UNIVERSITY HEALTH CENTRE 12 SAND STREET HUDDERSFIELD HD1 3AL PARTNERS:Dr M A O’Leary Dr J Littlewood Dr N L Mounsey Introduction The Practice is pleased to submit its Commissioning Plan for 2010/11. Prior to outlining priorities to be set for the coming year we would like to take the opportunity to report on progress made against Plan for 2009/10 as follows:PBC Incentive Targets •
We are pleased to report that the Practice is confident that it has fulfilled all of its obligations under this criteria by achieving the following:-
Health Status 1 •
Unfortunately the Diabetic Care Planning training programme was not delivered as had been envisaged by the PCT however the PCT did arrange for a workshop to be run, attendance at which would allow the Practice to achieve this target. We are pleased to confirm that three members of the Health Centre Team did attend the workshop.
Health Status 2 •
The Practice has submitted, at the PCT required intervals, a template report detailing attendances at A&E within surgery hours – the reason for attendance has been noted within the Practice and appropriate action has been taken – e.g. if the attendance was relevant no action taken, if it was not relevant the patient may have been sent a letter advising them that they should, in the first instance, consider utilising the service of the Practice or, in some instances, telephone calls have been made to patients to discuss with them their recent attendance. With a young patient population and often international students who may not be au fait with how to utilise NHS services this is a useful educational tool.
Innovation & Learning 1 •
The Practice has attended regular Stand Alone Meetings throughout the year which allows it to claim the points for this particular incentive scheme target. Page 1 of 17 The University Health Centre, PBC Plan 2010/11 Draft 1
Innovation & Learning 2 •
The Practice has undertaken regular peer reviews in-house and submitted reports to the PCT thereby achieving this target in full
Innovation & Learning 3 •
The Practice submitted a PBC Plan for 2009/10 as required and achieved this target in full.
Medicines Management 1 & 2 •
Due to the nature of the practice profile the “standard” medicines management targets are not ideally suited to this type of population, however, the Practice has achieved as high a target as it feels it could possibly achieve and, following discussions with the Prescribing Team, it was agreed that the Practice would undertake a respiratory audit which is nearing completion and will be submitted prior to the PCT prior to 31.3.2010.
Finance & Activity 1 •
The Practice did not manage to come under total PbR budget although we remained within the Prescribing budget and only just overspent on the remainder.
Finance & Activity 2 •
Unfortunately this target around Ambulatory Conditions appears to be of very little relevance to this particular practice. The rollout and availability of data for this target was delayed, however, we have submitted the required reports to the PCT and hope to have qualified for the target points.
Locally Determined Targets 1 and 2 •
Target 1 - The Practice undertook to complete a Health Needs Assessment survey and is pleased to report that this has been completed and submitted to the PCT. The Practice was hoping to utilise the results in planning for service development over the coming period, however, there was very little on the “wish list” of the patients. However, responses did confirm that the services already developed, i.e. Cash Clinics, extended Physiotherapy/Psychotherapy, MSK, Audiology, Patch Testing etc. were all welcomed by the patients surveyed with many of them having utilised these clinics. It was also interesting to note that some 30% of Page 2 of 17 The University Health Centre, PBC Plan 2010/11 Draft 1
respondents advised that they had been screened for Chlamydia which compares favorably when looking at the figures for the Practice from the National Programme of only around 3-4%. It is perhaps worth noting that STI screening is undertaken in many ways and that the national programme only includes a small number of total population as it excludes any patient with even mild symptoms etc and although patients perhaps cannot be classed as asymptomatic due to minor conditions they do not turn out to be positive for Chlamydia but are prevented from participation on the national programme. However, the Practice has recognised this shortcoming in the programme and does undertake extensive swab testing etc. in house as part of the CASH clinic. •
Target 2 – The Practice undertook to run data validation searches twice throughout the financial year – one was completed and submitted in September 2009 and the second validation has just been completed and will be submitted to the PCT by 31st March 2010, thereby ensuring that the Practice achieves all of the points for the Locally Determined Targets.
