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KIRKLEES PRIMARY CARE TRUST

PROVIDER SERVICES 1.0

Update 1.1

Provider Board The first meeting of the provider board is now arranged for July 4th. This will be chaired by Vanessa Stirum with Rob Millington as vice chairman. The Board will have 2 meetings in the first month and then will move to a meeting every 6 weeks. The first full report from the provider board will be submitted for the September board meeting.

1.2

Management Structure Provider Services is now in the final stage of implementing its management structure; this stage is the front line management of community nursing and therapies.

1.3

Working with GP Practices A key early action for provider services is to build positive relationships with GP’s. I have now met with the leads from all consortia, and the key players from the stand alone PBC’s. The locality managers have also set up a rolling programme of GP visits to ensure the issues with community nursing are addressed in a local setting.

1.4

Locality Meetings Provider Services have set up an initial meeting within the locality – scheduled for late June/early July. These meetings will concentrate on locality provision, in particular the setting up of patient feedback mechanisms.


2.0

ACCESS 2.1

Therapies and Intermediate Care 14 weeks Community Occupational Therapy Service Community Rehabilitation Team - Physiotherapy Community Rehabilitation Team - Speech & Language Therapy Community Rehabilitation Team - Dietetics Community Rehabilitation Team - Occupational Therapy Rheumatology – High Priority Rheumatology - Normal Intermediate Care MSK Service Community Matrons South Community Matrons North

2.2

12 weeks 5 weeks 0 weeks 6 – 8 weeks 1 week 5 weeks 0 weeks 2 weeks 0 weeks 0 weeks

Paediatric Occupational Therapy - Pre 5 Paediatric Occupational Therapy – MLD Paediatric Occupational Therapy - Mainstream Paediatric Occupational Therapy – Complex Needs

3 – 4 weeks 0 - weeks 1 – 3 weeks 0 - weeks

Speech & Language Therapy - Paediatrics Speech & Language Therapy - School Age Special Needs Communication Speech & Language Therapy - School Age Special Needs Dysphagia Speech & Language Therapy – Child Development Centre Speech & Language Therapy - Adults with a Learning Disability Dysphagia Speech & Language Therapy - Adult with a Learning Disability Communication Speech & Language Therapy - Adults Voice Speech & Language Therapy - Adults Neuro

11 weeks 6 weeks

Podiatry Podiatry Podiatry Podiatry -

8 - 12 weeks 11-19 weeks 11 weeks 8 weeks

Community Diabetic Biomech Nail Surgery

5 days 16 weeks 3 days 6 weeks 5 weeks 3 weeks

Specific Services Out of hours nursing Palliative care including Marie Curie and Sitting

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Same day


services Night social care (Huddersfield only) GP practices at Whitehouse and Broughton Road Homeless Continence Diabetic care Primary Prevention nurses Cardiac rehabilitation Contraception and Sexual health Interpreter and link worker service Kirklees Community Equipment Service Community Matrons Child health services Community Children’s team Community paediatrics 2.3

Localities 2.3.1 Dewsbury Reorganisation of supporting families team from medical model GP practice clinic to One Stop Shop at Overthorpe, Thornhill Surestart. The One Stop Shop has a range of services provided by supporting families, education and children’s centres, which are needs-led with accessibility to all clients. 2.3.2 Spen Spenborough Nursing Teams continue to have a high level of maternity leave. Health visiting staffing levels have also led to a lower level of home visiting 2.3.3 Batley No exceptions to report 2.3.4 CAND Health Visitor no access visit report W/B 02/06/07 showing: 14 visits – 2hrs 25mins wasted 2.3.5 Ashbrow, Greenhead & Lindley District Nursing Teams – sickness levels have reduced which has resulted in a reduction of Bank Staff used. Vacancies have arisen which are due to go out to advert. Staff are communicating well and sharing resources across the Locality

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TBC TBC 48 hours TBC Same day Same day TBC TBC TBC TBC TBC TBC TBC Same day TBC


Health Visiting Teams – One team in the Locality is experiencing significant staffing problems due to sickness and a secondment commencing 1st July 2007. Resources are being looked at and shared across the Locality. The HV reconfiguration has had an impact on the clerical support due to movement of records which is being addressed to ensure the efficient move of records to appropriate teams. There has proved to be some resistance from some GPs to the changes, however, one GP has emailed to say they have found the reconfiguration a very positive experience School Nursing – Staffing pressures due to a vacancy inn the Locality which is proving difficult to cover service for a school. The team leader has returned from maternity leave, and is covering as much as possible. 2.3.6 Dearne Valley No exceptions to report 2.3.7 The Valleys Health Visiting No Access Visits – weeky report showing time wasted on visits Colne Valley - 4 (126 mins) Holme Valley - 1 (17 mins) District Nursing Team from Elmwood Health Centre moving into Oaklands Health Centre week commencing 25th June 2007 2.3.8 HVMH Maple Ward Moorfield (open 8.00a.m to 5.00 p.m.) Current waiting times: Colposcopy Podiatric Surgery Dermatology Plastics - business case being developed to increase dermatology minor surgical sessions and plastic surgery sessions. Plastic surgeon currently picking up all dermatology minor surgery referrals to cover maternity leave of GPwSI Dermatology, who specialises in minor surgery. Neurology Podiatrist supporting MSK service – business case

