East Leicestershire and Rutland Clinical Meeting Commissioning Group – Governing Date Tuesday 11 September 2018 Title Body meeting Meeting 52 Time 9:30am – 11:45am no.
Dr Richard Palin Venue / Shearsby Room, Stamford Court, Chair (Chairman) Location 18 Manor Road, Oadby, LE2 2LH.
AGENDA ITEM ACTION PRESENTER PAPER TIMING Welcome and Introductions Dr Richard B/18/154 9:30am Palin
Dr Richard B/18/155 9:30am CCG Annual General Meeting Palin
BREAK (10:15am)
Governing Body meeting to commence following the break Apologies for Absences: To Dr Richard B/18/156 • verbal 10:20am Dr Tabitha Randell receive Palin
To Dr Richard B/18/157 Notification of Any Other Business verbal 10:20am receive Palin To B/18/158 Declarations of Interest on Agenda Topics All verbal 10:20am receive Minutes of the meeting held on 14 August To Dr Richard B/18/159 A 10:20am 2018 approve Palin
Matters Arising: Update on actions from the To Dr Richard B/18/160 B 10:25am meeting held on 14 August 2018 receive Palin
To receive questions from the Public in To Dr Richard B/18/161 verbal 10:30am relation to items on the agenda only receive Palin REPORTS To B/18/162 Accountable Officer’s Corporate Report Karen English 10:35am approve C ITEMS FOR DECISION, ACTION AND ESCALATION Future in Mind - Children & Young People’s To Chris West / B/18/163 Emotional, Mental Health & Wellbeing Elaine Egan- D 10:40am approve Transformation Plan Morris
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AGENDA ITEM ACTION PRESENTER PAPER TIMING To B/18/164 Finance Report: Month 4 update Donna Enoux E 10:50am receive (to follow) To B/18/165 Corporate Performance Assurance Report Paul Gibara F 11:00am receive Summary report from the Provider To B/18/166 Performance Assurance Group meeting (30 Clive Wood G 11:10am approve August 2018) and revised terms of reference Summary report from the Integrated Governance Committee meeting (4 To Warwick B/18/167 H 11:15am September 2018) and revised terms of approve Kendrick reference Extended Primary Care Procurement To Paula B/18/168 I 11:20am receive Vaughan Locality Chairs’ Report: . Oadby and Wigston To B/18/169 Locality Chairs J 11:30am . Melton, Rutland and Harborough receive . Blaby and Lutterworth ITEMS FOR INFORMATION Summary Report from the Commissioning To Dr Richard B/18/170 K Collaborative Board (August 2018) receive Palin Summary report from the Primary Care 11:40am To B/18/171 Commissioning Committee meeting (4 Clive Wood L receive September 2018) DATE OF NEXT MEETING The next meeting of the East Leicestershire and Rutland CCG Governing Body will take Dr Richard B/18/172 place on 11:45am Tuesday 9 October 2018, Council Palin Chamber, County Hall, Glenfield, Leicester, LE3 8TB.
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A Blank Page Paper A East Leicestershire and Rutland CCG Governing Body Meeting 11 September 2018 EAST LEICESTERSHIRE AND RUTLAND CLINICAL COMMISSIONING GROUP
Minutes of the Governing Body Meeting held on Tuesday 14 August 2018 at 9.30am In the Council Chambers, County Hall, Leicester LE3 8TB
Present: Dr Richard Palin Chairman Mr Clive Wood Deputy Chair / Independent Lay Member Mrs Karen English Managing Director Dr Andy Ker Clinical Vice Chair Mr Tim Sacks Chief Operating Officer Ms Donna Enoux Chief Finance Officer Mr Alan Smith Independent Lay Member Dr Nick Glover GP Locality Lead, Blaby and Lutterworth Dr Anuj Chahal GP Locality Lead, Melton, Rutland and Harborough Dr Girish Purohit GP Locality Lead, Melton, Rutland and Harborough Mr Warwick Kendrick Independent Lay Member Mr Simon Pizzey Head of Planning and Strategic Commissioning (on behalf of Mr Paul Gibara) Mrs Amanda Bland Acting Deputy Chief Nurse (on behalf of Mrs Tracy Burton) Dr Tim Daniel Public Health Consultant
In Attendance: Mrs Daljit K. Bains Head of Corporate Governance and Legal Affairs Mrs Emma Casteleijn Head of Communications Dr Hilary Fox Senior Clinical Lead for Planned Care Dr Janet Underwood Healthwatch Rutland Mrs Sarah Warmington Associate Director of Commissioning Mrs Cheryl Davenport Director of Health and Care Integration (Item B/14/141 only) Mrs Claire Middlebrook Corporate Affairs Support Officer (minutes)
Members of the public: 5 members of the public seated in the public gallery
ITEM DISCUSSION LEAD RESPONSIBLE B/18/132 Welcome and Introductions
Dr Richard Palin welcomed members of the Governing Body and members of the public to the August 2018 meeting of the East Leicestershire and Rutland Clinical Commissioning Group (ELR CCG) Governing Body, specifically welcoming Mrs Amanda Bland and Mrs Sarah Warmington. B/18/133 Apologies for Absence: Apologies for absence were received from: • Dr Vivek Varakantam, GP Locality Lead, Oadby and Wigston • Mrs Tracy Burton, Interim Chief Nurse and Quality Officer • Dr Graham Johnson, GP Locality Lead, Blaby and Lutterworth • Dr Tabitha Randell, Secondary Care Clinician • Mr Paul Gibara, Chief Commissioning and Performance Officer
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Paper A East Leicestershire and Rutland CCG Governing Body Meeting 11 September 2018 ITEM DISCUSSION LEAD RESPONSIBLE B/18/134 Notification of Any Other Business
The Chairman informed that he had received no items of additional business.
B/18/135 Declarations of Interest on Agenda Topics
All GP members declared an interest in items relating to primary care where a potential conflict may arise and also where there are any items concerning the Leicester, Leicestershire and Rutland Provider Arm where GP members’ are minor shareholders. It was noted that no further action was required at this stage and that the Register of Interests is published on the CCG website.
Dr Palin noted that all members of the Executive Management Team (EMT) are conflicted with Paper M, Next steps towards greater collaboration between LLR CCGs. Members of EMT will remain in the room for the discussion; however, will not be voting for this item although will remain in the meeting room.
Mrs Daljit Bains informed that all GPs, with the exception of Dr Richard Palin and Dr Andy Ker, were conflicted in relation to Paper K, Review of clinical roles and responsibilities on the Governing Body, and therefore will be excluded when voting on this paper, however will remain in the meeting room.
It was RESOLVED to:
• RECEIVE and NOTE the declarations made and the actions agreed.
B/18/136 Minutes of the Meeting Held on Tuesday 10 July 2018 (Paper A)
The following amendments were noted for the minutes of the Governing Body meeting held on 10 July 2018:
Dr Palin apologised to Dr Underwood, for the incorrect salutation being used on the previous set on minutes and noted that Dr Underwood has sent some clarifications on the minutes to Mrs Daljit Bains, which will be included in the final, approved version. This included the following:
• Page 3, item B/18/121 Full Business Case for the Relocation of Level 3 ICU and associated service off the LGH site – bullet point three should state, “urology” not “neurology”. In addition, Dr Underwood advised that within this discussion she had cited the NHS England (2018) Planning, assuring and delivering service change for patients in particular that where a proposal for
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Paper A East Leicestershire and Rutland CCG Governing Body Meeting 11 September 2018 ITEM DISCUSSION LEAD RESPONSIBLE substantial service change is made by the provider rather than the commissioner, the 2013 Regulations require the commissioner to undertake the consultation with the local authority on behalf of the provider and that both commissioners and providers need to ensure that they have satisfied their statutory duties to involve and consult. It was noted that Dr Underwood was unconvinced that public consultation has been adequate.
• Page 7 and 8, Finance Report – Ms Donna Enoux raised some corrections to item B/18/122: o Page 7, Second paragraph, second sentence to read: “At month two there is £10.4m of QIPP risk plus £0.8m of co- commissioning cost pressure; £0.6m of running cost expenditure control; £3m of potential pressures from 2017/18 and the EMAS contractual pressure ….”
o Page 7, Third paragraph to be amended to read: “ELR CCG has an activity reserve of £4.8m with a £2m contingency; adding up all the reserves equates to £7m, against a risk of £15m and therefore we are reliant on existing QIPP schemes delivering or new schemes being developed.”
o Page 8, first paragraph, first couple of sentences to read: “Ms Enoux confirmed that the net budget for CHC has been reduced from 2017/18 to 2018/19 and has been set using a forecast as a starting point. The budget has been uplifted by 9% in line with historic growth spends and then reduced down based on QIPP schemes. ELR CCG was an outlier in the CHC spend, however, ….only appropriate packages were being put in place, in ….”
It was RESOLVED to:
• APPROVE the minutes of the meeting held on Tuesday 10 July 2018 SUBJECT to the amendments made.
B/18/137 Matters Arising: Update on Actions from the Meeting held on Tuesday 10 July 2018 (Paper B)
The following action was noted as complete:
• B/18/109 Summary report from the Primary Care Commissioning Committee – this item will be covered by the Paper O on the agenda.
It was RESOLVED to:
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Paper A East Leicestershire and Rutland CCG Governing Body Meeting 11 September 2018 ITEM DISCUSSION LEAD RESPONSIBLE • RECEIVE and NOTE the update on the actions.
B/18/138 To Receive Questions from the Public in relation to items on the agenda
Dr Palin welcomed the members of the public and invited questions from the members of public relating to items on the agenda. There were no questions raised on the agenda items.
It was RESOLVED to:
• NOTE that no questions were raised on agenda items from the public.
B/18/139 Chairman’s Report (Paper C)
Dr Palin presented the report, which provided an overview and update on some of the key constitutional and strategic areas that affect the Governing Body, including meetings attend by Dr Palin since his last report in July 2018. The report was noted.
It was RESOLVED to:
• RECEIVE the Chairman’s Report
B/18/140 Accountable Officer’s Corporate Report (Paper D)
Mrs English drew attention to the following key items from the report:
• Integration Executive and Integration and Finance Performance Group (IFPG) - a proposal to change the remit of these meetings has been discussed with the Local Authority and it is therefore proposed to change these meetings to bi-monthly. The Integration Executive will concentrate on the Better Care Fund agenda, such as Delayed Transfer of Care (DTOCs). The Terms of Reference have been revised to take into account the proposed changes and have since been approved by Leicester City (LC) and West Leicestershire (WL) CCGs and the Local Authority.
The Integration Executive will remain as a sub-group of the Health and Wellbeing Board and will be chaired by a CCG; currently East Leicestershire and Rutland (ELR); however, this will shortly change to WL CCG. The aim is to make it easier to have strategic discussions regarding Finance and Performance. The revised Terms or Reference are attached as appendices.
• Emergency Preparedness, Resilience and Response (EPRR) –
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Paper A East Leicestershire and Rutland CCG Governing Body Meeting 11 September 2018 ITEM DISCUSSION LEAD RESPONSIBLE The annual return on EPRR is due to be submitted to NHS England; Mr Tim Sacks is ELRs EPRR lead and Mr Clive Wood has agreed to become the LLR Lay Member responsible for this area of work.
Ms Enoux asked that the membership list be changed to read ‘Chief Finance Officer’ rather than ‘the finance director’ and also that the role of Chief Strategy and Planning director be corrected to read ‘Chief Performance and Commissioning Director’.
Ms Enoux further noted that the fifth paragraph on Page 6, is hard to understand and asked that this is re-worded.
It was RESOLVED to:
• RECEIVE the Accountable Officer’s Corporate Report. • APPROVE the revised terms of reference and extended remit for the Integration Finance and Performance Group (Appendix 1); and APPROVE the minor amendments to the terms of reference for the Integration Executive (Appendix 2) subject to the amendments raised.
B/18/142 Summary Report from the Financial Turnaround Committee (26 July 2018) (paper F)
Mr Smith took the paper as read and no questions or queries were raised.
It was RESOLVED to:
• RECEIVE the Summary Report from the Financial Turnaround Committee (26 July 2018) B/18/143 Finance Report: Month 3 update (Paper G)
Ms Donna Enoux took the detailed paper as read and highlighted the following items from the summary report:
The summary report shows the month three total, which is reported as break-even; there is still £8m of QIPP risk, when looking at red and amber rated schemes. This is based on the assumption that red rated schemes will deliver only 10%; and amber 40% of their totals.
Ms Enoux confirmed that this is still a massive risk to the CCG and the current list of risks is shown in the table on page two. The main risks to highlight are: acute, CHC, prescribing, running costs, 2017/18 accruals and EMAS but there is an unreleased contingency reserve of £2m and national growth reserve of £4.8m to aid mitigation.
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Paper A East Leicestershire and Rutland CCG Governing Body Meeting 11 September 2018 ITEM DISCUSSION LEAD RESPONSIBLE Dr Nick Glover noted paragraph eight, on page five and queried the figure for University Hospitals of Leicester NHS Trust (UHL) over- performance of £1.883m, and its relationship to the Independent Sector, which is showing an underspend. Dr Glover asked if the Independent Sector continues to under-perform; if the £1.833m will also reduce. Ms Enoux stated that this could potentially happen; the contract team are currently focussing on the relationship between activity at UHL, independent sector and out of county.
Dr Glover noted that historically Referral to Treatment (RTT) performance has been modest and resulted in unmet needs and additional activity in the system. Following a recent presentation from Mr Simon Pizzey, the team are aiming to direct patients to more appropriate clinics / health care settings, in an effort to reduce costs in this area.
Dr Glover asked if patients sitting on the RTT waiting list could be looked at to see if they could be re-directed to an alternative Simon place for treatment; this would also be of a benefit for patients. Pizzey Mr Pizzey concurred that this was a good idea and noted that if UHL have patients on a 20 week waiting list this could be a good opportunity to look at reducing the lists. Mr Pizzey will take this suggestion forward.
Dr Hilary Fox asked for some more information on CHC. Ms Enoux confirmed that the CHC QIPP is on track to deliver.
Mr Alan Smith reported that the Financial Turnaround Committee noted their concern with the current financial situation; ELR has been looking for QIPP for the past two years and therefore savings are getting harder to find each year. The list of risks, noted, this early in the year is worrying.
It was RESOLVED to:
• RECEIVE the finance report, month 3 update
B/18/144 Corporate Performance Assurance Report (Paper H)
Mr Pizzey took the paper as read and highlighted the following items from the report:
The annual performance assessment result from NHS England, noted that ELR ‘requires improvement’, this was mainly due to the CCGs finances and some elements of performance that require improvement.
All 31 day cancer waits were achieved in May 2018.
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Paper A East Leicestershire and Rutland CCG Governing Body Meeting 11 September 2018 ITEM DISCUSSION LEAD RESPONSIBLE Improving Access to Psychological Therapy (IAPT) performance remains a challenge and a contract notification has been given to the providers.
Referral to Treatment (RTT) is not achieving targets; in May it reached 86.94% against a target of 92%.
Mrs Bland noted the reduction in 12 hour trolley waits, on page six of the report and reported that this was good news for patients and due to UHLs hard work.
Dr Glover expressed concern over the IAPT performance, as NHS England have focussed on this at previous checkpoint meetings; the recovering rate of 64% is acceptable, however, waiting times continue to be a problem. Mrs Karen English confirmed that contract notices have been issued to providers and waiting time initiatives have been put in place; there have been improvements in the past few months. The waiting list is reducing and an action plan is in place to make further improvements. The regional ‘intensive support team’ have been working with the CCGs to help; including trying to change attitudes. Staff are now ensuring that cases are referred upwards, when appropriate and real time data is now available. The team are also looking into what the situation feels like for practices. The main problem with the service; is the number of therapists available.
Dr Glover asked how slots are filled by practices, as he noted this as a problem and GPs do not have any control over this area. Mrs English confirmed that the team are looking at the performance of therapists; however, this information will not be shared or discussed outside of the team. Dr Palin noted that Dr Graham Johnson has previously provided information about slot issues. Dr Ker reported that the number of sessions for patients is being cut and although this will help reduce the waiting times the impact on patients will be significant. Dr Ker does not know why the changes have been put in place.
Mrs English expects that waiting lists will reduce, in line with less sessions being offered; however, how this will affect the recovery rates of patients remains to be seen.
Mr Warwick Kendrick queried the a LLR cancer wait figures for 62 day waits and asked for clarity on the performance levels. Mr Pizzey was unsure and confirmed he would seek clarity from Dr Vivek Varakantam outside of the meeting; however, thought the performance would not be improving.
Mr Sacks left the meeting; Mrs Cheryl Davenport joined the meeting.
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Paper A East Leicestershire and Rutland CCG Governing Body Meeting 11 September 2018 ITEM DISCUSSION LEAD RESPONSIBLE Dr Purohit noted the good news around dementia diagnosis rates; of 67% for June and 67.7% for July. Currently 3125 patients’ over 65 years of age have been diagnosed with dementia; the challenge is the attrition rate and the fact that the population is getting older. The fact that the GP Cost Improvement Programme (CIP) has been fundamental in focussing on Primary Care has enabled the diagnosis rates to continue to improve.
It was RESOLVED to:
• RECEIVE the Corporate Performance Assurance Report
B/18/141 Better Care Fund 2018/19 Plan update (Paper E)
Mrs Davenport reported that the national Better Care Fund (BCF) guidance for 2018/19 was published on 18 July 2018, which meant that possible changes were needed to the expenditure plan; although once checked no changes were required. The contingency and risk pool amounts are shown in paragraph nine. The cost improvement plan has also not changed.
The BCF plan was assessed against the national outcome metrics and a paper presented to the Integration Executive. The DTOC target of 7.88 days, per 100,000 population was not met in May or June, however, did improve from 4.72 to 5.51; the situation is being carefully monitored.
Mr Sacks re-joined the meeting.
The baseline for non-elective admissions has been aligned to the CCG Operational Plan for 2017-19. The BCF guidance states that the local areas can submit revisions to the planned residential admissions metric, if they wish too; and therefore some slight adjustments have been made; these have been agreed with adult social care and the Integration Executive.
The new guidance includes a new section on long term stays, of 21 days or more and therefore this area is being focussed on and discharge plans are being put in place to take the account of this cohort of patients; adult social care are looking into this further with the discharge group.
Due to pre-work taking place, before the guidance was issued, the team did not have a lot of additional work to carry out and confirmation of the changes made will be sent to NHS England by 24 August 2018.
Planning for 2018/19 has commenced, with a session arranged for 24 September with all partners, to look at community services and new
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Paper A East Leicestershire and Rutland CCG Governing Body Meeting 11 September 2018 ITEM DISCUSSION LEAD RESPONSIBLE models of care etc.
Mr Pizzey noted the non-elective target has not been met and the NHS England guidance splits this area into two sections. Providers are being pushed to look at short-term admissions, such as one day admissions and this should be reflected in the paper.
Dr Purohit spoke about paragraph 43 in the paper, noting the 16 interventions developed by the LLR Frailty Working Group. Whilst the group understands the pressure on primary care, the needs of the patient have to be taken into account when looking at resources available.
Mrs Davenport reported that as part of the frailty interventions all areas of care, including community, hospital and primary care will be discussed in detail by the multi-agency group. The wider integrated local team will then carry out testing of the model of care and share learning from the testing. It is hoped to use existing resources, as some interventions should be happening already; however, a query has been raised over if they are being consistently applied.
Mr Sacks confirmed that the primary care team are also looking at frailty in GP practices and are cross-checking the key interventions of the frailty group against the core contract and GP CIP. The vast majority of the interventions are already managed, through care planning. The number of Summary Care Records is high and therefore coding levels appear to be lower than they should be.
Dr Purohit noted that whilst the CCG commissions services for the frail elderly, in practice, communities are not accessing the services available and identifying these patients is important to reduce the pressure on the service.
It was RESOLVED to:
• NOTE the revisions to the BCF plan for 2018/19 following the publication of the operating guidance, per the target for each BCF metric as set out in paragraphs 14 to 33.
• NOTE that the Integration Executive approved the revised metrics at its meeting on 7 August and that the BCF Plan will be submitted to NHS England, in line with the national timetable, by 24 August.
• NOTE the new NHS England / Improvement requirements for long stay patients and the outputs of the LLR frailty work.
Mrs Davenport left the meeting.
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Paper A East Leicestershire and Rutland CCG Governing Body Meeting 11 September 2018 ITEM DISCUSSION LEAD RESPONSIBLE The meeting was paused at this time for a short break.
B/18/145 Summary report from the Integrated Governance Committee meeting in August 2018 (Paper I)
Mr Kendrick took the paper as read and highlighted the following two items:
• Finance Update - The committee will now receive a regular finance update each month; this is to ensure that the committee has an overview of the financial position, prior to committing any expenditure. • Redirection of Adults form the Emergency Department - The committee agreed this procedure in principle, however, asked for some changes to terminology and queried the tariff.
It was RESOLVED to:
• RECEIVE the Summary report from the Integrated Governance Committee meeting in August 2018
B/18/146 Summary Report form the Audit Committee (1 August 2018) and Annual Report from the Audit Committee Chair (Paper J)
Mr Kendrick noted that the Annual Report from the Audit Committee Chair is attached as an appendix; this has been drafted in line with the Audit Committee Handbook, to show that the Audit Committee has discharged its responsibilities and met its Terms of Reference. The report also confirms that the Committee has the right systems in place to identify risks and review the Board Assurance Framework to ensure that it is fit for purpose. The report further confirms that the Committee has checked that the organisation has no outstanding areas of significant duplication in the system of governance.
The Audit Committee has been proactive in supporting the Executive Management Team in identifying risk and the independence of the external auditors has been confirmed.
Dr Palin formally thanked the Audit Committee for their work over the past 12 months.
It was RESOLVED to:
• RECEIVE the Summary Report form the Audit Committee (1 August 2018) and Annual Report from the Audit Committee Chair
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Paper A East Leicestershire and Rutland CCG Governing Body Meeting 11 September 2018 ITEM DISCUSSION LEAD RESPONSIBLE B/18/147 Review of clinical roles and responsibilities on the Governing Body (Paper K)
Dr Ker noted that the report was a follow up from a previous report to the Governing Body and includes results following consultation with the CCG Member Practices. It was noted that the majority of the CCG Member Practices approved the move to six localities which essentially means splitting Blaby and Lutterworth Locality into two localities: North Blaby, and South Blaby & Lutterworth.
The outcome of the consultation with the Membership also highlighted support for Option 3 as described in the report which related to the focus of the GP Locality Lead role, which was positive as this would include a session dedicated to developing the locality. It was noted that the membership did not support the move to change the term of office for GPs and therefore the tenure remains as three years, following which the CCG will seek expressions of interest as it does at present.
The proposed next steps were detailed on page 12 of the report, along with the recommendations.
Governing Body members who were not conflicted with this item were in agreement and approved the recommendations.
It was RESOLVED to:
• RECEIVE the results of the consultation process with Member Practices; • APPROVE the next steps as outlined in paragraph 26 of the report, and to APPROVE the amendments to the CCG Constitution to reflect the agreement from the member practices.
B/18/148 Locality Chairs’ Report: (Paper I)
Melton, Rutland and Harborough Dr Purohit noted the following items from the report: • Acute Visiting Service – a presentation was well received from Mr Rob Haines, the main item highlighted by the members was the number of rejected referrals. Care homes can no longer directly refer into the service; this was due to be a temporary arrangement, however, has not been reverted back. This means that the service is not responsive for housebound patients. The comments will be fed back to WL CCG as the contract lead. • Primary Care – a presentation was received and covered acute access, extended primary care and the QIPP / CIP funding options for 2018/19. Members felt that the 4%
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Paper A East Leicestershire and Rutland CCG Governing Body Meeting 11 September 2018 ITEM DISCUSSION LEAD RESPONSIBLE reduction was not clearly communicated. Practices are looking to work at scale by changing structures etc and felt that having a clear picture of the potential funding available was Tim Sacks important; alongside how much is recurrent or time limited. • Alzheimer’s Society presentation – the presentation was well received by the members and the service was noted as excellent, however, underutilised. The main reasons for this were noted to be the PRISM form being onerous to complete and the SPA telephone service not being easy to use.
North Blaby Dr Glover noted the following items from the report / locality: • House bound INR patients – work is ongoing with community nurses, to look at blood tests for this cohort of patients. • Governing Body Report - whilst members agreed in principle with the reduction of 4%; however, asked for more clarity around the funding streams and how these are represented in planning. • The MH practitioner post - this post has now been filled and patients are being seen. • MSK – this service (at The Limes and Glenfield Surgery) is working successfully. All referrals have been accepted and funding is being sought to fund additional Physiotherapists.
South Blaby and Lutterworth Dr Glover noted the following items from the report: • Locality Integrated Leadership Team – it was noted that patients discharged from hospital with self-injecting drugs, such as Heparin, cannot have the Community Nurses to carry out this work, as a 12 hour gap is required and this is outside the time that the nurses work and therefore the integrated care system (ICS) is being used, which is not a cost effective use of time. • 4% funding gap – this was discussed and the locality would welcome some clarity on what this means for them. It as • Patient Safety - two patient safety issues were raised in relation to rejected letters; however, no easy solution to resolve the situation was suggested.
Oadby and Wigston In the absence of Dr Varakantam, the report was taken as read.
It was RESOLVED to:
• RECEIVE the Locality Chairs’ Report.
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Paper A East Leicestershire and Rutland CCG Governing Body Meeting 11 September 2018 ITEM DISCUSSION LEAD RESPONSIBLE B/18/149 Next steps towards greater collaboration between the LLR CCGs (Paper M)
Dr Palin noted that this is a follow up paper, to the one brought to Governing Body two months ago and although it is being discussed in the public section of the meeting, all EMT members are conflicted and therefore will not participate in the vote. Dr Palin proposed that a vote is taken later this afternoon at approximately 3:00pm when the Governing Body will reconvene its meeting in public. Dr Palin advised that this will enable the non-conflicted Governing Body members to reflect on the report and vote on the proposals. Members of the public present in the public gallery were invited to join the Governing Body at 3;00pm should they wish to, alternatively if they could not attend and wished to know the outcome to provide Mrs Bains with their contact details and she would inform them of the outcome following the meeting.
Dr Ker noted that the paper follows the CCG not approving the move to a single Accountable Officer in June 2018; the main reasons for this was that there was a lack of detail available on how the model would work; a lack of governance structure; and also a lack of detail about how the proposal would benefit patients.
Although WL and LC CCGs did support the initial paper, it was noted that they still had some concerns.
A joint informal meeting of the three LLR CCGs’ Governing Bodies was held in July 2018 in order for all members to gain a better understanding of the position. Since then the Chairs of the three CCGs have met to discuss a move to more collaborative working and how to follow the national direction. The paper presented today is a result of all of these discussions.
Dr Ker informed that the proposal is that a detailed piece of work is completed in the next 12 weeks to look at the benefits of appointing a single accountable officer and the governance arrangements. An external consultant will be appointed for a short period of time to complete this work and ensure that it is done independently.