FEEDBACK ON CLINICAL AREAS REDESIGNED THROUGHOUT THE FINANCIAL YEAR OF 2009/10 Physiotherapy Services The Practice has provided physiotherapy clinics in-house for many years and was able to further develop this service through a PBC Business Case which would allow the clinics to run all year round (not just during term time). The Practice has seen a growth in list size over the last six months and there has been a slight lengthening of waiting list times for the Physiotherapy clinics but this service continues to add value to the facilities available for patients and does help to reduce secondary care referrals. There have been 148 referrals to the inhouse physiotherapy service in the year to date. Psychotherapy Services As above with the Physiotherapy services, the Practice was able to extend the Psychotherapy sessions via a PBC Business Case and this has enabled us to provide continuity to patients over the summer months and to prevent lengthy waits for patients. We currently have a waiting list of only around three weeks which is crucial for students who need to keep up with their studies etc. There have been in excess of 70 referrals to the in-house Psychotherapist in the year to date. Sexual Health – Delivery of Level 2 Services This service was introduced in September 2008 and is now firmly embedded within the services offered within the Health Centre. The clinics are extremely Page 3 of 17 The University Health Centre, PBC Plan 2010/11 Draft 1
well attended as demonstrated within the recently completed Health Needs Assessment with very positive feedback having been obtained from patients utilising the clinic. The biggest challenge has been to target male patients and we continue to work on this aspect with consideration being given to a “mens only session” during the busy Autumn term in order to see what kind of response the Practice receives for this and if it proves popular it will be followed with regular “men only sessions”. Young males and females at University are at a time in their lives when many of them become very sexually active and it is important that they are educated well on all sexual health issues in order to prevent bigger problems in the future and to set the trend for their future behaviour. By providing this type of service within the primary care environment we are helping to de-stigmatise the subject and delivering a very accessible and quality service led by clinicians who have been trained under the guidance of Dr Lindsay Short at the local GUM and who have undertaken STIF training courses. Statistics as at 9.3.2010 Males
Number of Contact Tracing
Blood tests requested
Referred to GUM
The Plan was to offer 1560 appointments throughout the year – to date we have seen 1266 patients 1st April to the end of February 2010 – the above statistics do not take into account the number of patients who have failed to attend their appointments. There is also a further hidden workload in that many of the “results” are given via telephone consultation and these are not included within the above figures but should be and we are currently putting systems in place to ensure the read coding is entered which will allow us to capture this data. In addition patients often present within the “normal” GP surgery for results and again these follow up appointments have not always been captured in the data collection process. We continue to develop the service and are keen to roll this programme out to include patients of other local Stand Alone practices that we are grouping with. We would hope to acquire microscopy equipment within the next twelve months which would further enable treatment to commence more quickly. Page 4 of 17 The University Health Centre, PBC Plan 2010/11 Draft 1
Audiology The Practice was very pleased when the PCT approved its Audiology Business Case in the Autumn of 2009. This has enabled the Practice to acquire audiology testing equipment and to train staff in the use of this equipment with the service being rolled out to patients in January 2010. During January and February 2010 the Practice was able to screen 5 patients in-house which will help to prevent secondary care referrals for patients who require reassurance – many of the referrals for students to ENT for hearing loss have been for “worried well” and over exposure to loud music etc. This system allows us to screen and rescreen if required at a fraction of the cost of a secondary care referral. If a hospital referral is required we are able to submit the audiology test result with the referral form, thereby removing that aspect of the outpatient journey. Patch Testing This is a service which was rolled out during the summer of 2008 and which has been very popular and useful with both clinicians and patients. Under the business plan, approval was given for fifteen patients to be patch tested – to date we have screened fourteen patients between the period 1st April 2009 – 28th February 2009. From the fourteen patients that had the patch testing there were 9 with normal results, two patients with allergy and medication being prescribed to help them deal with the problem. Three patients were referred to secondary care for more complex problems. Minor Injuries A Business Case was submitted around Easter 2008 for the practice to try and reduce the number of patients attending A&E for minor injuries, often within surgery opening hours. As the Practice has a significant number of international students who are not always familiar with how to utilise NHS services, it was felt that investment in a high publicity campaign around Fresher intake time would be useful. This business case has been approved and accreditation paperwork submitted and the programme was eventually commenced in October 2009. Within the first three months of this clinic being introduced we have treated 60 patients for minor injuries within the surgery. The Practice is able to offer minor suturing, gluing of wounds etc. Practice Based Commissioning Management Allowance The Practice is pleased to report that it has met all of the targets contained within the scheme which has allowed the Practice to drawdown monies against time Page 5 of 17 The University Health Centre, PBC Plan 2010/11 Draft 1
