PBC COMMISSIONING PLAN FOR NEWSOME SURGERY
INTRODUCTION This document sets out the practice based commissioning intentions for Newsome Surgery for 2010/11. Newsome Surgery a semi-rural practice with 6550 patients located in the centre of Newsome village in the Huddersfield South locality area. The practice has 3 GP partners, one Nurse Practitioner and two Practice nurses. A community pharmacy is within the practice premises and a dental practice is situated a few metres away. There is an attached District Nursing Team and Newsome Surgery has strong links with the Health Visitors, School Nurses and Midwifery teams. Constraints on available treatment rooms has meant that the practice has been able to offer a limited amount of in-house services, however with the premises redevelopment made possible through freed up resources, it is envisaged that more services will be developed, commissioned and provided. Newsome Surgery aims to provide more community based services, thereby offering more choice and local access to services for our patients. Our vision is to provide good health care to our patients and to underpin this aim by enabling provision of access to services that support the wider determinants of health. The practice now has a website (www.newsomesurgery.co.uk) which provides information on practice services, contact details and special interests of the GPs, Nurse Practitioner and Practice Nurses, together with useful links to local services. QIPP â€“ Quality, Innovation, Prevention and Productivity Newsome Surgery has identified areas of work that will support QIPP, e.g. through improving the quality of patient care including increased provision of choice and local services; providing more preventative care; improving productivity through better value for money e.g. reducing unnecessary secondary care activity and more proactive management of long term condition patients, for example through care planning and data verification. The improved outcomes for patients will lead to the efficiency savings necessary in the current financial climate.
FINANCE The PCT is moving towards the end of the current 5 year comprehensive spending review, with the last being 2010-11. During this period the levels of growth it has received have been relatively high compared with historic levels and these continue in 2010-11. As we move into 2011-12 and onwards, the levels of growth are anticipated to be much lower than in recent years and therefore this Commissioning Plan is produced in the context of a more difficult financial climate and with greater uncertainty than in recent times. As a consequence of the current financial circumstances Newsome Surgeryâ€™s plan to spend efficiency savings from 2008/09 on provision of an in house physiotherapy service has been suspended but this service will be provided when the FuR monies become available in the future.
ACCOUNTABILITY AND GOVERNANCE ARRANGEMENTS All business cases will be subject to scrutiny by the PCT Business and Finance Committee and be subject to the robust approval and accreditation process required for appropriate clinical governance.
MAP OF KIRKLEES LOCALITY AREAS
Newsome Surgery in the Huddersfield South Locality
Practice Population Demographics Newsome Surgery R egistered Practice Population (WYCSA 31st D ecember 2009) 90 and Over
85 to 89
80 to 85 75 to 79 70 to 74 65 to 69 60 to 64 55 to 59 50 to 54 45 to 49 40 to 44 35 to 39 30 to 34 25 to 29 20 to 24 15 to 19 10 to 14 05 to 09 00 to 04 5.5 5.0 4.5 4.0 3.5 3.0 2.5 2.0 1.5 1.0 0.5 0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 5.0 5.5 % % % % % % % % % % % % % % % % % % % % % % %
Ag e Ba nd 90 and Over 85 to 89 80 to 85 75 to 79 70 to 74 65 to 69 60 to 64 55 to 59 50 to 54 45 to 49 40 to 44 35 to 39 30 to 34 25 to 29 20 to 24 15 to 19 10 to 14 05 to 09 00 to 04 Gra nd T ota l
M a le s 8 30 66 97 123 152 219 194 212 255 252 222 221 243 182 209 196 201 209 3,291
% Ma le s Fe ma le s % Fe ma le s 0.1% 35 0.5% 0.5% 70 1.1% 1.0% 78 1.2% 1.5% 121 1.9% 1.9% 121 1.9% 2.4% 184 2.9% 3.4% 196 3.1% 3.0% 163 2.5% 3.3% 195 3.0% 4.0% 199 3.1% 3.9% 216 3.4% 3.5% 229 3.6% 3.4% 187 2.9% 3.8% 231 3.6% 2.8% 189 2.9% 3.3% 192 3.0% 3.1% 184 2.9% 3.1% 173 2.7% 3.3% 167 2.6% 51.3% 3,130 48.7%
T ota l % T ota l 43 0.7% 100 1.6% 144 2.2% 218 3.4% 244 3.8% 336 5.2% 415 6.5% 357 5.6% 407 6.3% 454 7.1% 468 7.3% 451 7.0% 408 6.4% 474 7.4% 371 5.8% 401 6.2% 380 5.9% 374 5.8% 376 5.9% 6,421 100%
THE HEALTH NEEDS OF OUR POPULATION Details The health needs of our population taken from the Kirklees Joint Strategic Needs Assessment (Refreshed in 2009/10) are:
The key issues for adults in Kirklees are: Specific populations: • Older people • Adults with disabilities • Carers. Developmental: Conditions:
• Mental health • Dementia • Obesity • Pain (including MSK) Behaviours: • •
Heart disease and stroke Diabetes.
