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Enhanced Services Roll-out process

Enhanced Services Roll-out process. Lynette Daws Head of Primary Care Development and Service Integration March 2014. Background. Securing Excellence in Commissioning in Primary Care – published June 2012 Transfer of enhanced services CCGs NHS England Local Authority. Procurement.

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Enhanced Services Roll-out process

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  1. Enhanced Services Roll-out process Lynette DawsHead of Primary Care Development and Service IntegrationMarch 2014

  2. Background • Securing Excellence in Commissioning in Primary Care – published June 2012 • Transfer of enhanced services • CCGs • NHS England • Local Authority

  3. Procurement • Any qualified provider (AQP) – any provider who is able to provide a specific service and meets the required minimum standards • Competitive tender (CT) – different providers are invited to tender for a contract • Single action tender (SAT) – contracts awarded directly without competition (code of conduct / conflicts of interest)

  4. Any qualified provider (AQP) • Services: • Ear irrigation • ECGs • H pylori breath testing • Phlebotomy • Treatment room • Awarded through a Standard NHS contract

  5. Single action tender (SAT) • Services: • Anti coagulation monitoring • Asylum seekers • Chronic disease monitoring/shared care (x4) • Homeless • Neo natal checks • Primary support to care homes • PSA • Awarded through a Standard NHS contract

  6. What happens now? • Provider event held 18 February 2014 • All services commence 1 April 2014 (except Phlebotomy) • AQP – awarded following tender process • Single tender actions – communication to practices for continuation • Guide produced and communicated

  7. Primary care services - making a referral • GPs that are not on the AQP provider list: • Referrals via CAS • Patient contacts CAS and offered choice of provider • Referral sent to chosen provider (nhs.net) • Outcome communicated to referring GP

  8. Primary care services - making a referral • GPs that are on the AQP provider list: • Offered choice and choice recorded • If appointments can’t be provided patient contacts CAS (except if patient chooses to wait for an appointment)

  9. Clinical assessment service (CAS) • Offer patient choice • Turn around times • 24 hours • 48 hours • 4 days • Send referral to chosen provider • Chosen provider contacts patient to arrange an appointment • It is the patients responsibility to contact the CAS

  10. Key contacts • Susanne Croll – contract officer • Joanne Milner – CAS manager • Andy Taylor – finance

  11. Area Team Update Jonathan Rycroft, Keith Mann, Joe Lunn Primary Care March 2014

  12. This session …… • Changes to primary care commissioning • What this means for primary care contractors • Our approach to quality improvement • Strategic challenges and opportunities for primary care • Questions and answers NHS | Primary Care Presentation | March 2014

  13. Reforms: Understanding the new NHS NHS | Primary Care Presentation | March 2014

  14. Reforms: Derbyshire and Nottinghamshire • D&N Area Team • 10 CCGs in Area • 4 Local Authorities • 4 HW Boards • c 2m population • c 1200 primary care providers NHS | Primary Care Presentation | March 2014

  15. Reforms: Area Team functions • Assuring the effectiveness of CCG commissioning • Direct commissioning: • Primary Care (AT) • Public Health (AT) • Health and Justice (EM) • Armed forces Health (M&E) • Specialised Services (LL AT lead) NHS | Primary Care Presentation | March 2014

  16. Reforms: PC team responsibilities • Completing a safe transition – legacy issues? • Commissioning and assuring: • A core offer of high quality primary care services • Continuous improvement in primary care quality and patient outcomes • Facilitating longer term transformation of primary care in line with practice, CCG, AT and national vision NHS | Primary Care Presentation | March 2014

  17. Reforms: PC team for Nottinghamshire Nottinghamshire GP & Pharmacy Team 156 GP Contracts, 219 Pharmacy Contracts, 6 CCGs Keith Mann: Contract Manager Kerrie Woods & Liz Gundel: Assistant Contracts Manager Rachael Owen (0.5 wte): Assistant Contracts Manager (Estates) Richard Hobbs: Primary Care Support Mark Yates: Primary Care Support Jayne Bouch: Primary Care Support Denise Ellis: Administrator NHS | Primary Care Presentation | March 2014

  18. Reforms: What does all this mean for PC? • Less close relationship than with PCTs • National policies / single operating models with less local flexibility. E.g. Xmas opening, mergers • New requirements e.g. e-declaration, CQRS • More commissioners and procurement processes (e.g. enhanced services) • Mapping investments to benefits • Knowing who to call! NHS | Primary Care Presentation | March 2014

