National Enhanced Service s1

Contents:

1. Service Aims

2. Background

3. Criteria 1 - 11

4. Signature Sheet

1. Service Aims

All practices are expected to provide essential, additional and enhanced services they are contracted to provide to all their patients. This Directed Enhanced Service (DES) specification is designed to:

Encourage practices to provide an annual health check to patients on the Local Authority Learning Disabilities register.

No part of this Directed Enhanced Service (DES) specification, omission or implication, defines or redefines essential or additional services.

2. Background

There is good evidence that patients with learning disabilities (LD) have more health problems and die at a younger age than the rest of the population.

The existing QOF registers do not differentiate LD by severity. There are estimated to be 240,000 people with moderate to severe LDs in England known to social services. The DES is designed to encourage practices to identify those patients with moderate to severe LD as defined by the same criteria used by the local authority (LA).

Practices that wish to participate in the scheme will be required to sign and return a copy of the signature sheet.

3. Criteria

This Directed Enhanced Service Specification details the following criteria. 1. Service Delivery

2. Data Collection and Patient Monitoring

3. Facilities

4. Staff Competence

5. Sterilisation and Infection Control

6. Consent

7. Annual Review

8. Accreditation

9. Financial Details

10. Agreement Variations and Dispute Resolution Processes

11. Termination of Agreement

Criteria One: Service Delivery

A practice may be accepted for the provision of this DES if it has a partner, employee or sub-contractor, who has the necessary skills and experience to carry out the contracted procedures. Clinicians taking part should be competent in clinical practice and have a responsibility for ensuring that their skills are regularly updated.

The provision of this service will not be prejudicial to those common principles that underpin the GMS/PMS contract to ensure minimum standards are met and to encourage high quality care. The range of standards includes:

(i) minimum legal requirements, eg having effective clinical governance systems in place; (ii) complying with the NHS complaints system; (iii) producing patient leaflets; (iv) adequate facilities including premises and equipment, as are necessary to enable the proper provision of services, including facilities for cardiopulmonary resuscitation.

The pre-requisites for taking part in the DES are as follows:

• practices will have liaised with the Local Authority to share and collate information, in order to identify the people on their practice Learning Disabilities register with moderate to severe learning disabilities. If the practice agreed a register in the previous financial year which was in operation immediately before 1st April 2013 there is no need to agree a new register.

• a practice providing this service will be expected to have attended a multi- professional education session. The minimum expectation of staff attending will include the lead general practitioner (GP), lead practice nurse and practice manager/senior receptionist. Practices may also wish to involve specialist Learning Disabilities staff from the community learning disability team to provide support and advice.

Practices will be expected to provide an annual health check to patients on the local authority LD register. Practices are recommended to use the Cardiff health check protocol or a protocol as agreed locally with the Area Team as devised by South Birmingham Specialist Learning Disability Health Facilitation Service.

Further information on the Cardiff Protocol is available at: http://www.rcgp.org.uk/PDF/clinical_Welsh_Health_Check_newA.pdf

As a minimum, the health check should include:

 a review of physical and mental health with referral through the usual practice routes if health problems are identified: - health promotion - chronic illness and systems enquiry - physical examination - epilepsy - behaviour and mental health - specific syndrome check

• a check on the accuracy of prescribed medications • a review of coordination arrangements with secondary care • a review of transition arrangements where appropriate.

Health checks should integrate with the patients’ personal health record or health action plan. Where possible, and with the consent of the patient, this should involve carers and support workers. Practices should liaise with relevant local support services such as social services and educational support services in addition to learning disability health professionals.

Criteria Two: Data Collection and Patient Monitoring

This directed enhanced service will fund:

(i) The service described above (ii) History taking, and relevant clinical examination (iii) Documentation of any procedure carried out under this DES in the patient record (iv) Maintenance of adequate records of the service provided, incorporating all known information relating to any significant events e.g. hospital admissions, drug reactions and premature withdrawal of therapy (v) Collection of activity related to the provision of these services including: appropriate read coding, type of activity, number of contacts and who provides the service (vi) The following Read codes are to be used

Mild Mental Retardation, IQ in range 50-70 - E30 Moderate Mental Retardation, IQ in range 35-49 - E310 Severe Mental Retardation IQ in range 20-34- E311 Profound Mental Retardation with IQ less than 20 - E312

It is a condition of participation in this DES that practices will give notification, in addition to their statutory obligations, to the Area Team (through the usual reporting mechanism) of emergency admissions or harm/potential harm to patients under this service, where such events may be attributable to the relevant underlying medical condition using the standard Incident Reporting form.

