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NORTH KIRKLEES COMMISSIONING CONSORTIUM

PBC COMMISSIONING PLAN

2008/09

Chairman: Rob Napier Chief Executive: Mike Potts


Table of Contents 1. INTRODUCTION 2. VISION 3. HEALTH NEEDS OF THE POPULATION 4. COMMISSIONING PRIORITIES AND TARGETS 5. IMPLEMENTATION TIMETABLE

Chairman: Rob Napier Chief Executive: Mike Potts


NORTH KIRKLEES COMMISSIONING CONSORTIUM GEOGRAPHICAL AREA The geographical area covered by North Kirklees Commissioning Consortium is across 3 localities in the North of the Kirklees patch. Within the 3 localities is a varied picture of health needs including areas of high deprivation.

Chairman: Rob Napier Chief Executive: Mike Potts


1. INTRODUCTION

This document sets out the practice based commissioning intentions for North Kirklees Consortium for 2008/9. Background The Consortium consists of 22 GP Practices covering a total population of 139, 082.

Group Name

North Kirklees

Number of practices in group

22

Names of all GP Practices in Group 1

Dr B Ahmad

17

Dr M Ahmad

2

Dr Balasunderam & partners

18

Dr Mehrotra

3

Dr Barker & partners

19

Dr Khan & Woodhall

4

Dr Gogna & partners

20

Dr Houghton

5

Dr Scrivings & partners

21

Dr Bhat

6

Dr Hicks & partners

22

Dr Ghafoor

7

Dr Bedford & partners

23

8

Dr Youd & partners

24

9

Dr Lee & partners

25

10

Drs Lidhar & Lidhar

26

11

Dr Lynch & partners

27

12

Dr Medley & partners

28

13

Dr Miller & partners

29

14

Dr Rajpura & partners

30

15

Dr Unnikrishnan

31

16

Victoria Medical Practice

2. VISION We wish to ensure that services are available as close as possible to people’s homes, are delivered safely and to the highest standard and offer patients and their families a positive experience of the NHS in Kirklees. We aim to encourage new and innovative ways of delivering services that offer choice, improve health and well being, are sensitive to the diverse needs of our community and are easily accessed and delivered in an environment that staff and local people can be proud of. We aim to achieve real involvement of patients, staff and our local community in identifying their needs and sharing responsibility for improving health, prioritising service development and allocating resources.

Chairman: Rob Napier Chief Executive: Mike Potts


3. HEALTH NEEDS OF THE POPULATION

From the Joint Strategic Needs Assessment 2008 HEALTH CHALLENGES LOCALITY

DEWSBURY

CHILDREN & YOUNG PEOPLE

Infant mortality Low birth weight

ADULTS

Women of child bearing age Obesity Smoking in pregnancy & at birth Binge drinking alcohol Dewsbury Adults Depression, anxiety & nervous illness Heart disease High blood pressure Diabetes Higher rates of early death Smoking Binge drinking alcohol Mirfield Adults

MIRFIELD Cancer High alcohol consumption (men) Alcohol consumption women of child bearing age High blood pressure BIRSTALL & BIRKENSHAW

Infant mortality Low birth weight Alcohol use by 14 year olds

Women of child bearing age Smoking in pregnancy & at birth Maternal malnutrition Batley Adults Diabetes Stroke Smoking & drinking alcohol Birstall & Birkenshaw adults Heart disease over 65’s High blood pressure over 65’s Cancer under 75’s

SPEN

Infant mortality

Women of child bearing age Overweight Binge drinking alcohol Adults Suffering pain Heart attacks over 65’s High blood pressure Smoking Obesity

Chairman: Rob Napier Chief Executive: Mike Potts


QOF data CHD prevalence for 06/07 shows an average of 4.26% across the three localities as compared to a national average of 3.51% Diabetes prevalence for 06/07 is an average of 3.81% in this area, compared to the national average of 3.62%

Key Objectives The main focus of the Consortium will be achieving key objectives in the following areas: o o o o o o

Development of Primary Care Services Care closer to home 18 week target Improve data quality Patient & Public involvement Budget management including prescribing

Within the framework of the above objectives the Consortium will focus on the following key clinical priorities as supported by the Joint Strategic Needs Assessment.

o o o o o o o o

Diabetes CHD Intermediate care Minor surgery Carers of people with dementia Obesity Alcohol Maternal Health