spent on commissioning workload. The Practice has representation on the Sexual Health and Mental Health HITs and is keen to continue to work with these two groups in the coming year. CONCLUSION We are happy to report that in light of the above the Practice is confident that it has: Improved the quality of patient care within the community by providing easily accessible services for patients. Reduced the amount of secondary care referrals for a number of specialities particularly around the areas highlighted above. By operating the above in-house pathways we believe we have assisted the Trust in achieving its 18 week targets and have given patients choice. We have tried to work with the practice population by seeking their views and feedback on service delivery and hope to further develop services over the coming months to reflect the feedback received. The Practice does not have a lot of patients suffering with Chronic Disease and, therefore, has not significantly benefited from investment seen over the last year into this area. However, as the Practice has a “bespoke” patient profile, the Partners feel it is beneficial and in the interests of the patients to continue to “stand alone” for the purpose of Practice Based Commissioning. This allows more freedom to develop services which are linked to the population of the practice and also tie in with the JSNA as mentioned above and the Operating Framework for the NHS in England 2009/10 by improving patient experience and staff satisfaction as new skills are developed, together with improving overall health and education of a specific population at a time when they are best able to make lifestyle changes which will benefit them and the NHS for years to come. It is worth noting that the Practice is keen to work alongside other local Stand Alone Practices and is currently working closely with Oaklands, Elmwood, Slaithwaite and Newsome practices. Whilst being stand alone does allow the practice to prioritise its own unique issues/requirements the benefits of working closely together with other like minded practices is evident and we are keen to further explore the route of cross referrals for pathways developed in-house in order to ensure the patient has an improved patient experience and financial savings are maximised wherever possible both for the benefit of the PCT and the practices involved. Page 6 of 17 The University Health Centre, PBC Plan 2010/11 Draft 1
PRACTICE BASED COMMISSIONING PLAN FOR THE UNIVERSITY HEALTH CENTRE APRIL 2010 TO MARCH 2011 The University Health Centre is a three Partner Practice with three Salaried GPs and caters for around 8,800 patients, the majority of whom are students/families of students. There are a high number of international students based at the University as it has been extremely successful in attracting students from overseas with a recent increase in applications from Eastern European countries. We are advised by the University that applications for the academic year commencing September 2010 have trebled when compared to the same period last year and we are advised that there are currently no caps on the intake of international students, unlike the caps in place for home students. The Practice does find that high recruitment from overseas has a direct impact on patient list size – over recent years we have seen an increasing number of students remaining local, i.e. attending Huddersfield University whilst residing in the Huddersfield area with their families, whereas international students are obviously all new into the area and eligible to register with the Practice. We have also noted that there is significant growth in the area of graduates remaining in the Huddersfield area and choosing to stay with the Practice. The practice profile, therefore, is very different to that of our peer group surgeries and the needs of this specific practice population often differ significantly. As a result of this, the Practice workload does not fit with the National QOF and a Local Student QOF has been put into place which works very well and addresses areas of need as demonstrated through the JSNA, i.e. obesity, alcohol, contraception and sexual health. There is also a significant demand for robust Mental Health provision and MSK provision within the Practice. With regard to commissioning, due to the very young population of the Practice, it was felt preferable to “stand alone” in order to better facilitate changes which would benefit the patients of this practice by tailoring services to the unusual age profile as demonstrated in the age breakdown included below. Population as at 4.1.2010 – 8858 patients Aged 0-4 years 179 (male 96 – female 83) Aged 5-16 164 (male 83 – female 81) Aged 17-24 5337 (male 2855 – female 2482 Aged 25-34 2347 (male 1541 – female 806) Aged 35-44 598 (male 406 – female 192) Aged 45-54 155 (male 97 – female 58) Aged 55–64 57 (male 34 – female 23) Aged 65–74 17 (male 10 – female 7) Aged 75-84 4 (male 2- female 2)