Physical activity Smoking
• • • •
Housing conditions and options Employment Isolation and social networks Educational attainment.
The main health challenges children and young people in Kirklees are:
• • •
Dying before first birthday Personal unhappiness and social isolation Rising levels of obesity.
The Key Issues for Adults in the Huddersfield South Locality The overall health status is lower than nationally with health status being lowest for mental health and bodily pain, with older people having significantly worse health status for physical functioning, physical ability and bodily pain There is a higher proportion of older people than elsewhere and the highest proportion of black people in the Kirklees area with a slightly higher proportion of Asian people in Huddersfield North. Biological: Higher rates of long term conditions especially amongst older people, particularly: • Heart disease (1 in 13) • Asthma (1 in 7), • Diabetes (1 in 13) • Hypertension in the under 65s (1 in 5) Strokes in the over 65s (1 in 17). • Premature deaths from cancer are higher than Kirklees and nationally. Living and working conditions: • Income and disability related benefits higher than Kirklees and national levels. • 1 in 7 homes in mid Huddersfield are unsuitable and the highest in Kirklees. • 1 in 4 households are fuel poor Personal behaviours: • 20 – 25% of adults in the area smoke • 1 in 5 adults were obese, • 1 in 5 adults ate 5 a day, which is well below the national average • High rates of adults binged on alcohol, particularly females The Key Issues for children and young people in Huddersfield South Key issues with considerable action already are: physical activity; smoking; teenage conception and contraception; high numbers of children on child protection registers. Health challenges: Alcohol; Emotional well being; Teenage pregnancies Developmental: Food; Alcohol; Emotional well being; Educational attainment
COMMISSIONING PRIORITIES for 2010/2011
Collaboration with other stand alone practices The main focus for Newsome Surgery in 2010/11 is on joint working with the stand alone practices of Elmwood, Slaithwaite, Oaklands and the University Practice. The monthly stand alone forum has been the arena in which these ideas have been discussed and developed with a view to submission of joint business cases aimed at improving care pathways, achieving efficiency savings and offering greater choice and accessibility to patients. The proposed services now include Ophthalmology, Orthopaedics, ENT and Sexual Health. Newsome Surgery plans to collaborative with the other practices to provide a range of these services in house and to participate in inter practice referral of patients to other services. Long Term Conditions Management To enable improvements in the management of patients with long term conditions the practice aim to undertake data verification of secondary care activity for long term condition areas that are high cost in secondary care, e.g. COPD, Diabetes, Geriatric medicine, and will lead to: • • • • •
Improved quality in the primary care management of patients Increase number of patients identified with a long term condition and improve QoF registers Enable challenges to inappropriate charges from secondary care Acute Trusts Improve secondary care charging and data coding Reductions in secondary care costs
Care Planning Newsome Surgery aim to increase the provision of personalized care plans for patients with long term conditions. In 2009/10 Newsome Surgery achieved personalized care plans for all patients with COPD. The practice used the financial support available under the PBC Financial Incentive Scheme but exceeded the requirements of the FIS and achieved 100% care planning for COPD patients. The Joint Strategic Needs Assessment shows that in the Huddersfield South Locality there are higher rates of diabetes. Personalized Care Planing supports the Operating Framework Vital Sign indicator that patients with long term conditions are to be supported to be independent and in control of their condition.