Chairman: Rob Napier Chief Executive: Mike Potts


We have clinical leads working with the HIT teams in the following areas, some of which are clearly identified as key objectives and others are seen as potential areas for future development for the Consortium : o o o o o o o o o o o o o o o

CHD – Dr Kelly Obesity – Dr Kohi Alcohol – Dr Kelly Maternal Health – Dr Barker Diabetes – Dr Rajpura 18 week – Dr Ghosh Intermediate care – Dr Mehrotra/Dr Kohi Budget management – Dr Barker/Dr Chandra Mental health – Dr Balasunderam Respiratory – Dr Hicks Long term conditions – Dr Kohi Sexual health – Dr Ghosh Diagnostics – Dr Warner Urgent care – Dr Kohi/Dr Mehrotra Cancer – Dr Chandra

Chairman: Rob Napier Chief Executive: Mike Potts


4. COMMISSIONING PRIORITIES & TARGETS Priority area No.1

DIABETES

Planned Initiatives Redesign of the current diabetes service across the North or Kirklees in conjunction with the Wakefield District and North Kirklees Diabetes Network. AIMS • •

To ensure that specialist diabetes services are available in a timely manner and closer to patients homes and; To provide a resource to clinicians, sharing of knowledge and skills and to improve patient care and outcomes through collaborative working practices and the quality of specialist care diabetes services.

OBJECTIVES • • •

• • • • • • • • • •

To improve the quality of primary care diabetes services in all GP practices To ensure that the patient is seen and treated by the most appropriate person, in an appropriate setting. This will reduce the number of people receiving routine ongoing care from specialist care. To improve the education of patients and their families by developing structured and comprehensive patient education programmes (as per NICE Guidance on Educational Models). DESMOND for newly diagnosed Type 2 patients is currently running in the area but only to a minority of patients. Foundation course due shortly for those patients with diabetes who have not attended a newly diagnosed programme To explore alternative structured education programmes for those patients who are not suitable for DESMOND To provide structured education programme for people with Type 1 diabetes To introduce the new concept of care planning for all patients with diabetes To support those practices that are willing to deliver more services to their patients i.e. insulin initiation in Type 2 diabetes To ensure that patients, who are referred to specialist care, are the ones who actually will benefit from such input and actually need it. To reduce hospital admissions and accident and emergency attendances for patients with diabetes To increase the capacity of specialist care staff to provide specialist services (i.e. renal clinics, foot clinics) by more patients being managed in primary care To ensure all services needed are available e.g. psychology To increase the capacity of specialist dieticians and podiatrists to care for people close to home To ensure that all health care staff involved in working with people with diabetes have the appropriate competencies

The Diabetes Network recognises that to achieve this all health professionals have a key role, but also that they may need to work differently in the future. The principles of the redesign are to look at a broad picture of what activity needs to be commissioned from primary care and secondary care. Patients will have access to services locally and will benefit from integrated clinics.

Chairman: Rob Napier Chief Executive: Mike Potts


A detailed service specification will be developed for the levels of care that practices will be delivering, levels 1 – 2 being covered by QOF with an option for practices to deliver levels 3-4 in a primary care setting. Part of the service redesign will include a baseline assessment to identify potential gaps in service provision and local solutions. A detailed educational programme will be devised to enable practices to develop skills in order to deliver services to higher levels where desired. Expected Outcomes Improving care in primary and community settings Access to the right professional at the right time Care closer to home 18 week target Patient experience & choice Swift referral to the specialist team if an unfortunate event occurs and prompt intervention by the most appropriate member of the team Structured education programmes being delivered in their locality Care planning to support the self management element of their condition Reduce acute hospital admissions and accident and emergency attendances Performance indicators •

Number of practices with the ability to achieve the service specification and deliver services to levels 3 & 4. • Successful identification and implementation of the educational programme. • Equity in access to diabetes care to level 4 in primary care. • Patient satisfaction survey Priority area No.2 CHD Planned Initiative CHD prevalence is above national average and has been identified within the Joint Strategic Needs Assessment as a high priority for the people of Kirklees. The Consortium wish to ensure that North Kirklees practices are involved in future developments within the primary prevention nurse services. To link with Kirklees HIT team (with Dr Kelly as Lead GP) to ensure service provision across practices in North Kirklees is equitable and further developed within a clear framework. To link with the Contracting Team to ensure progress is made to commission a local cardiology service. We would expand the present pilot of 24 hour blood pressure monitoring across all practices. We will support a Consortium member practice to submit a business case for anti-coagulant therapy. Expected Outcomes /Performance Indicators To successfully work with the HIT team and implement any agreed developments in practices across the North Kirklees Consortium.