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We are about to commence our fourth year as a “stand alone” commissioning Practice and, as detailed earlier in the report, have made significant progress in improving the service delivery to patients. The Practice chose to submit a Business Plan for one year only last year due to the fact that the Practice had been running one Partner down from February 2008. The Practice was able to recruit an additional Salaried GP in August 2009 which has now restored the clinical team to a more balanced position. With the recent growth in capitation there remains a need for additional clinical time and the Practice has been utilising locum sessions to bridge the gap for the time being. Due to the staffing issues highlighted above, the beginning of the financial year was one of consolidation of services already in place. The internal restructuring absorbed a lot of clinical and administrative time and, therefore, limited time was available for commissioning issues. However, the Practice is pleased with the progress made to date and, in fact, as the year rolled out it was able to introduce the new Audiology service in January 2010 and purchased an ultrasound machine for use within its existing MSK clinics in the Autumn of 2009. Three GPs and the Physiotherapist have undertaken training on use of the ultrasound equipment and the Practice is looking forward to finalising internal systems which will allow it to utilise this service with effect from April 2010. Organisational Development – the growth in capitation has identified a lack of clinical capacity and as mentioned earlier there has been some bridging of this gap by the use of locum sessions. The Practice has also increased its nursing capacity by a few hours per week – we would like to increase even further but delays in receipt of additional capitation monies following the growth seen in September 2009 have curtailed further expansion in this area at present. The Practice is currently in negotiation with the PCT regarding the unique nature of the practice and the need for a more equitable system to be utilised for payment of capitation monies. Administrative duties continue to grow, particularly as a stand alone practice – the Practice has been able to increase administrative capacity by one day per week which has allowed more staff to become involved in the duties associated with PBC and significant training has also taken place. We have one member of the administrative team undertaking an NVQ with a further member of the team having recently attended a two day workshop in Business Administration, together with other members of the team being able to gain a wider understanding of the workload involved with PBC by assisting with web browser interrogation, audits for data collection etc. Nursing staff have been trained in the use of audiology equipment and three members of the team continue to receive four monthly updates from Dr. Short at GUM. Training continues in a variety of other areas for staff, including Cardiovascular Risk, Contraception, Asthma Management, Cytology, Minor Injuries/Minor Illness.
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The Practice recently met with the PCT lead for Sexual Health who was pleased with the way in which the CASH clinics were developing. During the 2009/10 Financial Year the Practice was able to utilise some of its Freed Up Resources to purchase a “DIY” health check booth which allows patients to perform blood pressure readings together with BMI readings which are then added to their records and proved to be an extremely useful piece of equipment during the busy Fresher registration period. The Practice will be submitting evaluation reports as required by the PCT for all business cases over the coming months with some of them now into their second/third years of implementation. These services include:• • • • • • •
Level II Sexual Health Services Physiotherapy Clinics Psychotherapy Clinics Audiology Clinics Minor Injuries Clinics Patch Testing Ultrasound Clinic
Goals - Medium Term In addition looking forward, the Practice is keen to explore the possibility of undertaking toe nail surgery – three GPs currently remove toe nails but if the nail bed requires removing these patients are currently referred to secondary care. Clinicians within the Practice have undertaken this procedure previously and are keen to consider, via a Business Case, the possibility of performing this procedure in-house which would be advantageous for the patient in that waiting times are likely to be shorter, the procedure is being undertaken in a familiar environment and the service should be able to be delivered at a significant reduction of current tariff price. Goals - Longer Term With the introduction of the Ultrasound machine for MSK purposes it is hoped that this will have a significant impact on secondary care referrals as it is brought into use in the coming financial year following finalisation of in-house procedures/ securing of additional clinical time etc. In addition the intention is to further develop the use of this equipment to cover Gynaecology problems. It has been noted via the RUP data/Web Browser that the highest areas for secondary care activity for the Practice are Gynaecology/Obstetrics. It has also bee noted that often patients are referred to Gynaecology for bleeding problems – often simply because the Practice is unable to undertake a smear test due to the age of the patient. Action taken at the hospital is frequently simple/conservative measures which could be undertaken in-house and the use of ultrasound equipment would Page 9 of 17 The University Health Centre, PBC Plan 2010/11 Draft 1