It is suggested that the proposal is re-submitted to the Governing Body for consideration in November, with further discussion expected in early 2019. This will also allow for further discussions on a possible legal merger of the organisations.
Dr Palin reported his personal opinions which include further clarity around how the governance of having one Accountable Officer, Chief Nurse and Chief Finance Officer might work; alongside having three CCG Governing Bodies all needing to satisfy their legal requirements. The discussion on potential savings was welcomed and NHS England
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Paper A East Leicestershire and Rutland CCG Governing Body Meeting 11 September 2018 ITEM DISCUSSION LEAD RESPONSIBLE has been clear in directing the CCGs to work through the issues highlighted. Dr Palin is happy with the proposed suggestion for the next three months and is now supportive of the paper and would welcome a final decision being made in November.
Mr Smith asked that clarity is given on how the Audit Committee would work in the future, as this is not clear in the proposals. Mr Smith also asked how the performance report will work; as the CCGs will remain as separate bodies, and therefore how would they can discharge their own responsibilities, with their own management teams and maintain three separate Governing Bodies.
Mr Wood noted paragraph ten in the report, which recommends that an external resources is brought in and welcomed this suggestion, noting that the independent, impartial nature of this post is a positive step; alongside including Managing Directors’ in the discussion to ensure that all local issues / concerns have been addressed. Whilst the idea of a merger needs further discussion, Mr Wood is keen to ensure that the CCG retains localism and does not lose its independence.
Mr Kendrick concurred that the proposal is a logical way to review the benefits, identify risks to staff and patients, whilst ensuring that the best service is still delivered for our patients.
Dr Glover commented that whilst he appreciated that this has been a difficult task and the CCG needs to find a constructive way forward; it is important that the local identity is not lost. The proposal does seem a more coherent way forward to explore what the structure may look like.
Dr Ker thanked colleagues for their comments regarding the appointment of an external person to oversee the next piece of work and suggested that informal meetings will take place with potential appointees, prior to a final decision on the appointment being made. Mrs English concurred that this was a sensible suggestion to ensure that all members of the Governing Body were satisfied with the candidate and also were engaged in the review process.
Dr Palin reminded members that a vote will be taken, by the non- conflicted members when the Governing Body re-convened at approximately 3.00pm. Dr Palin reminded members of the public were welcome to stay for the reconvened meeting, or, if they wished to be informed of the decision outside of the meeting, could provide their contact details to Mrs Bains.
Notes from the meeting re-convened at 3:00pm:
Dr Palin reconvened the meeting in public of the Governing Body to
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Paper A East Leicestershire and Rutland CCG Governing Body Meeting 11 September 2018 ITEM DISCUSSION LEAD RESPONSIBLE consider this item. The Executive Management Team absented themselves from the discussion. Further to the earlier discussion, it was unanimously agreed to support a further detailed piece of work, in regards to options for future collaboration, to take place over the course of the next 12 weeks. The specific scope of this work includes:
• Gathering information about the experience of other areas. This will include looking for the benefits, if available, of any new arrangement to the system, individual organisations and the patients they represent. • Further analysis of potential management arrangements and how a single accountable officer and management team could interact with, and fulfil their obligations to, individual statutory bodies. • Development of a firm proposal setting out how the governance arrangements of individual organisations and the wider system might evolve over time. This would include examination of existing organisational and collaborative arrangements, and consideration of any further opportunities (or otherwise) to streamline processes through the alignment of meetings and/or committees. • Examination of further opportunities to strengthen collaboration through consideration of the desirability and feasibility of moving towards sharing of some other key governing body posts.
It is proposed that the findings of the above work would be presented back to governing bodies, along with final recommendations, for consideration in November 2018.
It was RESOLVED to:
• APPROVE the scope of the additional work set out in this paper, noting the expected timing of the outcome and recommendations coming back to boards in November 2018.
• APPROVE the inclusion of current managing directors to the existing Joint Executive Steering Group to further strengthen input through their experience and expertise.
• SUPPORT the proposal to bring in dedicated external management resource to provide additional capacity and independence.
• AGREE that a review of long-term configuration options for the CCGs will take place in early 2019, concluding by mid-2019.
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Paper A East Leicestershire and Rutland CCG Governing Body Meeting 11 September 2018 ITEM DISCUSSION LEAD RESPONSIBLE B/18/150 Summary Report from the Commissioning Collaborative Board (July 2018) (Paper N)
Dr Palin took the report as read and no questions or queries were raised.
It was RESOLVED to:
• RECEIVE the Summary Report from the Commissioning Collaborative Board
B/18/151 Summary report from the Primary Care Commissioning Committee (August 2018) (Paper O)
Mr Wood took the paper as read and highlighted the following items from the report:
• Delegated Financial Authority – a discussion took place on the proposals, which are shown in section 14 of the report. This is in line with the Terms of Reference of the Committee. • Option on the future of Ketton Surgery – the hard work of Mr Jamie Barrett and the Primary Care team on this piece of work was recognised and Mr Sacks was asked to ensure that this was fed back to his whole team. Mr Wood also asked that thanks be conveyed to Mrs Pragati Baddhan, from the CCG’s Communications team, for all her hard work on the consultation and presentation to the public. This was particularly noted as the representative from the Ketton Patient Participation Group left the meeting happy with the answers they had received.
Dr Glover noted that the section 14.2, the budget being overspent, will always apply and even though GPs are excluded from voting at the PCCC meetings, due to being conflicted, the clinical voice is listened to. Difficult decisions have to be made and the Committee has the support of the GPs on the panel.
Mr Wood thanked Dr Glover for his comments and noted that the clinical voice will always be heard at PCCC and the views of GPs sought and be taken into consideration.
It was RESOLVED to:
• RECEIVE the Summary report from the Primary Care Commissioning Committee. B/18/152 Minutes from the System Leaders’ Meeting (June 2018) (paper N)
Mrs English took the paper as read; and noted the following item from the report:
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Paper A East Leicestershire and Rutland CCG Governing Body Meeting 11 September 2018 ITEM DISCUSSION LEAD RESPONSIBLE
The draft Business Intelligence strategy was presented and discussed; discussion focussed on the need for an IT system across the patch. Some additional LLR resource has been identified and may be used to invest money in UHL IT systems.
It was RESOLVED to:
• RECEIVE the minutes from the System Leaders’ Meeting (June 2018).
B/18/151 Summary report from the Primary Care Commissioning Committee (August 2018)
Mr Wood asked that an amendment be added to this section of the minutes.
Mr Wood noted that due to the Secondary Care Clinician being conflicted with the Committee, Dr Tabitha Randell had stood down from the PCCC. Mr Wood formally thanked Dr Randell for her contributions and noted that he is working with Mrs Bains to look for an alternative member to join the committee.
B/18/153 Date of next meeting
The next meeting of the Governing Body of the East Leicestershire and Rutland CCG Governing Body will be take place on Tuesday 11 September 2018, in Stamford Court, Oadby, (venue to be confirmed)
The meeting concluded at 11.05am
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B Blank Page Paper B ELR CCG Governing Body Meeting 11 September 2018
NHS EAST LEICESTERSHIRE AND RUTLAND CLINICAL COMMISSIONING GROUP Key ACTION NOTES Completed On-going Outstanding Minute No. Meeting Item Responsible Action Required To be Progress as at Status Officer completed September 2018 by B/18/143 14 August Finance Report: Simon Pizzey To explore the option of looking at October Work in progress. AMBER 2018 Month 3 update Referral to Treatment waiting lists to 2018 see if patient could be re-directed to an alternative place for treatment. B/18/148 14 August Locality Tim Sacks Clarity to be given to practices on September A verbal update to be AMBER 2018 Chairs’ Report the 4% reduction in funding 2018 provided at the meeting.
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C Blank Page Paper C East Leicestershire and Rutland CCG Governing Body meeting 11 September 2018 EAST LEICESTERSHIRE AND RUTLAND CLINICAL COMMISSIONING GROUP GOVERNING BODY MEETING 11 September 2018
Accountable Officer’s Corporate Report Introduction
1. This report sets out to the Governing Body some of the key updates and activities the Executive Management Team (EMT) and I have been involved in since the last meeting of the Governing Body in August 2018.
Workforce Race Equality Standard (WRES)
2. The main purpose of the Workforce Race Equality Standard (WRES) is to help local, and national, NHS organisations to review their data against the nine WRES indicators and to produce an action plan to improve workplace experiences of Black, Asian and Ethnic Minority (BME) staff. The WRES also places an obligation on NHS organisations to improve BME representation at Board level.
3. In 2014, NHS England and the NHS Equality and Diversity Council agreed action to ensure employees from BME backgrounds have equal access to career opportunities and receive fair treatment in the workplace. The WRES was introduced and implemented as mandatory for NHS trusts in April 2015 and from 1 July 2016, CCGs have been required to publish an annual WRES report and action plan.
4. The WRES is a tool designed for both providers of NHS services (including NHS and independent providers of NHS services) and NHS Commissioners. It can also be applied to national healthcare bodies; many of whom are also implementing and using the WRES.
5. Clinical Commissioning Groups (CCGs) have two roles in relation to the WRES – as commissioners of NHS services and as employers. In both roles their work is shaped by key statutory requirements and policy drivers including those arising from: • The NHS Constitution; • The Equality Act 2010 and the Public Sector Equality Duty; • The NHS standard contract and associated documents; • The CCG Improvement and Assessment Framework.
6. Whilst CCGs as employers are required to commit to the principles of the WRES and apply as much of it as possible to their workforce, they are not required to fully apply the WRES to themselves as some CCG workforces may be too small for the WRES indicators to either work or to comply with the Data Protection Act.
7. As Commissioners, the CCG seeks assurance from providers that they are implementing the WRES and working on their action plans as a part of the contract monitoring process.
Karen English 1 Accountable Officer Paper C East Leicestershire and Rutland CCG Governing Body meeting 11 September 2018 8. To support CCGs with the implementation of the WRES, CCGs should: • Collect data on their workforce; • Carry out data analyses; • Produce an annual report; • Report and action plan publication.
9. The NHS is mandated to show progress against a number of indicators of workforce equality, including a specific indicator to address the low numbers of BME board members across the organisation.
10. Table 1 below shows the nine WRES indicators that NHS organisations have to report against on an annual basis, which are based on existing data sources such as Electronic Staff Records (ESR) and the NHS Staff Survey results:
Table 1 Nine WRES Indicators:
Workforce indicators For each of these four workforce indicators, compare the data for White and BME staff 1. Percentage of staff in each of the AfC Bands 1-9 and VSM (including executive Board members) compared with the percentage of staff in the overall workforce disaggregated by non-clinical and clinical staff. 2. Relative likelihood of staff being appointed from shortlisting across all posts. 3. Relative likelihood of BME staff entering the formal disciplinary process, as measured by entry into a formal disciplinary investigation. Note: This indicator will be based on data from a two year rolling average of the current year and the previous year. 4. Relative likelihood of staff accessing non-mandatory training and CPD. National NHS Staff Survey indicators (or equivalent) For each of the four staff survey indicators, compare the outcomes of the responses for White and BME staff. 5. KF 25. Percentage of staff experiencing harassment, bullying or abuse from patients, relatives or the public in last 12 months. 6. KF 26. Percentage of staff experiencing harassment, bullying or abuse from staff in last 12 months 7. KF 21. Percentage believing that trust provides equal opportunities for career progression or promotion. 8. Q17. In the last 12 months have you personally experienced discrimination at work from any of the following? b) Manager/team leader or other colleagues. Board representation indicator For this indicator, compare the difference for White and BME staff. 9. Percentage difference between the organisations’ Board voting membership and its overall workforce disaggregated by voting membership of the Board and by Executive Membership of the Board.
11. This following provides an update to the Governing Body on the progress made against the WRES action plan since it was last published in August 2017. It also provides the new WRES report for 2017/18 against the nine workforce indicators when compared with the baseline data for 2016/17. The updated WRES
Karen English 2 Accountable Officer Paper C East Leicestershire and Rutland CCG Governing Body meeting 11 September 2018 template and action plan were agreed by the Executive Management Team on 13 August 2018 and will be published shortly after approval by Governing Body in September 2018. All NHS trusts are required to publish their data and WRES action plan by 5 October 2018.
12. The Head of HR and Organisational Development collated the CCG’s information against the nine WRES indicators for 2016-17, which was published with a WRES action plan in early August 2017, following approval by the Governing Body in July 2017. The initial recruitment analysis raised some concerns regarding the relative likelihood of BME applicants being appointed in comparison to white applicants which resulted in a ‘deep dive’ into recruitment data which found a more favourable result for the number of White and BME applicants that were shortlisted and appointed and an updated WRES report was published on 23 August 2017 and the Governing Body updated in September 2017.
13. Since initial publication, the CCG has made progress against the actions listed within the WRES action plan for 2016-17, for which progress has been provided in Table 2 below and under review on an ongoing basis:
Table 2: WRES Action Plan 2016-17 Progress Update Action to be taken Progress so far RAG rated: 1. Explore options for The HR Business Partner at MLCSU has AMBER recording non- developed a local reporting solution for mandatory training recording completed training activity. Members of staff have been reminded to provide details and CPD of any non-mandatory training completed and resource has been identified to maintain updates. 2. Hold a staff focus The Equality & Inclusion Business Partner at GREEN group to explore MLCSU hosted a focus group with staff on SOS results and 07/09/17. An anonymous narrative report was produced and findings and recommendations differences between were discussed at EMT on 03/10/17. Following White and BME staff this, a summary of feedback and recommendations was included at Team Brief on 01/10/17. 3. Review success of An analysis of 2016/17 and Q1 2017/18 data GREEN BME and White was completed by 03/08/17. As a result, the applicants at various WRES template was updated to reflect the stages of recruitment decreased likelihood of a White applicant being to identify the appointed than a BME applicant. reasons for difference in Updates were provided to Team Brief on likelihood of success 23/08/17 and Governing Body on 08/09/17. for both groups and identify if there is evidence of discrimination or bias 4. Deliver recruitment The revised Recruitment and Selection policy AMBER and selection training was published on 12/10/17. for recruiting managers which Recruitment and selection training for incorporates equality managers is due to be delivered between
Karen English 3 Accountable Officer Paper C East Leicestershire and Rutland CCG Governing Body meeting 11 September 2018 and diversity and August and October 2018. bias 5. Introduce quarterly Quarterly reporting was introduced in 2017/18 GREEN monitoring of the as it was initially thought that the CCG may percentage of White have an issue in the recruitment process. A and BME applicants summary of analysis was included in the who are shortlisted quarterly Workforce Metrics reports submitted and appointed to EMT and IGC during 2017/18.
Overall in 2017/18, there was a 1.2 times greater likelihood of a white applicant being appointed and in 2016/17 this was 1.14. as the difference between the two years is not considered significant it was recommended and agreed by EMT and IGC in July 2018 to cease quarterly reporting and continue the annual reporting of recruitment data in WRES reports.
6. Continue to report Q1 2017/18 data was reported to EMT on GREEN workforce metrics to 07/08/17 and IGC on 05/09/17. EMT and Integrated Q2 data was reported to EMT on 06/11/17 and Governance IGC on 05/12/17. Committee quarterly Q3 data was reported to EMT on 26/02/18 and and annually to the IGC on 06/03/18. Governing Body Q4 data was reported to EMT on 19/06/18 and IGC on 03/07/18.
7. Roll out training to The updated Harassment and Bullying policy GREEN support the new was published on 12/04/17. Bullying and Training was delivered to the Finance, QIPP Harassment policy and Corporate Affairs Team on 03/08/17 as and procedure and part of the 2016/17 SOS Action Plan. local staff opinion A further session was facilitated at the CCGs survey action plans. Time Out on 27/04/18 as part of the 2017/18 SOS Action Plan when it was agreed to roll out training between July and August 2018 to include information regarding the policy update. This was confirmed at Team Brief on 24/05/18 and two workshops were delivered on 24/07 and 01/08.
14. Appendix 1 provides the CCG’s WRES report and action plan for 2017-2018, which was initially completed by the Equality and Inclusion Business Partner at MLCSU.
15. Having compared the results of the WRES information and action plan for the last two consecutive years, the following key areas are highlighted for the Governing Body: • The proportion of BME staff identified within the CCG has remained the same from 2016-17 to 2017-18 (25%);
Karen English 4 Accountable Officer Paper C East Leicestershire and Rutland CCG Governing Body meeting 11 September 2018 • The self reporting of ethnicity has decreased slightly from 2016/17 (99.1%) to 2017/18 (97.1%). However, this is a very high level of self-reporting when compared to other CCGs; • A slightly higher proportion of white applicants were shortlisted and appointed compared to BME applicants. White applicants have a 1.18 times greater likelihood of being appointed compared to BME applicants; • Thirty four members of staff subscribed to programmes or events delivered by the East Midlands Leadership Academy (EMLA), of which 85% were white and 15% were BME staff; • The percentage of staff experiencing harassment, bullying or abuse from patients, relatives or the public has increased for white staff but remained the same for BME staff. Proportionally, more white staff are now reporting experiencing this kind of harassment, bullying or abuse than BME staff; • The percentage of staff experiencing harassment, bullying or abuse from staff has increased for both white and BME staff; • The percentage of staff believing the CCG provides equal opportunities for career progression / promotion has decreased for both white and BME staff; • The percentage of staff who have personally experienced discrimination at work from their manager/team leader/other colleagues has increased for both white and BME staff; • The percentage difference between the CCGs Board voting membership and its overall workforce has decreased slightly from -6.82% to -6.25%.
16. In light of the above, the following actions have been identified for approval by the Governing Body: a) Continue to develop the recording of non-mandatory training and continued professional development; b) Monitor the impact of the introduction of the TRAC recruitment system to identify any changes in numbers of applicants from difference backgrounds; c) Deliver recruitment and selection training for recruiting managers which incorporates equality, diversity and inclusion issues, and unconscious bias; d) Continue to report an analysis of recruitment activity in the workforce metrics to EMT, IGC and GB on an annual basis; e) Review the need for further training to support the Harassment and Bullying Policy in light of the results of the 2018 Staff Opinion Survey.
17. In relation to the CCG’s commissioner responsibilities, the Corporate Affairs Team has monitored the WRES requirements for providers in relation the NHS Standard Condition of Contract since 2016 and the CCG has been assured that all providers are currently compliant with the WRES obligations.
18. In summary, the WRES is included within contracts for the following service providers: • Continuing Health Care (CHC); • Domiciliary Care; • Leicestershire Partnership NHS Trust (LPT); • Out of County (Mental Health); • Out of Hours Service (OOHs); • The Alliance;
Karen English 5 Accountable Officer Paper C East Leicestershire and Rutland CCG Governing Body meeting 11 September 2018 • The Independent Sector; • University Hospitals of Leicester (UHL) NHS Trust.
19. In line with the national NHS standard contract, service providers are required to: • implement the national WRES; and • submit an annual report on progress to the co-ordinating commissioner on progress in implementing the Standard as well as their actions plans, following the identification of any issues.
Competition and Procurement Panel Terms of Reference
20. The Competition and Procurement Panel has undertaken an annual review of its terms of reference to ensure they remain fit for purpose. The three LLR CCGs have established the Competition and Procurement Panel as a joint advisory panel and not a joint committee. This has now been reflected more clearly in the amended version, which is as at Appendix 2. In addition the membership no longer includes a representative from the commissioning support unit (CSU), although a representative is required to be in attendance. For information, if a representative from the CSU were to form part of the membership the CCGs would need to establish the group as a joint committee with appropriate decision making in line with the regulations governing CCG joint committees. The establishment of a joint committee would require a more detailed review and would be considered as part of the wider review of the collaborative arrangements, and hence the group remains a joint advisory panel across the CCGs with no decision making authority.
21. The updated terms of reference are as at Appendix 2 for approval.
PUBLICATIONS
22. Publications and updates published by NHS England via its fortnightly newsletter Bulletin for CCGs can be found at the following http://www.england.nhs.uk/publications/bulletins/bulletin-for-ccgs/. The Executive Management Team undertakes a regular review of the content of the Bulletin and ensure actions are taken accordingly. Assurances and updates are reported through to the Governing Body as evident on the agenda and through updates in the Accountable Officer’s report.
Recommendation The East Leicestershire and Rutland CCG Governing Body is requested to:
• RECEIVE the report.
• APPROVE the Workforce Race Equality Standard (WRES) report and action plan for 2017/18 for publication in September 2018.
• APPROVE the revised terms of reference for the Competiton and Procurement Panel as at Appendix 2.
Karen English 6 Accountable Officer Workforce Race Equality Standard REPORTING TEMPLATE (Revised 2016) Template for completion
Name of organisation Date of report: month/year
Name and title of Board lead for the Workforce Race Equality Standard
Name and contact details of lead manager compiling this report
Names of commissioners this report has been sent to (complete as applicable)
Name and contact details of co-ordinating commissioner this report has been sent to (complete as applicable)
Unique URL link on which this Report and associated Action Plan will be found
This report has been signed off by on behalf of the Board on (insert name and date)
Publications Gateway Reference Number: 05067 Report on the WRES indicators
1. Background narrative a. Any issues of completeness of data
b. Any matters relating to reliability of comparisons with previous years
2. Total numbers of staff a. Employed within this organisation at the date of the report
b. Proportion of BME staff employed within this organisation at the date of the report Report on the WRES indicators, continued
3. Self reporting a. The proportion of total staff who have self–reported their ethnicity
b. Have any steps been taken in the last reporting period to improve the level of self-reporting by ethnicity
c. Are any steps planned during the current reporting period to improve the level of self reporting by ethnicity
4. Workforce data a. What period does the organisation’s workforce data refer to? Report on the WRES indicators, continued
5. Workforce Race Equality Indicators Please note that only high level summary points should be provided in the text boxes below – the detail should be contained in accompanying WRES Action Plans.
Indicator Data for Data for Narrative – the implications of the data and Action taken and planned including e.g. does reporting year previous year any additional background explanatory the indicator link to EDS2 evidence and/or a narrative corporate Equality Objective For each of these four workforce indicators, compare the data for White and BME staff 1 Percentage of staff in each of the AfC Bands 1-9 and VSM (including executive Board members) compared with the percentage of staff in the overall workforce. Organisations should undertake this calculation separately for non-clinical and for clinical staff.
2 Relative likelihood of staff being appointed from shortlisting across all posts.
3 Relative likelihood of staff entering the formal disciplinary process, as measured by entry into a formal disciplinary investigation. This indicator will be based on data from a two year rolling average of the current year and the previous year.
4 Relative likelihood of staff accessing non-mandatory training and CPD. Report on the WRES indicators, continued
Indicator Data for Data for Narrative – the implications of the data and Action taken and planned including e.g. does reporting year previous year any additional background explanatory the indicator link to EDS2 evidence and/or a narrative corporate Equality Objective National NHS Staff Survey indicators (or equivalent) For each of the four staff survey indicators, compare the outcomes of the responses for White and BME staff. 5 KF 25. Percentage of staff White White experiencing harassment, bullying or abuse from patients, relatives or the BME BME public in last 12 months.
6 KF 26. Percentage of staff experiencing White White harassment, bullying or abuse from staff in last 12 months. BME BME
7 KF 21. Percentage believing that trust White White provides equal opportunities for career progression or promotion. BME BME
8 Q17. In the last 12 months have you White White personally experienced discrimination at work from any of the following? BME BME b) Manager/team leader or other colleagues
Board representation indicator For this indicator, compare the difference for White and BME staff. 9 Percentage difference between the organisations’ Board voting membership and its overall workforce.
Note 1. All provider organisations to whom the NHS Standard Contract applies are required to conduct the NHS Staff Survey. Those organisations that do not undertake the NHS Staff Survey are recommended to do so, or to undertake an equivalent. Note 2. Please refer to the WRES Technical Guidance for clarification on the precise means for implementing each indicator. Report on the WRES indicators, continued
6. Are there any other factors or data which should be taken into consideration in assessing progress?
7. Organisations should produce a detailed WRES Action Plan, agreed by its Board. Such a Plan would normally elaborate on the actions summarised in section 5, setting out the next steps with milestones for expected progress against the WRES indicators. It may also identify the links with other work streams agreed at Board level, such as EDS2. You are asked to attach the WRES Action Plan or provide a link to it.
Click to lock all form fields and prevent future editing
Produced by NHS England, April 2016
Leicester City Clinical Commissioning Group West Leicestershire Clinical Commissioning Group East and Rutland Leicestershire Clinical Commissioning Group
Leicester, Leicestershire & Rutland (LLR) Clinical Commissioning Groups (CCG) Competition and Procurement Committee Panel (CPPC)
Terms of Reference (v11, 30 August 2018)
1. Constitution
1.1 Leicester City Clinical Commissioning Group (LC CCG), East Leicestershire and Rutland Clinical Commissioning Group (ELR CCG) and West Leicestershire Clinical Commissioning Group (WL CCG) hereby resolve to establish a joint advisory committee group known as the LLR (Leicester, Leicestershire and Rutland) Clinical Commissioning Group’s (CCG’s) Competition and Procurement Committee Panel (the CommitteePanel).
2. Purpose
2.1 To assess and provide recommendations relating to competition and/or procurement law in respect of the LLR CCG’s scope of health services commissioning responsibilities. The Committee Panel will also retain links to external support both from NHS Improvement and from legal experts.
2.2 To advise on compliance with The Public Contracts Regulations (PCR) 2015.
2.3 To advise on compliance with The National Health Service (Procurement, Patient Choice and Competition) Regulations, section 75, 2013.
2.4 To advise on compliance with European Union (EU) Treaty Principles; • Equal Treatment • Transparency • Proportionality • Non-discriminatory.
2.6 To ensure that appropriate governance and legal issues have been considered in relation to procurement decisions undertaken by LLR CCG’s and any potential risks have been identified and mitigated appropriately.
2.7 To provide guidance around complaints relating to procurement decisions and matters that cannot be resolved by the Midlands and Lancashire Commissioning Support Unit (ML CSU) procurement team, including referral to an independently constituted dispute panel.
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3. Responsibilities
3.1 To provide recommendations to the LLR CCGs’’s Governing Bodies and the Commissioning Collaborative Committee on adherence to competition and cooperation law and principles and ensure that appropriate issues have been considered in relation to procurement decisions.
3.2 To advise and support CCG’s to ensure that procurement processes are in line with EU legislation enacted in to UK law and the EU Treaty Principles and to highlight any identified procurement risks.
3.3 To provide a local route for management of complaints relating to competition decisions, ensuring that dispute resolution policies are enacted appropriately.
3.4 To advise and support the CCG’s on decisions relating to competition and or procurement law which from time to time require external input to make decisions for determination.
3.5 ML CSU Procurement to ensure procurement law education for the membership to ensure the committee Panel is aware of up to date legislation.
3.6 To have oversight of the complaints register relating to procurement processes and ensure lessons learnt are captured and support the improvement of systems and processes.
3.7 To monitor and report to the CCGs, via the Commissioning Collaborative Board and via the CCG representatives through individual CCG governance processes, on the CPC activity log and work plan and related governance processes of the CCGs.