Priority area No.3 INTERMEDIATE CARE Planned Initiatives To review and improve access to intermediate care services both in and out of hours. To ensure appropriate services are available within primary care to prevent inappropriate admissions to secondary care. To ensure appropriate access to intermediate care services to meet the needs of patients in the North Kirklees area. Pursue the development of LES re nursing homes across Kirklees.

Expected Outcomes/ Performance indicators Improving care in primary and community settings Care closer to home Patient experience & choice

Chairman: Rob Napier Chief Executive: Mike Potts


Priority area No.4 MINOR SURGERY Planned Initiative To review current minor surgery provision with a view to identifying potential service provision within primary care and thereby reducing the volume of secondary care activity. Patients will be seen in a timely manner in a more appropriate setting. This is in line with the 18 week initiative. An initial focus will be on the development of a primary care service for vasectomies. We will also look to progress the carpal tunnel pathway to access direct listing. Expected Outcomes/ Performance indicators The vasectomy service will be operational from August 2008 Equity in provision of service Care closer to home Improvement in patient experience and choice Patient pathway reduced to achieve 18 week wait target

Priority area No. 5 PRESCRIBING Planned Initiative The Consortium will work with the PCT Medicines Management Team to identify and implement cost efficiency initiatives to make better use of financial resources locally. The National Audit Office has identified a number of areas where cost efficiencies can be made. The majority of these will be classed as ‘Better Care Better Value indicators’ but the DH. The Consortium will work with the medicines management team to identify the impact of movement from secondary care to primary care on the practice prescribing budgets to permit the appropriate unbundling of PBR tariffs and to facilitate the movement of the appropriate amount of funds from the PBC budget to the prescribing budget.

Expected Outcomes/Performance Indicators Working within the prescribing budget

Priority area No. 6 CARERS OF PEOPLE WITH DEMENTIA Planned Initiative To work in line with the developing Government initiative around carers of people with dementia by obtaining a complete register from each practice in order to take the initiative forward next year. As part of the Local Incentive Scheme each practice will be asked to obtain the full details of carers of patients with dementia. Expected Outcomes/ Performance indicators Create within each practice a complete record of carers for all patients with dementia

Chairman: Rob Napier Chief Executive: Mike Potts


Priority area No.7 PATIENT & PUBLIC INVOLVEMENT Planned Initiative To ensure both patients and the public are involved in the decisions made about local care. This will be achieved by working closely with the PCT PPI Team. As business cases are developed patient’s opinions will be sought in order to support any developments. Expected Outcomes/ Performance indicators Achieve the necessary patient and public involvement in the decisions being made regarding patient care and service redesign. Priority area No.8 IMPROVING DATA QUALITY

Planned Initiative To effectively utilise the skills of the Performance Analysts to facilitate the practices use and understanding of information. This will assist in maximising PBC consortia/practices’ ability to improve performance. By using the Local Incentive Scheme 4 data verification exercises will be carried out over the year for each practice. The areas to be identified will be proposed at the Consortium’s quarterly Forum meeting and will be relevant to business cases currently under consideration.

Greater accuracy of data Able to feed inconsistencies and errors back to secondary care via the Contracting Team Increase practice understanding of information Assist in preparation of business cases

Priority No.9 COMMISSIONING A PRIMARY CARE PHLEBOTOMY SERVICE Planned Initiative Following the successful submission of a business case the Consortium will deliver a service specification and work with the PCT through a procurement process to commission a primary care phlebotomy service. Expected Outcomes/ Performance indicators We will have a service available closer to home and closer to practice premises. Priority No. 10 IMPROVING ACCESS TO PRIMARY CARE

Planned Initiative To expand the range of services available and redefine roles within primary care. Within this there will be equitable provision of healthcare assistant hours across all practices. The Consortium will submit a business case outlining proposed changes and develop a service specification to ensure a consistent approach across all practices. Expected Outcomes/ Performance indicators Each practice will have access to a healthcare assistant and develop services offered to patients

Chairman: Rob Napier Chief Executive: Mike Potts


Priority No.11 - 18 WEEK TARGET Planned initiative Achieving target by working with Mid Yorks, the main secondary care provider and the patient to identify positive outcomes.