assist in this area. Terminations of pregnancy are a significant expenditure for the Practice and it is also an area for discussion re the Practice offering counselling around this issue with the intention of speeding up the process for the patient. There are tight regulations around where a termination can be carried out and despite pilots sites where Primary Care Medical Terminations have been offered, it does not look likely that this programme will be rolled out in the near future – therefore the Practice is keen to build on its sexually transmitted disease screening/contraceptive services (one stop shop) within the Level 2 CASH clinic, in addition to the use of LARC in order to prevent as many unwanted pregnancies as possible. PBC Incentive Scheme - the practice will work towards achieving the targets within the 2010-11 PBC Incentive Scheme and has identified two locally determined targets as follows:LOCALLY DETERMINED TARGET 1 The practice agrees to undertake the following audits throughout the 2010/11 year:•
Audit Minor Injuries Clinic under Business Case to see if there has been any impact on A&E attendances since introduction of the Minor Injuries Clinic in October 2009. The business case submitted for Minor Injuries was really a “dipping of toes in the water” – the Practice is keen to establish whether this is a service which requires more investment in clinical time in order to reap the main benefits of reduced A&E attendances.
Re-audit the Practice’s in-house treatment for acne to see if there is compliance with the internal pathway and whether the introduction of this pathway in late 2008/early 2009 has had any impact on the number of referrals to secondary care and if prescribing costs have reduced.
Implanon – the Practice will audit the number of implants fitted/removed in order to establish the efficacy of LARC for this particular population with the audit including:o How many Implants have been fitted in a given period o When was counselling carried out o How long after counselling did the patient wait for Implant to be fitted o Is the patient happy on Implanon o Has the implant been removed o If removed – what were the reasons o Main side effects identified Page 10 of 17 The University Health Centre, PBC Plan 2010/11 Draft 1
The Practice would prefer to have the whole of the year to undertake this workload and submit the audit reports to the PCT by the end of March 2011 for full payment upon completion of this work – i.e. no interim payment required for this particular target. LOCALLY DETERMINED TARGET 2 The Practice has in the past managed to work within prescribing budgets and has successfully reduced some of the high cost items. It has been noted that Enteral Feeds are currently the Practice’s main cost item for a relatively small number of patients. The Practice will seek to ensure that these supplements are being taken appropriately and within clinical guidelines. The Practice will also review its “top 10” drugs twice throughout the year in an attempt to identify any changes/improvements that can be made to reduce prescribing costs. Partial Payment – the Practice will undertake both of the above prescribing tasks by the end of September 2010 and again by the end of March 2011 for full payment. It is requested that the PCT note that discussions are to take place with the Commissioning Lead for the PCT/PCT Prescribing Team re some of the targets contained within the Incentive Scheme for 2010/11 which may not be relevant for this particular type of Practice – with a view to replacing them with something equally stretching but more relevant. Practice Based Commissioning Management Allowance The Practice will work towards achieving the targets contained within the Management Allowance Scheme and will draw monies down against this scheme in line with the agreement. As last year, we believe that the areas of service redesign/services to be consolidated will contribute to improvements in all of the following which are currently high on both local and national agenda:Vital Signs
Providing care closer to home and avoiding secondary care referrals, thereby assisting the Trust to meet its 18 Week deadline and by offering services in familiar surroundings we would hope to increase the satisfaction and confidence that patients have in the NHS. Robust Mental Health Services being provided in-house to a vulnerable population. Development of the Care Planning Pathway for patients with LTCs as per the PBC Incentive Scheme and in relation to the national target. Page 11 of 17 The University Health Centre, PBC Plan 2010/11 Draft 1
Improving health and reducing health inequalities – work around alcohol and obesity together with educating patients on correct usage of NHS services and preventing unnecessary A&E attendances for minor injuries – often alcohol related.
