General Medical Services Shropshire Clinical Commissioning Group - PowerPoint PPT Presentation

General Medical Services Shropshire Clinical Commissioning Group Dave Evans, Interim Accountable Officer Tracy Savage, Head of Primary Care Support & Medicines Management

Background

Shropshire Clinical Commissioning Group (SCCG) ∗ The CCG covers a large ∗ 43 practices geographical area of roughly 1,235 square miles, with a ∗ 2 have merged (Mount Pleasant & population of around 306,100 Haughmond View) to form Severn ∗ Shropshire has a larger number Fields Medical Practice of older people than many other ∗ 18 practices dispense medicines to locations across the country their patients ∗ The over 65s represent 20.7% of ∗ 9 practices currently PMS practices the population compared to (Personal Medical Services) 16.4% for England and Wales ∗ 34 are GMS (General Medical (2011 census) Services)

Primary Care Governance Arrangements

Governance and Links to NHS England ∗ April 2015 Shropshire CCG adopted full delegated commissioning ∗ A Primary Care Working Group arrangements for the management was set up to facilitate effective and commissioning of the majority of working between CCG teams and GP contracts ∗ A Primary Care Commissioning other key stakeholders [e.g. NHS England] in order to ensure Committee established to review robust oversight of Primary Care planning and procurement of Primary medical contracts and service Care services in Shropshire –NHS provision England provide dedicated support ∗ A Primary Care and Quality ∗ Terms of reference are in place for the Director (Interim) provides PCCC, which detail its membership and leadership and direction representation; meetings are held in public monthly and are chaired by a lay member

Quality of Primary Care

Quality Assurance of Primary Care CCG assures quality and performance by: Care Quality Commission (CQC) ∗ Providing regular data and Assures quality by : ∗ Gathering data, evidence and information to practices (dashboard) on key quality information ∗ Using feedback from patients outcomes ∗ Regular visits to practices to and public ∗ And inspections carried out support and provide appropriate challenge by CQC experts.

Quality of Primary Care Quality Commission (CQC) ∗ CQC monitor, inspect and regulate services to ∗ There are 4 categories of ensure they meet inspection criteria: fundamental standards of ∗ Outstanding quality and safety ∗ CQC set out what good ∗ Good ∗ Requires improvement and outstanding care ∗ Inadequate looks like and ensure services meet fundamental standards below which care must never fall

Shropshire CCG Practices CQC Outcomes ∗ The CQC inspection team has inspected and ∗ 5 practices are good published reports on 33 overall with requires Shropshire practices since improvement in some October 2014 ∗ 5 Shropshire practices elements ∗ Only 1 practice requires have a rating of improvement outstanding overall ∗ There are no practices ∗ 2 have good overall with falling into the outstanding elements ∗ 18 have a rating of good ‘inadequate’ category overall

Quality of Primary Care Shropshire CCG ∗ Monthly reports provided to practices ∗ Dedicated primary care ∗ Visits to practices which support team made up of include key individuals pharmacists, nurses, from the CCG senior team pharmacy technicians, and directors (depending dieticians and individuals on the needs of the with social care practice) experience ∗ Locality board meetings ∗ To support the CCG to where peer to peer deliver high quality review is also undertaken services

Quality of Primary Care Shropshire CCG – Good practice Medicines Management and ‘Polypharmacy’, ∗ The concurrent use of several medicines The Community and Care Co-ordinator (C&CC) ∗ by one individual, leads to adverse project involves non-clinical individuals, reactions, side effects, medicine working as part of the practice team, to interactions and impaired quality of life proactively case-manage people at risk of loss ∗ During 2015/16 GP practices and CCG of independence and hospital admission as a pharmacists have teamed up to result of more pastoral or social unmet need ∗ systematically assess the medicines of It improves communication between the local patients as part of a ‘Polypharmacy authority, voluntary sector, community groups Review Scheme’ – this continues into and the practice; identified frail and vulnerable 16/17 patients at risk of inappropriate hospital ∗ 4,500 reviews were undertaken in 15/16, admission ∗ with which has resulted in patients During 2015/16, almost 6,000 people received having more streamlined medicine support from their practice-based C&CC regimes with a significant reduction in ∗ It has been identified by NHS England as a medicines waste high-impact project

Polypharmacy review project – outcomes Average number of unique medicines that a patient is prescribed in Shropshire for the year 2015/16 compared with national CCGs – the CCG is below average (all patients, patients aged 65, 75 and 85 years and over)

Polypharmacy review project – outcomes The percentage of patients (all patients, patients aged 65, 75 and 85 years and over) on 8 or more medicines

Primary Care – going forward

Primary Care Strategy Primary Care Strategy published Jan 2016 - identified 8 key strategic aims: 5. Information Technology - enable different methods of communication and 1. The Benefits of Scale - Practices should, facilitate the development of new models wherever possible, be large enough to provide the of care and the provision of a more full range of services integrated service 2. Workforce – develop opportunities for more 6. Premises – ensure appropriate collaboration between practices and different premises to deliver services staffing models 7. Supporting change - to support 3. Collaboration between practices “GP organisational development, clinical Networks” – Support practices to manage leadership and the professional workload - sharing good practice, functions, support development of front line staff staff and services. 8. Commissioning - use the levers and 4. Integrated care - Primary and community flexibilities available to them to facilitate health and care services should work in a more innovation, improvement and integrations closely integrated way, supported by hospital specialists

Primary Care Needs Assessment (PCNA) ∗ Work has commenced in Shropshire on the PCNA – which is designed to ∗ The expected outcome is to have a assess the current landscape of Primary Care in Shropshire publication which contains up-to-date ∗ To provide support to the emerging relevant information, on which the CCG, Local Health Economy and STP Sustainability an Transformation Plan can base future decisions, on how to (STP) further improve and support Primary Key Elements of the Needs Assessment ∗ Assessment of ill health & inequalities Care in Shropshire. ∗ The PCNA will also cross reference with ∗ Baseline mapping of services – capacity other important strategies, such as the and workforce issues, service supply & CCG Primary Care Estates Plan, the demand wider Five Year Forward View, STP, ∗ Evidence of effectiveness - models of and will be used to define priorities and care future investment in Primary Care going forward.

Estates Strategy ∗ A draft estates strategy was published in June ∗ Work is ongoing to 2016 publish a final version that cross references to the wider health economy need that is emerging through the neighbourhood plans of the STP

Workforce Capacity and Planning ∗ Shropshire CCG has ∗ Practices are asked to consider commenced a workforce plan collaboratively with other their workforce implications Shropshire and Staffordshire over the next 5 years ∗ It will provide information on CCGs and is currently gathering data on workforce capacity those practices that are at ∗ This data will be collated and highest risk from recruitment used together with the and retention problems so that national data to provide a we can target innovation in starting point for a Pan workforce development and Staffordshire and Shropshire training and new ways of Workforce plan 2017-2021 working