processes for care home patients (with input from Medicines Management practice support team) What does the practice need to do to achieve standard level? Patient register in place (which can be searched easily on the GP clinical system) plus one full mediation review (level 3 review – patient present and with access to medical records) for patients on the register in either the first six months of the financial year or the second six months of the financial year. Clear evidence of medication reviews having been undertaken for all patients on the register (including details within the clinical records of the reviews and any changes to treatment / monitoring including read codes needs to be made – use of “medication review” read code only is not acceptable evidence). Review of repeat prescribing processes for care home patients (with input from Medicines Management practice support team) How and when will feedback be given to practices? Regular contact with the practice support team as required, with quarterly feedback on patient numbers, progress with registers and reviews etc. General findings to be fed back to PBC execs / plenary events as agreed with PBC execs. Who should practices contact for support? The Medicines Management Practice Support team will work with practices where this indicator has been agreed to improve patient care for patients in care homes where time permits. For any issues which cannot be resolved with the Practice Support Pharmacist / technician please contact either Eric Power (Senior Medicines Management Advisor) or Neill McDonald (Assistant Director - Medicines management)

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FINANCE Description of the Indicator; The indicator is designed to incentivise practices to reduce Actual Expenditure so that the PCT can achieve financial balance in the areas of the budget which have been devolved to practices in PBC Budgets (Mandated; A&E; Prescribing). The focus has shifted from asking practices to operate within the budget (which some practices felt were unachievable and others achieved more easily) to a fairer spread of responsibility across all practices. In addition, a further incentive is being suggested to incentivise consortia and stand alones (co-opting for purposes of this Indicator to work with a consortia) to work towards achieving the overall gross target for consortia by encouraging consortia oversight to support achievement of the target and earn further reward. Cost reductions need to be as a result of improved efficiency and productivity whilst maintaining or improving the quality of patient care (QIPP). This proposal does not set out how this will be achieved, however there are implied opportunities for cost reductions within QIPP in other incentive areas e.g. Care Planning; Medicines Management. Some aspects of this proposal remain under review and therefore are subject to change. Why has this indicator been included? The PCT is required to operate within financial balance on an annual basis and the year on year increases in costs for providing acute and prescribing services needs to be reversed if this is to be achieved as the PCT moves into an era of zero growth. World Class Commissioning Prioritise investment according to local needs, service requirements and the values of the NHS Make sound financial investments to ensure sustainable development and value for money Operating Framework The Operating Framework identifies the need to view future decisions in the context of delivering cash releasing strategies while sustaining and improving the quality of services. Work over recent months with NHS stakeholders on the quality and productivity challenge has identified the following characteristics of a system that can achieve this:-

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1. 2. 3. 4. 5. 6. 7.

More care closer to home Fewer acute beds Reduced unit costs Reduced variation More standardisation of pathways Early and more upstream intervention; and Greater co-production, with people taking greater ownership of their health.

What does the practice need to do to achieve GOLD Reward? Each practice needs to reduce their 2009-10 “Actual Expenditure” by suggested 2.5% to achieve “gold” reward based on patient list size of 01/01/2010. If the Consortia together with co-opted Stand Alones meet the overall financial target of suggested 2.5% savings, in a scenario where some practices have failed to reach the target and others have exceeded the target, a further “gold” reward will be made to the consortia for distribution across successful practices. What does the practice need to do to achieve SILVER point? Each practice needs to reduce their 2009-10 “Actual Expenditure” by suggested 2.0% to achieve a “silver” reward based on patient list size of 01/01/2010. If the Consortia together with co-opted Stand Alones meet the overall financial target of suggested 2.0% savings, in a scenario where some practices have failed to reach the target and others have exceeded the target, a further “silver” reward will be made to the consortia for distribution across successful practices. What does the practice need to do to achieve BRONZE point? Each practice needs to reduce their 2009-10 “Actual Expenditure” by suggested 1.0% to achieve a “bronze” reward based on patient list size of 01/01/2010. If the Consortia together with co-opted Stand Alones meet the overall financial target of suggested 1.0% savings, in a scenario where some practices have failed to reach the target and others have exceeded the target, a further “bronze” reward will be made to the consortia for distribution across successful practices. What payment is available for this indicator? The current indicator is 32p per patient for two points and 16p per patient for one point. This rewards bigger practices more for the financial savings they are being asked to make, which are bigger in large practices so seems fair. The new proposal is that the following rewards will be available to practices as follows:Gold £1.00 per patient to each practice achieving a 2.5% saving Silver £0.80p per patient to each practice achieving a 2.0% saving Bronze £0.40p per patient to each practice achieving a 1.0% saving

