Annual Report 2018/19 Excellence in patient and primary care

P s ri e m ic v ar r y e In y S teg nit rated Commu 2 Alison Sutherland, PICS Respiratory Nurse, on a visit to China (second from right) with representatives from Ningbo, Zhejiang province and the University of Ningbo campus (UNNC).

3 Foreword Primary Integrated Community Services (PICS) presents our fifth Annual Report.

This report highlights our achievements and progress over the last year, including a summary of our accounts and current financial position. PICS has grown substantially in terms of services provided and staff employed over the 2018-19 period and is maintaining a good financial position. PICS was established in 2013 as a supplier of local health services, provided by local clinical staff and owned by local clinical staff. PICS has increased in size from a very small organisation employing less than 20 people to now employing over 230 staff with an annual turnover in excess of £8 million.

‘For Profit’ The organisation is a company limited by shares and (nominally) for profit. Any surplus above cost we do achieve goes towards further service improvement. Our board consists of a small group of Directors; Anita Dixon (Chair), Dr. Kelvin Lim, Dr. Andrew Parkin, Dr. Paul Scullard, Dr. James Cusack, Dr. Junaid Dar and the Managing Director Mrs. Alison Rounce.

4 ‘We Care’ “We Care” about our patients, carers and families, our partners and all the people we work with, underpinned by our core values and our “can do” approach. We regularly review our values and ensure these are integral at all levels of the organisation. Our Values

All PICS services are for NHS patients and are provided free at the point of access. PICS services can be accessed in a number of ways including referrals from GP practices and self-referrals in certain cases.

The PICS values below are integral at every level of the organisation.

n Family and patient need is central to our decision making. n We have a “can do” approach that is responsive, creative and innovative. n We are non-judgmental, open and transparent with a “no blame” culture. n We are inclusive and collaborative inside and outside the organisation. n We are professional and passionate about our care for patients and one another. n We protect and support General Practice and our clinicians. n Our care is evidence based, safe and effective. n We put safety first in everything we do.

5 Message from Alison Rounce Managing Director

It is my pleasure to introduce the 2018/2019 Annual Report We have built a stronger and more diverse management to for Primary Integrated Community Services Limited. support our external development including improved data analysis, HR and Finance. 2018/2019 has been a year of building on our existing successes within the health economy. We are thrilled to be Our people remain paramount to our success. In 2019, we delivering services in Mid Notts community pain management launched our refreshed Multi Disciplinary Team to review our and Acute Home Visiting for GPs in the area. values, support and commitment to quality. In response to feedback from our staff, we will be launching a development Our relationships with general practice continue to flourish, programme for managers, a new and simplified approach and now includes caretaking the practices at Whyburn and to support staff and their managers to have better quality Peacock and partnering at a GMS practice at Meden Vale. conversations. On the national scene, the NHS Long Term Plan was published I would also like to thank all the partners we work with in in January 2019, outlining the NHS vision for the next 10 years. secondary and primary care and the third sector who help us to The plan reiterates the ambition to deliver more services within work together to give our patients the good care they deserve. community settings with increased collaboration and across system working. There is an emphasis on the formation of There is so much to be proud of and look forward to. I hope you Primary Care Networks. We are looking forward to working enjoy reading our achievements and I very much look forward in partnership with 11 PCNs in . We are to working with you in the coming year. recruiting the additional roles for this new agenda including Social Prescribers and Clinical Pharmacists.

6 Message from Dr Kelvin Lim Medical Director

PICS continues to grow and expand and with this comes an If we continue to put patients at the centre of everything we increase in governance issues. As an organisation we are do and continue to provide a quality health service we will committed to patient safety and quality care and this has to be continue to prosper as an organisation. delivered whilst enabling clinicians to act with autonomy and I am proud to be a member of a company that continues to accountability. pursue excellence in patient care. The Clinical governance structure which has a Clinical Governance Committee (CGC) that reports directly to the PICS board has been working well. The CGC reviews all complaints and significant events and looks at all audit and review results. It also disseminates learning to all the members of PICS. This year we did a thematic review into Sepsis and the information from PICS’s practices suggest that PICS is able to respond to both local and national changes in guidelines and implement new findings quickly.