The practice is meeting the target of keeping adults and children well by improving their health and reducing health inequalities as highlighted above, particularly around areas identified within the JSNA i.e. obesity, sexual health, and alcohol which are high areas of concern for this particular cohort of patients. We shall aim to target actions to meet the needs identified within the Health Needs Assessment recently undertaken – various promotional themes will be adopted throughout the year as highlighted within the recently completed patient survey in order to help patients address issues around healthy eating/immunisation status etc. The Practice may look towards introducing some group obesity sessions as the recent survey indicated that students might welcome this. In addition the Practice has recently completed an audit on alcohol consumption on a group of students that were screened upon arrival at University in September 2008 and then again at the end of their first year/as they entered their second year of study. Whilst not surprising the results were disappointing and are detailed below:-
Year Audit Completed
Drinking Habits coming out as Normal
Drinking Habits coming out as Hazardous 40 84
Drinking Habits coming out as Harmful 5 4
Number of Patients Surveyed 117 117
Of the patients who indicated that they were normal/hazardous/harmful in 2008, their 2009 survey results are now broken down as follows:2008 (72) Normal – 2009 responses changed to
2008 (40) Hazardous – 2009 responses changed to
2008 (5) Harmful – 2009 responses changed to
22 Normal 49 Hazardous 1 Harmful 5 Normal 33 Hazardous 2 Harmful 1 Normal 3 Hazardous 1 Harmful
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It is obviously disappointing that 61.5% of students who upon arrival at University were noted to be drinking at normal levels (i.e. 72 out of 117 patients surveyed) has seen a significant adverse shift - the number dropped to 29 out of the 117 patients surveyed (i.e. only around 25%) indicating that they remain at Normal drinking levels within 6-12 months of being at University. At the Hazardous level in 2008 we had 40 students (40/117 i.e. 34%) drinking at a Hazardous level but some 6-12 months later with the same cohort of students we have 84 students drinking at Hazardous levels (i.e. almost 72% of students surveyed). There was noted to be little change at the level of Harmful drinking with one of the students previously indicating as drinking at Harmful level now drinking at a Normal level which was pleasing to see together with a further three that have dropped from Harmful levels of drinking to Hazardous levels of drinking. The Practice is keen to re-audit the same cohort of students as they enter their third year of studies to see if the “newness of the student experience” has started to wear off and whether perhaps financial pressures or heavier academic workloads have any impact on their drinking habits – i.e. are they likely to become heavy drinkers in the future or is it just a transient “student experience”? Whatever the outcome it is felt that every opportunity should be taken to promote the issues associated with excessive alcohol consumption and this will be a driver for in-house educational displays throughout the coming year. The Practice has worked closely with the PCT Alcohol Health Practitioners and the University in developing “young people friendly” material to highlight health damage/personal safety issues associated with alcohol abuse.
We believe that the development of the Level 2 Sexual Health Services within the primary care setting has been a culture shift and has enabled us to work in partnership with other local organisations (GUM) and has been very well received by patients as demonstrated by the recently undertaken Health Needs Assessment – the results of which have been returned to the PCT under the Locally Determined Indicators for PBC Incentive Scheme 2009-10). We are pleased that development of this type of service will allow the patient to have a stronger role in determining how, where and by whom the service is delivered.
Improving patient experience – by delivering robust and efficient services within the primary care environment to a very high standard we are improving the patient journey, together with developing staff and allowing them to extend their scope of duties.
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The practice continues to ensure patients are offered choice at the point of referral.
Over the last 12 months the Practice has worked closely with a handful of other “stand alone” practices and is keen to further develop this relationship. The practices involved have each developed in-house services which they feel could easily be delivered to patients of other practices, thereby delivering care closer to home (i.e. within the Primary Care setting) at a fraction of the secondary care costs normally associated with these pathways. The practices have approached the PCT with a view to rolling out these services to their primary care colleagues as quickly as possible and look forward to this being concluded in the very near future.
