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QIPP initiative analysis: summary by PCT by type – shown cumulatively for impact on gap. QIPP initiative analysis: detail by PCT by year. Cumulative impact of initiatives on cumulative gap. Cumulative impact of initiatives on cumulative gap. In £m’s. Menu of improvement opportunities.
Initiative: Right Care, Right Place
Reconfiguration of local secondary services in as part of shift to polysystems (e.g. outpatients and diagnostics)
Redesign of certain planned and LTC pathways (e.g. diabetes, COPD, MSK, sexual health, end of life and dementia)
Decommission and/or introduce evidence based thresholds for PoLCE
Primary care management of out patient referrals
Currently no structured or integrated care for COPD and adult asthma patients
Improve the diabetes care pathway and ensuring delivery of a greater part of the pathway in the community.
Expand the current model of service and use the Long Term Conditions models for delivering a Heart Failure service in
Establish Referral Management Centres as part of a package of measures to address referral management
Savings will be achieved by decommissioning – in year 1 and 2, with patients actively discharged to primary care.
Implementation of LTC Development Programme will raise the standard of primary care to achieve Tier 1 services.
From year 3, savings will be achieved by continued primary care management and shift to community based walk-in
Target to shift 80% of OP activity to community settings
Initiative: Specialist services
KCH is accredited as a HASU and Major Trauma Centre
GSTT has the Dimbleby Cancer centre
Vascular inpatient services across KCH and GSTT are to be centralized onto one site
Improve access to cancer services
Improve secondary prevention for cardiac and vascular diseases.
Prevention and improved management of stroke and heart disease
Decentralizing some of the ambulatory specialist services (inc. chemotherapy) across SEL
Centralising of specialist services e.g. aspects of cardiac
Centralise the number of paediatric inpatient units
Reductions in hospital admissions
Improved quality of services to those who are at the end of their lives
Implement the CSL Cancer model of care
Overseeing enhanced recovery after surgery (ERAS) in all acute trusts in a range of tumour sites.
Meeting the 14 day turnaround from the cervical screening test to receipt
Implementing the acute oncology measures for all trusts with an A&E
Commissioning new models of care for systemic therapy services
Implementation of revised tariff and recharge mechanisms for commissioning of systemic therapy services
14 day Turnaround
Establishment of an acute oncology service in all hospitals with an A&E
Initiative: Urgent Care
The focus of this initiative is:
Development of Urgent Care Centres
Diversion to primary care for primary care interventions
Build on the success of the rapid response team
Single point of telephone access to urgent care
Providing greater clarity for local people on how to access these services.
Reduced inappropriate use of A&E
Better management of primary care conditions in primary care
Increase the number of terminally ill cancer and non cancer patients
enabled to die in their own home.
Initiative: Medicines management
Drugs related savings
Maximising the scope for further in year savings on drugs.
New contract monitoring processes for high cost drugs
The growth rate in 2009/10 for primary care prescribing was 2.9%
Increase for 2010/11 on 2009/10 spend was 1%
Current forecast is £1million overspend on primary care prescribing budget of £35million.
Reductions in spend achieved by:
Leverage increased buying power of purchasing consortia / more effective procurement of clinically effective drugs
Enforce compliance for drugs for OP prescriptions
Ensure drugs are used within guidelines
Increased use of generics and reduced variability on prescribing