4. Confidentiality
4.1 The matters and papers discussed in Committee the Panel meetings must be kept strictly confidential and must not be reproduced, copied, discussed with, disclosed or distributed to any or other person and/or organisation outside of the organisations that are part of this Committee Panel at any time.
5. Membership
5.1 The membership of the Competition and Procurement Committee Panel will be:
• 3 Governing Body Lay Representatives (one from each LLR CCG - one to be Chair and another deputy Chair) • 3 Governing Body Director Representatives (one from each LLR CCG) • ML CSU Senior Procurement Manager (or ML CSU Head of Procurement)
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5.2 In attendance:
• Commissioning Leads as required from the (LLR CCGs) • Support Officer to administer the meeting from one of the LLR (CCGs) • Midlands and Lancashire Commissioning Support Unit (ML CSU) Senior Procurement Manager or ML CSU Head of Procurement
5.3 Membership will be reviewed regularly to adjust for changes as a result of changes in relevant guidance and/or legislation. Individuals relating to specific agenda items will be advised to attend as required.
5.4 Each member shall nominate a deputy to attend in their absence and, if applicable, voting rights shall transfer to the nominated deputy when making recommendations back to the CCGs.
6. Quorum
6.1 The meeting will be quorate when at least:
• 2 of the 3 CCG Lay Representatives, • 2 of the 3 CCG Governing Body Director Representatives • ML CSU Senior Procurement Manager or Head of Procurement are in attendance, with each CCG being represented. The following can deputise on behalf of the above:
• A nominated CCG Governing Body Lay Representative • A nominated CCG Senior Management Team representative • A nominated ML CSU Procurement representative.
7. Decision Making
7.1 A decision put to a vote at a meeting shall be determined by a majority of the votes of members present. In the case of an equal vote, the Chair of the Committee Panel shall have a second and casting vote in relation to making a recommendation to the CCG.
8. Administration
8.1 Administration and taking minutes for the Competition and Procurement Committee Panel is the responsibility of the Leadone of the CCG Corporate Officers.
8.2 The template for each item to be discussed at the Competition and Procurement Committee shall be the standardised document as agreed by the Panel (currently this document is entitled the “Appendix A”) and shall be completed and presented by the relevant member(s) of the CCG(s).
9. Frequency of meetings
9.1 The Competition and Procurement Committee Panel shall meet on a monthly basis.
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10. Reporting arrangements
10.1 The Committee Panel will report to each CCG and will provide a report of the recommendations and any identified risks to the next available step in CCG governance procedure (i.e. Governing Body, Commissioning Collaborative Board, Senior Management Teams) meeting via the CCG attendance representative in attendance and meeting minutes produced.
11. Review
11.1 These Terms of Reference will be reviewed annually or sooner if required and recommendations made to the CCG’s for approval.
Date of approval: 27/07/201711 September 2018
Review Date: TBCSeptember 2019
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EAST LEICESTERSHIRE AND RUTLAND CLINICAL COMMISSIONING GROUP GOVERNING BODY MEETING
Front Sheet
Future in Mind REPORT TITLE: Children & Young People’s Emotional, Mental Health & Wellbeing Transformation Plan
Implementation Review October 2018 MEETING DATE: 11 September 2018 Elaine Egan Morriss REPORT BY: CAMHS Commissioner / Future in Mind Transformation Programme Lead Chris West SPONSORED BY: Director of Nursing and Quality Elaine Egan Morriss PRESENTER: CAMHS Commissioner / Future in Mind Transformation Programme Lead
EXECUTIVE SUMMARY: The Children and Young People’s Mental Health and Wellbeing National Taskforce (2014) focussed on how to make it easier to access help and support when needed and to improve how children and young people’s mental health services are organised, commissioned and provided. The Leicester, Leicestershire and Rutland’s Transformational Plan aims to:- . Develop in partnership with children and young people (C&YP) and key stakeholders . Set out a multi-agency approach to improve mental health and wellbeing in C&YP . Address gaps in current service provision
Our vision is that children & young people will have access to the right help at the right time through all stages of their emotional and mental health development. For this to happen, we have developed a whole system approach to delivering a range of emotional, mental health and wellbeing services that meet all levels of need.
We have engaged with all stakeholders, including education, social care, health, police, housing and justice, and children & young people and their families. We have developed a shared work plan with key priorities, including joint commissioning. We have improved the interfaces between our agencies to reduce fragmentation in commissioning and service delivery so that organisational boundaries are not barriers to care.
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Paper D ELR CCG Governing Body Meeting 11 September 2018
We continue to monitor progress and implementation of the Transformation Plan through our monthly Future in Mind Governance Meetings. This presentation is intended to provide an update on our progress this year (2018-19) and our plans for 2019-21.
In 2017-18 we have been focussed on a system-wide ‘children & young people’s emotional, mental health and wellbeing’ pathway. Services include: • Primary Mental Health Teams • Resilience (including resilience in schools, 0-19 healthy child programmes) • Online counselling • Social Care & Early Help (Local Authority Services) • Early Intervention (working with voluntary sector) • Specialist Mental Health (working with CAMHS and specialist teams e.g. early psychosis, eating disorders) • Crisis Resolution and Home Treatment • Learning Disability Assertive Outreach • Family Action Post Sexual Abuse Counselling • Liaison Psychiatry • City Early Intervention Psychology Support (CEIPS)
In 2019-20 we will continue working in partnership with children, young people, families, carers and professionals to shape the pathway. We have already identified investments for the next year to help transform services further, these include: • Interventions for children & young people who have Autism with or without Learning Disability • ADHD • Triage & Navigation Service • Trailblazer Mental Health Support Teams working in partnership with education providers • The Mistle Project developing a ‘wraparound’ service for looked after children (LAC) • Support for children & young people who have come into contact with the criminal justice system and developing trauma focussed interventions
RECOMMENDATIONS: The East Leicestershire and Rutland CCG Governing Body is asked to note the progress made in relation to implementation of the Local Transformation Plan and to agree proposed next steps for 2019-21.
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Paper D ELR CCG Governing Body Meeting 11 September 2018
REPORT SUPPORTS THE FOLLOWING STRATEGIC AIM(S) 2017 – 2018: Transform services and enhance quality of x Improve integration of local services x life for people with long-term conditions between health and social care; and between acute and primary/community care. Improve the quality of care – clinical x Listening to our patients and public – x effectiveness, safety and patient experience acting on what patients and the public tell us. Reduce inequalities in access to healthcare x Living within our means using public x money effectively Implementing key enablers to support the strategic aims (e.g. constitutional and governance arrangements, communications and patient engagement). x
EQUALITY ANALYSIS Throughout the delivery of the Transformation Plan, consideration has been given to ensure that health inequalities are appropriately identified and addressed. Actions are taken as appropriate through the completion of equality impact assessments. This has included the following criteria within agreed service specifications: • Delivery of services in an anti-discriminatory manner in accordance with the Equality Act 2010 which protects individuals against discrimination on the grounds of age, disability, gender identity, race, pregnancy or maternity, religion or belief, sexual orientation, sex or any other relevant protected characteristic defined under the Equality Act 2010. • Sensitivity and response to the fact that some patients and communities are often the most vulnerable, and might have different expectations of health services, to the majority. In particular, they may have difficulty making or keeping appointments and they might have difficulties making their needs understood. There might also be cultural, practical or social barriers that affect their ability to follow treatment regimes. Challenges might be faced in organising systematic follow-up because of age, mobility, lifestyle, mental health and wellbeing, and practical issues such as transport. • Ensuring that patients, who have information and communication needs arising from their disability, have their needs met by fully implementing the NHS Accessible Information Standard. Guidance and resources for providers can be found at: http://www.england.nhs.uk/ourwork/patients/accessibleinfo-2/ • The provider will ensure that patients whose first language isn’t English and who require a language interpreter will be provided with a suitably qualified interpreter in order that their needs are identified and met. Interpreters should be provided on request and booked in advance of an appointment. In urgent cases arrangements should be made to use a telephone interpreting service. • British Sign Language (BSL) interpreters must be provided on request or where there is an immediate need to communicate with a deaf person. Arrangements should be made where a deaf person may require a BSL interpreter in an urgent medical situation. • Service providers will comply fully with relevant articles of the Human Rights Act 1998. • Service providers will ensure that they engage with and report to the Commissioner on all protected characteristics in respect of who is accessing the service, patient experience, complaints and customer satisfaction as a minimum.
RISK ANALYSIS AND LINK TO BOARD ASSURANCE FRAMEWORK: The content of the report identifies action(s) BAF to be taken / are being taken to mitigate the following corporate risk(s) as identified in BAF the Board Assurance Framework:
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Future in Mind Transforming Emotional, Mental Health & Wellbeing Services for Children and Young People
Elaine Egan Morriss CAMHS Commissioner & Transformation lead
October 2018
National Ambition
The Children and Young People’s Mental Health and Wellbeing National Taskforce (2014) focussed on how to make it easier to access help and support when needed and to improve how children and young people’s mental health services are organised, commissioned and provided
Self-care and Prevention
Early Help/Intervention
Easy Access to Specialist Care
Urgent Care and Crisis Response Developing a Local Transformation Plan
• The Transformation Plan has been designed and built around the needs of all children, young people and their families, that have or may develop a range of emotional and wellbeing problems, requiring low level mental health or specialist CAMHS services
• We have considered local intelligence and evidence bases e.g. JSNA
• We have involved Children, Young People and Families in shaping the pathway of services
• We have worked in partnership with stakeholders to develop a pathway that meets all levels of need Our Transformation Journey 2015-17
2015-16 2016-17
• Developed LLR Transformation • Designed new services to meet Plan local gaps in provision • Established governance - CRHTx structure -Enhanced Access to CAMHS - • Reviewed services - Eating Disorder Service
• Identified a pathway with 6 schemes of work • Introduced concept od a whole system pathway
Our Transformation Journey This Year….
• Worked in partnership to design services and to take a whole system approach to care
• Pathway revised to include a range of services to meet all levels of need
• Procurement and delivery of o Resilience, o Online Counselling, o Early Intervention
Our Transformation Journey This Year….
• Established the Workforce Development Partnership Group to oversee delivery of a shared Workforce Development Strategy
• Established the Participation & Involvement Network to improve opportunities for partnership working and engaging Children & Young People
• Established Data Flow group 75% of providers are flowing data onto MHDS
The next steps in our Transformation Journey 2018-21
Next Steps- Commissioning investments & transforming services
1. Transforming Care - interventions for complex children & young people with Autism with or with out Learning Disability
2. ADHD joint commission with shared service specification to reduce service fragmentation
3. Triage and Navigation Service – to reduce inappropriate referrals to CAMHS and to ensure CYP get the right help at the right time.
4. Trailblazer Mental Health Support Teams – Partnership Bid to develop wave 1 teams to work with designated school mental health leads.
5. The Mistle Project- developing a ‘wraparound’ service for Looked After Children (LAC) aged 5-18 - County LA Led
6. Youth Offending Service (YOS) - support for children & young people providing specialist trauma focused interventions e.g. those who have been in contact with the paediatric sexual assault referral centre (SARC)
Our C&YP produced a leaflet to share with stakeholders
Resilience Early Help Early Intervention Online Specialist Mental Where 0-19 healthy child (is in each area) Relate Counselling Counselling Health Services programmes provided Youth & Family Support Anonymous online help Help for children & can I get by professionals Support ADHD Solutions, ADHD & support for Young young people with help? Welfare Education family support/parenting People emotional & behavioural Connexions Advice groups Chat & Forums difficulties that need Children Centres Centres for Fun & Messaging specialist support Youth Offending Families offer group work Information & advice to help with anxiety Parent/Carers help
We work 0-19 5-18 11-19 Any age with…
Young People can Referrals need to be made Referrals need to be made by Professionals Only GPs and CAMHS can Refer… access service directly by a Healthcare working with Children & Families refer Professional
Getting Visit our website Leicester 0116 2543011 Kooth.com Speak to your GP, www.leicspart.nhs.uk 0116 454 1004 School Nurse or a In Touch Leicestershire Social Worker With Us Text ChatHealth 0116 3050005 Leicester 07520615381 Rutland Leicestershire & www.rutland.gov.uk/educatio Rutland 07520615382 n_and_learning/family_infor mation_service 01572 722577 Any Questions? E Blank Page Paper E East Leicestershire and Rutland CCG Governing Body meeting 11th September 2018
EAST LEICESTERSHIRE AND RUTLAND CLINICAL COMMISSIONING GROUP GOVERNING BODY MEETING
Front Sheet
REPORT TITLE: Finance Report – July 2018 (month 4)
MEETING DATE: 11 September 2018
REPORT BY: Colin Groom, Deputy Chief Finance Officer
SPONSORED BY: Donna Enoux, Chief Finance Officer
PRESENTER: Donna Enoux, Chief Finance Officer
EXECUTIVE SUMMARY: This report confirms the reported financial position for 2018/19 for East Leicestershire and Rutland Clinical Commissioning Group (ELR CCG) at month 4. The first page of this report contains an Executive Summary.
RECOMMENDATIONS: The ELR CCG Governing Body is requested to: Receive for information the contents of the report and the appendices attached Note the breakeven position reported at month 4 along with the risks currently being assessed to the delivery of the breakeven control total
REPORT SUPPORTS THE FOLLOWING STRATEGIC AIM(S) 2018 - 2019: Transform services and enhance quality of Improve integration of local services between life for people with long-term conditions health and social care; and between acute and primary/community care. Improve the quality of care – clinical Listening to our patients and public – acting effectiveness, safety and patient on what patients and the public tell us. experience Reduce inequalities in access to Living within our means using public money healthcare effectively Implementing key enablers to support the strategic aims (e.g. constitutional and governance arrangements, communications and patient engagement).
EQUALITY ANALYSIS An Equality Analysis and due regard to the positive general duties of the Equality Act 2010 has not been undertaken in the development of this report as it is judged that it is not proportionate on the basis that the financial reporting underpins the commissioning strategy and priorities of the CCG. The commissioning strategy and priorities have and continue to be equality impact assessed as the strategy is reviewed and refreshed and this includes the financial plans. This completes the due regard required.
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Paper E East Leicestershire and Rutland CCG Governing Body meeting 11th September 2018 EAST LEICESTERSHIRE AND RUTLAND CLINICAL COMMISSIONING GROUP GOVERNING BODY MEETING 11 September 2018
Finance Report
Executive Summary
2018/19 Financial Position
1. This report confirms the year to date and forecast position as at July 2018 (Month 4) based on three months of activity information and two months of prescribing data.
2. QIPP monitoring processes during month 4 have confirmed a number of schemes that have slipped or will otherwise not deliver in 2018/19 and therefore further stretch and replacement schemes have been identified to ensure the continued delivery of the full £19.6m QIPP programme. In addition, due to continuing identified cost pressures it has been necessary to release the full 0.5% contingency into month 4.
3. Following the release of the contingency and the identification of a range of additional mitigations, the month 4 forecast is still to deliver a breakeven position but with no further uncommitted reserves to support ongoing pressures, the CCG will need to ensure it can fully deliver the required mitigations if it is to deliver the in year control total.
Risks
4. The principle financial risks facing the CCG in year are as follows;
Risk area Estimated Risk £m SRO Assessed QIPP slippage requiring replacement schemes 3.26 Further PMO assessed QIPP shortfall 3.52 Sub-Total PMO Assessed QIPP Shortfall 6.78
Adjustment for QIPP that is not relied upon within financial forecast * -2.74 Sub-Total potential QIPP impact on forecast 4.04 Potential for acute activity beyond existing forecast and potential for loss on 1.00 activity challenges Potential for in year CHC, S117 and Children’s Complex cases growth 0.30 beyond existing forecast. Potential for in year Prescribing growth and NCSO exceeding forecast levels 0.60
Expenditure control required to deliver current Running Cost forecast 0.15
Potential pressures from 2017/18 accrual settlements 2.85
Potential EMAS Contractual pressure 0.15
Total Gross Risk 2018/19 9.09
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Paper E East Leicestershire and Rutland CCG Governing Body meeting 11th September 2018 *This adjustment relates to QIPPs that are transacted within contracts/budget lines and their delivery or otherwise is therefore reflected in the forecast for that expenditure line.
The CCG continues to support the delivery of existing QIPP schemes, alongside pursuing additional QIPP savings’ opportunities and other cost control measures. However, as we enter the second half of the year, the opportunity for in year impact of further mitigations continues to reduce.
Other Financial Metrics
5. Cash flow – Cash target met for the month.
6. Better Payment Practice Code – continued strong performance in month. All cumulative metrics in excess of 99% compliance
7. CSU Performance – CSU report for month 4 confirms all KPIs achieved and tasks completed to timetables bar two internal deadlines that did not impact on the overall reporting processes.
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Paper E East Leicestershire and Rutland CCG Governing Body meeting 11th September 2018
EAST LEICESTERSHIRE AND RUTLAND CLINICAL COMMISSIONING GROUP GOVERNING BODY MEETING 11 September 2018
Detailed Finance Report
Introduction
1. This report provides details of the financial position for East Leicestershire and Rutland Clinical Commissioning Group (ELR CCG) at month 4 of 2018/19, the pressures contained within that position and the risks to the delivery of the CCG’s financial targets for the year.
2018/19 Allocations
1. The overall revenue allocation for ELR CCG at month 4 stands at £429.072m, an increase of £0.576m since month 3 following the receipt of additional allocations to support LD Transformation.
2. The CCG has no identified core capital funding for 2018/19.
3. The allocation is detailed in Appendix A. Included in the allocation is the carry forward from 2017/18 of the CCG cumulative surplus of £2.45m. This is excluded from the in-year allocation of £426.622m shown on Appendix B to show the true in-year position.
Financial Performance
4. The budget statement in Appendix B details the ledger position for 2018/19 as at month 4. Following the identification of further QIPP slippage at month 4, a series of additional stretch schemes have been forecast to ensure the delivery of the full £19.6m programme.
5. As a result of continued pressures on the co-commissioning budget, impact of confirmed 17/18 pressures and 18/19 pressures including the recently confirmed prescribing Category M pricing uplift, the 0.5% contingency reserve of £1.91m has been released in month 4 to support the overall financial position. In addition a further £2.5m of required mitigations have been included in the forecast.
6. Following the application of these mitigations, the CCG is still forecasting the achievement of its in year breakeven target but, as identified in the introduction to this report, is facing significant risks to this delivery. The LLR-wide QIPP PMO continue to operate their Confirm and Challenge process evaluating the deliverability of the QIPP programme and ensure that any further slippage or non delivery is identified at the earliest opportunity to ensure mitigations can be identified.
7. Acute budgets total £213.507m. This includes a reserve of £4.935m, the majority of which (£4.868m) has been created to cover anticipated acute growth not attached to individual contracts and to support the delivery of Referral to Treatment (RTT) waiting time targets. 4
Paper E East Leicestershire and Rutland CCG Governing Body meeting 11th September 2018 In aggregate, assuming the delivery of identified stretch QIPP and a range of further mitigations, acute budgets are forecast to underspend by £2.297m. The Acute contracts team is closely monitoring the transfer of acute activity to independent sector providers to ensure the delivery of the planned growth levels and this activity remains a significant area of volatility.
8. The UHL contract value is £143.987m. Based on 3 months’ activity data the forecast continues to show material overspends on Outpatient, Daycase and Non elective activity, and the contract is forecast to overspend by £1.625m. Within this overspend, the element attributed to outpatient procedures is counted as a commitment against the £4.868m reserve identified above.
9. Out of County NHS contracts total £30.369m and in aggregate are forecast to overspend by £0.115m. Within this, the Kettering General Hospital, North West Anglia and Northampton General Trusts are forecast to overspend, largely as a result of overperformance on acute activity lines. The George Elliot, University College London and Cambridgeshire University Hospitals Trusts are forecast to underspend across a range of activity areas. The CCG is analysing the impact of recent trends in elective activity with these providers to ensure the forecast is robust.
10. Independent sector provider contracts total £10.266m and are currently forecast to overspend by £0.284m. Within this, at this relatively early stage in the year there is a significant range of under and overspending contracts within the portfolio and this is being closely monitored against the anticipated growth covered by the £4.868m reserve highlighted above as the majority of this activity is likely to be delivered in the Independent Sector due to capacity limitations within NHS providers.
11. Non acute budgets total £106.484m including for £56.155m for Leicestershire Partnership Trust (LPT). As a result of variability in out of area mental health placements and slippage in QIPP, this contract is forecast to overspend by £0.302m.
12. Continuing Healthcare (CHC) and similar individually commissioned packages of care budgets total £24.934m. As a result of strong QIPP delivery and cost control in this area, these budgets are forecast to underspend by £0.153m.
13. Primary Care budgets for the year total £95.87m.Prescribing elements total £46.621m and are forecasting an aggregate overspend of £1.169m by year end, largely driven by continuing NCSO cost pressures and the recently announced Category M pricing increase. This is, however, still only based on 2 months’ data and therefore will be subject to a level of variability. Further growth in DOACs, NCSOs and Category M beyond the values forecast remains a risk.
14. The CCG has a co-commissioning allocation for the year of £41.834m. £40.809m is shown directly on Appendix B and a further £1.025m relating to the Oadby walk in centre is included within the Primary Care Services total of £8.441m.
15. To plan to deliver the detailed requirements of contract uplifts and funding commitments within the GP 5year forward view has created a base funding gap of approximately £1m. Work is continuing to progress a range of cost control measures that will contribute to closing this gap but the forecast overspend of £0.983m remains the most likely outturn and is needing to be covered by mitigations in other areas.
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Paper E East Leicestershire and Rutland CCG Governing Body meeting 11th September 2018
16. Miscellaneous (inc reserves) represents a range of budgets totalling £1.488m supporting the Commissioning function and £2.669m of identified reserves.
17. These reserves include a contingency reserve of £1.906m (equal to 0.5% of the programme allocation). Due to the pressures highlighted within this paper, this reserve has been released in full in the month 4 position to support overall financial balance.
18. The remaining identified reserves totalling £0.763m include funding to cover the CCG’s anticipated commitment to the national risk share for Charge Exempt Overseas Visitors, an allowance for potential realignment of specialised services activity funding and a number of CCG wide QIPP investments and projected savings not yet allocated to contracts.
19. The forecast underspend on this line comprises £0.118m of overspend on Commissioning support services offset by the £1.906m underspend due to releasing the contingency reserve.
Running Costs
20. Running cost budgets for the year on line 67 total £6.604m. This has deliberately been set £0.31m below the published allocation in order to support front line healthcare budgets. Based on the budget setting of agreed staffing establishments, approximately £0.6m of cost control measures are required to achieve overall balance. Following a number of posts being vacant in the first months of the year the base forecast for the year is approximately £0.3m overspent. A further £0.15m saving from holding vacancies to the end of the calendar year have reduced the forecast overspend to £0.158m.
Capital
21. The CCG had not been allocated any capital in its base plan for 2018-19. Funding is anticipated to support GPIT investments on behalf of NHSE. The resultant assets will be held on the NHSE asset register and are not counted as CCG capital expenditure.
Better Payment Practice Code (BPPC)
22. The BPPC performance for the CCG as at month 4 is shown in Appendix C and confirms continued strong performance across all metrics taking the cumulative performance to the following levels;
• NHS creditors (number) – 99.73% • NHS creditors (value) – 99.97% • Non NHS creditors (number) – 99.75% • Non NHS creditors (value) – 99.92%
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Paper E East Leicestershire and Rutland CCG Governing Body meeting 11th September 2018 CSU Performance
23. The ‘Month End Summary CFO Report’ for month 4 confirms all KPIs achieved and tasks completed to timetables bar two internal deadlines that did not impact on the overall reporting processes.
24. All payroll payovers were made by the deadlines and all control accounts were reconciled and the full reconciliation pack distributed.
25. The payroll deduction for childcare vouchers is flagged as red due to an understated adjustment against an individual staff member’s contributions. This will be resolved in September. The manual payments code is red as it contains one balance from March and one from May and the unidentified receipts code is also red as it contains balances from April and May. Both of these codes are anticipated to be resolved in September. The employee overpayments code is amber as it contains a balance from June that has been resolved in August.
26. The CCG closing cash book balance for month 4 was £0.229m and the closing bank balance was £0.144m. Since its authorisation, the CCG has monitored itself against the initial NHSE requirement to hold no more than 1.25% of their monthly draw down at month end. For July, this target was £0.408m and therefore the CCG has comfortably achieved against its ambition
Balance Sheet and Cash Flow Statement
27. Appendix D contains the balance sheet at 31 March, 30 June and 31 July 2018. Current Assets have remained largely unchanged from the previous year end, the main differences being accruals and prepayments that are largely offsetting and represent the quarterly nature of charging for some services. Prescribing accruals have increased largely as a result of seasonal fluctuations and other accruals has increased as a result of accruals for in year acute overperformance and the payment profile of charges received from local authorities.
28. Appendix E outlines the Cash Flow Statement for ELR CCG for Month 4. The CCG cash flow to month 4 is within £0.699m of a straight 1/12ths profile.
NHSE Reporting
29. The most recent CCG metric return submission covered month 4 finance and month 3 Activity. The return focuses on activity reporting and overall financial profile. The majority of activity points of delivery are within the 2% tolerance level. The summary dashboard within the file is under development by NHSE.
Risks and mitigations
30. As identified in the Executive Summary, there are several risks that have the potential to adversely affect the CCG’s financial position for 2018/19, the main ones are highlighted below:
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Paper E East Leicestershire and Rutland CCG Governing Body meeting 11th September 2018
• Non achievement of QIPP schemes • In year Acute activity beyond current forecasts • In year cost pressures relating to Co-Commissioning • In year cost pressures relating to Running Costs • Potential pressures from 17/18 • Potential EMAS contractual pressure • Delivery of £2.5m of additional mitigations
31. The CCG continues to progress a range of mitigations to offset any cost pressures that may materialise but as highlighted in the summary report, the further we go through the year, the ability to deliver material in year benefits reduces.
Summary
32. The financial position of ELR CCG is reporting an aggregate year to date underspend against plan of £0.013m and a forecast outturn break even position at month 4. There are a number of key risks that have the potential to adversely affect the CCG’s financial position during the financial year and work is on-going to minimise/mitigate these.
Recommendations:
The ELR CCG Governing Body is requested to: Receive for information the contents of the report and the appendices attached Note the breakeven position reported at month 4 along with the risks currently being assessed to the delivery of the breakeven control total.