Criteria Three: Facilities

 Practices carrying out this DES should have such facilities as are necessary to enable them to provide such services properly.  Adequate and appropriate equipment should be available for the clinician to undertake the procedures chosen, and should also include appropriate equipment for resuscitation. National guidance on premises standards has been issued  All personnel providing the service through the contract have appropriate indemnity cover to meet in full claims made against them as individuals.  Comply with any relevant Health and Safety legislation requirements.

Criteria Four: Staff Competence

As with any clinical intervention, it is important that staff carry out sufficient volume of activity to ensure they are appropriately skilled to provide high quality care and meet appropriate standards.

The practitioners can provide evidence that they have the experience and qualifications to undertake the procedure/s and all personnel providing the service are competent to provide those aspects of the service for which they are responsible and will keep their skills up to date.

Each practice must ensure that any personnel involved in providing any aspect of care under this scheme has the necessary training and skills to do so.

Any practitioner involved in the provision of this DES will satisfy at appraisal (and revalidation if necessary) that s/he has such continuing clinical experience, training and competence as is necessary to enable her/him to contract for the enhanced service and shall be deemed professionally qualified to do so.

Criteria Five: Sterilisation and Infection Control

General practitioners are responsible for the effective operation and maintenance of sterilizing equipment in their practices. Practices must have infection control policies that are compliant with national guidelines including inter alia the handling of used instruments, blood, excised specimens and the disposal of clinical waste.

Criteria Six Consent

In each case the patient should be fully informed of the treatment options and the treatment proposed.

Criteria Seven: Annual Review

The service delivered by this Directed Enhanced Service will be subject to clinical audit monitoring. This will be carried out as part of the annual review of the contract based on evidence of activity and quality of record-keeping.  Full records of all procedures should be maintained in such a way that aggregated data and details of individual patients are readily accessible.  Clinical audit must be undertaken within the Practice and be accessible by the Birmingham Solihull and the Black Country Area Team.

The Practice must comply with NHS complaints procedure and notify the Area Team as appropriate of any complaints.

Complaints and Incidents telephone 0300 311 2233 email [email protected]

Criteria Eight: Accreditation

Those doctors who have previously provided services similar to this enhanced service and who satisfy at appraisal and revalidation that they have such continuing medical experience, training and competence as is necessary to enable them to contract for the enhanced service shall be deemed professionally qualified to do so.

Criteria Nine: Financial Details

This agreement is to cover 12 months commencing 1st April 2013

The reward for each health check will be £102.16.

There will be no variation to the increase in the agreement value in year. Payment will only be made upon receipt of practice signature sheet, agreement with NHS England on the health check LD register and submission of the health check report at the end of the Financial Year.

Criteria Ten: Agreement Variation and Dispute Resolution Process

In the event of contractual issues failure outside of the formal notification by either partner this will be covered by the Area Team disputes procedure as per nGMS. In the event of failure to deliver against the agreed standards both parties can instigate procedures for a breach. There will be no variation to the increase in the agreement value in year.

Criteria Eleven: Termination of Agreement

In the event of the practice wishing to terminate the agreement with the Area Team to provide the service, three months notice should be given in writing to the Area Team. Three months notice in writing will also be given to the practice should the Area Team wish to terminate the agreement. 4. Signature Sheet

NHS England

Learning Disabilities Health Check Scheme.

Participation Agreement.

This document constitutes an agreement between the NHS Commissioning Board (the commissioner) and a GMS/PMS or APMS contractor (the contractor) in respect of delivering an enhanced service for improving patient online access.

By entering into this agreement the contractor enters into an arrangement to deliver enhanced primary medical services:

(i) in line with the requirements of the service specification published by the commissioner which is deemed to be a part of this agreement (and which may be attached for reference); and,

(ii) for the duration specified below.

Duration of agreement: From 1st April 2013 to 31st March 2014

The contractor reserves the right to withdraw from the enhanced service by giving 3 months notice to the commissioner. The commissioner reserves the right to terminate this agreement should the contractors GMS/PMS/APMS contract be terminated or be subject to such conditions that in the reasonable opinion of the commissioner warrant early termination.

Signed on behalf of the commissioner Date

Signed on behalf of the contractor Date

Please note for GMS practices, one partner may sign, for PMS and APMS contractors, all signatories to the PMS or APMS agreement must sign

Practice stamp:

Please return by 30th June 2013 to: [email protected]