7 Anita Dixon retires February 2018

Anita retired as Business Development Manager for PICS and has become Chair of the PICS Board.

Anita said:

“I have worked for PICS in a part time capacity for over three years as a Business Development Manager. The culture and values of PICS are ultimately one of “caring” and this shines through at every level of the organisation from patients to staff and to partners. The management and leadership team are excellent and democratic and aim to “bring the best out in everyone”. The NHS is 70 I have seen many changes to PICS over the last year and PICS is proud to support the NHS and has celebrated it’s 70th have seen considerable growth and expansion but PICS birthday. 100% of PICS services are funded by the NHS and have always continued to maintain high standards of clinical are and all are provided free at the point of access. care and service delivery. It is one of the most enjoyable and impressive organisations I have worked in and I am sad to leave the lovely people that work here.”

8 End of Life Care Together Launched October 2018 PICS is part of the “End of Life Care Together” Integrated We Have A Winner! Delivery Model for Mansfield and Ashfield and Newark and November 2018 Sherwood registered patients which launched on 1st October 2018. Our partners in the new model are Nottinghamshire Alison Rounce, Managing Director of PICS has been awarded Healthcare Trust (Local Partnerships), John Eastwood the prestigious Nottingham Post Women in Business Award Hospice, Beaumond House Community Hospice and for Public Service 2018. Ali managed to pip the other two Nottinghamshire Hospice. shortlisted finalists from Nottingham University Hospitals Trust and the University of Nottingham. The service utilises a holistic approach to support patients and their carers to address their individual end of life needs. Ali said to the Post “I am honoured and humbled to be shortlisted for this award, if I was to win, I would feel it would be recognition for the whole of the PICS family”.

9 Warsop Primary Care Centre PICS Network Navigation Service Launched January 2019 PICS launched the Network Navigation service across mid Nottinghamshire. The Network Navigators provide a link between acute, community, general practice, adult social care, public health and the third sector.

Their aim is to reduce the need for non-elective care and to achieve a better quality of life for patients by providing high quality non-clinical and administrative support including health information analysis. The Network Navigator role helps those living with the effects of long term conditions PICS managing Meden including frailty and heart failure. Medical at Warsop The Network Navigation team Primary Care Centre February 2019 From the beginning of February 2019 PICS have managed the GMS contract to provide GP Services at Warsop Primary Care Centre, Warsop, Nottinghamshire. The practice made the decision to join PICS with the aim of ensuring the sustainability of the practice in the future. Dr. Allen remains as the lead GP for the practice.

10 Clinical Pharmacy Ambassador appointed March 2019 In recognition of the work conducted by PICS in the development of clinical pharmacy roles throughout Expanded Pain Nottinghamshire, Health Education England has appointed Gerald Ellis to act as Clinical Pharmacy Ambassador across Pathway Service March 2019 Nottinghamshire, Derbyshire and Lincolnshire. In March 2019, PICS launched the pain pathway and chronic This part-time role contributes to the development of the fatigue community service for registered patients in the workforce and acts as an interface across healthcare sectors. Mansfield, Ashfield, localities. The PICS service now covers , Nottingham West, It assists in the integration of pharmacists into multi Nottingham North and East, Mansfield, Ashfield, Sherwood professional primary care clinical work forces with local training and Newark. This was a significant expansion of the service, hubs, integrated care providers and commissioning bodies. with PICS now providing a comprehensive community pain service across Nottinghamshire. Potential service users with chronic pain can access the service via their GP. PICS won this mid Nottinghamshire contract following a competitive tender process organised by the local CCGs. It means users of the service can access venues across a wide area of Nottinghamshire.

11 PICS staff at Ash Tree Court Acute Home Visiting Service April 2019 In April 2019, PICS became the provider of a new acute home visiting service (AVS) in Newark. The service was expanded in November 2017 to include Sherwood practices, including , Blidworth and Clipstone. Since April 1st 2019 PICS have provided the service across the whole of Newark and Sherwood and Mansfield and Ashfield. This followed a successful tender bid for the service by PICS. A small team of Advanced Nurse Practitioners (ANPs) and Emergency Care Practitioners (ECPs) provide acute visits to patients in their own homes or care homes. The aim of the service is to reduce inappropriate hospital admissions and enable patients to be cared for at home when it is clinically safe to do so. GP Practices Working Together April 2017 PICS actively supported the establishment of the Newark practices. In March 2018, PICS began to actively support the establishment of GP Federations in both Nottingham West and Nottingham North and East CCGs.