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ELR CCG Allocation 2018/19 Appendix A
Movement M1 M2 M3 M4 from M1 £'000 £'000 £'000 £'000 £'000 Recurrent allocation (programme) Recurrent baseline 373,525 373,525 373,525 373,525 0 Primary Care Co-Commissioning 42,170 42,170 42,170 42,170 0 Market Rent 509 509 509 509 0 Total recurrent allocation (programme) 416,204 416,204 416,204 416,204 0
Non recurrent allocation (programme) 2017/18 Brought Forward Surplus/Deficit 0 2,450 2,450 2,450 2,450 18/19 Paramedic Allocations 115 115 115 115 0 HSCN 103 103 103 103 0 GP WIFI Maintenance 2018/19 26 26 26 LPFT Agreement + Transformation Support + Risk Share 1,830 1,830 1,830 2018-19 CYP IAPT Trainee staff salary support funding 25 25 25 GPFV-Improving Access to General Practice 829 829 829 Share of 18/19 Ambulance Funding 89 89 Transformation - M04 IAT Adjustment for IR Changes (1) (1) LD Transformation Funding to TCP (full amount 18/19) 238 238 LD programme funding for Community Service Investments 250 250 Total non recurrent allocation (programme) 218 2,668 5,378 5,954 5,736
Total allocations (programme) 416,422 418,872 421,582 422,158 5,736
Recurrent allocation (running costs) Recurrent baseline 6,911 6,911 6,911 6,911 0
Non recurrent allocation (running costs) HSCN - running Costs 3 3 3 3 0
Total allocations (running costs) 6,914 6,914 6,914 6,914 0
TOTAL ALLOCATIONS 423,336 425,786 428,496 429,072 5,736
Capital Funding Approved by NHSE 0 0 0 0 0
Allocations formally received 0 0 0 0 0 Allocations anticipated East Leicestershire & Rutland CCG Summary - 2018/19 Month 4 Appendix B
Year to Date Draft Outturn Month 12
Expenditure Variance Budget Expenditure Variance Budget (£000) (£000) (£000) (£000) (£000) (£000)
Total allocation Excluding Brought Forward 144,825 144,825 0 426,622 426,622 0 Surplus
Acute Commissioning 72,313 72,046 (266) 213,507 211,210 (2,297)
Non-acute Commissioning 35,711 36,648 937 106,484 106,584 100
Practice Prescribing 15,432 16,014 582 46,621 47,790 1,169
GP Commissioning 13,603 13,872 269 40,809 41,791 983
Primary Care Services 3,085 3,372 287 8,441 10,116 1,675
Miscellaneous (inc reserves) 2,425 573 (1,852) 4,157 2,369 (1,788)
Total Programme Expenditure 142,569 142,526 (43) 420,018 419,860 (158)
Total Running Costs 2,257 2,287 31 6,604 6,762 158
Total Expenditure 144,825 144,813 (13) 426,622 426,622 0
In year position Programme control total -48 (17) 31 -310 (152) 158 Running Costs control total 48 17 (31) 310 152 (158) Total control total 0 0 0 0 0 0
Cumulative Surplus Programme control total 769 812 43 2,140 2,298 158 Running Costs control total 48 17 (31) 310 152 (158) Total control total 817 829 13 2,450 2,450 (0) Appendix C East Leicestershire & Rutland CCG
Better Payment Practice Code July 2018
NHS Creditors Non NHS Creditors A B C D E F A B C D E F % Value of % Value of No of Bills No of Bills % of Bills Value of Bills Value of Bills No of Bills No of Bills % of Bills Value of Bills Value of Bills Bills Paid Bills Paid Paid Within Paid Within Paid Within Paid Within Paid Within Paid Within Paid Within Paid Within Paid Within Paid Within Within Within Period Target Target Period Target Period Target Target Period Target Target Target No. No. % £'000 £'000 % No. No. % £'000 £'000 % April 339 338 99.71 21,917 21,916 100.00 508 506 99.61 2,500 2,498 99.90 May 200 199 99.50 21,388 21,387 100.00 725 724 99.86 3,933 3,930 99.93 June 316 316 100.00 20,051 20,051 100.00 574 573 99.83 3,234 3,233 99.96 July 265 264 99.62 22,758 22,733 99.89 556 554 99.64 3,037 3,034 99.88 Aug September October November December January February March
Totals 1,120 1,117 99.73 86,114 86,088 99.97 2,363 2,357 99.75 12,704 12,694 99.92 Appendix D
Balance as at Balance as at Balance as at 31st March 30th June 31st July Statement of Financial Position 2018 2018 2018 £'000s £'000s £'000s Non Current Assets: Premises, Plant, Fixtures & Fittings 1,393 1,325 1,303 IM&T 68 62 60 Other 0 0 0 Long-term Receivables 0 0 0 TOTAL Non Current Assets 1,461 1,387 1,363 Sub Analysis 31 July 2018 Current Assets:
Inventories 0 0 0 Value Trade Receivables 1,001 1,611 1,365 Trade Receivables Volume (£'000) Bad & Doubtful Depts Prov (23) (23) (23) UHL Maternity Prepayment 1,590 1,590 1,590 Not yet due 17 7 Includes £20k income from Department of Health relating to Research Capability Funding Prepayments – In Month 467 1,602 1,664 1-30 days 15 -22 awaiting allocation to invoices. Accrued Income 3,968 2,303 2,566 31-60 days 3 1
VAT and CHC Risk Pool 55 56 93 61-90 days 3 883 Includes £896k NHS England invoice re Specialised Commissioning allocation changes. Cash and Cash Equivalents 239 232 144 91+ days 83 497 Includes £62k Urgent Care Centre recharges to various organisations, £47k outstanding with Central Nottinghamshire Clinical Services, £42k oustanding with NHS Newcastle and Other Receivables 0 0 0 121 1,365 Gateshead CCG for patient relocation on Low Density Lipoprotein Treatment, £104k TOTAL Current Assets 7,297 7,371 7,399 outstanding with University Hospital of Leicester mainly for Alliance capital charges. Includes £102k outstanding with Leicester City CCG for Recharge of a patient charged to LD Pooled budget in error.
TOTAL ASSETS 8,758 8,758 8,762 Value (£'000) Trade Payables (1,709) (1,702) (1,190) Trade Payables Volume Aged creditor report Includes £18.378m of payables that are not due by 31st July, these Prescribing Accruals (6,786) (6,956) (7,445) Not yet due 130 1,939 have been adjusted out of the payables values.e.g UHL
Includes £166k outstanding with Nottinghamshire Healthcare that was paid in August. Also Other Accruals (9,060) (9,357) (10,959) 1-30 days 41 100 includes a debit balance with Arden and GEM CSU of (£74k) which was taken in August. Inlcudes (£1,031k) credit note with UHL re 17-18 final year end settlement, credit taken in Payroll Creditors (183) (178) (191) 31-60 days 27 -1,072 August. Provisions (109) (109) (92) 61-90 days 4 2 Includes £74k balance with NHS Arden and GEM CSU re disputed CHC values cleared in August. Includes £84k outstanding with ELR GP Federation and Leicestershire Partnership Trust which have been paid in August. Includes £60k with University Hospital Leicester for Borrowings 0 0 0 91+ days 19 221 Alliance Property services charges. Total Current Liabilities (17,847) (18,302) (19,877) 221 1,190
TOTAL LIABILITIES (17,847) (18,302) (19,877)
ASSETS LESS LIABILITIES (Total Assets Employed) (9,089) (9,544) (11,115)
TAXPAYERS EQUITY General Fund (Opening Balance, Fixed) (9,112) (9,092) (9,092) Income & Expenditure (year to date) (419,589) (107,055) (144,813) Parliamentary Funding (year to date) 419,609 106,600 142,787 Co Commissioning (year to date) 0 0 0 Revaluation Reserve 3 3 3 Other Reserves 0 0 0 Total (9,089) (9,544) (11,115) Appendix E East Leics and Rutland Cashflow Reporting 03W Month 4 2018/19
Year to date 2018/19 April May June July £'000 £'000 £'000 £'000 £'000
Receipts
Balance b/fwd 232 243 222 254 265 NCB-Drawdown 129,268 32,900 31,568 32,200 32,600 Other (including VAT) 1,794 564 300 614 316
Total Receipts 131,294 33,707 32,090 33,068 33,181
Payments Creditors NHS 86,842 22,212 21,251 20,166 23,213 Creditors BACS/CHAPS 25,624 7,484 6,047 6,901 5,193 Salary BACS/CHAPS 963 241 243 234 245 Pensions (Including GP pensions) 1,580 425 393 409 352 Tax & NI 450 113 116 115 106 Standing Orders /Direct Debits 0 0 0 0 0 PCS Payments 15,617 3,010 3,787 4,977 3,843 Total - Expenditure 131,077 33,485 31,837 32,803 32,952
Balance c/fwd 222 254 265 229
April May June July £'000 £'000 £'000 £'000 Cumulative Cash Drawn 32,900 64,468 96,668 129,268 Assumed Drawdown in equal 1/12ths 32,142 64,285 96,427 128,569 Cumulative Variance to equal 1/12ths profile 758 184 241 699 F Blank Page Paper F ELR CCG Governing Body meeting 11 September 2018 EAST LEICESTERSHIRE AND RUTLAND CLINICAL COMMISSIONING GROUP GOVERNING BODY MEETING
Front Sheet
REPORT TITLE: Performance Report 2018/19
MEETING DATE: 11th September 2018
REPORT BY: Alison Buteux, Performance Manager, (MLCSU)
SPONSORED BY: Karen English, Managing Director, (ELR CCG)
PRESENTER: Paul Gibara, Chief Commissioning and Performance Officer, (ELR CCG)
EXECUTIVE SUMMARY: This report provides an overview of performance for East Leicestershire & Rutland CCG and LLR where data is available for March/April 2018. It sets out the key performance indicators that the CCG are held to account for. These are detailed in the CCG Improvement & Assessment Framework (IAF) for 2018/19.
The format of the performance report has been reformed to ensure a more effective and consistent service across LLR, whilst meeting ELR CCG requirements. The Integrated Governance Committee approved the changes in July’s meeting.
The Key Organisational Measures demonstrate the following:
As part of the planning round for 2018/19 the A&E four hour wait target is based on the UHL level. This target has achieved April, May and June against the local trajectory. The A&E four hour waits, all UHL and UCCs did not achieve the local trajectory in July (82.3% against 87.5%). The CCG A&E performance for all providers was 78.07%.
The RTT 18 week incompletes target was not achieved (unpublished data) in July (87.10% against 92% target). There were three 52 week waiters (unpublished data) for ELR CCG in July (2 at Spire Healthcare and 1 at Oxford University Hospitals).
Out of 8 cancer targets, 2 achieved target, these were 31 day standard; patients receiving first definitive treatment within 1 month of cancer diagnosis and 31 day for subsequent cancer treatments where the treatment is radiotherapy. 2 weeks for an urgent referral for breast symptoms and both 62 day targets have not achieved targets from April 18 – June 18.
IAPT Performance continues to be challenging and formal contract performance routes are now underway with the provider for ELR CCG. There was a significant improvement in performance for accessing treatment, for April 18 the national data showed performance at 21.5% against 16.4% target. Local data for May and June 18 is currently Paper F ELR CCG Governing Body meeting 11 September 2018 not looking favourable.
RECOMMENDATIONS: The East Leicestershire and Rutland CCG Governing Body is requested to: receive the contents of the report REPORT SUPPORTS THE FOLLOWING STRATEGIC AIM(S) 2016 – 2017: Transform services and enhance quality Improve integration of local services of life for people with long-term between health and social care; and conditions between acute and primary/community care. Improve the quality of care – clinical Listening to our patients and public – effectiveness, safety and patient acting on what patients and the public experience tell us. Reduce inequalities in access to Living within our means using public healthcare money effectively Implementing key enablers to support the strategic aims (e.g. constitutional and governance arrangements, communications and patient engagement).
EQUALITY ANALYSIS An Equality Analysis and due regard to the positive general duties of the Equality Act 2010 has not been undertaken in the development of this report as it is judged that it is not proportionate on the basis that the Performance Assurance reporting underpins the commissioning strategy and priorities of the CCG. This completes the due regard required.
RISK ANALYSIS AND LINK TO BOARD ASSURANCE FRAMEWORK: The content of the report identifies BAF 1: ACUTE – The quality of care provided action(s) to be taken / are being by acute providers does not match taken to mitigate the following commissioner’s expectation with respect to corporate risk(s) as identified in the quality and safety. Board Assurance Framework: BAF 2: QUALITY – The quality of care provided by non-acute providers does not match commissioner’s expectation with respect to quality and safety. BAF 8: URGENT CARE – Increased pressure on the Emergency Department which could results in sub-optimal care due to ability to access urgent care services.
EAST LEICESTERSHIRE AND RUTLAND CLINICAL COMMISSIONING GROUP INTERGRATED GOVERNANCE COMMITTEE Performance Report September 2018
INTRODUCTION
1. The performance report is the vehicle to ensure that appropriate governance and assurance process is in place for CCGs. In November 17 NHS England refreshed the Improvement and Assessment Framework (IAF) for CCGs for 2018/19.
2. The Better Health and Better Care dashboards within the appendix of this report mirror the format of the new 2018/19 IAF. Previously reported key performance indicators that are not contained within the IAF are also reported in other dashboards in the appendix to ensure full performance reporting.
The report contains performance on; • Improvement & Assessment Framework (Better Health & Better Care) – Appendix A • Constitutional & Other Key Performance Indicators – Appendix B • CCG Quality Premium 2018/19 – Appendix C • LLR Long Waiters Cancer report - Appendix D • Benchmarking Analysis of Cancers detected at stage 1 and 2 – Appendix E
Future Reports will also include; • Out of County Providers (Quarterly) • Better Care Fund (Quarterly) • Outcomes Framework (Bi-Annually)
KEY ORGANISATIONAL MEASURES
3. The Key Organisational Measures demonstrate the following:
As part of the planning round for 2018/19 the A&E four hour wait target is based on the UHL level. This target has achieved April, May and June against the local trajectory. The A&E four hour waits, all UHL and UCCs did not achieve the local trajectory in July (82.3% against 87.5%). The CCG A&E performance for all providers was 78.07%.
The RTT 18 week incompletes target was not achieved (unpublished data) in July (87.10% against 92% target). There were three 52 week waiters (unpublished data) for ELR CCG in July (2 at Spire Healthcare and 1 at Oxford University Hospitals).
Out of 8 cancer targets, 2 achieved target, these were 31 day standard; patients receiving first definitive treatment within 1 month of cancer diagnosis and 31 day for subsequent cancer treatments where the treatment is radiotherapy. 2 weeks for an urgent referral for breast symptoms and both 62 day targets have not achieved targets from April 18 – June 18.
IAPT Performance continues to be challenging and formal contract performance routes are now underway with the provider for ELR CCG. There was a significant improvement in performance for accessing treatment, for April 18 the national data showed performance at 21.5% against 16.4% target. Local data for May and June 18 is currently not looking favourable.
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CCG IMPROVEMENT AND ASSESSMENT FRAMEWORK
Better Health Dashboard
4. This section looks at how the CCG is contributing towards improving the health and wellbeing of its population. Delivery narrative for any ‘at risk’ metrics is outlined below;
Further details are shown in Appendix A. Narrative relates to ‘At risk’ indicators within the Better Health dashboards are:
Indicator LC ELR WL Action in Place % 10-11 classified overweight / obese Diabetes patients who achieved NICE targets Attendance of structured education course Injuries from falls in people A falls and steering group has been established across 65yrs + LLR health and social care. There is a key representation from public health (PH).
A pilot programme is taking place in Leicestershire and Rutland regarding triage and assessment to improve the care and patient pathway.
A postural stability programme has been commissioned for Leicestershire through PH. Cont’d This is essentially a strength and balance prevention programme to support patients.
East Midlands Academic Health Services network (EMAHSN) is piloting a falls prevention programme and currently engaging with CCG practices.
Personal Health Budgets The figures were those for CHC and work is being done to per 100,000 population ensure that all PHBs are included. AMR: Broad spectrum The GPs will undertake an audit for C.diff, as part of the prescribing GP Service Improvement Plan (SIP) which will identify over prescribing of antibiotics. The results are due by the end of the financial year. The cephalosporin, quinolone and co-amoxiclav indicator is part of this audit.
A review of the current practice level data indicates that 11 practices are above the target, one of these was previously below at the start of the year from their baseline prescribing. Although from the baseline data 15 practices have increased the prescribing in this area.
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Better Care Dashboard
5. This principally focuses on care redesign, performance of constitutional standards, and outcomes, including key clinical areas. Narrative relates to ‘At risk’ indicators within the Better Care dashboards are:
Indicator LC ELR WL Action in Place Cancers diagnosed at Analysis of this metric is shown in Appendix E. early stage Cancer 62 days of Narrative below, also see Long Waiters Report. referral to treatment Cancer patient experience IAPT Access There are currently a number of admin vacancies, this function is being reviewed by the provider to enable the therapists to use the admin team more effectively which will free some capacity of PWP workers.
Local data indicates that access rates have achieved in April- June this is due to targeted work taking place to improve the position of the 6ww. This has meant that access rates have increased, however commissioners are aware that this increase is not sustainable due to the current number of referrals coming into the system.
A detailed action plan has been produced to cover all areas of improvement within the IAPT service. The commissioner met with the IST, NHSE and the Clinical Network to review this and provided recommendations for areas of improvement. The provider has been asked to provide more SMART actions and to demonstrate the interdependency between actions and milestones to ensure these can be monitored. A draft of this has been shared with a number of IAPT recovery rate NHSE colleagues.
A data cleansing exercise is taking place as the provider has concerns that some of the 6ww are not genuine.
Stress control groups continue to be used to enable multiple patients to be treated at one time. This will be a rolling programme and is compliant with NICE guidelines. This is being communicated via GP news letters in July. EIP 2 week referral LD - reliance on With regards to the CCG TCP numbers, these have been specialist IP care successfully reduced over the past 6/7 months due to the following;
Introduction of regular panel meetings with an LD consultant to review TCP cases where an inpatient has high-functioning ASD and will not require specialist support on discharge. With this regular review, we’ve reduced our numbers significantly in 2018.
The number of admissions has reduced this year, due to LD Outreach now managing the At Risk of Admission Register for Adults with LD in the community who are at risk of admission. This have given the team ownership of the admission avoidance process.
This will also be rolled out to CAMHS Crisis & Adult Mental Health Crisis teams in the near future, but significant training will be required prior to the handover.
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Indicator LC ELR WL Action in Place Dementia diagnosis rate A&E admission, transfer, During June & July, UHL have seen high attendances and discharge within 4 hours admissions and the Clinical Decisions Unit (CDU) emergency activity at the Glenfield Hospital remains higher than the same period last year.
Highlighted as major priority for UHL via escalation with NHSE and NHSI. Remains a priority area monitored daily alongside admitted breaches, and evidence demonstrating performance continues to improve however is not meeting the standard. The primary reasons for non-admitted breaches are continually identified as ED processes indicating internal delays to the multiple activities within the service reflecting the demand and capacity imbalance of senior medical staffing in the evening and overnight.
ED staff allocate their time based on clinical need and prioritisation, with majors’ activity high during the month of June.
UHL continues to undertake a series of material actions to address the imbalance and improve performance. Delayed transfers of care per 100,000 population Population use of There is a delay in the published data for this metric. The hospital beds following latest available is for Q3 2017/18. For 2017/18 performance emergency admission is measure of 2016/17 baseline which has not been achieved. Patient experience of GP services Primary care workforce 18 week RTT Key UHL Actions
Wider admin team (utilising booking centre) to contact patients out of hours.
Alliance reviewing criteria to expand potential that can be taken.
Theatre productivity programme to improve volume of admissions.
UHL Chief Operating Officer to review cancellation processes
Right sizing bed capacity to increase number of admitted patients.
Demand reduction with primary care as a key priority to achieving on-going performance.
Utilising external capacity on the Independent sector. % NHS CHC TBC assessments taking place in acute hospital setting
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Constitutional & Other Key Performance Indicators
6. This identifies other KPIs not associated with the CCG IAF above, but that are still notable. Further information is contained within Appendix B. Narrative relates to ‘At risk’ indicators:
Indicator LC ELR WL Action in Place % of patients seen within Intensive Support Team are scheduled to review the Urology 2 weeks for an urgent GP recovery plans and governance in August 2018 referral % of patients seen within Chief Operating Officer to chair monthly cancer Taskforce 2 weeks for an urgent meetings to drive CMG ownership from August 2018 referral for breast onwards. symptoms % of patients receiving NHSI hold monthly Confirm & Challenge meetings with the definitive treatment within Heads of Ops on a rotational basis. 1 month of a cancer diagnosis Working in partnership with Cancer Alliance to progress the % of patients receiving RAPID Prostate and Optimal Lung Cancer Pathways. subsequent treatment for cancer within 31 days Ongoing weekly validation of the backlog through a QA (Surgery) process with the Cancer Centre and at the weekly Cancer % of patients receiving Action Board in addition to the PTL meetings held by the subsequent treatment for tumour sites. cancer within 31 days (Radiotherapy Treatment) Oncology continues to impact on a number of tumour sites, % of patients receiving 1st however 4 Oncologists have recently been appointed. definitive treatment for cancer within 2 months Also see Appendix D – Long Waiters Report (62 days) % of patients receiving treatment for cancer within 62 days from an NHS Cancer Screening Service Proportion of patients on This metric is measured through the LPT quality schedule (CPA) discharged from (contract). Performance has declined due to the changes in inpatient care who are the methodology, this is being monitored. followed up within 7 days IAPT Waiting Times - 6 See Better Care Section Week Waiters IAPT Waiting Times - 18 See Better Care Section Week Waiters The number of completed TBC CYP ED urgent referrals within 4 weeks The number of completed CYP ED urgent referrals within 1 week Mixed sex ELR CCG accommodation breaches In June there were 3 breaches for ELR patients. 1 breach at - All Providers the Royal National Orthopaedic Hospital and 2 at UHL. All UHL breaches go through the root cause analysis which details the cause of the breaches. % of all Incomplete RTT See Better Care Section Above pathways within 18 weeks Referral to Treatment 3 breaches occurred for ELR CCG. 2 at Spire Healthcare RTT - No of Incomplete and 1 at Oxford University Hospital (OUH). OUH confirmed Pathways Waiting >52 that the patient has now been treated. Breaches that weeks occurred at the Spire are being reviewed.
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Indicator LC ELR WL Action in Place % of patients waiting 6 National target is no more than 1% of patients waiting over weeks or more for a 6wks for a Diagnostic Test. diagnostic test The radiology service at UHL has rented 2 additional MR vans which has resulted in a month on month improvement in MRI diagnostic breaches.
CT capacity remains a challenge in June.
Additional Endoscopy capacity will start in early August with the introduction of an Endoscopy Fellow, providing an additional 6 sessions per week.
The standard remains at risk for July due to high inpatient demand for radiology and higher than predicted volume of 2ww referrals requiring endoscopy. NHS e-Referral Service GP practices will receive a log of all rejected referrals. (e-RS) Utilisation Communications are on-going with practices. Coverage Practices have raised concerns with expedite letters being rejected and communications have been circulated to all UHL departments to implement robust processes to ensure that this stops. Number of MRSA TBC incidences Number of C.Difficile TBC incidences Ambulance Waits There was significant improvement for Cat 1 and Cat 3 Cat 1 performance at a regional and local level. However, EMAS th Cat 2 only achieved the 90 Percentile standard for LLR for Cat 1, Cat 3 and just missed the standard for Cat 4. This month, West Cat 4 Leicestershire CCG had the best performance for Cat 2 and Ambulance Handovers & Cat 4, East Leicestershire & Rutland CCG had the best Crew Clear performance for Cat 3, whilst Leicester City CCG continues to have the best performance for Cat 1.
Ongoing work continues to improve handover performance;
• Reduced conveyance, by providing frailty training to EMAS staff, and having GPs in EMAS fast response vehicles
• Embedding the new ED Floor Standard Operating Procedures
• Senior leadership on the ED floor (both clinical and managerial) to support ambulance offloading
• Daily SITREP meetings identifying key actions to improve processes
• Real time escalation by duty team to Director on call of all patients that have waited longer than 60 minutes in an ambulance
• Extended opening hours for GPAU to improve flow and stream patients from assessment bay into GPAU.
LRI had the highest number of handovers in the region in June. 62% of the handovers were achieved within 15mins, rising to 93% achieved within 30 minutes. The average pre- handover time increased by 58 seconds to 15 minutes 41 seconds, which was the second-best average clinical handover time in the region. 6
Indicator LC ELR WL Action in Place Cancelled Ops - % of This continues to be non-compliant. This relates to the patients re-admitted within continuation of prioritising cancer, clinically urgent and 52 28 days (UHL) week breach patients. Available capacity to book 28 day breach patients therefore remains limited. NHS 111 - Abandoned The transfer of calls to a clinical advisor (warm transfers and Calls after 30 seconds call backs by urgency) continues to be impacted on this NHS 111 - Abandoned period and has fluctuated below target for some time Calls within 60 seconds however there are signs of significant improvement.
Despite an increase in staffing hours for both Health Advisors and Clinical Advisors for the service there was a negative impact on those available for the rota.
Taking into consideration the levels of all staff available to take all types of calls it is important to note that there is no evidence, to date, in the patient experience reports to suggest that LLR patients are unduly impacted on by these difficulties. However, this will be continually monitored. Children’s wheelchair TBC waits
QUALITY PREMIUM 18/19
7. The following table outlines the current expected position for the Quality Premium 18/19. This is dependent on finalised published national data agreeing to local data where this has been used. Further detail can be found in Appendix C.
Emergency Quality section Total expected Demands section ELR £0 £0 £0 LC £0 £0 £0 WL £0 £0 £0
Benchmarking Against ELR CCG Peers for Cancers Detected at stage 1 and 2
8. Appendix E shows the percentage of cancers detected at stage 1 and 2 against ELR CCG peers. This was discussed from August’s IGC meeting, action log reference ICG/18/109.
OUT OF COUNTY (Quarterly)
9. Will outline the current position for the LLR Out of County providers (To be added quarterly – to be reported in Q3).
BETTER CARE FUND (Quarterly)
10. Will show the most recent performance of the BCF metrics 1-4. (To be added quarterly – to be reported in Q3).
OUTCOMES FRAMEWORK (Bi-Annually)
11. Outcomes framework will be added bi-annually and show the most recent performance. (Will be added bi-annually– to be reported in 2018/19 Q3-Q4).
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RECOMMENDATIONS:
The Committee is requested to:
• NOTE the contents of the report • IDENTIFY any areas for in depth reviews at future IGC Sub-group meetings.
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APPENDIX A BETTER HEALTH
Indicator Description / Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 YTD Latest Latest Target Position Baseline Standard Outturn/ Standard
16/17 Percentage of children aged 10 - 11 classified as 29.2% Below 1 2015/16 CCG 28.7% overweight or obese CCG Baseline Childhood Obesity Childhood (29.7% Leicestershire CC / Rutland 24.5% UA / 33.8% England)
Diabetes patients that have achieved all of the 2015/16 NICE-recommended treatment targets 41.9% Above 42.6% 2 2015/16 3 Targets - Adults HBA1C - Cholesterol & Blood (CCG) Baseline 2016/17 Pressure - Children HBA1C (39% National) 2.4% Diabetes 2014 People with diabetes diagnosed less than a year (CCG) Above 3 2013 3.4% who attend a structured education course 1.9% Baseline (CCG) (England)
Injuries from falls in people aged 65 and over Q4 Reduction on Q1 Q2 Q3 4 2016/17 Falls (per 100,000 population) 1442 baseline 1507 1529 1572
Personal Health Budgets (PHB) Trajectory Q1 Q2 Q3 Q4 No of PHB per 100,000 population Q1 - 2 2017/18 28.39 36.63 44.87 53.11 (Number of PHB's in place per 100,000 CCG 2016/17 Q2 - 13 5 Increase to 50 - population (based on the population the CCG is Q3 - 20 100k by 2020 25.1 22.6 25.1 44 and choice and responsible for) CCGs are aiming for between 100- Q4 - 69
Personalisation (England) 200 per 100,000 by 2021.
