Comissioning NIS Commissioning Facilitators Meeting Tuesday 13 September 2016
Meeting agenda Agenda item Lead Chairs welcome, introductions and aim of the meeting Shah Overview of the Acute Transformation programme & the Cheryl purpose of the NIS Developing the 17/18 Commissioning NIS & the role of Shah commissioning facilitators 16/17 NIS: Calprotectin audit Shah 16/17 NIS: IMAPS audit Victoria 16/17 NIS: Dermatology audit Monir Next steps & AOB Shah
Background to the NIS… • Running since 2010 • Evolution from Bill Jenks’ referral data • In 16/17: £560k cost per annum • Aims of the NIS to date: • Supporting engagement of GP members as commissioners • Collating and analysing data in key areas to help understand the variation in usage of services between different practices’ patient populations to improve commissioning decision making. • Increasing quality of care delivered in the community in order to reduce costs further down stream • Allocating resource via commissioning facilitators
Acute Transformation – previously Planned Care • Pathway redesign – • Pathway redesign – Gastro Straight To Test (STT) Anticoagulation, LTC bundles • Direct GP access to diagnostics – • Direct GP access to diagnostics – Calprotectin dedicated TST Diagnostics project • Community alternatives – • Community alternatives – Teledermatology & IMAPS Ophthalmology & Gynae • Virtual access to specialists – • Virtual access to specialists – eCKD consultations Advice & Guidance, non F2F FUps • Peer review of elective referrals – • Peer review of elective referrals – Commissioning NIS? Commissioning NIS 17/18
16/17 NIS structure Locality engagement Education: Internal & External Audits x 3 Claims validation E-Referrals
Changes from last year Section under 15/16 NIS Amendments to 16/17 NIS Engagement in commissioning No change Network Education – Internal Mental Health continues to be an important improvement area and as such continues to be Education one of the priorities. Amendment to the provision of contact details for MH commissioning managers to assist networks with this (area of feedback by GPs). Network Education – External Reduced requirement from 16 hours down to 12 hours of education to be undertaken by Education for patients each network. This is to reflect the resource required to undertake these sessions. Three areas to be targeted: MH (with contact details for MH commissioning managers to assist networks with this), frequent A&E attenders eg new parents and frequent GP attenders eg offering appropriate self management Clinical audit Increased weighting to 40% of total. This is from GP feedback that the resource required to undertake the audits is considerable. Provided pro formas for audits in three CCG priority areas: Calprotectin, MSK referrals and Dermatology referrals. Each of these reflect new pathways offering faster access to consultant-led care and improved management of patients in the community (under the care of their GP). Pro formas designed by CCG clinical leads/Governing Body lead. Validation and Quality No change Encouraging greater use of Choose Renamed section to “Encouraging greater use of e - Referrals for acute referrals” in line with & Book for acute referrals new name for Choose and Book. Encouraging Use of Technology Removed this section. This was previously allocated 10% of the total NIS which the CCG felt was better used to reward other parts of the NIS (ie audits) and practices have made considerable progress towards this goal already. Furthermore, significant funding and borough-wide approaches are often required to introduce new technologies. Projects such as e-Consult and the technology innovations in general practice planned in Tower Hamlets as part of the Vanguard programme are better placed to support this objective. Commissioning Facilitators No change Payment values/calculation No change
16/17 Funding 1. Engagement in 2. Network 3. Network Education - 4. Clinical 5. Validation Commissioning Education - External Internal Audit and Quality 6. E-referrals 30% 70% Network 5%* 10%* 20%* 40% 15% 10% Total Payment Payment Network 1 £2,857.56 £5,715.13 £11,430.25 £24,671.16 £9,251.69 £6,167.79 £60,093.58 £18,028.07 £42,065.50 Network 2 £2,857.56 £5,715.13 £11,430.25 £25,757.87 £9,659.20 £6,439.47 £61,859.47 £18,557.84 £43,301.63 Network 3 £2,857.56 £5,715.13 £11,430.25 £18,910.43 £7,091.41 £4,727.61 £50,732.39 £15,219.72 £35,512.67 Network 4 £2,857.56 £5,715.13 £11,430.25 £20,048.74 £7,518.28 £5,012.18 £52,582.13 £15,774.64 £36,807.49 Network 5 £2,857.56 £5,715.13 £11,430.25 £18,123.63 £6,796.36 £4,530.91 £49,453.84 £14,836.15 £34,617.69 Network 6 £2,857.56 £5,715.13 £11,430.25 £22,418.84 £8,407.06 £5,604.71 £56,433.55 £16,930.06 £39,503.48 Network 7 £2,857.56 £5,715.13 £11,430.25 £25,604.88 £9,601.83 £6,401.22 £61,610.86 £18,483.26 £43,127.60 Network 8 £2,857.56 £5,715.13 £11,430.25 £27,348.46 £10,255.67 £6,837.11 £64,444.18 £19,333.25 £45,110.93 £22,860.50 £45,721.00 £91,442.00 £182,884.00 £68,581.50 £45,721.00 Total £457,210.00 £137,163.00 £320,047.00 % Split per Element 5.0% 10.0% 20.0% 40.0% 15% 10.0% 100.0% 30.0% 70.0% Split per Element £22,860.50 £45,721.00 £91,442.00 £182,884.00 £68,581.50 £45,721.00 £457,210.00 Commissioning Facilitators Funds per Network Total available fund Total £13,440 £107, 520
Looking forward to 17/18 An emerging challenge awaits the Tower Hamlets health economy • How can we best support our members as commissioners • What is the role of commissioning facilitators • How do we make this role as effective as possible • Given the Acute Transformation agenda, what could this investment be directed towards • How could we re-design the system to enable it to be more responsive to all of our needs and less bureaucratic • How could we monitor the quality • Forming a steering group • How do we take this work forward
16/17 Audits Calprotectin : an essential precursor to the new ‘Straight to Test’ Gastroenterology pathway (currently piloting with 3 practices, roll out planned for October 2016) IMAPS : ascertaining the quality of GP musculoskeletal management and identifying areas for local service improvement with the new integrated community MSK service Dermatology : assessing the local management of dermatological presentations and the quality of the new community dermatology service How will we feedback to you on your audits
Next steps • FAQs from the CCG – please disseminate to your practices • Complete the audits – you can send these in as soon as they’re done • CCG to develop a simple template for consistent returns • Complete the 16/17 return – should be able to return in March or April 2017 • Contribute to the plans for 17/18 NIS development • Contribute to the development of the Commissioning Facilitator role • Finalise and agree 17/18 NIS in early 2017, before start of new financial year
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