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Please note: Only ONE of the level rewards is available to practices/consortia. In addition, the new proposal is that the following additional rewards will be available to consortia as follows:Gold £0.34p per total number of patients in the consortia + co-opted stand alones to each consortium achieving an overall 2.5% saving Silver £0.27p per total number of patients in the consortia + co-opted stand alones to each consortium achieving an overall 2.0% saving Bronze £0.13p per total number of patients in the consortia + co-opted stand alones to each consortium achieving an overall 1.0% saving Please note Stand Alone Practices will need to be co-opted onto a consortium for the purposes of achieving this additional reward. If they choose not to associate with a consortium the additional reward will not be available. After consultation, the proposal to have a minimum target at “Bronze” level of 1.0% savings was deemed to be reasonable in the light of trying to incentivise a “whole system approach” to PCT financial management which is required next year and beyond. The cost of the Finance Indicator is potentially £1.34 (was £0.32p in 2009-10) x 413,671 patients = £554k. This equates with a total incentive of £3.00 per patient (£1.98 in 2009-10). However, Bryan Machin explained at the Commissioning College on 17th March 2010, that if a satisfactory baseline cannot be established which will deliver the savings which are required, then he reserves the right to withdraw the extension to the Finance Indicator proposal and the scheme would revert back to 2009-10 rewards of £0.32p with reward being based on under spend against budget as outlined in the 2009-10 scheme. The baseline figure for each practice will be made available to practices at the end of July 2010 if the proposal is implemented. When will payment be made? The payments for this element of the 10-11 FIS will be calculated in July 2011 and paid in August 2011. There will not be any interim payments for this area of the FIS How and when will feedback be given to practices? Actual Expenditure will be available in the web browser, however if adjustments need to be made then the impact of these will be provided by the Finance Team on a quarterly basis together with a forecast position at Consortia Plenaries.

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Who should practices contact for support? The PBC Finance Team:Rob Willis PBC Finance Manager Nicola Dunford – Assistant PBC Finance Manager – covers South Kirklees Practices Andrea Issott – Assistant PBC Finance Manager – covers North Kirklees Practices.

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DIABETIC RETINAL SCREENING Description of the Indicator To ensure that there is a single collated list of people with diabetes by identifying newly diagnosed patients and any variances between the PCT’s retinopathy screening database and the practice management system records on a timely and regular basis. Newly diagnosed patients to be identified and notified to the PCT. Any identified variances to be investigated and the reason and amendment required to be notified to the PCT diabetes team on a regular basis. Why has this indicator been included? Quality – helps to ensure that only the correct patients are recalled, promptly and when necessary. Therefore contributing to improved standards of patient care. Will also help improve the standard of patient information held. Productivity - establishment of an accurate and regularly maintain diabetic retinal screening register will help ensure that only those necessary will be recalled for screening on a timely basis. Prevention – target will help ensure more effective running of the screening programme which in turns helps to reduce risk of sight loss amongst people with diabetes by allowing prompt identification and effective treatment as necessary at the appropriate stage during the disease process. What does the practice need to do to achieve stretch level? Nominate a lead person and deputy to cover annual leave and sickness from each practice to whom the PCT screening team will send the data to and who will be responsible for completing the template and returning this to the PCT screening team. The nominated lead and their deputy must be notified to the PCT screening team and the designated PBC Facilitator by the 30th April 2010. Each practice must also notify the PCT at the start of the scheme whether they are aiming for partial of full achievement of the target i.e. whether they will be submitting monthly (11 months commencing May 2010) or quarterly returns. Data will come out to practices in weekly bags from the 7th of the month. As well as completing the template the normal practice of letting the diabetes team know the amendments on the usual forms needs to continue. Submit completed template to the designated PCT diabetes screening team by the last day of each calendar month. The completed return must be received by the PCT screening team by the following dates. A return must be submitted even if there are no amendments or new patients to be updated – the nil return box on the template should be ticked and the form returned to the screening team as usual. The