Inequality in unplanned hospitalisation for chronic ambulatory care sensitive and urgent care sensitive 2016/17 Gradient Reduction in Q1 Q2 Q3 6 conditions (linked to deprivation) (Low score is Q4 of 1650 Gradient 1644 1631 1395 Health good. Baseline indicates average inequality levels Inequalities Inequalities compared to other CCG)
2018-19 CCG Anti-microbial resistance: Appropriate prescribing of Target Value Apr-18 May-18 7 antibiotics in primary care Mar-18 1.001 to be 1.161 or 0.998 0.993 (Star PU) below Anti-microbial resistance: Appropriate prescribing of 2018-19 CCG Resistance
Anti-microbial Anti-microbial 8 broad spectrum antibiotics in primary care Mar-18 10.5% Target Value to 10.5% 10.5% (Antibiotic-Co-Amoxiclav) be 10% or below
Quality of life for carers Above 2014/15 68.3% 9 (Proportion of carers with a long term condition N/A N/A 2017
Carers Position who feel supported to manage their condition)
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APPENDIX A BETTER CARE
Indicator Description Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 YTD Latest Latest Target Position Baseline Standard Outturn/ Standard/
Overall scores indicative of the quality of care in a CCG area as determined by CQC inspection ratings based on five key questions are: Is it safe? Is it effective? Is it caring? Is it responsive? Is it well-led? 50 50 52 54 10 Hospital 51 => 51 Q1 - CCG Score Q2 - CCG Score Q3 - CCG Score Q4 - CCG Score 2016/17 63 65 66 66 11 Primary Medical Services 62 => 62 Q4 Provision of HighProvision of Quality Care Q1 - CCG Score Q2 - CCG Score Q3 - CCG Score Q4 - CCG Score 62 62 62 62 12 Adult Social Care 61 => 61 Q1 - CCG Score Q2 - CCG Score Q3 - CCG Score Q4 - CCG Score
Cancers diagnosed at early stage - % of cancers Above 2015 50.3% 13 2015 52.1% diagnosed at stage 1 & 2 Position 2016
Cancer 62 Day Waits - % of patients receiving first 82.6% 14 definitive treatment for cancer within 62 days of an 2016/17 85% Q4 Aristotle Reporting urgent GP referral for suspected cancer
2015
Cancer Above 15 One-year survival for all cancer 2014 72.5% Baseline (Followed up December 2016) 73.3% 8.6 CCG 8.7 2016 16 Cancer patient experience 2015 8.7 Above National 8.6 (CCG) National position. Patient`s average rating of care scored from very poor to very good. Average)
Indicator Description Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 YTD Target Position Standard Outturn/ Standard/ Latest Baseline
56% 55% 17 IAPT Recovery Rate (CCG) 2017/18 64.00% 50% 63% Local Data Local Data
16.4% IAPT Access Q1 - 3.8% 16.18% 13.96% 18 Proportion of people that enter treatment against 2017/18 13.50% Q2 - 3.9% 21.50% the level of need in the general population (CCG) Q3 - 4.0% Local Data Local Data Q4 - 4.8%
Completed within 30 50% of people experiencing first episode of 2 Weeks 19 psychosis to access treatment within two weeks of Total 50% Aristotle Reporting 37 referral (CCG) Patients
Mental Health 2016/17 81.08%
Improve access Rate to Children and Young People Mental Health (CYPMH) Increase in the % of CYP (aged 0-18) receiving 20 New Indicator community services as a proportion of the CYP population with a diagnosable mental health disorder
Out of area placements for acute mental health Reduction on inpatient care (no of bed days for inappropriate baseline 21 New Indicator OAPS in mental health services for adults in non- Eliminate by specialist acute inpatient care (eliminate by 20/21) 20/21
Mental health crisis team provision (proportion of crisis resolution and home treatment (CHRT) 22 New Indicator To be assessed via Health Education England commissioned survey (not yet in publication - Annual Data) services able to meet selected core functions (by 20- 21 all areas to deliver best practice 24/7 CRHT) 11
APPENDIX A
Indicator Description Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 YTD Target Position Standard Outturn/ Standard/ Latest Baseline
Target 48.42 Trajectory <46.11 <43.80 <41.50 <38.04 (42 2018/19 (40 LLR patients) (38 LLR patients) (36 LLR patients) (33 LLR atients) Reliance on specialist inpatient care for people with patients) Q4 23 a learning disability and/or autism 2016/17 (per 1m pop) ALL LLR 51.87 54.18 (45 LLR 47 Patients patients (ELR) Learning DisabilityLearning for LLR) (9 ELR)
Proportion of people with a learning disability on Above 24 2016/17 58% National Data is Published Annually the GP register receiving an annual health check baseline
Completeness of the GP Learning Disability Register Above 25 Proportion of the population (all ages) that are 2016/17 0.36% National Data is Published Annually baseline included on a GP Learning Disability register
Q1 2016/17 Q2 Q3 Q4 26 Maternal Smoking at Delivery 2016/17 6.8% Below Baseline 6.8% 9.3% 7.8% 9.2% (CCG) (National Data) (National Data) (National Data) (Unvalidated Data)
2016 Neonatal mortality and still births per 1,000 4.65 27 2015 Below Baseline 5.1 population ONS Data (Data Source - MBRRACE-UK - Perinatal Mortality Surveillance Report) 2017
Maternity 79.2 Higher Than 28 Women's experience of maternity services (England) 2015 Change in definition from 2015 Survey (CCG) Baseline 79.6
2017 67.3 Higher Than 29 Choices in maternity services 2015 Change in definition from 2015 Survey (CCG) Baseline 62.8
Standard/ Indicator Description Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19
Latest Latest Target Position Baseline Standard Outturn/
Estimated diagnosis rates for people with dementia 66.7% 67.8% 67.6% 67.6% 67.7%
People Diagnosed with Dementia (Age 65+) 2017/18 30 68.2% Recorded 3099 3104 3110 3123 Numerator March
Dementia People estimated Prevalence (Age 65+) Denominator Estimated 4574 4590 4603 4614
Dementia care planning and post-diagnostic support 2016/17 74% Above 15/16 31 (The percentage of patients diagnosed with 2015/16 (CCG) baseline 81.11% (QOF Data) dementia whose care plan has been reviewed in a 74.3% (IAF Jan 18) face-to-face review in the preceding 12 months)
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APPENDIX A
Standard/ Indicator Description Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 YTD Target Position Standard Outturn/ Latest Baseline
2018/19 80.5% 82.5% 85.0% 87.5% 89.0% 90.0% 90.0% 91.0% 92.0% 93.0% 94.0% 95.0% A&E Waiting Time - % of patients admitted, Trajectory transferred or discharged from A&E within 4 hours Mar-17 33 2016/17 including 83.90% Standard All UHL+UCC's 82.1% 90.8% 86.5% 82.3% 95%
UHL - A&E Type 1 & 2 76.1% 88.2% 82.1% 76.3%
UCC Attendances (VoCare and DHU) 97.0% 97.5% 97.2% 97.6%
A&E Waiting Time - % of patients admitted, transferred or discharged from A&E within 4 hours - 77.21% 87.53% 82.73% 78.07% CCG Urgent and Emergency Care DTOC attributable to the NHS per 100,000 Average population Reduction on per day in 50 33 26 30 Average number of delayed bed days per day baseline 2017/18 (Leicestershire LA Level) 34 DTOC attributable to the NHS per 100,000 Average population Reduction on per day in 2 2 4 1 Average number of delayed bed days per day baseline 2017/18 (Rutland level)
Population use of hospital beds following 2016/17 Reduction on 486 506 513 35 476.3 emergency admission days Q4 baseline Q1 Q2 Q3
Indicator Description Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 YTD Target Position Standard Outturn/ Standard/ Latest Baseline End Of Life Percentage of Deaths with 3 or more emergency 7.2% 36 New Indicator admissions in last 3 months of life 2017
Indicator Description Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 YTD Target Position Standard Outturn/ Standard/ Latest Baseline
Equal to or 84% 37 Overall Patient Experience of G.P Services 2017 83.5% above 83.5% 2016
Target - Part of 90.3% 90.3% Planning Round 28 Practices 28 Practices
Primary Care Access - % of registered population 87.5% (28 out of 32 practices) - partial
Primary Care offered full extended access Planning round Sept 17 March 18 (General Practice provision of pre-bookable provision for extended 38 17/18; 100% by 0 out of 32 practices - fully provision for extended access 0 out of 31 practices - fully provision for extended access appointments during extended hours on weekdays access April 19 28 out of 32 practices- partial provision for extended access 28 out of 31 practices - partial provision for extended access and weekends) 12.5% (4 out of 32 4 out of 32 practices - no provision for extended access 3 out of 31 practices - no provision for extended access practices) - no provision for extended access March 2017
Primary Care Workforce Sept 2017 March Above 39 Number of GPs and Practice Nurses (full-time 1.22 1.22 2017 baseline equivalent) per 1,000 weighted patients by CCG Full Time Equivalent Number of GPs, Practice Nurses and Direct patient care staff per 1,000 weighted patients at 31 March 2017
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APPENDIX B NHS CONSTITUTION AND OTHER KEY CCG METRICS
The following provides the positon for EL&R CCG on the NHS Consitution and other key metrics that have previously been reported
Indicator Description Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 YTD Target Position Standard Outturn/ Standard/ Latest Baseline Baseline Latest
75% of people with relevant conditions to access 43% 47% 2017/18 52% 75% 47% talking therapies in 6 weeks Local Data Local Data
95% of people with relevant conditions to access 95% 94% 2017/18 96% 95% 98% talking therapies in 18 weeks Local Data Local Data
Mental Health - Care Programme Approach (CPA) - % of
Mental Health patients under adult mental illness on CPA who were 2016/17 98.2% 95% followed up within 7 days of discharge from psychiatric Aristotle Reporting in-patient care Q1 Q2 Q3 Q4 % of routine CYP Eating Disorder Referrals waiting 80% 100% 100% 88.24% Q4 16/17 60% (5 pts) 95% by 2020 within 4 weeks (complete) (10 patients seen / 8 completed within (7 patients seen / 7 completed within 4 (13 patients seen / 13 completed within (17 patients seen / 15 completed within 4 weeks) weeks) 4 weeks) 4 weeks) Q1 Q2 % of urgent CYP Eating Disorder Referrals waiting Q3 Q4 Q4 16/17 0% (1 pt) 95% by 2020 100% 100% within 1 week (complete) (0 Patient) (0 Patient) (1 Patient) (1 Patient)
Indicator Description Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 YTD Latest Latest Target Position Baseline Standard Outturn/ Standard/ Patients between 30 6321 800 mins 1 sec- 1 476 126 198 hour Ambulance Handover time - Number of handover 2017/18 Total (all time delays of > 30 mins and <60 mins (UHL) 62714 15807 bands) 5140 5457 5210
Zero 10.1% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! 5.1% Tollerance 9.3% 2.3% 3.8% Patients 2498 over 1 hour 1 195 6 41 242 sec Ambulance Handover time - Number of handover Total (all time 2017/18 62714 15807 delays of > 1 hour (UHL) bands) 5140 5457 5210 Urgent Emergency and Care Zero 4.0% 3.8% 0.1% 0.8% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! 1.5% Tollerance
Crew Clear delays of > 30 and <60 minutes (LRI) 4.3% Zero Tollerance 5.5% 7.6% 8.2% 7.1% 2017/18 Crew Clear delays of > 1 hour (LRI) 0.4% Zero Tollerance 0.5% 0.2% 0.4% 0.4%
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APPENDIX B
Standard/ Indicator Description Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 YTD
Latest Latest Target Position Baseline Standard Outturn/
Diagnostic Test Waiting Time >6 weeks (CCG) 2016/17 0.80% 1.00% Aristotle Reporting Zero 52 Week Waiters Mar-17 Tollerance Aristotle Reporting Elective Access Elective Cancelled Operations - % of patients re-admitted 79.1% 100% 79.1% 79.9% 82.6% 80.4% 2017/18 within 28 days (UHL) 338 Standard 23 pts 28 pts 24 pts 76 pts
Indicator Description Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 YTD Latest Latest Target Position Baseline Standard Outturn/ Standard/
2016/17 0 0 Healthcare acquired infection (HCAI) measure (MRSA) Trajectory Aristotle Reporting Healthcare acquired infection (HCAI) measure 2017/18 2016/17 86 (Clostridium diffficile infection)
2.1% NHS111 - Abandoned Calls after 30 seconds 2016/17 <1% 4.1% 5.3% 90.4% NHS111 -Calls answered within 60 secsonds 2016/17 >95% 81.3% 77.4% 17/18 Additional Indicators requiring focus 2017/18 2017/18 2017/18 2017/18 Part of Planning 92% Children waiting more than 18 weeks for a wheelchair 2016/17 Q1 Q2 Q3 Q4 Round 2017/18 18/19 88.24% 95.24% 92.2% 87% 100%
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APPENDIX B 2018-19 Reporting Metric Information Q1 Q2 Q3 Q4 YTD Level Apr May Jun Jul Aug Sep Oct Nov Dec Jan Fe b Mar
Preventing People from Dying Prematurely
Cancer Waiting Times
191: % Patients seen within two weeks for an urgent GP referral for Latest Date: 30/06/2018 RAG G G R G suspected cancer (MONTHLY) The percentage of patients first seen by a specialist within two weeks East Leicestershire P = Published Status P P P - when urgently referred by their GP or dentist with suspected cancer and Rutland CCG U = Unpublished Actual 94.09% 94.63% 92.44% 93.73%
Target 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00%
17: % of patients seen within 2 weeks for an urgent referral for breast Latest Date: 30/06/2018 RAG R R R R symptoms (MONTHLY) Two week wait standard for patients referred with 'breast symptoms' not East Leicestershire P = Published Status P P P - currently covered by two week waits for suspected breast cancer and Rutland CCG U = Unpublished Actual 90.00% 91.43% 83.33% 88.76%
Target 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00%
535: % of patients receiving definitive treatment within 1 month of a Latest Date: 30/06/2018 RAG R G G G cancer diagnosis (MONTHLY) The percentage of patients receiving their first definitive treatment within East Leicestershire P = Published Status P P P - one month (31 days) of a decision to treat (as a proxy for diagnosis) for and Rutland CCG U = Unpublished Actual 93.53% 97.79% 97.28% 96.36% cancer Target 96.00% 96.00% 96.00% 96.00% 96.00% 96.00% 96.00% 96.00% 96.00% 96.00% 96.00% 96.00% 96.00%
26: % of patients receiving subsequent treatment for cancer within 31 Latest Date: 30/06/2018 RAG R G R R days (Surgery) (MONTHLY) 31-Day Standard for Subsequent Cancer Treatments where the treatment East Leicestershire P = Published Status P P P - function is (Surgery) and Rutland CCG U = Unpublished Actual 83.33% 97.37% 87.50% 89.34% Target 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00%
1170: % of patients receiving subsequent treatment for cancer within 31 Latest Date: 30/06/2018 RAG G G R G days (Drug Treatments) (MONTHLY) 31-Day Standard for Subsequent Cancer Treatments (Drug Treatments) East Leicestershire P = Published Status P P P - and Rutland CCG U = Unpublished Actual 100.00% 100.00% 97.30% 99.18%
Target 98.00% 98.00% 98.00% 98.00% 98.00% 98.00% 98.00% 98.00% 98.00% 98.00% 98.00% 98.00% 98.00% 25: % of patients receiving subsequent treatment for cancer within 31 Latest Date: 30/06/2018 RAG R G G G days (Radiotherapy Treatments) (MONTHLY) 31-Day Standard for Subsequent Cancer Treatments where the treatment East Leicestershire P = Published Status P P P - function is (Radiotherapy) and Rutland CCG U = Unpublished Actual 92.86% 100.00% 100.00% 97.24% Target 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 539: % of patients receiving 1st definitive treatment for cancer within 2 Latest Date: 30/06/2018 RAG R R R R months (62 days) (MONTHLY) The % of patients receiving their first definitive treatment for cancer within East Leicestershire P = Published Status P P P - two months (62 days) of GP or dentist urgent referral for suspected cancer and Rutland CCG U = Unpublished Actual 76.00% 83.00% 83.13% 81.01% Target 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 540: % of patients receiving treatment for cancer within 62 days from an Latest Date: 30/06/2018 RAG R R R R NHS Cancer Screening Service (MONTHLY) Percentage of patients receiving first definitive treatment following referral East Leicestershire P = Published Status P P P - from an NHS Cancer Screening Service within 62 days. and Rutland CCG U = Unpublished Actual 83.33% 81.82% 86.67% 84.38% Target 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 541: % of patients receiving treatment for cancer within 62 days upgrade Latest Date: 30/06/2018 RAG their priority (MONTHLY) % of patients treated for cancer who were not originally referred via an East Leicestershire P = Published Status P P P - urgent GP/GDP referral for suspected cancer, but have been seen by a and Rutland CCG U = Unpublished Actual 75.00% 80.00% 87.50% 80.00% clinician who suspects cancer, who has upgraded their priority. Target
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APPENDIX B Enhancing Quality of Life for People with Long Term Conditions
Mental Health
138: Proportion of patients on (CPA) discharged from inpatient care who Latest Date: 30/06/2018 RAG R R are followed up within 7 days The proportion of those patients on Care Programme Approach P = Published Status U - East Leicestershire discharged from inpatient care who are followed up within 7 days U = Unpublished Actual 67.33% 67.33% and Rutland CCG Target 95.00% 95.00% 95.00% 95.00% 95.00%
Episode of Psychosis
2099: First episode of psychosis within two weeks of referral Latest Date: 31/07/2018 RAG R G R G G The percentage of people experiencing a first episode of psychosis with a NICE approved care package within two weeks of referral. The access and P = Published Status P P P U - East Leicestershire waiting time standard requires that more than 50% of people do so within U = Unpublished Actual 50.00% 66.67% - 83.33% 69.23% two weeks of referral. and Rutland CCG Target 53.00% 53.00% 53.00% 53.00% 53.00% 53.00% 53.00% 53.00% 53.00% 53.00% 53.00% 53.00% 53.00%
Dementia
2166: Estimated diagnosis rate for people with dementia Latest Date: 31/07/2018 RAG G G G G G Estimated diagnosis rate for people with dementia P = Published Status P P P P - East Leicestershire U = Unpublished Actual 67.76% 67.62% 67.55% 67.69% 67.65% and Rutland CCG Target 66.70% 66.70% 66.70% 66.70% 66.70% 66.70% 66.70% 66.70% 66.70% 66.70% 66.70% 66.70% 66.70%
Ensuring that People Have a Positive Experience of Care
EMSA
1067: Mixed sex accommodation breaches - All Providers Latest Date: 30/06/2018 RAG R G R R No. of MSA breaches for the reporting month in question for all providers P = Published Status P P P - East Leicestershire U = Unpublished Actual 2 0 3 5 and Rutland CCG Target 0 0 0 0 0 0 0 0 0 0 0 0 0
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APPENDIX B Referral to Treatment (RTT) & Diagnostics
1291: % of all Incomplete RTT pathways within 18 weeks Latest Date: 31/07/2018 RAG R R R R R Percentage of Incomplete RTT pathways within 18 weeks of referral P = Published Status P P P U - East Leicestershire U = Unpublished Actual 85.76% 86.94% 87.27% 87.10% 86.78% and Rutland CCG Target 92.00% 92.00% 92.00% 92.00% 92.00% 92.00% 92.00% 92.00% 92.00% 92.00% 92.00% 92.00% 92.00%
1839: Referral to Treatment RTT - No of Incomplete Pathways Waiting Latest Date: 31/07/2018 RAG R R R R R >52 weeks The number of patients waiting at period end for incomplete pathways >52 P = Published Status P P P U - East Leicestershire weeks U = Unpublished Actual 1 4 4 3 12 and Rutland CCG Target 0 0 0 0 0 0 0 0 0 0 0 0 0
1828: % of patients waiting 6 weeks or more for a diagnostic test Latest Date: 31/07/2018 RAG R R R R R The % of patients waiting 6 weeks or more for a diagnostic test P = Published Status P P P U - East Leicestershire U = Unpublished Actual 4.96% 2.64% 2.96% 2.69% 3.30% and Rutland CCG Target 1.00% 1.00% 1.00% 1.00% 1.00% 1.00% 1.00% 1.00% 1.00% 1.00% 1.00% 1.00% 1.00%
Treating and Caring for People in a Safe Environment and Protect them from Avoidable Harm
HCAI
497: Number of MRSA Bacteraemias Latest Date: 31/07/2018 RAG G G R R R Incidence of MRSA bacteraemia (Commissioner) P = Published Status P P P U - East Leicestershire U = Unpublished YTD 0 0 1 1 1 and Rutland CCG Target 0 0 0 0 0 0 0 0 0 0 0 0 0
24: Number of C.Difficile infections Latest Date: 31/07/2018 RAG G G G R R Incidence of Clostridium Difficile (Commissioner) P = Published Status P P P U - East Leicestershire U = Unpublished YTD 6 12 18 26 26 and Rutland CCG Target 6 12 18 25 31 38 44 51 57 64 70 77 25
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APPENDIX B Ambulance Response Times This shows monthly performance measures against the national standards and county level trajectories, currently for monitoring purposes only.
Category 1 Category 2 Category 3 Category 4 April 2018
Mean 90th centile Mean 90th centile Mean 90th centile 90th centile National standard 00:07:00 00:15:00 00:18:00 00:40:00 01:00:00 02:00:00 03:00:00 EMAS 00:08:38 00:15:42 00:31:57 01:08:06 01:07:21 02:41:18 02:01:15 Leicestershire 00:08:22 00:15:09 00:34:01 01:12:43 01:24:04 03:20:19 01:01:14 East Leicestershire & Rutland 00:10:20 00:18:42 00:37:21 01:16:44 01:27:56 03:23:28 01:03:53 Leicester City 00:06:55 00:10:54 00:30:53 01:08:42 01:29:53 03:44:47 00:56:23 West Leicestershire 00:09:07 00:16:27 00:34:54 01:13:35 01:16:13 02:54:40 01:00:58
Category 1 Category 2 Category 3 Category 4 Jul-18
Mean 90th centile Mean 90th centile Mean 90th centile 90th centile National standard 00:07:00 00:15:00 00:18:00 00:40:00 01:00:00 02:00:00 03:00:00 EMAS 00:07:41 00:13:53 00:33:17 01:10:26 01:19:14 03:13:58 02:29:24 Leicestershire 00:07:52 00:14:06 00:38:59 01:24:17 01:41:57 04:12:56 02:18:40 Northamptonshire 00:07:28 00:13:11 00:29:15 01:02:54 01:07:28 02:49:26 01:59:28 East Leicestershire & Rutland 00:10:03 00:18:03 00:41:55 01:29:09 01:42:41 04:00:48 02:41:37 Leicester City 00:06:06 00:10:05 00:36:43 01:23:58 01:50:58 04:41:10 01:39:28 West Leicestershire 00:08:42 00:15:09 00:39:04 01:21:43 01:34:03 03:46:45 02:33:59
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APPENDIX B Category 1 – Calls from people with life-threatening illnesses or injuries (eg; cardiac arrest or serious allergic reaction) Category 2 – Emergency calls (eg; burns, epilepsy or stroke) Category 3 – Urgent calls (eg; late labour, non-severe burns or diabetes – may be seen in own home) Category 4 – Less urgent calls (eg; diarrhoea & vomiting or urinary infections – may be referred to GP or called back)
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APPENDIX C Quality Premium 2018/19
It should be noted that 2018/19 reporting is at an early stage with very limited data available. Therefore, reported Expected Quality Premium should not be taken as a meaningful predication until we are closer to having 2018/19 out-turn positions. Emergency Demand Management Section
This new section is not subject to the Constitution Indicators Gateway. Therefore, any payments achieved will be made even if the 2 constitution indicators are below target.
Two months of validated National data is now available;
Indicators - A1 Type 1 A&E and A2 Emergency Admissions with Length of Stay (LOS) = 0. Both indicators need to be on target to achieve the payment of £599,653. Based on June 18 (YTD) data A2 is on target but A1 is not.
Indicator B - Actual number of non-elective admissions with LOS of 1 day or more is not on target, a change from last months position, however this indicator is likely to fluctuate. This is worth £599,653. June was not on target.
Current projected income in this section is therefore £0 at this stage.
Quality Elements
The indicators remain largely unchanged from 2017/18 and are still subject to reduction if Constitution Gateway indicators are below target. There are now 2 such constitution indicators;
• RTT incomplete waiting list which was over target higher in June 2018, therefore not achieving. • Cancer 62 day waits which were not meeting national target as at June 2018.
Current projected income in this section is therefore £0 at this stage.
