DR JENNISON & PARTNERS
ELMWOOD HEALTH CENTRE HOLMFIRTH
PRACTICE BASED COMMISSIONING PLAN 2010/11
Table of Contents
1. INTRODUCTION & PRACTICE PROFILE
3. ACCOUNTABILITY AND GOVERNANCE ARRANGEMENTS
5. HEALTH NEEDS
6. UPDATE ON 2009-10
7. COMMISSIONING PRIORITIES
8. KEY AIMS FOR 2010-11
INTRODUCTION & PRACTICE PROFILE
This document sets out the practice based commissioning plan for Elmwood Health Centre for 2010-11. Elmwood Health Centre in Holmfirth has a patient population of approximately 13,200 (at 1.4.2010). It covers an area of approximately 75 square kilometres in the Holme Valley and adjacent areas, including a small area outside Kirklees around Dunford Bridge and Crow Edge which are within the NHS Barnsley administration. The area is largely rural although the growth of housing in recent years has led more of the Holme Valley to be classified by local government as “urban”. The Practice has 8 GP partners and 4 salaried GPs who together provide a GP WTE of approx 8.5. The Practice provides a full range of general medical services under a PMS Plus contract. The Practice has endeavoured over recent years to increase the scope of clinical services provided at Elmwood for the better access of patients to key health treatments such as Physiotherapy, Ophthalmology and Podiatry
To commission, for patients of Elmwood Health Centre, a range of services which will be delivered according to recognised and measurable standards of best practice and care and which will provide a greatly improved ease of access both in terms of “near patient provision” and of reduced waiting times. In doing so, the Practice also aims to commission more cost effective alternatives to the services hitherto offered to the Primary Care Trust by providers.
FINANCE Our commissioning plan for 2010-11 is one of consolidation and continuity, set against a background of financial constraint at PCT and national level, which does not lend itself to new service commissioning at the present time. The anticipated refurbishment of the premises (due to happen during 2009/10) has been a victim of the financial climate. This means that some of the ideas we might have developed for improving local services are constrained by the lack of space and facilities that we could otherwise have gained. The Practice is now in discussion with the Director of Finance about possibilities for a modified plan and we hope that some improvement may still be possible in the coming year. The Elmwood Practice has succeeded in remaining within its hospital services and prescribing budgets during 2009-10, despite the impact of Pace of Change. The Practice hopes to maintain a position within budget during the coming year.
ACCOUNTABILITY AND GOVERNANCE ARRANGEMENTS Our commissioning plan for the coming year is one of consolidation and continuity, set against a background of financial constraint at PCT and national level, which does not lend itself to new service commissioning at the present time. The anticipated refurbishment of the premises (due to happen during 2009/10) has been a victim of the financial climate. This means that some of the ideas we might have developed for improving local services are constrained by the lack of space and facilities that we could otherwise have gained. The Practice is now in discussion with the Director of Finance about possibilities for a modified plan and we hope that some improvement may still be possible in the coming year.
QIPP – Quality, Innovation, Prevention and Productivity Elmwood’s plan will support QIPP through • its ongoing commissioned services which improve the quality of patient care through provision of valued local services. These deliver high quality care in a short time-scale and contribute to reducing unnecessary secondary care activity • more proactive management of long term condition patients, for example through care planning and data verification. • the improved outcomes for patients leading to the efficiency savings necessary in the current financial climate.
MAP OF KIRKLEES LOCALITY AREAS WITH APPROXIMATE ELMWOOD PRACTICE AREA SUPERIMPOSED
PRACTICE POPULATION DEMOGRAPHICS (QE DECEMBER 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 % % % % % % % % % % % % % % % % % % % % % % %
Age 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
Ma le s 9 56 85 168 239 309 518 489 527 593 609 476 320 285 320 415 451 407 352 6,628
% Ma le s Fe ma le s % Fe ma le s 0.1% 61 0.5% 0.4% 102 0.8% 0.6% 148 1.1% 1.3% 191 1.4% 1.8% 234 1.8% 2.3% 312 2.3% 3.9% 488 3.7% 3.7% 467 3.5% 4.0% 510 3.8% 4.5% 584 4.4% 4.6% 626 4.7% 3.6% 530 4.0% 2.4% 344 2.6% 2.1% 267 2.0% 2.4% 281 2.1% 3.1% 375 2.8% 3.4% 406 3.1% 3.1% 393 3.0% 2.6% 339 2.6% 49.9% 6,658 50.1%
T ota l % T ota l 70 0.5% 158 1.2% 233 1.8% 359 2.7% 473 3.6% 621 4.7% 1,006 7.6% 956 7.2% 1,037 7.8% 1,177 8.9% 1,235 9.3% 1,006 7.6% 664 5.0% 552 4.2% 601 4.5% 790 5.9% 857 6.5% 800 6.0% 691 5.2% 13,286 100%
The 2009 (refreshed) Joint Strategic Needs Assessment (JSNA) for Kirklees provides an assessment of some of the health issues of the population of The Valleys locality. Significant issues highlighted for the locality as a whole are: General adult health is worse than the national average but better than Kirklees overall – The Valleys has the lowest rate in the borough of premature deaths from cancer and heart disease. The elderly: The Valleys has the highest proportion of people in Kirklees about to reach retirement age, therefore there is a need to encourage behaviours and provide care that will promote “healthy ageing”. Also, despite the comparatively healthier picture for general adult health, the current Valleys elderly population have significantly worse health status of physical functioning, physical ability and bodily pain. Incontinence in the over 65s is the highest in a rising elderly population and is likely to place increasing pressure on primary care services locally. 2 in 3 pensioner households comprise people living alone. Young people: despite Holme Valley being one of the least socio-economically deprived areas of Kirklees and one of the highest achieving for GCSE education, more of its 14 year olds reported feeling “miserable”, “angry” and “lonely” than in any other locality. Lifestyle issues: A third of adults reported “binge” drinking in a given week; 40% of males and 30% of females regularly drank more than the recommended weekly limits. Also, 16% of all adults in the “Valleys” were recorded in the JSNA as obese – the lowest rate in Kirklees. However, this figure looks less optimistic when compared with the statistic that 39% of women aged 18 - 44 in the Holme Valley were obese or overweight. The Practice believes that 16% is an underestimate. There is a significant link between obesity and diabetes. The expectation is that the national prevalence of diabetes will continue to rise and this is bound to be reflected to some extent among the Practice population. We shall continue to review prevalence and to develop opportunities to screen “at risk” patients for Type II diabetes.