  19. Reforms: What does all this mean for PC? • Contractual approach in 2014/15 • GMS – contract changes • QOF pts reduced by 341 to core funding and enhanced services • Seniority to be removed over 6 years – funds back to core funding • New DES on unplanned admissions • Three DESs removed from 2013/14 • New IT requirements, including ability for patients to book online and access their Summary Care Record • All patients 75 and over assigned a named accountable GP to ensure coordinated care NHS | Primary Care Presentation | March 2014

  20. Reforms: What does all this mean for PC? • PMS / APMS – as predecessor PCT arrangements • PMS baseline exercise to inform national review • GP Premises • New national premise development process expected • New landlords - NHS PS, CHP • Triennial rent reviews NHS | Presentation to [XXXX Company] | [January 2014]

  21. Reforms: Quality improvement • Identifying potential concerns: • Performance against the GP HLIS / GPOS • CQC compliance • Fitness to practice concerns • Incidents, complaints, GP patient survey • AT improvement actions: • Collaborative approach with CCGs • Contractual action • Fitness to practice process NHS | Primary Care Presentation | March 2014

  22. CCG integral to process Informed by CCG Regular review of intelligence Learning / best practice shared Triangulation with other intelligence / stakeholders (e.g. CCGs / CQC) Primary Care Quality and Performance AT PC QAG logs outcome of actions AT contract lead proposes next steps & urgency AT PC QAG considers, approves and logs next steps AT and / or CCG review success of actions AT / CCG liaise to agree approach / actions AT and / or CCG lead agreed actions (improvement or contractual) NHS | Primary Care Presentation | March 2014

  23. Strategic context: Call to action • Today: • The NHS treats 1,000,000 people every 36 hours • Between 1948 and 2010, life expectancy in England for men increased by 13 years to 79 • 88% of patients in the UK described the quality of care they received as excellent or very good

  24. Strategic context: Call to action • Demand and costs are increasing • Ageing population, growing co-morbidities and increasing patient expectation • Innovation and technological advances increasing costs • Quality challenges • Recent unacceptable quality failures • Unwarranted variation in quality and outcomes • Some pockets of unacceptable performance NHS | Primary Care Presentation | March 2014

  25. Strategic context: Call to action • A Call to Action, requires each CCG and NHS England to engage with the public, health and wellbeing boards and other stakeholders to explain the challenges ahead, and to then develop a 5 year commissioning plan. • Improving General Practice A Call to Action aims to stimulate a specific debate in local communities – amongst general practice, area teams, CCGs, health and wellbeing boards and other community partners – as to how best to develop general practice services NHS | Presentation to [XXXX Company] | [January 2014]

  26. But over the last 10 years…50% increase in GP consultations35% increase in emergency care admissions65% increase in secondary care episodes for >75’s • 50% increase in GP consultations • 35% increase in emergency care admissions • 65% increase in secondary care episodes for >75 • Combination of factors – • Demographic change • Poorly joined up services between primary, secondary and social care • Technical advance • Economic decline NHS | Presentation to [XXXX Company] | [January 2014]

  27. Consequences • Hospitals under greater pressure • Too many older people or people with a long term condition admitted to Hospital • Poorly coordinated services • People not supported to remain independent • Too many people being admitted too early to long term care • Unsuitable model of care (primary care) NHS | Presentation to [XXXX Company] | [January 2014]

  28. Tight and growing economic constraints

  29. Strategic context: Primary care strategy • There is a need to create an environment that enables general practice to play a much stronger role, as part of a more integrated system of out-of-hospital care • CCGs are drafting local primary care strategies in response to these challenges • Local pilots and PM’s challenge fund to trial innovative working NHS | Primary Care Presentation | March 2014

  30. This session …… • Changes to primary care commissioning • What this means for primary care contractors • Our approach to quality improvement • Strategic challenges and opportunities for primary care • Questions and answers NHS | Primary Care Presentation | March 2014

  31. Nottingham City CouncilLocally Commissioned Public Health Services(formerly Local Enhanced Services)PLT Session Practice Managers • Speakers: • Quality and Commissioning: Kaj Ghattaora • Public Health: Carl Neal, Sarah Bolstridge • Crime and Drugs Partnership: Clare Fox

  32. Health and Social Care Act. • Public Health transferred to the local authority 1st April 2013 • Locally Enhanced Services transferred from PCT to: • Nottingham City Council (Public Health & CDP) • CCG • NHS England • Contracts transferred to the respective 3 organisations • 2013/14 Interim Arrangements: LA & CCG working together re payments • New Name: Locally Commissioned Public Health Services (LCPHS) • Local Authority developing Contract and Performance team