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APPENDIX C 18/19 Current Position % of Value for Measure Quality premium Measure 2017/18 Standard Baseline (Monthly/ QP CCG Achieving funding Quarterly/Annually) QUALITY INDICATORS Cancers Diagnosed at early stage 1. Demonstrate a 4% point improvement in the proportion of cancers (specific cancer sites, morphologies and behaviour*) that are diagnosed at stages 1 and 2 in the 2013 - 48.9% 2017 data due June 19 2018 calendar year compared to the 2017 calendar year. 2014 - 52.2% Cancers Diagnosed at early stage Target of xx in 2018 17% £66,160 N £0 Or 2015 - 52.1% (due Jan 20) 2. Achieve greater than 60% of all cancers (specific cancer 2016 - 50.3% sites, morphologies and behaviour*) that are diagnosed at stages 1 and 2 in the 2018 calendar year Overall experience of making a GP appointment Either: 1. Achieve a level of 85% of respondents who said they had Overall experience of making a GP a good experience of making an appointment, or; Target of xx% in July 19 July 18 publication xx% 17% £66,160 N £0 appointment 2. Achieve a 3 percentage point increase from July 2018 publication publication on the percentage of respondents who said they had a good experience of making an appointment NHS Continuing Healthcare A two part indicator: (a) worth 50% - CCGs to ensure that in more than 80% of 90.32% cases with a positive NHS CHC Checklist, the NHS CHC >80% 8.5% £33,080 N £0 July 2018 NHS Continuing Healthcare eligibility decision is made by the CCG within 28 days from receipt of the Checklist (b) worth 50% - CCGs to ensure that less than 15% of all full 19.35% <15% 8.5% £33,080 Y £33,080 NHS CHC assessments take place in an acute hospital July 2018 Mental Health Awaiting national baseline from NHS England - Recognising the issues early on with data quality (to be expected with any data collection in its infancy), Option Chosen by CCG & NHSE: Out of A 33% reduction in the number of inappropriate adult NHS England is reviewing how best to assure local 17% £66,160 N £0 Area Placements (OAPs) OAPs for non-specialist adult acute care performance on reducing OAPs over 2017/18 for those CCGs which selected the OAPs Quality Premium, to ensure it is awarded appropriately. Anti-biotic Prescribing A three part indicator: Reduction in the number of gram negative blood stream E coli BSI 12 mth rolling data infections across the health economy Jan-Dec 2016 Baseline May 2018 5.1% £19,848 N £0 (ai) A 10% reduction (or greater) in all E Coli BSI reported at 189 217 CCG level based on 2016 performance data (aii) Collection and reporting of a core primary care data set for E coli cases (100% of all E coli BSI cases in Q2 (10% National Data 2.6% £9,924 N £0 weighting) and 50% of all E coli BSI cases in Q3 (5% No Publication Date weighting) in 2018/19) Reduction of inappropriate antibiotic prescribing for UTI Reducing Gram Negative Bloodstream in primary care 30% reduction Target to Infections (GNBSIs) and inappropriate (bi) A 30% reduction (or greater) in the number of achieve FY 2018/19 3.4% £13,232 N £0 antibiotic prescribing in at risk groups Trimethoprim items prescribed to patients aged 70 years ELR or greater on baseline data (June15-May16) Sustained reduction in in-appropriate prescribing in primary care 2018-19 CCG 12 mth rolling data (ci) Items per Specific Therapeutic group Age-Sex Related Target Value May 2018 1.7% £6,616 Y £6,616 Prescribing Unit (STAR-PU) must be equal to or below to be 1.161 or below 0.993 England 2013/14 mean performance value of 1.161 items per STAR-PU (cii) Additional reduction in Items per Specific Therapeutic 2018-19 CCG 12 mth rolling data group Age-Sex Related Prescribing Unit (STAR-PU) equal to Target Value May 2018 4.3% £16,540 N £0 or below 0.965 items per STAR-PU. to be 0.965 or below 0.993 Local Priority Baselines: 2014/15 = 73.72% (equates to 1830 out of 16/17 2482) 74.27% 2015/16 = 74.04% (2272 out of 3059) Patients diagnosed with dementia whose Increase in % of patients diagnosed with dementia whose (equates to 2119 out of care plan has been reviewed in a face-to- care plan has been reviewed in a face-to-face review in the 2862) 15% £58,377 N £0 17/18 face review in the preceding 12 months preceding 12 months 2016/17 = 74.27% National data to be (equates to 2272 out of published 3059) November 2018 Targets: 2018/19 = 74.87% Quality Premium Achieved from indicators above £39,696 Constitution Rights & Pledges Referral to Treatment Times The number Target of patients on an incomplete pathways June 18 <= 20,661 (Total waiters March 18) June 18 50% £19,848 N £0 (Total) not to be higher in March 2019 22,089 20,832 than in March 2018 Maximum 62 day (2 month) wait from June 18 urgent GP referral to first definitive National Standard 85% 50% £19,848 N £0 83.13% treatment for cancer Quality Premium Adjustments taken from for NHS Constitution Measures £0 MAXIMUM QUALITY PREMIUM AVAILABLE FROM THIS SECTION (24.5% of total QP of £1.59m) £389,179 EMERGENCY DEMAND MANAGEMENT INDICATORS A1 - Actual number of Type 1 A&E Plan 2018/19 June 18 attendances to be no greater than the <= 65,370 June YTD YTD N planned number of Type 1 A&E 2018/19 Annual Plan 16,439 17,065 attendances. 50% £599,653 £0 A2 - Actual number of non-elective Plan 2018/19 June 18 admissions with LOS =0 to be no greater <= 9,614 June YTD YTD Y than the planned number of non-elective 2018/19 Annual Plan 2,505 2491 admissions with LOS =0 (EM11a) B - Actual number of non-elective admissions with LOS of 1 day or more to Plan 2018/19 June 18 <= 23,611 be no greater than the planned number of June YTD YTD 50% £599,653 N £0 2018/19 Annual Plan non-elective admissions with LOS of 1 day 5,777 5,807 or more (EM11b) EXPECTED QUALITY PREMIUM ACHIEVED FROM THIS SECTION. (NHS CONSTITUTION GATEWAY RULE DOES NOT APPLY TO ED MANAGEMENT) CURRENT POSITION £0 MAXIMUM QUALITY PREMIUM AVAILABLE FROM THIS SECTION (75.5% of total QP) £1,199,306
CCG Population > 317697 Price per head > £5 Potential Quality Premium > £1,588,485
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APPENDIX D LLR Cancer Waits Report (+62 day breaches)
end of April end of June end of July end of Aug end of Sept end of Oct end of Nov end of Dec end of Jan end of Feb end of Mar 18/19 17/18 Number of treated patients that waited over 62 days, all 3 62day metrics 18 end of May 19 18 18 18 18 18 18 18 19 19 19 YTD LC CCG Patients 176 20 19 22 61 All providers WL CCG Patients 261 29 30 31 90 EL&R CCG Patients 235 22 21 17 60 Total 672 71 70 70 211
All CCGs 646.0 72 70.5 69.5 212 LC CCG 168.5 19.5 19 22 60.5 UHL Only WL CCG 220 27 27 28 82 EL&R CCG 204 21 18 15 54
As at 9th As at 6th As at 4th May As at 4th As at 6th As at 10th As at Sept As at Nov As at Dec Current backlog of patients waiting over 62 days Mar 18 April 18 18 June 18 July 18 Aug 18 18 As at Oct 18 18 18 As at Jan 19 As at Feb 19 As at Mar 19 UHL All CCGs (Unadjusted Position) 67 67 75 103 123 114 UHL All CCGs (Adjusted Position - excludes tertiary referrals post day 38 of pathway) 55 55 65 93 Derby Teaching Hospital NHS Foundation Trust 28 26 45 45 George Eliot Hospital Trust 7 21 26 30 UHCW 34 59 45 72 Burton Hospital Trust 7 5 6 5 North West Anglia NHS Foundation Trust (NWAFT) 47 52 99 73 Kettering General Hospital NHS Foundation Trust (KGH) 16 17 33 19 United Lincolnshire Hospitals NHS Trust (ULHT) 67 76 56 64 Nottingham University Hospitals NHS Trust (NUH) 37 34 52 57
Outcomes / Learning themes for over 62 day breaches UHL Please see the tab '62 day themes' for the details of the July 2018 62 day breaches. This information is routinely provided as part of the monthly UHL Trust Board Report and Joint Cancer/RTT Board. 62 day breaches are reviewed quarterly by UHL. Any thematic findings are shared on a quarterly basis and where appropriate new actions are added to the Remedial Action Plan. There is a triangulation exercise which looks at the Thematic Findings, NHSE/NHSI Review, Exeter Data (Trust level) and the RAP.
The local Clinical Quality Review Group and Quality Assurance Group are sighted on any quality and patient safety/experience concerns. The contracting Quality Lead is also a member of the Cancer/RTT Working Group and associated Board. Escalation is via the Cancer/RTT Board and Contract Performance meeting. The regional Quality Surveillance Group also receives any quality and patient safety/experiences concerns.
Actions undertaken by CCG this period: • First meeting of the amalgamated 2020 Group and the Cancer Board has been scheduled for 17th September 2018 • Letter agreed for the rejection of referrals to LGI without a FIT test result attached where appropriate
Actions undertaken by UHL this period: •Intensive Support Team reviewed Urology plans and governance. 4 primary recommendations identified and work commences to address these w/c 20/8/18 • New Director of Operational Improvement leading on Cancer Taskforce and recovery from early August • Targeted pathway review for Lower GI to remove multiple MDT discussions resulting in pathway delays being led by the Cancer Centre Clinical Lead and Clinical Director of CHUGGS • Revised and improved RAP actions supporting grip and control against cancer performance and patient experience expected by end August 2018 • Working in partnership with the Cancer Alliance to progress RAPID Prostate and Optimal Lung Cancer pathways
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APPENDIX D
24
APPENDIX D LLR Cancer Waits Report (+104 day breaches)
end of April end of May end of June end of July end of Aug end of Sept end of Oct end of Nov end of Dec end of Jan end of Feb end of Mar Number of treated patients that waited over 104 days 17/18 18 19 18 18 18 18 18 18 18 19 19 19 18/19 YTD LC CCG Patients 40 4 3 2 WL CCG Patients 53 5 4 5 All providers EL&R CCG Patients 44 2 4 6 Total 137 11 11 13
All CCGs 150.5 15 15 14 LC CCG 40 4 3 2 UHL Only WL CCG 46 5 4 4 EL&R CCG 37 2 2 5
As at 9th As at 6th As at 4th As at 4th As at 6th As at 10th As at Sept As at Nov As at Dec As at Mar Current backlog of patients waiting over 104 days Mar 18 April 18 May 18 June 18 July 18 Aug 18 18 As at Oct 18 18 18 As at Jan 19 As at Feb 19 19 UHL All CCGs 14 17 11 9 12 23 Derby Teaching Hospital NHS Foundation Trust 4 6 6 12 George Eliot Hospital Trust 10 3 1 5 UHCW 14 8 8 3 Burton Hospital Trust 0 2 1 0 North West Anglia NHS Foundation Trust (NWAFT) 4 4 7 14 Kettering General Hospital NHS Foundation Trust (KGH) 3 5 3 9 United Lincolnshire Hospitals NHS Trust (ULHT) 11 12 12 10 Nottingham University Hospitals NHS Trust (NUH) 14 8 7 10
Outcomes / Learning from RCA and harm reviews for over 104 day breaches UHL Please see the tab '>104 day themes' for the details of the July 2018 >104 day breaches. This information is routinely provided as part of the monthly UHL Trust Board Report and Joint Cancer/RTT Board. Harm reviews are carried out by UHL for confirmed cancer patients who have waited >104 days once treated. The local Clinical Quality Review Group and Quality Assurance Group are sighted on any quality and patient safety/experience concerns. The contracting Quality Lead is also a member of the Cancer/RTT Working Group and associated Board. Escalation is via the Cancer/RTT Board and Contract Performance meeting. The regional Quality Surveillance Group also receives any quality and patient safety/experiences concerns.
25
APPENDIX D
26
APPENDIX D
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APPENDIX E Cancers Diagnosed at Early Stage
The metric was designed to monitor the proportion of early staged cancers, which are associated with higher survival than late staged cancers. All cases of cancer diagnosed at stage 1 or 2, for the specific cancer sites, morphologies and behaviour: invasive malignancies of breast, prostate, colorectal, lung, bladder, kidney, ovary, uterus, non-Hodgkin lymphomas and invasive melanomas of skin.
The data is published annually and the latest available is 2016.
Below is a breakdown of ELR CCG peers. ELR CCG is ranked 11/11 against its peers.
Key:- First 2012 data / Current 2016 data
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On an England level the data shows the CCG in the top 10 performing CCGs and nationally ranked 146/207 CCG’s.
29
Below is a table showing for all LLR CCG’s from 2012 to 2016 for additional information.
Reporting period Period of coverage Level description Indicator value Denominator Numerator 2012 01/01/2012 to 31/12/2012 NHS East Leicestershire and Rutland CCG 38.1% 1216 463 2012 01/01/2012 to 31/12/2012 NHS Leicester City CCG 35.6% 814 290 2012 01/01/2012 to 31/12/2012 NHS West Leicestershire CCG 36.5% 1416 517 2013 01/01/2013 to 31/12/2013 NHS East Leicestershire and Rutland CCG 48.9% 1331 651 2013 01/01/2013 to 31/12/2013 NHS Leicester City CCG 42.9% 764 328 2013 01/01/2013 to 31/12/2013 NHS West Leicestershire CCG 46.0% 1431 658 2014 01/01/2014 to 31/12/2014 NHS East Leicestershire and Rutland CCG 52.2% 1380 720 2014 01/01/2014 to 31/12/2014 NHS Leicester City CCG 45.5% 796 362 2014 01/01/2014 to 31/12/2014 NHS West Leicestershire CCG 49.1% 1397 686 2015 01/01/2015 to 31/12/2015 NHS East Leicestershire and Rutland CCG 52.1% 1381 720 2015 01/01/2015 to 31/12/2015 NHS Leicester City CCG 49.8% 860 428 2015 01/01/2015 to 31/12/2015 NHS West Leicestershire CCG 51.8% 1491 773 2016 01/01/2016 to 31/12/2016 NHS East Leicestershire and Rutland CCG 50.3% 1368 688 2016 01/01/2016 to 31/12/2016 NHS Leicester City CCG 45.8% 805 369 2016 01/01/2016 to 31/12/2016 NHS West Leicestershire CCG 52.7% 1496 788
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G Blank Page Paper G East Leicestershire and Rutland CCG Governing Body meeting 11 September 2018
EAST LEICESTERSHIRE AND RUTLAND CLINICAL COMMISSIONING GROUP GOVERNING BODY MEETING
Front Sheet
REPORT TITLE: Assurance Report from the Provider Performance Assurance Group (PPAG) –August 2018
MEETING DATE: 11 September 2018
REPORT BY: Jayshree Raval Commissioning Collaborative Support Officer ELR CCG
SPONSORED BY: Karen English, Managing Director
PRESENTER: Mr Clive Wood, Independent Lay Member
PURPOSE OF THE REPORT: This report is from the Provider Performance Assurance Group (PPAG); a meeting held in common of the 3 Leicester, Leicestershire and Rutland CCGs. This report provides the Governing Body with assurance about the arrangements in place to collaboratively monitor the contract arrangements and performance of our key providers.
RECOMMENDATIONS: The East Leicestershire and Rutland CCG Governing Body is requested to:
• RECEIVE the assurance report from PPAG. • APPROVE the updated terms of reference as at Appendix 1.
Page 1 of 7 Paper G East Leicestershire and Rutland CCG Governing Body meeting 11 September 2018
EAST LEICESTERSHIRE AND RUTLAND CLINICAL COMMISSIONING GROUP GOVERNING BODY MEETING 11 September 2018
Assurance Report from the Provider Performance Assurance Group (PPAG) – August 2018 Introduction
1. The purpose of this report is for Provider Performance Assurance Group (PPAG) to provide the Governing Body with a summary of the assurance received from the Contract Leads in relation to performance across the collaborative contracts, and the respective providers’ performance.
2. In addition, the report provides a summary of the items for escalation from PPAG during August 2018 for consideration by the Governing Body, and to ensure that the Governing Body is alerted to emerging risks or issues.
3. PPAG is a meeting held in common consisting of members from across each of the 3 Leicester, Leicestershire and Rutland CCGs. PPAG’s role is to:
• Receive assurance and hold to account the Contract Leads; • Advise, make suggestions and recommend actions on provider performance as appropriate; and • Provide onward assurance to the respective Governing Bodies.
Provider review and areas of concern
4. At the meeting in August 2018, PPAG received a report from each of the Contract Leads from across the 3 CCGs. The detailed review on this occasion related to University Hospitals of Leicester (UHL), with a focus on:
• UHL’s performance for Cancelled Operations; and • UHL’s Quality Monitoring and Improvement.
5. This report provides an overview and update on key areas of discussion and highlights issues for escalation from PPAG to the Governing Body.
6. Provider Performance Assurance Group (PPAG) Terms of Reference: PPAG reviewed and agreed amendments to its terms of reference ahead of presenting them to the Governing Body for approval. The updated terms of reference are as appended to this report at Appendix 1 and amendments highlighted throughout the document for ease of reference. The key amendments relate to the membership and quoracy arrangements in relation to the lead officers and lay members, the amendments proposed provides more flexibility to ensure that the group is able to function with a sufficient number of representatives. The Governing Body is asked to approve the terms of reference as at Appendix 1.
Page 2 of 7 Paper G East Leicestershire and Rutland CCG Governing Body meeting 11 September 2018
Detailed Report from Leicester City CCG: Deep-dive into the University Hospitals of Leicester (UHL) performance for Cancelled Operations and Quality Update.
7. It was reported that following an elective pause in January 2018; UHL made the decision to prospectively cancel cancer operations for the first week in January 2018. As a result a root cause analysis investigation took place to ensure no harm had come to those patients from the action taken. PPAG were assured that no harm had come to the patients and were monitored regularly. In respect of this PPAG requested that a deep-dive was to be undertaken to understand the reasons behind the cancelled operations. Pre-operative assessment needs to be examined.
8. The report highlighted that UHL have missed the cancelled operations standard for the last 2 years with no evidence of significant improvement noted within this timeframe. PPAG noted that rebooking a cancelled operation within 28 days was a significant issue for UHL. The most common reason for UHL cancelling elective cancer patients was noted to be limited capacity in critical care. UHL have been asked to report ‘on the day cancelled cancer patients’ in order that this can be monitored closely.
9. PPAG noted that a recovery plan has been developed which is monitored via the contract technical meetings. Furthermore a desktop exercise is expected to take place which will be looking at elective capacity. Furthermore, it was noted that UHL is being assisted by an external consultant appointment by NHS Improvement.
10. Quality: The quality contracts team have developed a Quality Assurance Framework to ensure that the actions taken by UHL demonstrate safe delivery and high quality care. The report indicated that the current areas where quality concerns and clinical risks have been identified: • Cancer • Patient Safety and learning from incidents • A&E 12 hour trolley breaches • Radiology • Fractured Neck of Femur • Safeguarding and Prevent Training
11. There have been several never events, including two in the same department. PPAG noted that several Never Events had taken place over a period of time; however two similar Never Events had occurred recently within the radiology department within a period of a month. It was reported that these Never Events are currently under investigation. A “Safer Surgery” evaluation to review the outcomes of the safer surgery improvement actions have been implemented by UHL, and PPAG members raised that it was important for UHL to ensure that learning is taking forward from these incidents to prevent never events from occurring.
12. Overall it was reported that the Quality Contracts Team have triangulated the information and the risks have been stratified in order to identify key areas of focus for UHL in 2018/19. PPAG noted that these risks have been discussed with NHS England and NHS Improvement and updates will continue to be provided to the Clinical Quality Review Group (CQRG) and PPAG.
Page 3 of 7 Paper G East Leicestershire and Rutland CCG Governing Body meeting 11 September 2018
Exception Report from Leicester City CCG:
University Hospitals of Leicester NHS Trust (UHL)
13. Cancer standards: It was reported that UHL did not deliver the 2ww breast, 31 day surgery standard or 62 day standards in June 2018 however actions are being taken to remedy performance. In addition the late tertiary referrals are also affecting the backlog and account for some of the exceptional long waiters. The main factor impacting on backlog and 62 day performance continues to be emergency pressures and ITU capacity constraints. PPAG were assured that all cancer patients continue to be monitored until they have been treated, In addition the CCG receive position status on these patients on a daily basis.
14. It was reported that a new Chief Operating Officer has commenced in post who is leading on the Cancer Taskforce and recovery plans. Work is also underway with the key stakeholders in respect of reviewing the targeted pathways. In addition cancellations due to theatre capacity are being managed through the Theatre Programme Board’s efficient work stream, focusing on start on time and scheduling. Cancer patients and those over 46 weeks are being prioritised in terms of avoiding a cancellation and any cancellations would require a final approval from the Chief Operating Officer.
15. Referral to Treatment (RTT): PPAG members were informed that there is a risk that the CCGs will fail to meet the core standards in relation to RTT as there are a number specialities with performance concerns. Furthermore there is a risk of patient harm and poor patient experience. A recovery plan has been put in place and a sub-group of the Cancer RTT Board has been formed to have an oversight on identifying whether actions are delivering and or whether further actions are required to recover RTT performance.
Exception report from East Leicestershire and Rutland CCG:
Improving Access to Psychological Therapies (IAPT) Service (Nottinghamshire Healthcare NHS Foundation Trust)
16. It was noted that for County contract a number of actions have been identified which have helped to focus the provider on the delivery of the LLR service. Whilst an improvement in performance was seen when a focus was taken on access, there is concern that there is a recent deterioration in performance since this focus has reduced. For City, the performance is improving and progress is being monitored. Waiting time’s performance continues to achieve and recovery rate has improved. Access rates have however reduced due to a drop in monthly referrals and it is hoped a recent promotion of IAPT within Primary Care will help address this. It was reported that NHS England continue to focus on IAPT’s performance and a number of escalation calls are taking place with the Commissioners to ensure key actions are progressing.
Page 4 of 7 Paper G East Leicestershire and Rutland CCG Governing Body meeting 11 September 2018
Leicestershire Partnership NHS Trust (LPT)
Child and Adolescent Mental Health Service (CAMHS)
17. It was reported that the Care Quality Commission (CQC) report published highlighted an overall rating of ‘Requires Improvement with concerns remaining on increasing waiting times and risk management of children waiting for treatment. PPAG noted that progress on CAMHS actions is monitored via the CCG’s Children’s Services subgroup.
18. PPAG members expressed concerns that there are still gaps in medical staffing across CAMHS and Adult Mental Health services which poses a significant concern in regards to the quality of care being potentially compromised. PPAG were informed that assurances are provided via the Clinical Quality Review Group (CQRG) demonstrating that an operational oversight is in place to address areas of concern.
Exception Report from West Leicestershire CCG: (Non- Acute Contracts)
Non-emergency patient transport service (NEPTS) – Thames Ambulance Service Limited (TASL)
19. Performance: It was reported that TASL’s performance declined in June 2018 across many of the Key Performance Indicators (KPIs) however it was noted that the call centre performance improved significantly. The performance is not helped by the number of aborted trips related to patient discharge at UHL. The commissioners continue to work closely with the provider to improve performance and safeguard the continuity of provision.
20. PPAG were informed that the commissioners and TASL have devised a comprehensive organisational action plan to encompass the actions required and monthly meetings are taking place to monitor progress against this action plan. This will be subject to detailed review at the next PPAG meeting.
21. Quality: PPAG noted that at the monthly Contracts Performance Notice (CPN) meeting with TASL, it transpired that the commissioners remain unassured on the quality reporting and therefore it has been agreed to escalate the CPN to exception reporting.
22. It was reported that although TASL has established good working relationships with other providers and steady improvement to performance is seen; there remains a level of concern in relation to quality as well as TASL’s long-term financial sustainability.
Page 5 of 7 Paper G East Leicestershire and Rutland CCG Governing Body meeting 11 September 2018
East Midlands Ambulance Service (EMAS)
23. PPAG were informed that activity had increased significantly in July 2018, which had a detrimental impact on performance against Ambulance Response Programme (ARP) standards. PPAG were made aware that performance is currently being monitored against quarterly trajectories and are expected to meet the target by April 2019.
24. It was reported that in July 2018, EMAS saw a 6% increase in calls compared to June 2018 which impacted on performance for all standards. In addition EMAS did not achieve the improvement trajectory targets except for Category 4.
25. It was reported that handover performance declined at the Leicester Royal Infirmary (LRI) however 51% of handovers were completed within 15 minutes in June 2018, compared to 48% in June 2017. PPAG noted that the Commissioners were informed that the decline in performance was due to increased activity.
26. PPAG was informed that the lead commissioners for the EMAS contract in the East Midlands have undertaken a Quality Assurance assessment at regional level. The assessment provides assurances from a regional wide perspective on patient experience, safety and effectiveness, safeguarding and other quality aspects. It was reported that this provides overall assurances locally and can be triangulated to the locally provided information. This will also be subject to detailed review at the next PPAG meeting.
Personalised Commissioning including Continuing Health Care (CHC) 27. It was reported that under Continuing care for Children and Young people, the CCGs are ahead of plan in respect of: • The requirement to undertake a checklist prior to DST. • The requirement to have an MDT to determine eligibility. - The Continuing Care nurses are coordinating and carrying out DST’s with the Children’s Continuing Care administrator booking appointments. Diana team involvement is sought where appropriate.
28. Furthermore, on a positive note, PPAG members were informed that NHS England have acknowledged the CCGs work in getting the CHC process robust and have requested that they would like to carry out a peer review in the next few months, as a case study for other CCG’s.
RECOMMENDATIONS
East Leicestershire and Rutland CCG Governing Body is requested to:
• RECEIVE the assurance report from the Provider Performance Assurance Group. • APPROVE the updated terms of reference as at Appendix 1.
Page 6 of 7 Paper G East Leicestershire and Rutland CCG Governing Body meeting 11 September 2018
APPENDIX 1
Page 7 of 7 (Annex F of the Memorandum of Agreement) NHS WEST LEICESTERSHIRE, NHS EAST LEICESTERSHIRE & RUTLAND AND NHS LEICESTER CITY CLINICAL COMMISSIONING GROUPS' COLLABORATIVE ARRANGEMENTS
TERMS OF REFERENCE FOR PROVIDER PERFORMANCE ASSURANCE GROUP (v21, draft 21, reviewed 26 May 2016August 2018)
1. PURPOSE
NHS Leicester City Clinical Commissioning Group (LC CCG), NHS East Leicestershire and Rutland Clinical Commissioning Group (ELR CCG) and NHS West Leicestershire Clinical Commissioning Group (WL CCG) hereby resolve to establish tThe Provider Performance Assurance Group (PPAG). The PPAG has been established through the Memorandum of Agreement approved by the CCGs' Governing Bodies and is a meeting in common operating with delegations to named individuals from each CCG (in line with respective Schemes of Reservation and Delegation). The principal role of the PPAG is to receive assurance and hold to account the contract squares (including the Managing Directors); advise and recommend actions on provider performance as appropriate; and provide onward assurance to the respective Governing Bodies
2. DEFINITIONS
2.1.1 NHS West Leicestershire, NHS East Leicestershire & Rutland and NHS Leicester City Clinical Commissioning Groups ("the CCGs")
2.1.2 Provider Performance Assurance Group (PPAG)
2.1.3 Commissioning Collaborative Board (CCB)
2.1.4 The Memorandum of Agreement dated 2014 agreed by the CCGs to define their arrangements for collaboration (Memorandum of Agreement)
3. MEMBERSHIP
3.1 The membership of the PPAG shall be as follows:
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3.1.1 Three Lay Members, one to be appointed by the Governing Body of each CCG
3.1.2 The three Managing Directors of the CCGs or their deputies
3.1.3 the three executive officers (in addition to the lead for quality of care), one from each CCG, and one of whom is a Chief Finance Officers of one of the CCGs
3.1.4 three executive officers with the lead for quality of care, one from each CCG or their deputies
3.1.5 three General Practitioners, one to be appointed by the Governing Body of each CCG.
3.2 The Chair of the PPAG shall be one of the Lay Members from the CCGs. Each of the Lay Members shall serve as Chair for four months, the order of rotation amongst the Lay Members to be determined such that the Chair at any time represents the CCG whose Clinical Chair is Chair of the CCB at that time.
4. AUTHORITY
4.1 The PPAG is not a joint committee of the CCGs' Governing Bodies (either any one of them or of two or more of them acting jointly) and no authority is delegated to the PPAG in this capacity.