Chairman: Rob Napier Chief Executive: Mike Potts


5. IMPLEMENTATION PLAN Brief outline of rationale for choosing target

Detailed actions required to achieve target

Diabetes

Diabetes is a high & rising prevalence

Service redesign to include: self audit of practices

Completed

Develop Service Specification and submit a full Business Case.

Aug 08

Joint assessment of service provision in primary care with clinician and clinical lead Identifying patients currently in secondary care appropriate to be discharged to primary care Gap analysis to identify services to be commissioned to ensure equity of service provision to level 4 in primary care Educational programme developed to meet needs of practices to ensure they develop skills to the service delivery level they are aspiring to achieve. Identification of support services required in order to deliver a diabetic service in primary care e.g. diatetics psychology and podiatry

Comm May 08 – March 09

As above

Comm Aug 08 – March 09

As above

By March 2011

As above

By March 2009 Sep 08-09

As above

May 08

As above

Completi on date

Target No. 1

Description

Nominated lead

Key links

Dr Rajpura Helen Frain Jayne Crorken Janet Wilson HIT for Diabetes

JSNA Vital Signs Improving Health & reducing health inequalities Access to personalised and effective care

Chairman: Rob Napier Chief Executive: Mike Potts


2

3

4

5

CHD

Intermediate Care

Minor surgery

Prescribing

Sept 08

Dr Kelly Sara Fletche Naomi Reay

JSNA Vital Signs – improving health & reducing health inequalities

Link with HIT team

By March 2009

Dr Mehrotra Dr Kohi

Support Strategic development and identify local actions required

Aug 08

JSNA Vital Signs Improving health & reducing health inequalities

Commission primary care vasectomy service

By August 2008

Dr Kelly

Vital Signs Access to personalised & effective care.

Develop a carpal tunnel pathway to incorporate direct listing

By October 2008

Dr Chandra

To work closely with the PCT’s Medicines Management Team

Sept 08

Dr Barker Dr Chandra Michael Duckworth

Vital Signs Access to personalised & effective care

By March 2009

Helen Frain Jayne Crorken

Vital Signs Access to personalised & effective care

To work closely with the PCT’s PPI Team

By March 2009

Helen Frain Jayne Crorken

Vital Signs Access to personalised & effective care

Ensure PPI involvement in all business cases

Aug 08

Prevalence is above national average & identified as high priority for people in Kirklees

Link with HIT team

To improve access to intermediate care services

Provision of minor surgery in primary care

For each practice to be supported to work within their prescribing budget

6

Carers of patients with dementia

For each practice to create a register of patients with dementia and details of their carers

7

Patient & Public Involvement

To involve patients & the public in decisions being made about local care

Support HIT objectives Identify local service development

Ensure practices are aware of prescribing budget. As part of the Local Incentive Scheme obtain full details of carers of patients with dementia in each practice

Chairman: Rob Napier Chief Executive: Mike Potts


8

9

10

Improving Data Quality

Commission a primary care phlebotomy service

Improving access to primary care

To involve practices in checking of patient data.

LTC management is a key area and impacts greatly on the demand for phlebotomy services. Present access in primary care is not equitable and services available in secondary care are limited. To extend services in primary care and increase capacity through extra resources and redesigning roles.

For each practice to carry out 4 data verification exercises linked to business cases

By March 2009

Encourage practices to check data on a regular basis to identify trends and pick up anomalies in coding and costs. Business case submitted

May 08

Develop a detailed service specification.

August 2008

Work with Contracting through the procurement process to establish primary care phlebotomy services

December 2008

Successfully submit a business case

August 2008

Work with all practices to ensure equity in service

March 2009

Achieved

Helen Frain Jayne Crorken Harpreet Chahal Andrea Daley

Vital Signs Access to personalised & effective care

Consortia members PBC Manager Contracting Team Dr Kelly

Vital Signs Access to personalised & effective care. JSNA

Consortia members PBC Manager Contracting Team Dr Kelly

Vital Signs Access to personalised & effective care. JSNA

Chairman: Rob Napier Chief Executive: Mike Potts


I confirm that this plan is an accurate representation of the practice’s intentions for PBC for 2008/09.

Signed

Name

Date

Chairman: Rob Napier Chief Executive: Mike Potts

http://www.kirklees.nhs.uk/fileadmin/documents/publications/NKCC_plan_April_2008  

http://www.kirklees.nhs.uk/fileadmin/documents/publications/NKCC_plan_April_2008.pdf

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