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completed return must be received by the PCT screening team by the last date of the month commencing 31st May 2010 Month 1 - 31st May 2010 Month 2 - 30th June 2010 Month 3 - 31st July 2010 Month 4 - 31st August 2010 Month 5 - 30th September 2010 Month 6 - 31st October 2010

Month 7 - 30th November 2010 Month 8 - 31st December 2010 Month 9 - 31st January 2011 Month 10 - 28th February 2011 Month 11 - 31st March 2011

What does the practice need to do to achieve standard level? Nominate a lead person and deputy (in order to cover annual leave and sickness) to whom the PCT screening team will send the data to and who will be responsible for completing the template and returning this to the PCT screening team. The nominated lead and their deputy must be notified to the PCT screening team and the designated PBC Facilitator by the 30th April 2010. Each practice must also notify the PCT at the start of the scheme whether they are aiming for partial of full achievement of the target i.e. whether they will be submitting monthly or quarterly returns. Data will come out to practices in weekly bags from the 7th of the month. As well as completing the template the normal practice of letting the diabetes team know the amendments on the usual forms needs to continue. Submit the completed template showing any amendments and new patients to the PCT screening team by the last calendar day of each quarter i.e. the completed return must be received by the PCT screening team by the following dates. A return must be submitted even if there are no amendments or new patients to be updated – the nil return box on the template should be ticked and the form returned to the screening team as usual. Q1 Q2

30th June 210 30th September 2010

Q3 Q4

31st December 2010 31st March 2011

How and when will feedback be given to practices? Quarterly – either via PBC Facilitator and / or update reports to Forums / newsletters as appropriate. Who should practices contact for support? Designated PBC Facilitator PCT Diabetes Screening Team

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lead for south - Gillian Longbottom lead for north - Nicola Winter

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PEER REVIEW Description of the Indicator: Practice clinicians participate in peer review of referrals. It is the responsibility of the practice (with PCT support e.g. PBC Manager, Finance Manager, Performance Analyst, Public Health etc) to identify the areas to be peer reviewed. These will be based on local health needs derived from predictive risk, performance information; for example ambulatory conditions, first out patient appointments, areas of high or unusual activity or spending, benchmarked information demonstrating outliers or unusual referral patterns or response to external policies and drivers. Why has this indicator been included? Peer Review is a Care and Resource Utilisation tool that can be used to interrogate data providing information on patient pathways, capacity and demand issues etc. For Practice Based Commissioners Peer Review should focus on ambulatory condition admissions and 1st Out Patient attendances, with the potential for management in primary care, which will then enable peer review to inform areas where financial savings, as well as improved quality, care closer to home and improved access for patients, can be made. Peer review contributes to achievement of the 18 weeks target by supporting practices in identifying alternatives to referral. Peer review also contributes to clinical education and sharing of knowledge. What does the practice need to do to achieve stretch level? At least one GP (or nurse practitioner) from each participating practice will participate annually in 4 peer review meetings which will be held with a minimum of 3 GP/NP participants. Based on each of the peer review discussions the GP/NP will produce an action plan outlining the service area to be worked on in their practice which will have a clear objective and measurable outcomes. The action plans to be submitted to the PBC team with supplementary evidence of achievement against objectives (template attached as appendix 4). The GP/NP will share and discuss the peer review action plan at formal in house practice meetings which should be minuted. A random review of these minutes may be undertaken at practice visits undertaken by the Consortium. What does the practice need to do to achieve standard level? At least one GP (or nurse practitioner) from each participating practice will participate annually in 3 peer review meetings which will be held with a minimum of 3 GP/NP participants.