4.2 The PPAG will operate through authority delegated by the CCGs' Governing Bodies to the members of the PPAG acting jointly as a group meeting in common. This authority is recorded in the CCGs' Schemes of Reservation and Delegation.
4.3 The PPAG is authorised to decide any matter within its remit and the authority delegated to its members when acting jointly. The PPAG has no authority to compel any of its members to act against or in any way in contravention of the intentions, instructions or delegation of/from the CCG Governing Bodies which appointed those members.
5. DUTIES
The PPAG shall:
5.1 Agree annually with the CCGs' Governing Bodies:
5.1.1 the providers whose performance shall be within the remit of the PPAG; and
5.1.2 the elements of those providers' performance which shall be
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within the remit of the PPAG.
5.2 In addition to the duties agreed under 5.1 above, the PPAG shall seek assurance on any element on any provider's performance as directed by the CCGs' Governing Bodies at any time; and suggest, advise or recommend the contract squares teams on actions to be taken.
5.3 Obtain assurance in respect of the management by contract squaresteams, by the CCGs' Managing Directors and by any other executive arrangements of the performance of providers within the remit of the PPAG. In particular, obtain assurance in respect of:
5.3.1 the monitoring of quality of care, and of operational and financial performance against targets and limits; and
5.3.2 the effectiveness of action taken by contract squaresteams, by the CCGs' Managing Directors and by any other executive arrangements to address any variance from targets and limits, including the use of any delegated authority to impose contractual penalties.
5.4 In respect of matters which require action by the PPAG in accordance with the Scheme of Reservation and Delegation, agree the action necessary to address provider performance, ensuring that the agreed action is within the authority delegated to the members of PPAG. Where the PPAG agrees action in respect of provider performance it shall determine the arrangements through which the effectiveness of such action will be monitored, to include as a minimum reports to subsequent meetings of the PPAG for a period to be determined by the PPAG.
5.5 Determine the information which the PPAG requires such that it can discharge its duties as set out in these Terms of Reference.
5.6 Make recommendations to the CCB where the PPAG considers this appropriate to address matters not relevant to the performance of particular providers but which relate to commissioning or other strategic matters which are apparent from the performance of one or more providers.
6. CONDUCT OF BUSINESS
6.1 The PPAG shall conduct its business in accordance with these Terms of Reference and with other relevant governance documents.
6.2 The PPAG shall be deemed quorate if there are at least:
6.2.1 three two of the three Lay Members present (one from each
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CCG but each Lay Member may appoint a deputy who must be a Lay Member from the CCG which he/she representsthe two lay members must represent two of the three CCGs);
6.2.2 at least two representatives from each CCG present such that at least one of the two representatives from each CCG must be a clinician, i.e. a nurse lead or a GP.
6.2.3 A quorate meeting shall be competent to exercise all or any of the authorities, powers and duties vested in or exercised by the PPAG.
6.3 The Chair shall conduct each meeting of the PPAG such that it addresses the business on the agenda in accordance with these Terms of Reference and other relevant governance documents. In particular, the Chair shall ensure that the PPAG is robust in assessing the contract squares teams and the CCGs' Managing Directors. To support this the Chair shall ensure that at each meeting all present are aware of the roles in which they are participating at any one time, ie. that the Managing Directors, the Chief Finance Officers, the executive leads for quality and the General Practitioners are aware of when they are being held assessed by colleagues and when they are assessing others.
6.4 The PPAG shall approve the schedule and locations for its meetings. The PPAG Chair may in conjunction with the Lay Members representing the other two CCGs, request an extraordinary meeting if collectively they consider one to be necessary.
6.5 At the discretion of the PPAG Chair in conjunction with the Lay Members representing the other two CCGs business may exceptionally be transacted through a teleconference provided all parties are able to hear all other parties and where an agenda has been issued in advance.
6.6 Agendas and briefing papers shall be prepared and circulated five clear daysworking days before each meeting to give members sufficient time to give them due consideration.
6.7 The Secretary to the PPAG at any time shall be the one of the Assistant Directors of Corporate Services from the CCGs, this responsibility to be rotated such that the Secretary at any time represents the CCG whose Lay Member is Chair of the PPAG at that timeCommissioning Collaborative Officer. The Secretary shall advise the Chair of the PPAG on the PPAG's compliance with these Terms of Reference and with other relevant governance requirements and shall generally provide advice and support to the PPAG as required.
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7. REPORTING & RELATIONSHIPS
7.1 The PPAG will address matters agreed with, or directed at any time by, the CCGs' Governing Bodies and other matters referred by contract squaresteams, by the CCGs' Managing Directors or by other executive arrangements, including any matters referred from the CCGs' Governing Bodies.
7.2 The PPAG will report to each meeting of the CCGs' Governing Bodies through a report, the principal contents of which shall be agreed by the PPAG at each of its meetings. The report shall describe the matters which require the attention of the CCGs' Governing Bodies (particularly the matters in respect of which the PPAG was assured or not assured) and, where decisions are required from the CCGs' Governing Bodies, the report shall propose options and a recommendation. The PPAG shall agree the report such that as far as possible the options reflect any variation of views from amongst the three CCGs represented at the PPAG.
7.3 Where the PPAG decides that a matter requires escalation to the CCGs' Governing Bodies but the matter requires action before the next scheduled meetings of the CCGs' Governing Bodies, the matter shall be addressed through authority delegated to officers of each Governing Body (the authorised officers). The authority delegated to the authorised officers shall be as defined in the CCGs' Schemes of Reservation and Delegation. In the event that the authorised officers exercise such delegated authority they shall arrange for it to be reported to the next scheduled meeting of each CCG Governing Body. The report shall include a full description of the matter escalated by the PPAG and the action and decisions taken by the authorised officers. In the event that the report is verbal a full record shall be made in the minutes of the CCGs' Governing Bodies' meetings.
7.4 The minutes of the PPAG shall be circulated to the CCGs' Governing Bodies as deemed appropriate in line with the governance arrangements of each CCG. The minutes shall be presented alongside the report described in . In any event, each Managing Director shall give to his or her CCG Governing Body a verbal summary of the most recent PPAG meeting, referring to the report and to the minutes.
8. STATUS AND REVIEW OF THESE TERMS OF REFERENCE
8.1 These Terms of Reference were approved by the CCGs' Governing Bodies as follows:
8.1.1 NHS West Leicestershire CCG: 11 September 2018
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8.1.2 NHS East Leicestershire & Rutland CCG: 11 September 2018
8.1.3 NHS Leicester City CCG: 11 September 2018 8.2 These Terms of Reference shall be reviewed and submitted for re- approval by the CCGs' Governing Bodies not more than six months following their initial approval and then at intervals of not more than 12 months.
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H Blank Page Paper H East Leicestershire and Rutland CCG Governing Body Meeting 11 September 2018
NHS EAST LEICESTERSHIRE AND RUTLAND CCG GOVERNING BODY MEETING
Front Sheet
Integrated Governance Committee summary report Title of the report: (4 September 2018) Report to: Governing Body meeting Date of the meeting: 11 September 2018 Report by: Daljit K. Bains, Head of Corporate Governance and Legal Affairs Presented by: Warwick Kendrick, Independent Lay Member
PURPOSE OF THE REPORT: This report provides a summary of the key areas of discussion and outcomes from the Integrated Governance Committee meeting held on 4 September 2018; and items for escalation and consideration by the Governing Body ensuring that the Governing Body is alerted to emerging risks or issues. The Governing Body is also asked to approve the updated terms of reference for the Committee.
RECOMMENDATIONS: The East Leicestershire and Rutland CCG Governing Body is requested to: • RECEIVE the report. • APPROVE the proposed revised terms of reference for the Integrated Governance Committee as at Appendix 1.
REPORT SUPPORTS THE FOLLOWING STRATEGIC AIM(S) 2018 – 2019: Transform services and enhance quality Improve integration of local services of life for people with long-term between health and social care; and conditions between acute and primary/community care. Improve the quality of care – clinical Listening to our patients and public – effectiveness, safety and patient acting on what patients and the public experience tell us. Reduce inequalities in access to Living within our means using public healthcare money effectively Implementing key enablers to support the strategic aims (e.g. constitutional and governance arrangements, communications and patient engagement).
EQUALITY ANALYSIS An Equality Analysis and due regard to the positive general duties of the Equality Act 2010 has not been undertaken in respect of this report.
RISK ANALYSIS AND LINK TO BOARD ASSURANCE FRAMEWORK: The Integrated Governance Committee has the remit to have oversight and seek assurance in respect of the mitigation actions in relation to all risks on the Board Assurance Framework where appropriate.
Page 1 of 4 Paper H East Leicestershire and Rutland CCG Governing Body Meeting 11 September 2018 EAST LEICESTERSHIRE AND RUTLAND CLINICAL COMMISSIONING GROUP
GOVERNING BODY MEETING 11 September 2018
Integrated Governance Committee: Summary Report (September 2018)
Introduction
1. The ELR CCG Integrated Governance Committee held its meeting on 4 September 2018; the following provides a summary of the key areas of discussion during the meeting. The approved minutes from the August 2018 meeting are available upon request.
2. Terms of Reference for the ELR CCG Integrated Governance Committee – the terms of reference for the Committee were reviewed and amendments proposed were agreed by members of the Committee for onward approval by the Governing Body. The proposed amended terms of reference are appended to this report, In the main the key changes relate to:
a. Membership – amendments proposed provide additional flexibility for the GP members of the Governing Body and also enable the new clinical lead roles to offer assistance to the Committee; b. Quorum – the amendment again enables flexibility for GP colleagues; c. Duties – minor amendments have been made throughout to ensure the duties remain consistent with the CCG’s Scheme of Reservation and Delegation and also changes that have taken place following the establishment of the Commissioning Collaborative Committee as a joint committee.
3. The Governing Body is asked to approve the updated terms of reference as at Appendix 1.
4. Summary of ELR CCG Financial Position – the Committee received the summary report on the financial position for 2018/19 at month 4. It was highlighted that the report enables the Committee to have an overview of the financial position before committing any expenditure when making decisions in line with the authority delegated to it. It was noted that the Quality, Innovation, Productivity and Prevention (QIPP) monitoring processes during month 4 have confirmed a number of schemes that have slipped or will otherwise not deliver in 2018/19 and therefore further stretch and replacement schemes have been identified to ensure the continued delivery of the full £19.6m QIPP programme. In addition, due to continuing identified cost pressures it has been necessary to release the full 0.5% contingency into month 4. The Committee noted the month 4 forecast is still to deliver a breakeven position but with no further uncommitted reserves to support ongoing pressures.
5. CCG Corporate Performance Report 2018/19 – the Committee raised concerns in relation to a number of performance standards, in particular the East Midlands Ambulance Service (EMAS) Ambulance Response Standards (ARP); and Accident
Page 2 of 4 Paper H East Leicestershire and Rutland CCG Governing Body Meeting 11 September 2018 and Emergency performance for all providers. The Committee noted actions underway and that concerns were being escalated to the CCG leads and that meetings with the relevant providers were due to take place in September 2018. In addition, the Committee requested that the number of actual patients to be included within the reporting of the four ARP categories.
6. Quarter 1 2018/19 - Summary of GP Support Investment Plan Clinical Progress and Over GP Support Investment Plan Primary Care QIPP – the Committee welcomed the inaugural quarter one 2018/19 Primary Care report. It was noted that the report format will be reviewed further taking on board feedback received at the meeting to enable performance across GP Practices to be captured and reviewed in the same way was performance across other providers.
7. The Leicestershire Children and Families Partnership Plan 2018-2021 – the Committee welcomed the update and overview on the Leicestershire Children and Families Partnership Plan 2018-2021 presented by a representative from the Leicestershire County Council. The Plan is a strategic document which sets out the shared vision for children, young people and their families and the priority outcomes that need to be improved. The Leicestershire Children and Families Partnership has adopted the five supporting outcomes of the Joint Health and Wellbeing Strategy relating to children and young people as the priority areas for the Plan: • Ensure the best start in life • Keep children safe and free from harm • Support children and families to be resilient • Ensure vulnerable families receive personalised, integrated care and support • Enable children to have good physical and mental health.
8. It was noted that following Cabinet approval, the draft Plan is now being presented through the relevant governance processes across the key partners. The Committee received and accepted the Plan and noted that the final version will be launched later in September 2018.
9. Update on Oakham and Lutterworth Estates Appraisal Project – An update was received by the Committee noting that the final report will be presented in November 2018.
10. Patient Safety Report Quarter 1 – the Committee received, and discussed in detail, the themes identified relating to serious incidents reported in Quarter 1 2018/19 including the never events reported. It was noted that learning from such incidents is taking place across some providers, however further improvements are required and focus group meetings will be taking place to support this.
11. Workforce Metrics Report – the Committee received the Quarter 1 Workforce Metrics Report 2018/19, noting that ELR CCG is ranked as the highest in direct comparison with 31 other CCG organisations, that the Commissioning Support Unit (CSU) supports, for compliance with statutory and mandatory training. Furthermore, the CCG is ranked in the 13th lowest place for cumulative sickness absence in comparison with the other CCGs supported by the CSU.
Page 3 of 4 Paper H East Leicestershire and Rutland CCG Governing Body Meeting 11 September 2018
RECOMMENDATIONS
12. The East Leicestershire and Rutland CCG Governing Body is requested to:
• RECEIVE the report. • APPROVE the proposed revised terms of reference for the Integrated Governance Committee as at Appendix 1.
Page 4 of 4 APPENDIX 1 Paper H ELR CCG Governing Body meeting 11 September 2018 NHS EAST LEICESTERSHIRE AND RUTLAND CCG
INTEGRATED GOVERNANCE COMMITTEE
TERMS OF REFERENCE (v21, draft 42, 6 December 2016August 2018) 1. Introduction
The Integrated Governance Committee (the Committee) is established in accordance with the NHS East Leicestershire and Rutland Clinical Commissioning Group’s Constitution. These terms of reference set out the membership, remit, responsibilities and reporting arrangements of the Committee and shall effect as if incorporated into the CCG’s Constitution.
2. Purpose
The Integrated Governance Committee is a committee of the NHS East Leicestershire and Rutland CCG Governing Body. Its purpose is to: • oversee the development and delivery of the CCG’s commissioning plans (including collaborative commissioning where appropriate), strategies and intentions, ensuring effective monitoring arrangements are in place;
• approve business cases for healthcare commissioning, disinvestments and decommissioning in line with delegated financial authority following consultation with the Finance andFinancial Turnaround Committee;
• have oversight of quality, performance and clinical governance mechanisms, ensuring quality and patient safety is integral to commissioning processes and to the monitoring arrangements for all commissioned services’;
• seek assurance and adopt an integrated approach to clinical governance, information governance (including information security), and research governance;
• oversee the arrangements for the decommissioning of services and disinvestments, and approve the processes involved in carrying out these arrangements; and
• Ensure adherence to the CCG’s Standing Orders and Prime and Detailed Financial Policies.
3. Membership
The membership of the Committee will consist of:
• Secondary Care Clinician (Chair of the committee) • Independent Lay Member of the CCG - vice chair of the committee
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APPENDIX 1 Paper H ELR CCG Governing Body meeting 11 September 2018 • 4 x GP Governing Body members 3 General Practitioners (or Clinical Leads) appointed by the CCG with at least one appointed as a Governing Body member • Managing Director • Chief Strategy and PlanningCommissioning and Performance Officer • Chief Finance Officer • Chief Nurse and Quality Officer • Chief Operating Officer
Should Members not be able to attend, nominated deputies, with appropriate delegated authority, may take their place.
A decision put to a vote at a meeting shall be determined by a majority of the votes of members present. In the case of an equal vote, the Chair of the Committee shall have a second and casting vote.
Co-opted member:
The Consultant in Public Health Medicine (Leicestershire County Council) or another representative from Public Health will attend the Committee meetings as required as a co-opted member in an advisory capacity and shall not be considered as part of the quorum for decision-making.
4. Attendance:
Chairs of the Committee’s sub-groups will be in attendance (e.g. the Chair of the Leicester Medicines Strategy Group) as required.
The Head of Corporate Governance and Legal Affairs; and the Head of Planning will be in attendance. The other Heads of Service will be in attendance as required.
Other representatives may be invited to attend as required.
5. Quorum
The quorum for the Committee will be the following:
• Chair of the Committee or deputy Chair • Chief Finance Officer or deputy • Chief Strategy and PlanningCommissioning and Performance Officer or deputy • Chief Nurse and Quality Officer or deputy • 1 General Practitioner (or Clinical Lead) appointed by the CCG • 1 GP Governing Body Members;
Where members are conflicted and voting is required, 50% of the membership of the Committee consisting of persons entitled to vote upon the business to be 2
APPENDIX 1 Paper H ELR CCG Governing Body meeting 11 September 2018 transacted, shall be a quorum. The Chief Finance Officer; Strategy and Planning Commissioning and Performance Officer and the Chief Nurse and Quality Officer (or their deputies) must be present as part of the quorum.
6. Administration
The administration and minute taking for the Integrated Governance Committee is the responsibility of the Head of Corporate Governance and Legal Affairs.
7. Frequency of meetings
The Committee will hold monthly meetings and conduct its meetings ensuring adherence to the CCG’s Constitution, policies and the Nolan Principles.
8. Duties
The Integrated Governance Committee will:
a) Oversee the development and delivery of CCG’s agreed commissioning intentions and strategic operating plans, based on commissioning plans and strategies.
b) Consider, in conjunction with the Finance andFinancial Turnaround Committee, the implication of longer term financial and activity strategy for the CCG given the collaborative commissioning arrangements across Leicester, Leicestershire and Rutland CCGs, resources available and the local health economy position with regards to its providers. This includes Better Care Together Programme and the Sustainability and Transformational Partnership Plan.
c) Oversee delivery of component programmes and ensure that the work of the CCG is aligned with the Local Authority’s Health and Well-Being Board strategies.
d) Oversee development of and approve relevant commissioning process policies to progress commissioning prioritisation (e.g. Business Case process including the quality and patient safety aspects).
e) Approve the processes for decommissioning and disinvestments (clinical and non-clinical) and oversee the arrangements pertaining to these areas ensuring other committees are involved as appropriate.
f) Ensure that quality, patient safety, patient experience, and due regard to the public sector equality duty is integral to commissioning functions by identifying themes and trends which influence commissioning decisions.
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APPENDIX 1 Paper H ELR CCG Governing Body meeting 11 September 2018 g) Seek assurance that patient, public, partner and stakeholder engagement is integral to commissioning decisions.
h) Approve business cases for healthcare commissioning, disinvestments and decommissioning up to the value of £150k where budgets have already been approved (i.e. where the value being approved is within agreed budget). Make recommendations to the Governing Body in respect of business cases above this delegated financial authority.
i) Receive a report and recommendations from the competition and procurement group in respect of procurement exercises.
j) Approve healthcare procurements, including service specification for the procurement of healthcare for up to £1m annual value of contract for a maximum period of up to 5 years for a contract (i.e. where the value being approved is within agreed budget). Make recommendations to the Governing Body in respect of healthcare procurements above this delegated financial authority and for contracts that extend beyond 5 years.
k) Approve preferred bidder and contract award for healthcare services up to the value of £1m,000,000 annual value of the contract for maximum period of 5 years for a contract. l) Identify opportunities for improvement and service re-design and encourage innovation including in-year and future and make recommendations to the Governing Body.
m) Seek assurance from the appropriate groups (e.g. Provider Performance Assurance Group (collaborative meeting) and the Primary Care Commissioning Committee (CCG committee)) in relation to the quality and performance aspects of provider care provision (including primary medical care) to ensure appropriate monitoring of and identification of risks within commissioned services.
n) Review and consider national inquiries, reviews and reports and receive assurance in relation to local implementation of recommendations and lessons learnt.
o) Receive assurance on actions in respect of quarterly reports which impact on quality and patient safety (such as complaints, serious incidents, Health Care Associated Infections (HCAIs), safeguarding and prescribing and medicines management reports); workforce reports.
p) To have oversight of and receive assurance regarding Research and Innovation.
q) Approve CCG specific and Leicester, Leicestershire and Rutland wide clinical policies on behalf of the Governing Body; and make recommendations to the Governing Body in respect of region wide or 4
APPENDIX 1 Paper H ELR CCG Governing Body meeting 11 September 2018 national clinical policies. Approve Leicester, Leicestershire and Rutland wide clinical policies on behalf of the Governing Body where it has not been possible, for instance, to obtain approval in a timely manner via the LLR Commissioning Collaborative Group.
r) Approve relevant Information Governance and information security policies where Board or Committee level approval is required.
q)s) Monitor compliance with financial governance arrangements detailed within the CCG’s Constitution (i.e. the Prime Financial Policies and Detailed Financial Policies) to ensure sound system of internal control is in place.
r)t) Discussion and review of any issue likely to require inclusion on, or modification to, any risk register.
s)u) Establish a sub-group(s) where the sub-group(s) will assist the Committee in discharging the Committee’s responsibilities (responsibilities as agreed by the Governing Body and in line with the CCG Constitution). Sub-groups will include the Leicester Medicines Management Quality Strategy Group; LLR Medicines Optimisation Committee; Out of Hospital Care Board; Primary Care Quality Delivery Group; and the Strategic Safeguarding Assurance Group.
t)v) Ensure appropriate interface with other committees of the CCG’s Governing Body.
9. Reporting responsibilities
The Integrated Governance Committee will provide a written summary report of the outcomes of the meeting, actions taken and risks to be escalated to the Governing Body following its meeting. The Committee will also provide a appropriate.
All sub-groups will provide a summary report to the next meeting of the Committee supported by approved minutes.
10. Review of Terms of Reference
These Terms of Reference will be reviewed annually or sooner if required and recommendations made to the Governing Body for approval.
Date of approval: Approved by the Governing Body in December XXX2016
Review Date: June 2017September 2018
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I Blank Page Paper I ELR CCG Governing Body meeting 11 September 2018
EAST LEICESTERSHIRE AND RUTLAND CLINICAL COMMISSIONING GROUP
PUBLIC GOVERNING BODY
Front Sheet
REPORT TITLE: Extended Primary Care Procurement - (Improving access to Primary Care and Urgent Care Services in East Leicestershire and Rutland)
MEETING DATE: September 2018
REPORT BY: Paula Vaughan, Deputy Chief Operating Officer Emma Casteleijn, Head of Communications and Public Affairs Chris Lyon, Commissioning Manager
SPONSORED BY: Tim Sacks, Chief Operating Officer Dr Girish Purohit, Locality Board Member
PRESENTER: Paula Vaughan, Deputy Chief Operating Officer
EXECUTIVE SUMMARY:
Since April 2015, East Leicestershire and Rutland Commissioning Group (ELRCCG) has delivered an highly valued Urgent Care service for its patients through a community-based face to face Urgent Care service which supports both patients in receiving care closer to home and the sustainability of general practice.
The service has delivered over 100,000 primary care appointments to ELR patients since its inception providing out of hours care closer to home. The service has also supported over 32,000 non-ELR patients with face to face consultations in the community as an alternative to accessing Acute services and as an essential part of the wider Leicester, Leicestershire and Rutland (LLR) Urgent Care system.
ELRCCG is planning to change its approach to the commissioning of community- based urgent care. The service is being developed and delivered as part of the CCG’s response to the requirements of the GP 5 Year Forward View and will also provide the ELR out-of-hours community base service as part of the wider LLR
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Integrated Urgent Care system.
Significant engagement, consultation and service design work was undertaken between 2012 and 2014 which procured and implemented a new urgent care service from April 2015.
Patient and Care Quality Commission satisfaction with the current urgent care service is high, but confusion remains for some patients where service overlap exists or access routes differ across the CCG. The opportunities to further improve on the current model have been reviewed and appraised over the past year and the CCG plans to build on the current arrangements with further investment into primary care and the reshaping of local urgent care services to improve access to GP practices during opening hours (Acute Access) and to urgent care services when GP practices are closed (Extended Primary Care).
In developing the proposals, the CCG has undertaken clinical and patient involvement. The proposals have been shared with patients, the public and stakeholders and feedback has been analysed and used to shape a final proposed model for the future delivery of services.
This paper summarises the case for change, the engagement process and its findings and presents the recommended final model for procurement of a replacement service from 1 April 2019.
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RECOMMENDATIONS:
The East Leicestershire and Rutland CCG Governing Body is requested to:
Note the proposed changes to the current service model and the findings of the public engagement on which they are based
Approve the direction of travel of the revised service model pending final approval at the Confidential Governing Body
Approve further public engagement to determine the site for the new sixth Urgent Care Centre
REPORT SUPPORTS THE FOLLOWING STRATEGIC AIM(S) 2016 – 2017: Transform services and enhance quality X Improve integration of local services of life for people with long-term between health and social care; and conditions between acute and primary/community care. Improve the quality of care – clinical X Listening to our patients and public – X effectiveness, safety and patient acting on what patients and the public experience tell us. Reduce inequalities in access to X Living within our means using public X healthcare money effectively Implementing key enablers to support the strategic aims (e.g. constitutional and governance arrangements, communications and patient engagement).
EQUALITY ANALYSIS
The Equality Impact Assessment for Improving Access to Primary and Urgent Care has been updated during August 2018 and is attached for information in Appendix B2.
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RISK ANALYSIS AND LINK TO BOARD ASSURANCE FRAMEWORK: The content of the report identifies BAF 3. QUALITY – PRIMARY CARE: action(s) to be taken / are being taken to mitigate the following corporate The quality of care provided by primary care risk(s) as identified in the Board providers does not match commissioner’s Assurance Framework: expectation with respect to quality and safety.
BAF 6: OUT OF HOSPITAL – PRIMARY CARE: Risk in relation to Out of Hospital Services – Primary Care: Primary Care Commissioning – ability to perform delegated duties whilst maintaining member relations.
BAF 8: URGENT CARE:
Increased pressure on the Emergency Department which could result in sub-optimal care due to ability to access urgent care services.
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EAST LEICESTERSHIRE AND RUTLAND CCG
PUBLIC GOVERNING BODY
SEPTEMBER 2018
Extended Primary Care Procurement - (Improving access to Primary Care and Urgent Care Services in East Leicestershire and Rutland)
1. Introduction
1. Since April 2015, East Leicestershire and Rutland Commissioning Group (ELRCCG) has delivered a highly valued Urgent Care service for its patients through a community- based face to face Urgent Care service which supports both patients in receiving care closer to home and the sustainability of general practice.
2. The service has delivered over 100,000 primary care appointments to ELR patients since its inception providing out of hours care closer to home. The service has also supported over 32,000 non-ELR patients with face to face consultations in the community as an alternative to accessing Acute services and as an essential part of the wider Leicester, Leicestershire and Rutland (LLR) Urgent Care system.
3. ELRCCG is planning to change its approach to the commissioning of community-based urgent care. The service is being developed and delivered as part of the CCG’s response to the requirements of the GP 5 Year Forward View and will also provide the ELR out-of-hours community base service as part of the wider LLR Integrated Urgent Care system.