Signed …………………………………………………………… On behalf of Drs O’Leary, Littlewood & Mounsey Date ………………………………………………………………
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UNIVERSITY HEALTH CENTRE â€“ PBC IMPLEMENTATION PLAN 2010-11 NO.
DETAILED ACTION REQUIRED
The practice will aspire to meet all of the targets within the PBC Incentive Scheme
Requirements of the final Incentive Scheme will be circulated to all staff and discussed at the first full team meeting to be held in April 2010.
PM to disseminated and feedback to staff
Staff will be identified as being responsible for monitoring of specific targets and will report to the Practice Manager on a monthly basis in order to enable progress to be reported back to the PCT as requested.
PM to identify teams and to undertake reporting to PCT
PM to identify teams and undertake reporting to PCT
The Locally Determined Targets will require a specific team to be set up to ensure that they are fulfilled and reported upon as required to the PCT. 2
The Practice will aspire to meet all of the targets within the PBC Clinical Engagement Scheme
The Practice will circulate details of the Management Allowance Scheme and will maintain accurate records which will aid submission of claims under this programme.
PM will ensure accurate records are maintained thereby enabling appropriate claims to be submitted
The Practice will work closely with the PCT Commissioning and PCT Prescribing Team in order to ensure that targets are set for the Incentive Scheme which are comparable in difficulty to those set under the local PBC Incentive Scheme
It is hoped that agreement can be reached by early April.
GPs/PCT Commissioning Lead/PCT Prescribing Team/PM and Audit Assistant to meet and set targets and then monitor as required.
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DETAILED ACTION REQUIRED
The Practice will continue to work towards remaining within budget both for PbR and Prescribing
Regular meetings with PBC Manager/PCT Finance personnel and regular interrogation of the Web Browser system will be required
Ongoing – usually monthly
Partners/PM/Data Quality Officer to be involved in regular meetings with the PCT and other members of the team to support administratively as requested
Existing Business Cases:Physiotherapy Psychotherapy Level 2 Sexual Health Audiology Clinics Patch Test Minor Injuries/Illness Ultrasound
Evaluations to be provided to the PCT as requested by them on PCT templates.
To be submitted as required by PCT
PM to submit documentary evidence as requested by PCT
Urgent consideration to be given to rolling out some of these services to the patients of other stand alone practices as per ongoing discussions with the PCT
Aim is to have these services up and running to other practices as soon as possible after 1.4.2010
Stand Alone Group to take these issues forward with the PCT collectively and to drill down to practice level as appropriate with the PCT
Medium Term Goal – Business Case for performing toe nail bed surgery
The practice will establish the number of patients currently being referred into secondary care for this procedure and will consider submission of a Business Case to perform such surgery in-house
Dr Littlewood to lead on this topic with further inhouse discussions required/audits required – followed by submission of Business Case if appropriate – we would anticipate this business case being submitted towards the second half of
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the financial year with a view to it being introduced early in 2011 if approval received
DETAILED ACTION REQUIRED
Longer Term Goal – Further exploration of a revised Gynae pathway, particularly around bleeding problems and consideration to be given to the use of ultrasound equipment for gynae purposes
Further discussion required in-house and consultation with secondary care consultants required – data collection to be undertaken with a view to revising pathways if appropriate and submission of Business Case at that time
Dr Mounsey to lead on this topic with assistance from other team members as required
The Practice will continue to attend regular Stand Alone Meetings in order to share experience and benefits of revised pathways etc.
Regular attendance at the monthly meetings
Work to be undertaken within the next 18-24 months – commencing with the revision of gynae pathway for referral of patients with “bleeding” problems within this financial year and further consideration to utilising ultrasound equipment for gynae purposes within the next 1224 months Ongoing
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Lead GP for this – Dr O’Leary supported by Practice Manager and Data Quality Officer
Published on Oct 25, 2010