  33. Locally Commissioned Public Health Services • General Practice • IUCDs • Sub Dermal Implants • Asymptomatic Chlamydia Screening • Asymptomatic STI Screening • NHS Health Checks • Alcohol • Substance Misuse (CDP)

  34. Locally Commissioned Public Health Services • Policy Leads: • Crime and Drugs Partnership (CDP) • Alcohol • GPwSI • Public Health • Sexual Health • NHS Health Checks

  35. Locally Commissioned Public Health Services • Procurement and Contracts 2014-15 • Public Health – managed by Quality and Commissioning • Drug and Alcohol Services – managed by Crime and Drugs Partnership

  36. Public Health- Procurement & Contract Arrangements • New 1 year Contracts for 2014/15 on LA T&C • One Contract per practice with service specifications attached for each LCPHS (Sexual Health & Health Checks) • Contracts to go out by first week of March • Please return asap to LA Contracts Team • Audits and monitoring

  37. Sexual Health Services

  38. Sexual Health - Claims Process • All claims for 2014/15 NCC, not the CCG. • New contracts: a new quarterly monitoring claim form, completed on a quarterly basis • New contract also includes a supplier detail form for practices to complete and return asap • For 2014/15: please submit your 2014/15 claims tolphcs@nottinghamcity.gov.ukby the 10th day of the following month • Public Health Contracts Team will be available to answer your query. Named individual to be identified • Payments Levels to be maintained for 2014/15

  39. Sexual HealthNew Business • We are happy to receive enquiries regarding new business • There is an application to complete and a process to follow for practices to sign up for new business • Payments structure will be issued by Nottingham City Council to practices quarterly • For Sexual Health: please send any enquiries to lphcs@nottinghamcity.gov.uk

  40. Sexual HealthAccreditation • As Commissioners: - evidence for practitioners who provide LARC and STI services for quality assurance and patient safety. • GMC registration (or NMC for Nurses) • DBS • Letters of Competencies for IUT / Sub-Dermal • Recertification of LoC • Sexual health related CPD training in last 5 years (for Nurses) • Evidence of minimum number of procedures • Completion of BASHH STIF3 course- including date and level. • 2014/15 Claims cannot be processed until we receive evidence.

  41. Sexual HealthTraining • FSRH recently announced changes to its General Training Programme (FSRH Diploma and Letters of Competence). Includes: • Introduction of an on-line knowledge assessment (eKA) for health professional to qualify for a FSRH Diploma or Letter of Competence • Current holders of the DFSRH wishing to take a LoC will not be required to do this • The opening up of the FSRH Diploma to nurses, linked to full nurse diplomate membership of the Faculty (NDRSRH). • The opening up of the Letters of Competence in IUT and SDI to nurses and doctors without having to first obtain the Faculty diploma. • http://www.fsrh.org/pages/TempPage1.asp

  42. Sexual HealthTraining • Chlamydia: training or review meetings for may be arranged with the CSO as required • Chlamydia: Health care professionals - update, maintain & develop their capabilities according to their own identified learning needs. • STIs: professionals required to attend a BASHH STIF course and training sessions provided by NUH (GUM) • LARC:LoC IUT3 from FSRH / LoC SDI5 from FSRH (doctors) • LARC: RCN accreditation (nurses) • NUH training sessions within their service specification – inc. FSRH and BASHH accredited postgraduate training • PMs ?? Your understanding of training needs??

  43. Sexual Health LCPHS– the future • Commissioners are looking at how we commission LCPHS from April 2015 onwards across the City and County

  44. NHS Health Checks

  45. NHS Health Checks: • Business as usual – standardised service specification to be used across City and County, and updated with national guidance • GP NHS Health Check software - purchased by LA from The Computer Room (TCR) for a further year • NHS Health Check clinical system templates being updated with support from NHIS (to be issued to practices shortly) • Accreditation – appropriately trained staff as per national workforce competences guidance

  46. NHS Health Checks: • Revised payment structure to reflect change of emphasis from invitations to uptake, to increase effectiveness of the programme

  47. Health Checks - Payments • Data submitted via The Computer Room NHS Health Check software will continue to be used to calculate payments • Payments will be issued by Nottingham City Council to practices quarterly

  48. NHS Health Checks – the future • Commissioners are looking at awarding long term contracts from April 2015 across the City and County • Procurement options are being explored and there will be a consultation in the summer.

  49. Crime and Drugs Partnership

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