Council of Members 3 September 2014
Minutes of last meeting: 27 March 2014 Dr. Richard Proctor, Council of Members Chair
Five Areas to Track Bulletin 4 - Item For Information - Dr. Richard Proctor
1. Hospital waiting times: 18 weeks for admitted patients The Current Situation 1. The NHS Constitution sets a right for patients to be treated within 18 weeks of referral should they require admission. Trusts must ensure that a minimum of 90% of all patients referred are treated within this timeframe. In 2013/14 KCH Denmark Hill failed to achieve the admitted RTT target for the year . 2. As part of the 2014/15 contract the CCG has agreed revised trajectories for RTT performance, which would see the trust achieve the RTT standard from the end of Q2 2014/15. In April, 84.4% of admitted patients were treated within 18 weeks of referral. 3. The over 18 week backlog at the trust is currently at approximately 1,846 (April 2014 figure). The backlog is largest in a number of specialties of which General Surgery, Neurosurgery and Orthopaedics are the main ones. 4. It is important to note that a number of specialties affected by over 18 week waiting times are for services that from 1 April 2013 are commissioned by NHSE England and not the CCG. Actions Taken Acquisition of the PRUH site and development of the Centenary Wing at Denmark Hill has provided further ‘ring - fenced’ elective c apacity 1. since October and November respectively. Additional capacity at the Orpington site includes 45 beds and 3 theatres both with phased openings with the last theatre opening in January 2014. Centenary Wing development has provided a net additional 16 beds and 1 HpB theatre which opened in February. These development will increase capacity in Q1 and Q2 2014/15 compared to the same period last year. 2. The trust is focusing on increasing internal capacity and reviewing the funding necessary to continue outsourcing work to the private sector. Providing more information to primary care to support informed choice in relation to waiting times – local CCGs have written to GPs setting 3. out the issues associated with KCH waiting times to ensure GPs are informed of waiting times and able to discussing choice with patients . On-going Actions 1. From February 2014 there has been an agreed process to transfer Orthopaedic patients from KCH to GSTT. KCH will aim to transfer 30 patients a month until end of Q2 , when the process will be reviewed. Following a meeting in June, KCH will also be looking to transfer spinal patients. 2. Maximising internal trust capacity to support the overall decompression of the KCH acute hospital sites and the effective management of available emergency and elective capacity across the trust, to allow for a sustainable pattern of services across each site for the future. King’s consultants undertake regular clinical review of all patients waiting in excess of 18 weeks for treatment . 3. 4
2. IAPT and practice-based counselling The Current Situation 1. Southwark Psychological Therapies Service (SPTS) is provided by SLaM. Practice-based counselling also provide services in 43 practices. Both providers deliver talking therapies under the Improving Access to Psychological Therapies (IAPT) national programme. 2. The CCG has a predicted prevalence of 41,929 people in Southwark with depression/anxiety and a target that 15% of these people are seen by IAPT services each year and that 50% of patients ‘move to recovery’ following the intervention. The CCG failed both targets in 2013/14. At present we know there aren’t enough people being seen by all IAPT services ( SLaM and counsellors) and not enough of these 3. patients are getting the outcomes they want. 4. We also know there is significant variation in the delivery of counselling services offered across practices in Southwark, which impacts on delivering NICE and IAPT compliant services. 5. Following the CSC decision in December 2013 to re-commission the entire primary care psychological therapies service, a period of engagement with stakeholders ended on 31 May. Mental health commissioners have initiated the procurement process for a Southwark Talking Therapies Service. 6. The tendering process will start on 9 September 2014 with contracts being awarded on 5 January 2015 and the new service commencing on 1 April 2015. Recent Actions Taken 1. Recovery plan to achieve national target by increasing capacity of services using additional staff within main provider. 2. Notice given to providers and information provided about Market Engagement Event on 7 July. 3. HR support to GP practices to clarify the value of TUPE transfers to inform procurement and provide clarity and reassurance to staff involved. 4. Development of procurement documents e.g. Memorandum of Information (MOI), Service Specification. 5. Project Steering Group for procurement identified with meeting dates set. Outcome of Actions / Planned Outcome 1. Effective market testing event on 7 July to guide procurement process. 2. Successful start of the procurement process by end July 2014. 3. Feedback report from engagement period to be reported, currently delayed due to a technical issue with survey. 5
3. Community clinics and single point of referral The Current Situation 1. Over the last two years Southwark CCG has been developing pathway specific single points of referral (SPR) and community clinics as part of the CCG’s Programme of Service Redesign. There is a commitment to further expand this community provision in or der to shift care out of hospital (as per the aim included in the CCG strategic plans). 2. SPRs are currently operating for MSK (MCATS), Diabetes, Respiratory, and ENT . Community services/clinics exist for MSK, diabetes, dermatology, gynaecology and heart failure (as a step down from secondary care) and a CVD service (AF/hypertension/lipid management). In addition to the SPR & community clinic functions, a number of our community services provide ‘ virtual clinics ’ to support Primary 3. Care in reviewing practices’ caseloads and providing advice on management. Recent Actions Taken 1. Over the last year via virtual clinics, the Diabetes Community Service has supported general practice in their management of patients with HbA1c and have made a significant contribution - in 2012/13 67.8% of patients on the diabetic register were controlled with HbA1c ≤ 64 mmol/mol and in 2013/14 this increased to 70% (non validated QOF data 13/14). 2. May’s PLT was delivered by the ENT Referral & Advice Service, which delivered training targeted at both GPs & nurses. Feedback from the event was positive and practices have been asked to feedback how they would like to receive additional training and support from the service. 3. The CCG recently reviewed Southwark’s patient referral services (PRS); however findings were inconclusive. National evidence suggests that models which build on peer review and learning have maximum clinical and cost effectiveness. Therefore, the next stage will be for the CCG to work with localities in exploring a potential model of PRS embedded in neighbourhoods. This will consider the value of condition specific versus system wide approaches. Outcome of Actions / Planned Outcome The delivery and uptake of the local SPRs by all Southwark practices is vital to reduce activity and deliver Southwark’s acute QIPP 1. plans and we ask for practices to ensure appropriate utilisation is increased. 2. Future engagement events are currently being scheduled to design future service models for neighbourhood networks of care and community hubs. This will support the future development of community clinics. 3. The development of community hubs will provide Southwark residents with services closer to home with reduced waiting times . 6
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