Continuation of the Elmwood Podiatry service
Continuation of the Elmwood-based Ophthalmology service
To develop practice-based diabetic services
To facilitate, through the “stand-alone forum”, the commissioning of further services for our patients, via service level agreements with established
practice-based commissioned services.
Update on Progress during 2009/10
Performance monitoring The Web browser has now improved in performance. However, it has until recently only provided data which is already nearly 3 months old when first made available. The migration to SystmOne 2009/10 was completed successfully and Practice staff regard it as (on the whole) a big improvement.
Podiatry service The podiatry service has been operating within budget for several months now. This was achieved through a programmed discharge of â€œlow riskâ€? patients who no longer met the service criteria, coupled with a review of the frequency of patient attendances against need. There are currently about 400 patients on the service list. The podiatrist is working with the Practice nurses and district nurses in trying to ensure at least one attendance a year by all patients on the diabetic register, and helping them optimise skills in diabetic foot care. Ophthalmology The ophthalmology service continues its success and the team now includes an ophthalmology clinical nurse specialist. Physiotherapy Our Elmwood Physiotherapy service transferred from PMS Plus to PBC this year. We aim to have acute cases seen by the physiotherapist as quickly as possible. The service keeps within budget through a limit on appointments. Ideally, the Practice would like to extend service provision as the waiting list is tending to grow and the service provider would like to provide more sessions to combat this. We feel the accessibility of this service is a key factor in our low activity on non-elective attendances in the musculo-skeletal HRG. Medicines Management The Practice is achieving well on all prescribing targets and anticipates keeping well within its indicative Prescribing budget. GP Training The Practice had one GP registrar from August 2009 to 31st March 2010. Unfortunately, our accredited trainer has now left the Practice so we have had to withdraw from the scheme for the foreseeable future.
Key Aims for 2010-11
Collaboration with other stand alone practices During 2009/10, Elmwood has participated in the Stand-Alone Forum (which also comprises Newsome, Slaithwaite, Oaklands and the University Practice) to share ideas and experiences and develop services. The group’s intention in 2010-11 is to seek PCT approval for the adoption by other practices of existing business cases for the provision of local services. These are already demonstrating improved care pathways, efficiency savings and offering greater choice and accessibility to patients. The proposed services include Ophthalmology, Orthopaedics, ENT and Sexual Health. Continuation of Existing Service Commissioning We intend to continue commissioning local Podiatry and Physiotherapy services (funding for the latter has been switched from PMS Plus to PBC). Both services are popular with patients and experience heavy demand. Commissioning College To continue attendance at the Commissioning College and contribute ideas to the development of healthcare in the local community Performance Monitoring To extend our activity in analysing web-browser data and identify factors influencing expenditure in key areas and to document evidence of how locally commissioned services may be producing savings in areas of secondary care Service Development & Long Term Conditions Management We still wish to work towards providing a “one-stop-shop” for diabetic patients attending for annual reviews by seeking to co-ordinate where possible the work of Podiatry, Ophthalmology and practice nurses. We aim during the coming year to develop care planning for patients with long term conditions (LTC). We shall use the PBC financial incentive scheme to support work in LTC management. Patient and Public Involvement To develop an effective means of Patient and Public Involvement specifically in the area of Diabetes care. To continue building on collaborative work with the community nursing team to improve communication and sharing of best practices among the whole primary care team. Medicines Management Continue work with the Medicines Management team in addressing aspects of the ‘Better Care, Better Value’ national indicators and to maintain our position of keeping within budget and meeting local prescribing targets. Education Training & Governance The Practice has reviewed its clinical / organisational meetings schedule and will run a programme of weekly meetings to support on-going learning and change, and to meet the various training and educational requirements of statute, PPD, QOF and Revalidation.
I confirm that this plan is an accurate representation of the practiceâ€™s intentions for PBC for 2010/11.