The practice will again use the financial support available under the PBC financial incentive scheme but will exceed the requirements of the FIS to introduce personalized care planning for all patients with diabetes. Medicines Management Newsome Surgery plan to use the local indicators for the PBC Financial Incentive Scheme to undertake review prescribing of repeat benzodiazepine and Z drug (zopiclone, zopidem and zaleplon) prescribing with a view to withdrawal in a controlled and supportive manner in appropriate patients. This indicator has been chosen as: • • •
Reducing the prescribing of these drugs has the potential to reduce adverse drug events in the population e.g. fractures resulting from falls etc. It will require dedicated clinical time to support patients in reducing/stopping benzodiazepine and Z drugs Patients who stop taking benzodiazepines and Z drugs following chronic use under a supported withdrawal process report improved quality of life.
The practice will aim to: 1) Reduce quantity of benzodiazepines prescribed by 10% for half the points. 2) Reduce the quantity of benzodiazepines prescribed by 15% for full points. The starting benchmark will be benzodiazepine and Z drug prescribing for quarter ending December 2009. The results will be based on prescribing in quarter 4 (Jan – March) 2010-11. Review of Secondary Care Ear procedures Working with the PBC team, Newsome Surgery plan to undertake reviews of referrals aiming to reduce inappropriate referrals for ear procedures due to spending on secondary care ear procedures, such as ear syringing, being high when benchmarked against other practices. A review of all patients attending hospital for these procedures will be undertaken to ensure that any patient who can be seen in the practice will be discharged from secondary care. Update on Ongoing Developments: The surgery began a number of new services in 2008 and 2009 which are to continue and be kept under review. Freed up Resources Efficiency savings or Freed up Resources were not achieved in 2008/09 however, Newsome Surgery received freed up resources in 2007/08 which were used to undertake building redevelopment of the practice premises, completed in November 2009. The redevelopment has increased clinical consulting capacity and will enable a 9
greater number of services to be offered, for example the Kirklees LEA are now using a room for counseling of pupils under the Primary Pupil Referral Service. Work has begun on developing an in house physiotherapy service funded through freed up resources from 2007/08, however this project is suspended until these monies become available to the practice. Diabetic Foot Screening High waiting times for diabetic foot screening meant that patients were at risk. In 2008 the practice nurses were trained in diabetic foot screening and a weekly clinic is now held with an additional investment of 4 nursing hours per week to support this clinic. Patients now receive annual foot screening whereas previously this was averaging 15 months. Teenage Clinics The practice commenced teenage clinics in October 2008 providing advice, treatment and screening for young people in sexual health, smoking, alcohol and emotional support. Newsome Surgery was awarded the KITE mark under the Kirklees Young People Friendly Initiative in May 2009. Whilst patient satisfaction surveys have been very positive the uptake of the service has not been as high as anticipated despite advertising the service. The number of sessions has not been increased but will be reviewed to ensure demand can be met. The practice will continue to advertise the service and find new ways of raising awareness. Hypertension Drop in Clinics/B12 Injections The weekly drop in sessions for people with hypertension and pernicious anaemia are well used and liked by patients will be continued.
PATIENT AND PUBLIC INVOLVEMENT Newsome Surgery has created good links with the local community and has taken part in many initiatives in the community including Health Promotion/Awareness campaigns in local public houses, clubs and community centres. In addition the practice has surveyed patients on many issues over recent years and plans to continue and develop this work. In a multicultural area of Huddersfield Newsome Surgery is aware of diversity and equality issues and aims to ensure that all views are represented.
TRAINING AND DEVELOPMENT Newsome Surgery actively take part in the development of practice based commissioning through regular meetings with the PBC team. The clinical and management PBC leads for the practice attend relevant training e.g. the local meetings of the National Association of Primary Care (NAPC) and other relevant training or development sessions provided in the region. Representatives from the practice will continue to participate in the NHS Kirklees Commissioning College and in Health Improvement Teams.
I confirm that this plan is an accurate representation of the practiceâ€™s intentions for PBC for 2010/11.