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Based on each of the peer review discussions the GP/NP will produce an action plan outlining the service area to be worked on in their practice which will have a clear objective and measurable outcomes. The action plans to be submitted to the PBC team with supplementary evidence of achievement against objectives (template attached as appendix 4). The GP/NP will share and discuss the peer review action plans at formal in house practice meetings which should be minuted. A random review of these minutes may be undertaken at practice visits undertaken by the Consortium. How and when will feedback be given to practices? Learning from this indicator gained from the feedback templates will be shared 6 monthly through the PBC Newsletter. Who should practices contact for support? For advice or further information about this indicator practices/consortia should contact the PBC Manager or PBC Facilitator working with the consortium/practice.

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EDUCATIONAL EVENTS Description of the Indicator: For consortium practices, each participating practice attends consortium plenary /forum meetings. For stand alones, the practice attends other meetings for learning relating to practice based commissioning. The practice representative attending the relevant plenary /forum or other meeting should usually be a GP or practice partner. For one of the meetings this can be a Practice Manager (or other practice representative appropriate to the topic of the meeting) who is able to feed back learning and information from the meeting to the practice through a formal practice meeting which will be minuted or notes taken. Random review of the notes of such meetings will be undertaken at practice visits by the PBC team and/or consortium representatives. Why has this indicator been included? This indicator allows practices to keep up to date with issues relevant to PBC and to ensure this information is shared within the practice. Many consortia plenary meetings also have a clinical educational session which is based on needs identified through peer review. What does the practice need to do to achieve stretch level? During the 12 month period a practice representative from participating practices will attend 100% of consortium Plenaries. This should be a GP or practice partner although for one of the meetings this can be a practice manager or other practice representative. For stand alone practices this can be the stand alone forum or at least 4 other relevant meetings as agreed with the PBC Manager. The representative should sign attendance registers for consortium plenary/ forums. Stand alones will submit confirmation of attendance for external meetings to the PBC Manager. What does the practice need to do to achieve standard level? During the 12 month period a practice representative from participating practices will attend 75% of consortium Plenaries. This should be a GP or practice partner although for one of the meetings this can be a practice manager or other practice representative. For stand alone practices this can be the stand alone forum or at least 3 other relevant meetings as agreed with the PBC Manager. The representative should sign attendance registers for consortium plenary/ forums. Stand alones will submit confirmation of attendance for external meetings to the PBC Manager. How and when will feedback be given to practices? Practices will be asked to complete evaluation forms and the findings from these will be fed back at the subsequent plenary or forum meeting

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Who should practices contact for support? For advice or further information about this indicator practices/consortia should contact the PBC Manager or PBC Facilitator working with the consortium/practice.

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LOCAL INDICATORS Local indicators are agreed between consortia/ stand alones and the PCT

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PAYMENTS Indicator

Standard achievement

Stretch achievement

Payment Points

Care planning

Not applicable

24 points

May 2011

A and E

12 points

24 points

Predictive risk

Not applicable

Flat rate of £1800

November 2010 and May 2011 May 2011

Medicines management 1 BCBV indicator 1 Medicines management 1 BCBV indicator 2 Medicines management reserve indicator (care homes) Finance

4.5 points

9 points

August 2011

4.5 points

9 points

August 2011

4.5 points

9 points

November 2010 and May 2011

Tba

Tba

August 2011

Based on prevalence: payment for standard achievement is £120 per hundred patients with diabetes 6 points

Based on prevalence: payment for stretch achievement is £240 per hundred patients with diabetes 12 points

November 2010 and May 2011

Flat rate of £500

Flat rate of £750

May 2011

Split can be agreed locally with maximum available 6 points Split can be agreed locally with maximum available 6 points

Split can be agreed locally with maximum available 12 points Split can be agreed locally with maximum available 12 points

To be agreed locally To be agreed locally

Diabetic Retinal Screening

Peer review Educational events Locally determined one Locally determined two

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May 2011


http://www.kirklees.nhs.uk/fileadmin/documents/publications/PBC_Plans/2010_PBC_Plans/FINAL_VERSION_-