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The Practice is pleased to submit its Commissioning Plan for 2008/09 The Plan sets out what the Practice wishes to achieve through PBC during the 2008/09 Financial Year. As you are aware, the Practice has a “unique” patient profile in that it is a Health Centre associated with Huddersfield University, with the prime aim of providing PMS health services for the student population (and their families) of Huddersfield University, together with providing health care services to Staff (and their families) of Huddersfield University. Due to the practice population, the needs of the patients registered with the Practice differ from those of a “general practice”. Disease prevalence is low with a higher workload associated around Contraception and Sexual Health, Health Education, Musculoskeletal issues and Mental Health problems. The Practice made the decision to “stand alone” for Commissioning purposes last year with the intention of redesigning pathways which are relevant to the age profile of the Practice and the Practice has been pleased with progress to date Discussions have taken place with the PCT around budget setting for “fair share” allocation and the Partners have agreed the budget setting methodology for 2008/09 with Bryan Machin and the agreement that the PCT will move towards identifying an alternative tool which it can utilise for budget setting in 2009/10 for this particular Practice. The Practice will be involved in the implementation of the revised methodology to be utilised for 2009/10. National Priorities of Mental Health, Obesity, Sexual Health and Smoking are all key factors for the patients of this Practice and, in fact, were all highlighted under the recently completed Joint Strategic Health Needs Assessment and the Practice will continue its aim to tailor services which will address any unmet need in these areas for its Practice population. OJECTIVES The Practice will commit to engaging under Practice Based Commissioning and aspiring to achieve all targets contained within the locally agreed DES. This will involve the following:-

Health Status targets:Health Status 1 – if the Practice is able to utilise its Diabetic patients under this criteria it will be happy to accept this target – if however, following

Practice Manager – PBC – PBC Practice Plan Revised – 23.4.2008

further discussions with the PCT it is unable to utilise its Diabetic patients this would leave the Practice with a problem as there is relatively low prevalence of long term conditions and it has been agreed that an alternative indicator could be identified if required. We have been advised that inclusion of Diabetic patients within this target is acceptable. Health Status 2 – this target has been discussed with Jan Giles as the Practice has concerns re notification of patients moving in/out of the practice population (turnover of 2,000 patients plus per year). The Practice does accept the target of notification of patients newly diagnosed with Diabetes by the Practice and Jan Giles has advised that there is to be an exception made for the Practice with regard to notification of newly registered patients with existing Diabetes and removal of patients from the Practice List. The Practice is keen to come to some compromise with the PCT in this regard but does accept the initial target of notification of all newly diagnosed Diabetic patients to the PCT. Health Status 3 – Development of a comprehensive smoking register – the Practice is able to accept that it will work towards this target. •

Innovation & Learning Targets Innovation 1 Practice to ensure representation at three relevant events – Practice is able to accept this target. Innovation 2 The Practice will provide a Plan of Peer Group Meetings to be held in the forthcoming year and will submit Minutes to the PCT from these monthly meetings. Innovation 3 The Practice will Produce a PBC Plan for 2008/09 and submit to the PCT.

Medicines Management Medicines 1 and 2 – we are yet to receive final confirmation of these but as we believe them to be similar to last year – i.e. around the prescribing of Simvastain/Pravastatin and PPIs the Practice will be happy to accept these targets but would request that as they do not necessarily fit this type of practice population that significant progress made towards achieving these targets should be recognised by the PCT.

Finance and Activity Finance & Activity 1 – Practice to remain within PbR indicative budgets. Finance & Activity 2 – Practice to remain within Prescribing budget

• •

Locally Determined Targets 1 & 2 Locally Determined Target 1 – The practice will aim to increase the percentage of patients aged 16+ having a consultation within the last 15 months who have a BMI recorded in the same period. A baseline will be taken covering the period 1.10.2006 to 31.12.007 to establish the percentage with this recorded as a start point. The second search will be undertaken as at 31.3.2009 looking back 15 months to 1.1.2008 (i.e. patients having consulted within that period who have a BMI recorded within the same period). We would propose partial achievement is paid on a 5% increase and full achievement if a 10% increase is demonstrated at the 31st March 2009. This is not an easy target for the Practice as we have a turnover of some 2000 patients

Practice Manager – PBC – PBC Practice Plan Revised – 23.4.2008

registering and a further 2000 patients leaving – therefore frequently we are penalised by work having been undertaken and no recognition being gained as they have left the practice list by the data submission date. Locally Determined Target 2 – The practice constantly works with its patient population and regularly undertakes patient surveys/questionnaires. The Practice will aim to undertake two surveys during the financial year which will seek patient views on the following:•

Feedback on the provision of sexual health and contraceptive services – in house – with the aim of tailoring our services as required to meet patient expectation and demands.

Lifestyle survey regarding alcohol with the aim of helping to educate patients as to unit values and improving our statistical baseline. It is proposed that the Practice receives partial payment for completion of one of the above surveys and full achievement for completion of both surveys within the timescale.