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4 weeks 5 weeks 11 weeks 20 weeks

5 weeks 13 weeks


developed and awaiting approval to increase podiatrist session by one per week MSK GPwSI 4 weeks Extended Scope Physio - as 4 ESPs in post working 2 – 6 weeks variable sessions Walk in Centre (WiC) (open Mon-Fri 9.00 am to 6.30 pm) Number of patients visiting Centre: April 1305 May 1447 June 762 (up to and including 15 June 2007) Total waiting times: 0-1 hour 2372 1-2 hours 378 2-3 hours 2 3-4 hours 0 Over 4 hrs 0 Total waiting times from 1.4.07 – 15.6.07: 0-1 hour 3035 1-2 hours 474 2-3 hours 5 3-4 hours 0 Over 4 hrs 0 Preliminary meetings/discussions are about to commence re the opening times of the WiC and the impact the Centre has on A & E breeches at Dewsbury District General Hospital. 3.0

UTILISATION 3.1

Therapy and intermediate care 3.1.1 Bed based services Westmoor suite Fieldhead Park Batley Hall

20 beds 10 beds 5 beds

89% 81% 80%

3.1.2 Referral Rates for May 2007 Community Occupational Therapy Service Community Rehabilitation Team - Physiotherapy Community Rehabilitation Team - Speech & Language Therapy Community Rehabilitation Team - Dietetics

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37 6 2 1


Community Rehabilitation Team - Occupational Therapy Rheumatology MSK Service Community Matrons South Community Matrons North Intermediate Care Team North Rapid Response South

15 37 20 12 105 71

Paediatric Occupational Therapy - Pre 5 Paediatric Occupational Therapy – MLD Paediatric Occupational Therapy - Mainstream Paediatric Occupational Therapy – Complex Needs

4 0 2 0

Speech & Language Therapy - Paediatrics Speech & Language Therapy - School Age Special Needs Communication Speech & Language Therapy - School Age Special Needs Dysphagia Speech & Language Therapy – Child Development Centre Speech & Language Therapy - Adults with a Learning Disability Dysphagia Speech & Language Therapy - Adult with a Learning Disability Communication Speech & Language Therapy - Adults Voice Speech & Language Therapy - Adults Neuro

76 11

Podiatry Podiatry Podiatry Podiatry 3.2.

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Community Diabetic Biomech Nail Surgery

6 11 5 6 Not Collected Not Collected 58 60 47 11

Holme Valley Hospital Maple Ward Maple Ward 20 bedded GP led in-patient facility “Step-up” “Step down” beds Bed occupancy since January 2007 Length of Stay January 84% 16 days February 74% 16 days March 90% 18 days April 81% 16 days May 85% 17 days

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4.0

BUSINESS DEVELOPMENT and GROWTH 4.1

Transformational Change Teams  3 TCTs have been established to cover areas of Adult Services, Children’s Services and Therapies.  Early work to include baseline assessment of services, service delivery plan and workforce development plan.  These 3 outputs will form the basis of tailored packages of ongoing service improvement support over a sustained period, to ensure sustainability and growth of services in line with health needs and commissioner requirements.

4.2

Service Improvement and Business Development Unit At present this unit has two key tasks:  Offering support to 18 week groups and identifying potential opportunities for further growth and business development in the diagnostic phases of various pathways

4.3

 Ongoing system of spreading message about business awareness to frontline staff, getting them to identify blockages and choke points to further service development and supporting them in taking initiatives forward. Musculoskeletal Physiotherapy service (MSK) The MSK service has been taking patients since the 1 April 2007. Two full time MSK practitioners were joined by a GP with a special interest in musculoskeletal conditions in mid May for one session per week and we are expecting the appointment of an orthopaedic consultant for another session per week in the near future. In this time the team has received 125 referrals from north Kirklees GPs who would have referred to secondary care previously; 36 of these patients have been discharged after successful interventions. 7 patients have been referred to the orthopaedic department for further assessment. 9 patients have been referred back to their GP for referral to Physiotherapy. 13 Patients including the 9 that should have been referred to physiotherapy have been inappropriate for the service. These include a number of children and a patient referred for replacement

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heel pads. The team has also been attending the secondary care triage session each week, which has highlighted further work. On the week starting the 5th of June out of the 37 referrals triaged 24 should have been referred to the MSK service not secondary care. This shows a potential 64% reduction in referrals to secondary care. A percentage of these would ultimately have been referred to secondary care by the MSK service, post assessment but a substantial further reduction in secondary care activity is expected over time. The team is currently recording which GPs are referring inappropriately to secondary care and will initiate an education programmed to these GPs in the next 3-4 weeks. The team is also working with the secondary care consultants on a Carpal tunnel pathway which would lead to all carpal tunnel patients being referred to the MSK team for screening and then direct placement onto a surgical list when appropriate. This will lead to a substantial reduction in the number of wasted day cases for carpal tunnel surgery. 5.0

FINANCE

5.1

At present an outline finance plan is being produced. The fundamental drivers of this plan is that the organization needs to put in place a strategic reserve and that the best managers of budgets are the frontline. With this is mind the plan is identifying a reserve over the next 4 years and a training plan for the forthcoming year for all frontline budget holders. This plan is still being developed and will be discussed at the first provider services board meeting. On a more practical level, budgets are currently being set and will be sent out very shortly.

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