12 Patient survey Friends & Family Every year PICS undertakes the Friends and Family survey. Here are some of the 2018/19 responses. n 100% of PICS Community Services patients would recommend the service to friends or family. n 100% of PICS Community Services patients were treated with dignity and respect. n 92% of South Nottingham Pain patients would recommend the service to friends or family. n 96% of South Nottingham Pain patients were treated with dignity and respect by PICS clinical and administration staff. n 91% of South Nottingham Pain patients were given the opportunity to ask questions during their consultation.

13 Looking ahead The three broad service areas currently provided by PICS are: 1. Primary Care Support 2. Community Services 3. Out of Hospital Services All three provide local health services in Nottinghamshire The first services that were provided by PICS were and employ clinical and non clinical staff that are supported community services, using community nurses and local by a central corporate team. These service areas help to community facilities, for services such as diabetes, heart provide robustness for the relatively small sized PICS and failure and end of life. These services are at the core of PICS all three areas will be important to PICS looking ahead. and have demonstrated the benefits of developing local services for long term/chronic conditions in the community. PICS will continue to support local primary care services by PICS aims to develop and expand such services in the future. taking an active role in the newly emerging Primary Care Networks (PCNs). PICS already provides an extended GP A significant area of growth for PICS has been the access service in mid Nottinghamshire, Nottingham North establishment of the chronic pain service in both Greater and East and Nottingham West. This has enabled PICS to Nottingham and Mid Nottinghamshire. The service has demonstrate tangible services provided to the local GP successfully reduced the need for patients to go to hospital practices and has helped to bring practices and has also reduced the prescription of drugs and pain together as part of the PCN development. PICS hopes to injections. The PICS service has shifted the emphasis develop additional services with the same to greater use of exercise, psychological wellbeing and positive effect. PICS will continue to support local GP physiotherapy. The patient feedback evidenced in page 13 practices, providing proactive management shows the popularity of the service with patients. A key aim support wherever requested. for PICS is to develop further Out of Hospital services over the following 12 months.

14 PICS Care Coordination team

15 Financial Report Year to March 2019 During this period, the accounts show an increase in turnover to £8,219,210 from £6,426,018 in 2018, with an operating surplus of £266,594 before taxation and extraordinary items (2018 £59,742).

Overall the company has accrued net assets of £684,299 compared to £532,653 in 2018 and has a healthy cash position. The Directors consider the company to have adequate resources to remain in operation for the foreseeable future and have adopted the “going concern” basis in preparing these statements.

There is no requirement to submit the accounts for independent audit at the level of activity during the year. During this period, the turnover increase is largely attributable to a full year of the Greater Nottingham Pain Service contract, the commencement of the GP Extended Access Scheme, and the expansion of the Mid Nottinghamshire pain contract.

16 Balance Sheet as at 31 March 2019

2019 2018 £ £ £ £

Fixed assets Tangible assets 59,940 48,185 Investments 3 -

59,943 48,185 Current assets Debtors 316,082 1,130,421 Cash at bank and in hand 2,899,705 3,113,673

3,215,787 4,244,094 Creditors: amounts falling due within one year (2,581,241) (3,750,471)

Net current assets 634,546 493,623

Total assets less current liabilities 694,489 541,808

Provisions for liabilities (10,190) (9,155)

Net assets 684,299 532,653

Capital and reserves Called up share capital 137 136 Share premium account 88,852 88,103 Capitol redemption reserve 12 12 Profit and loss reserves 595,298 444,402

Total equity 684,299 532,653

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P s ri e m ic v ar r y e In y S teg nit rated Commu P s ri e m ic v ar r y e In y S teg nit rated Commu

Primary Integrated Community Services Limited Registered Office: Unit H4, Ash Tree Court, Nottingham Business Park, Nottingham NG8 6PY Tel: 03000 830000 [email protected] www.picsnhs.org.uk Registered in England & Wales Company Registration Number 8763136