CLINICAL AREAS FOR REDESIGN The Practice has undertaken a significant amount of work on planning areas for redesign during the last financial year and has submitted the following Business Cases to the PCT:• • •

• •

Request for extension of Physiotherapy Clinics – Approved – now implemented Request for extension of Psychotherapy Clinics – Approved to 31.12.08 as a minimum – we are currently awaiting confirmatory letter and will then instigate this extended service. Request to provide a Sexual Health Clinic working at Tier 2 on site – this has been approved and we currently await confirmatory letter when the Practice will commence work to set up this programme with a commencement date set for July 2008. Request to provide audiology testing in-house – this has been approved, however, the Practice is still awaiting final confirmation that it may proceed with this due to a query regarding soundproofing of the room to be utilised. Once final approval is received the necessary equipment will be purchased, staff will be trained and it is anticipated that commencement of the service could follow very swiftly. Request to provide patch testing in-house – this has been approved – we are currently in the process of arranging training for staff and hope to commence this service very quickly. Request to provide Minor Injuries Service in-house in an attempt to reduce the number of patients attending A&E during surgery opening hours with minor injuries/minor ailments. A further meeting is required with Jim Barwick before this Business Case can progress to Finance & Performance.

Due to our successful applications highlighted above we feel a period of consolidation is required in order to embed these services and ensure robust evaluation processes are in place. It is pleasing to note that the areas to be tackled, i.e. Sexual Health/Mental Health are areas highlighted within the Joint Strategic Health Needs Assessment and we would hope that the Practice Manager – PBC – PBC Practice Plan Revised – 23.4.2008

services we are developing in-house will go some way towards addressing the unmet need identified in these areas. We would also highlight to the PCT that we are currently a GP Partner down due to longterm sickness with the resultant reduction in GP time, which can be allocated to PBC Business Planning, and Development and this will obviously present us with a challenge over coming months. New Clinical Areas to be Considered for Redesign As mentioned above we do feel that a period of consolidation is required, however, the Practice is keen to further develop its Musculoskeletal services which, again, is an area of relatively high activity for this practice population, due in the main to sporting injuries. The Practice is keen to purchase an ultrasound imaging machine which will assist with both diagnosis and treatment of musculoskeletal injuries and it is anticipated that the Practice will look towards working up a Business Case to support the purchase of this equipment with the development of a service which could be rolled out to other Practices locally – the timescale for this is within the financial year of 2008/09. The Practice is short of nursing time and continues to devote an enormous amount of its nursing capacity towards health education/public health roles – it is envisaged that it may be possible to group clinics together which would target areas within the Joint Strategic Health Needs Assessment (smoking/alcohol/obesity etc.) This is an area, which the Practice would like to restructure, and which may lend itself to further development over the forthcoming financial year. Practice Based Commissioning Management Allowance The Practice agrees to adhere to the proposed Management Allowance Criteria as detailed below:•

Production of a PBC Plan for 2008/09 linking into JSNA

To provide a progress report on the Plan quarterly to the PCT (Sept, Dec, March)

To meet monthly with PBC Manager from the PCT

To sign up to a PCT PBC Agreement once Practice has been provided with the relevant documentation

To attend the Kirklees Commissioning Forum on a regular basis

To contribute towards the work of the HITs – the Practice has already identified Sexual Health and Mental Health as being the two HIT teams the Practice wishes to work with. Representation has already taken place at both of these groups with Dr O’Leary and Janet Hallam having attended the Sexual Health HIT Meeting and Dr Mounsey having attended the Mental Health Forum. The Practice envisages that the representation on these HITs will remain as above.

Practice Manager – PBC – PBC Practice Plan Revised – 23.4.2008

The Practice regularly obtains feedback on services from patient population and, in addition to the GP annual survey is to undertake a similar survey for Practice Nurses during this financial year. In addition the Practice would envisage seeking feedback from patients on redesigned areas during this period, i.e. we are proposing utilising the Locally Determined Target within the LIS for feedback on our sexual health and contraceptive services and possibly we will seek feedback on our TB services. The Practice is aiming to increase the use of (LARC) longer acting contraceptive devices and aims to utilise the survey as a means by which not only to gain valuable feedback but also to give/share information.

The Practice agrees to attend relevant locality meetings as made aware of such events by the PCT/Locality Managers.

NATIONAL AND LOCAL PRIORITIES (JSHNA) We believe that the areas of service redesign highlighted/services to be embedded will assist with improvements in the following areas:• • • • • • • •

Improves care within the community by providing easily accessible services for patient population Assists the practice in reducing secondary care referrals, particularly A&E, Musculoskeletal, Mental Health, ENT (Audiology and Patch Testing) GUM services Assist with ensuring the continuation of meeting the 18 week target for treatment Meets patient choice and quality of care as patients prefer to be treated within the practice, rather than be referred to secondary care, i.e. brings treatment closer to home. Responds to patient needs identified within surveys undertaken, hence improving the patient experience Mental Health/Sexual Health and Obesity are again listed as National and Local Priorities for the coming year. Reduce admissions to hospital in the longer term for chronic disease as a result of STIs, Obesity etc. Meets an unmet need during vacation periods for Musculoskeletal and Mental Health Problems and targets an identified vulnerable population for easy access to Sexual Health services. The optimum place to augment these services is within the primary care environment as patients are far more likely to present here with concerns re STIs than to attend a GUM Clinic, which would alleviate pressure on the local GUM services and enable them to continue to meet their 48 hour targets. Service in-house is more cost effective than in secondary care.

As this is only the second year of the Practice working as a “stand alone” Practice for Practice Based Commissioning it is still, relatively speaking, in its infancy but is pleased with progress made to date and hopes to have a further successful year ahead. We do feel that a period of consolidation is required in order to bed down

Practice Manager – PBC – PBC Practice Plan Revised – 23.4.2008

the newly redesigned care pathways but are keen to continue to identify other areas where improvement can be made which will enhance the quality of patient care delivered from this Practice.











Practice Manager – PBC – PBC Practice Plan Revised – 23.4.2008

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