4. Significant engagement, consultation and service design work was undertaken between 2012 and 2014 which procured and implemented a new urgent care service from April 2015.
5. Patient and Care Quality Commission satisfaction with the current urgent care service is high, but confusion remains for some patients where service overlap exists or access routes differ across the CCG. The opportunities to further improve on the current model have been reviewed and appraised over the past year and the CCG plans to build on the current arrangements with further investment into primary care and the reshaping of local urgent care services to improve access to GP practices during opening hours (Acute Access) and to urgent care services when GP practices are closed (Extended Primary Care).
6. In developing the proposals, the CCG has undertaken clinical and patient involvement. The proposals have been shared with patients, the public and stakeholders and
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feedback has been analysed and used to shape a final proposed model for the future delivery of services.
7. This paper summarises the case for change, the engagement process and its findings and presents the recommended final model for procurement of a replacement service from 1 April 2019.
8. To enable the procurement to run within agreed timescales and to enable mobilisation on 1 April 2019, the tender process must commence on 14 September 2018.
2. Local Context
9. The acute (secondary care) elements of the LLR urgent care system are in a period of improvement and continue to struggle to meet targets. To support the necessary improvement of the LLR urgent care system, ELR is committed to providing better core primary and community-based urgent care within its localities.
10.ELR’s scheme to invest in and improve access to core primary care is the Acute Access (AA) scheme. This workstream and investment programme has been made possible by ELR CCG’s commitment of the GP 5 Year Forward View (GP5YFV) funding into core primary care to meet the increase on-the-day and complex care needs of ELR patients.
11. This paper relates to the workstream to improve and re-commission its community- based urgent care service which ELR refers to internally as Extended Primary Care (EPC). These services are currently known to patients as ‘urgent care services’. To avoid confusion this is how the services have been referred to in all public materials relating to the proposed changes. AA covers all in-hours primary care services. EPC services cover out-of-hours primary care services and the Oadby walk-in centre which is open in and out of hours
12.Both AA and EPC have a direct link with the wider LLR urgent care system and are intrinsically linked with other key pieces of work focussing on avoiding unplanned acute admissions, non-essential ED activity, improved patient care and clinical outcomes. AA and EPC require financial and management commitment to ensure delivery for ELR patients and although both have the potential to deliver QIPP for the CCG, the imperative for both schemes must be also looked at in the wider context of delivering better care closer to home for our patients.
13.The key aim of re-procurement of the EPC service is to build on the services and model the CCG already delivers for its patients. However, there is the opportunity to further improve access, provide a more consistent service closer to home, appropriate use of 6
services by patients and develop local ways of incorporating the clinical triage aspects of the LLR urgent care system which have already been successfully introduced.
3. Service Development History
14. In 2013, ELR CCG undertook a review of urgent care (minor injury and minor illness) services to ensure local people were getting the best quality services in an accessible way. The review sought to meet the needs of local people whilst also considering the broader context of the LLR urgent and emergency care system.
15. The aims of the review were to recognise and make recommendations to improve: The inconsistency in the preceding urgent care services Patient confusion in the service offer Variations in use of out-of-hours services The appropriate use of the acute aspects of the LLR urgent and emergency care system
16. Patients shared their views on how valued local services are particularly their relatively short waiting times and their proximity to patients’ homes. They wanted consistency of opening times, seven day a week services and for services to be delivered from either practices or community hospitals.
17. The review was preceded by a two year period of engagement, public events and a series of press releases. The feedback and intelligence gained over this extensive period gave rise to a number of options on which the CCG consulted. The options were considered in the context of the wider LLR urgent care system and the alternative offers to patients provide by other CCGs in around the extensive peripheries of the CCG (e.g. Grantham, Peterborough, Corby, Kettering, Rugby etc).
18. The review included a Public Health led mapping (November 2013) of ELR patient urgent care use and demand across ELR. Of key note in this report, was the forecast of an aging population for ELR with a growing number affected by long term or complex conditions. This will have two major impacts on ELR in terms of patient need. Firstly, a growing number of patients will need access to GPs and primary care in terms of care planning for complex conditions. Secondly, a growing number of patients are predicted to have a physical disability which will have a direct impact on patient mobility.
19. Transport links were also reviewed and these have not changed considerably in the last four years. Public transport links make travel within localities feasible during the evenings and in most areas on Saturdays, but public travel services are sparse or
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unavailable on Sundays and Bank Holidays. To that end, a locality based approach to service provision balanced with patient demand was taken.
20. By understanding transport links by area, the preferred locations for service provision were recommended with Oadby and Northfield surgeries the most accessible locations. The inaccessibility of Lutterworth, Thorpe Astley and Countesthorpe was considered. The larger rural towns of Market Harborough, Melton Mowbray and Oakham are accessible by public transport at least in the evenings and Saturdays. 21. It is of important note that this original review by Public Health recommended that the best option to offer best access within two miles for the whole population was to provide services in both Oadby and Blaby. However, the Blaby site could have only been provided at the cost of the loss of the Lutterworth site. As this was not an option the CCG wished to pursue given the need for a service in Lutterworth, only the site in Oadby was commissioned.
22. In 2014 ELRCCG consulted the public on changes to improve urgent care services in East Leicestershire and Rutland. Those changes, which received public support, were implemented in April 2015.
23.We receive positive feedback about the services and we are pleased to be offering a number of locality based services for our patients for out of hours primary care and urgent care needs, with choices of care close to home. However, there are still areas we can improve on to make services easier for patients to access, understand and use appropriately which will improve patient experience and clinical outcomes.
4. Current Arrangements and Plans
24. As a result of the work done leading up and including the procurement of the current service in 2014/15, ELR CCG currently commissions two services which both provide primary care out of hours for ELR patients. Both contracts are in place until 31 March 2019 and so the service requires re-procurement for 1 April 2019.
25. One of the current contracts is for a GP led, nurse practitioner provided Urgent Care service which is delivered from four sites; Melton Mowbray, Oakham, Market Harborough and Oadby. The other is for a separate out-of-hours GP service which is delivered from Oakham and Lutterworth.
26. The Urgent Care service is run from 5pm until 9pm Monday to Friday and 9am until 7pm at the weekends and Bank Holidays. The exception to this is Oadby which is open 8am until 9pm Monday to Friday and 8am until 8pm weekends and Bank Holidays. The GP service is open at the weekends only but hours vary between the
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two sites. The Oadby in-hours service is well utilised by City, East Leicestershire and West Leicestershire patients as well as non-registered patients.
27. The current ELR Urgent Care service can be accessed via ‘walk-in’ or by booked appointment via NHS 111. From September 2018, patients will also be able to access booked appointments to this service via their own practice. The GP service can only be accessed by booking via NHS 111.
28. The Urgent Care service and out-of-hours GP services form part of the ELR Urgent Care offer. Emergency Departments and Urgent Care Centres in neighbouring CCGs (e.g. Loughborough, Corby, Grantham, Lincoln, Rugby and Peterborough) are also commissioned to offer patient choice and accessibility for those who live on the CCG borders.
29. A 24 /7 Urgent Care Visiting Service is commissioned for those patients who require community-based urgent care but who are house-bound.
5. Understanding Patient Flow
30. The current ELR Urgent Care service has been running since April 2015 and the number of patients using this service continues to rise as demonstrated in Figure 1.
Figure 1 – Total ELR UC Site Activity, March 2015 – Jan 2018
The number of patients seen by this service, by site is presented in Figure 2.
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Figure 2 – Total ELR Urgent Care Activity, April 2015 to January 2018
Melton Market Month Mowbray Oadby Harborough Oakham Total Apr-2015 46 501 146 50 743 May-2015 44 554 164 50 812 Jun-2015 82 1528 257 100 1967 Jul-2015 177 2283 495 190 3145 Aug-2015 296 2387 544 153 3380 Sep-2015 293 2342 404 203 3242 Oct-2015 334 2390 568 253 3545 Nov-2015 361 2624 587 256 3828 Dec-2015 383 2731 489 262 3865 Jan-2016 445 2806 571 291 4113 Feb-2016 316 2426 404 265 3411 Mar-2016 386 2484 484 308 3662 Apr-2016 329 2388 407 235 3359 May-2016 408 2757 563 264 3992 Jun-2016 245 2066 373 153 2837 Jul-2016 283 2151 416 228 3078 Aug-2016 382 2546 538 228 3694 Sep-2016 431 2557 444 263 3695 Oct-2016 515 2949 575 311 4350 Nov-2016 481 2904 532 243 4160 Dec-2016 602 3304 678 325 4909 Jan-2017 587 3128 556 337 4608 Feb-2017 504 2730 548 267 4049 Mar-2017 624 3080 568 329 4601 Apr-2017 671 3282 708 353 5014 May-2017 607 3102 728 347 4784 Jun-2017 605 2729 545 330 4209 Jul-2017 651 2731 622 336 4340 Aug-2017 575 2675 583 322 4155 Sep-2017 533 2913 553 294 4293 Oct-2017 603 2966 641 321 4531 Nov-2017 572 2856 666 306 4400 Dec-2017 746 3198 768 411 5123 Jan-2018 673 3332 684 371 5060 14790 87400 17809 8955 128954
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31. A user profile analysis of the current ELR Urgent Care services is useful to understand to help shape both the staffing model and in terms of determining any alternations to sites. Figure 3 demonstrates the service user profiles for all ELR Urgent Care services as a total by locality and by age profile.
Figure 3 – ELR CCG Service User Profiles of ELR Urgent Care Sites
Data for April 2017 to March 2018 Inclusive Total Activity % of Total Activity Age 18- Age 18- Total Practice Data Age 0-17 45 Age 46-64 Age 65-80 Age 80+ Total Age 0-17 45 Age 46-64 Age 65-80 Age 80+ North Blaby 963 1140 458 190 44 2795 34.5 40.8 16.4 6.8 1.6 South Blaby 816 944 452 202 45 2459 33.2 38.4 18.4 8.2 1.8 Oadby and Wigston 3723 4200 2280 1051 341 11595 32.1 36.2 19.7 9.1 2.9 SLAM 2801 2562 1397 681 197 7638 36.7 33.5 18.3 8.9 2.6 Harborough 3377 2786 1854 1005 367 9389 36.0 29.7 19.7 10.7 3.9
Rutland 1169 994 645 576 155 3539 33.0 28.1 18.2 16.3 4.4 CCG 12849 12626 7086 3705 1149 37415 34.3 33.7 18.9 9.9 3.1
32 Variations in the population profile using the current service is minimal with the majority of patients being under five and less and 10% of patients using most sites being over 65. This is slightly different in the two localities where an older population in general is found, i.e. Melton Mowbray and Rutland. In these two localities, the percentage of children being seen is the same, but the shift is from the age 18-45 population in the over 65s.
33 From a staffing model perspective and using the assumption that the very young patients are more likely to need to see a GP due to the clinical risk associated with their management, there are no obvious places to direct the more senior clinicians. The most sensible way therefore to approach staffing model planning is from a geographical spread and accessibility perspective.
34 The ELR urgent care sites are used by ELR patients as well as those living outside our CCG area and are an integral part of the wider LLR urgent care system. Figure 4 demonstrates the significant proportion of the activity which is non-ELR. This activity is income generating for the CCG as demonstrated.
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Figure 4 – West, City and Other use, In and out of hours by site and in total
User CCG Melton Mowbray Oadby Market Harborough Oakham Total In Out of In Out of In Out of In Out of In Out of Hours Hours Total Hours Hours Total Hours Hours Total Hours Hours Total Hours Hours Total
City CCG 12 29 41 5974 5351 11325 16 73 89 7 10 17 6009 5463 11472 West CCG 7 84 91 610 1144 1754 12 40 52 4 7 11 633 1275 1908 Other and Non-Reg 137 353 490 1582 946 2528 233 926 1159 113 399 512 2065 2624 4689 Total 156 466 622 8166 7441 15607 261 1039 1300 124 416 540 8707 9362 18069
35 The vast majority of use by non-ELR patients is at the Oadby site. However, numbers are also significant in the other three sites and are important to the CCG’s commissioning of these services as set out below.
36 The geography and population dispersal of the CCG lends itself to service provision within six localities. However, this can mean services provided for small local populations (e.g. Rutland’s population is less than 40,000) and are potentially therefore at risk of being unsustainable. However, the advantage of providing services which are on both CCG periphery and those which are historically well used opportunistically (e.g. Oadby), is that the associated income makes a number of smaller sites financially viable. Income from other CCGs is essential to the financial viability of so many local urgent care sites and to the locality-based access ELR wishes to provide to its patients.
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6. Review of Urgent Care Sites
37 Figure 5 demonstrates the CCG’s current locality structure and local populations.
Figure 5 – ELR CCG Locality Structure & Populations
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38 Figure 6 examines flow to Emergency Departments (all including University Hospitals of Leicester) of ELR patients. It is important to examine flow to all Emergency Departments and not just UHL given the high proportion of ELR patients who live on the borders with other CCG areas.
Figure 6 - ELR Locality Flow to ED, April 2017 to March 2018
UHL ED Total per UHL Practice per Other 1000 Total Practice Data ED Pop 1000 Eds Total Population North Blaby 14948 61581 242.74 362 15310 248.62 South Blaby 7951 46470 171.10 1347 9298 200.09 Oadby and Wigston 14513 58097 249.81 203 14716 253.30 SLAM 9536 65414 145.78 1925 11461 175.21 Harborough 5843 60725 96.22 4849 10692 176.07 Rutland 1100 37814 29.09 3837 4937 130.56 CCG 53891 330101 163.26 12523 66414 201.19
39 Emergency Department use is known to be driven in part by geography as seen by the high use of services by both the North Blaby and Oadby & Wigston localities. However, some areas of the North Blaby locality are twice as far away from UHL’s Emergency Department as Oadby & Wigston and yet use appears to be of a similar rate.
40 The majority of Emergency Department use by patients in Oadby & Wigston and North Blaby localities is UHL Emergency Department. This activity has been analysed both in-hours and out-of-hours in Figure 7.
Figure 7 – UHL ED Activity by ELR Locality, April 2017 to March 2018
UHL UHL Practice ED per In Hours Practice Data ED Pop 1000 North Blaby 6640 61581 107.83 Oadby and Wigston 6614 58097 113.84 CCG 23989 330101 72.67
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UHL UHL Practice ED per Out of Hours Practice Data ED Pop 1000 North Blaby 8308 61581 134.91 Oadby and Wigston 7899 58097 135.96 CCG 29902 330101 90.58
41 In hours, the high rate of use by North Blaby is driven by a single practice which has had significant issues during the period of data collection. If this practice is discounted, North Blaby has an in-hour per 1000 population use of ED for minors of 102 patients.
42 Of more significance, is the increase in use per 1000 population out-of-hours compared with in-hours. For the ‘UHL local’ localities (i.e. not Harborough or Rutland), most localities see an approximate 20 patient per 1000 increase. If Kingsway is omitted as before as an anomaly, the increase out-of-hours in North Blaby is an increase of 35 patients per 1000, despite the distance from UHL.
43 This information is an indication of the need for a service within this locality and helps to given a good indication of the potential demand. If the introduction of a North Blaby site could reduce ED flow out-of-hours comparable with that of other ELR localities, the demand from this perspective alone would be 885 patients per year.
44 Over 26% of all out-of-hours activity at the Oadby walk-in centre come from the Blaby and Narborough area practices in the North Blaby locality. This is the locality which does not currently have a site offering primary care out of hours. This means that almost 1600 patients per year have to travel to a neighbouring locality to access out-of- hours care, in some cases this is the same distance or further than travelling to Leicester’s Emergency Department. A new site in North Blaby may mean that a proportion of these patients would choose the new service instead of travelling however, this assumption is not built into the activity modelling as it is speculation at present.
45 Figure 8 demonstrates the current use of ELR’s Urgent Care centre by locality for a year. Unsurprisingly, it is the lowest for the North Blaby locality as a service in the immediate vicinity is not available. It is also notably low for South Blaby and Lutterworth, potentially due to the locality’s service not offering walk-in access.
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Figure 8 – Use of Out-of-Hours ELR Urgent Care Facility by Locality (April 2017 – March 2018)
Locality ELR UC Centre Registered Activity per 1000 Activity Population Population SLAM (Syston, 5599 65414 85.6 Long Clawson & Melton) Oadby & Wigston 6109 58097 105.2
Harborough 6495 60725 107.0
South Blaby & 1715 46470 36.9 Lutterworth
North Blaby 1687 61581 28.0
Rutland 2690 37814 71.1
46 If a North Blaby site was introduced and locality activity achieved in line with that of the other large localities, additional demand could represent up to 4500 appointments per year. In total this could mean local North Blaby demand for up to 7000 appointments per year (although there will be an element of double counting in this calculation as some of the current ED patients will be in the additional local demand numbers).
47 It is therefore proposed that a sixth site in the North Blaby locality could be introduced as part of the new service model. The demand calculated is similar to that of both SLAM, Oadby & Wigston and Harborough and so the service provision, opening hours and access policy will be replicated into this new site.
48 A further option is to retain current sites only, but this option does not deliver locality level care (on which the future commissioning of primary care and other key community based care is based) and does not address the proven inequalities of access which currently exist across our CCG.
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7. Review of Opening Hours
There is currently a 90 minute overlap between core primary care hours (8am to 6.30pm, Monday to Friday) and the opening time of our Urgent Care services in Melton, Oakham and Market Harborough (which open at 5pm).
Figure 9 demonstrates the number and percentage of service users who current use this facility during this weekday evening period. The usage equates to 9 patients per working day across the CCG.
Figure 9 - ELR UC Site Users between 5pm and 6.30pm Weekday Evenings (April 2018 Data)
Market Harborough Melton Mowbray Oakham Total
75 59 43 177 Number of Patients seen before 6.30pm Total Number of Patients Seen in the 352 308 146 806 Evenings % of Patients Seen in the Evenings before 21.3 19.2 29.5 22.0 6.30pm
54 After discussion with both PPGs and practices, a proposal is to remove the overlap to make best use of clinical time. This means that instead of opening at 5pm, out of hours primary care services during the week would open at 6.30pm. They would all remain open in the weekday evenings until 9pm as they do now.
55 The previous work done in 2013/14 indicated that an overlap in hours was advantageous to patients especially if they were finding access to in-hours primary care difficult. However, the CCG has already committed to investing the majority of the GP5YFV funding into AA which will make step change improvements to accessibility to core primary care across the CCG. This additional support into primary care in additional to direct booking into EPC addresses historical access issues.
56 Responding to current feedback from patients that undefined hours are confusing, it is proposed that the current evening hours change from a 5pm to a 6.30pm start. This change has been suggested as a change on which the CCG will engage and will form part of the new service model.
57 At weekends and on Bank Holidays, our data shows that there is low usage of the services by patients during the last two opening hours at the current Urgent Care centres in Melton, Oakham and Market Harborough. The CCG proposes to review with 17
patients, the appropriateness of current opening hours at the weekends. Based on the most recent information (April 2018), this proposal could impact on 11.7% (123) of the patients who use the service at the weekends across the three sites. This is equivalent to 15 patients a day across East Leicestershire and Rutland. The data by service site is provided in Figure 10.
Figure 10 – ELR UC Site Users between 5pm and 7pm Weekend and Bank Holiday Evenings (April 2018 Data)
Market Melton Weekends Harborough Mowbray Oakham Total Number of Patients seen 46 57 20 123 after 5pm Total Number of Patients 464 380 208 1052 Seen at the Weekend % of Patients Seen in the 9.9 15.0 9.6 11.7 Evenings after 5pm
58 While there is currently low usage of our urgent care services between 5pm and 7pm on weekends and Bank Holidays, we are committed to ensuring alternatives are available for our patients. This will be achieved through our investment in improved access to primary care services during the week and the fact that patients will be able to book weekend and evening appointments via their practices and 111 rather than having to rely on walking-in.
59 For patients who cannot travel to alternative services (i.e. those who are housebound) but who have an urgent care need after 5pm, the CCG already commissions a 24/7 Urgent Care Visiting Service which can be accessed via 111/Clinical Navigation Hub.
60 Changes to the weekday opening hours of the Oadby service are not proposed due to its high use and this would remain open until 8pm. Oadby will also remain open during the day due to the high number of patients who rely on this service for in-hours primary care access (17,339 patients February 2017 to January 2018; 9173 from ELR CCG, 5974 from Leicester City and 2192 patients from other CCGs or who are unregistered with a practice).
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61 Options to change Oadby’ s opening hours to remove overlap with core general practice have been considered. Partly due to perceived confusion for patients and partly due the cost of double-running services. Oadby is an integral part of the urgent care system for LLR and is used by more than 60 patients in-hours, per day. Any change to this service would have a direct impact on both primary care and Acute services across LLR.
62 However, it is vital to align the service model with that of Acute Access to address both the patient clarity and value for money issues. It is therefore proposed that two changes are made to the services structure. The first is the inclusion of a ‘see and signpost’ additional tariff to the contract, reducing non-urgent ELR patient activity in- hours at Oadby. The second is the inclusion of an appropriately weighted CQUIN within the final Acute Access contracts which correlates the improved access and communication to patients of ELR practices to the flow of patients to alternative in- hours services.
63 Over time, and as these schemes deliver, it may be appropriate to revisit the role of Oadby in-hours and the appropriate business case for change and public consultation exercise would have to be undertaken.
8. Review of Staffing Model
64 Both current services offer access to primary care services, one is GP only and the other is Nurse Practitioner delivered but supported by a GP. With a single provider of all ELR Extended Primary Care services, there is an opportunity to review the primary care staffing model out-of-hours.
65 To ensure the CCG understands the clinical needs of patients accessing the service, a 100 patient, six month clinical audit was carried out to determine the needs of the majority of patients the reasons some patients require GP only care. Over 90% of patient need could be safely and appropriate met by an Advanced Nurse Practitioner as demonstrates in the audit results in Figure 11.
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Figure 11 – Summary of Audit Results of Out of Hours GP Service
Lutterworth
90.7% of patients could be treated by an ANP if they treated ALL age ranges 83.3% of patients could be treated by an ANP if they do not treat UNDER 1 YEAR OLDS 66.6% of patients could be treated by an ANP if they do not treat UNDER 2 YEAR OLDS 59.2% of patients could be treated by an ANP if they do not treat UNDER 5 YEAR OLDS
Oakham
88.9% of patients could be treated by an ANP if they treated ALL age ranges 83.3% of patients could be treated by an ANP if they do not treat UNDER3 MONTH OLDS There were no 3month to 12 month olds in the audit 79.6% of patients could be treated by an ANP if they do not treat UNDER 2 YEAR OLDS 74% of patients could be treated by an ANP if they do not treat UNDER 5 YEAR OLDS
Reasons for ANP not to have capacity to treat patient: patient taking methotrexate mental health issues/suicide/depression GP prescribed diazepam GP prescribed Zomorph Patient already taking prophylactic medication/Antibiotic complex co-morbidities with no clear diagnosis - GP treated but unlikely ANP would.
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66 The proposed staffing model would see a Prescribing Advanced Nurse Practitioner available at all sites with support from General Practitioners provided from two sites.
9. Summary of Proposed Model (before public engagement)
67 The aim of the new model is to provide improved quality of access to out of hours primary care and urgent care services across the CCG area, to reduce confusion for patients and to integrate booking of out of hours primary care and 111 so patients are booked into the right service first time.
68 Care will be delivered at a CCG locality level. This means all six localities would have an out of hours primary care service offering face to face appointments with a primary care practitioner. Patients would be able to access all six sites by walk-in or booking via 111 or their own practice as in Figure 12.
Figure 12 – Proposed Locality Based Provision of ELR Extended Primary Care Sites
69 All sites would be open in the evenings Monday to Friday and at the weekend and on Bank Holidays with the exception of Lutterworth. This site is currently open weekends only (10am until 4pm). An average of 10 patients are seen each day at the weekend. By changing of access policy for this site to enable walk-in as well as bookable appointments, we believe the use of this site will increase. Patient feedback to date strongly indicates the need for retention of the current service due to the lack of public transport options available in Lutterworth for travel to other locations, especially on a Sunday.
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70 There will be minimum staffing of one Prescribing Advanced Nurse Practitioner at three sites (Market Harborough, Melton Mowbray and the new Blaby site) supported by GPs operating from three sites (Oakham and Lutterworth at weekends and Oadby seven days per week).
10. Proposals for change prior to public engagement
Please note that the details set out in this section relate to the proposals for change based on initial clinical and patient involvement and formed the basis of public engagement in June and July 2018.
The Contract
71 The commissioning of two separate primary-care based services has led to confusion and access problems for patients. The nurse practitioner service and GP service do not work as a cohesive team across the CCG area due to the contracting arrangements. Both services offer different opening hours and access routes leading to inequity of service across the CCG and confusion for patients. The CCG plans to procure a single Extended Primary Care service to replace the current two contracts from 1 April 2019. The model for this contract will be subject to further public and stakeholder engagement and the findings used to inform any future service specification.
A New Site
72 There are services currently provided in four of the six CCG localities. North Blaby has no locality based service. To address the equality of access issues across the CCG’s significant geography, the CCG has proposed a locality based solution to service provision with the inclusion of a new sixth site in the North Blaby locality.
73 This strategy wold not only improve access for patients and improve care options closer to home, it would also strengthen the direction of travel towards a locality-based solution for key elements of all community services in the future for ELR. If agreed, the future location of this service would be decided with engagement with the public.
Opening Hours & Access Routes
74 Opening hours vary across both current services. To address the resultant inequalities of access across the CCG, where possible and where demand is evident, opening hours we plan to ensure consistency across all sites. The proposed opening hours are different to those currently in place. The CCG plans to engage with the public on potential changes to opening hours during the week and at weekends and on Bank Holidays.
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A Single EPC Primary Care Team
75 The bringing together of both services offers an opportunity to commission and deliver the staffing model as a single, primary care multi-disciplinary team. The staffing model will also be discussed with patients.
Appropriate Signposting & Booking
76 As mandated by the GP5YFV, out-of-hours primary care services are not just about meeting urgent care needs, but also about providing some elements of on-the-day care to patients who find it difficult to travel to their practice in core hours. The ELR direct booking offer (currently being piloted) will go live for all ELR patients on the 1 September 2018. The key learning from this service development were the complexities associated with balancing access to an additional service with the need to ensure clinical outcomes were not compromised as a result.
77 Appropriate triage has been a key part of the patient pathway booking into out-of- hours services. Appreciating the benefits to patients of access to all parts of the urgent care system, being booked into a service which is not a patient’s own GP for appointments which are likely to lead to complex diagnostic, 2 week wait or secondary care referrals adds inherit risk into our current system. This is also true for patients who require clinical support with a long term or complex condition where continuity of care directly contributes to the likelihood of a patient remaining at home.
78 Triage also enables patients to access other more appropriate services (e.g. pharmacists, emergency social care services), quickly and at the first point of contact.
79 To that end, it is proposed that an element of clinical/appropriate triage is introduced to supplement the current service model to improve outcomes for our most complex patients. This concept is aligned with AA which aims to improve access for complex patients to their own GP. A two tariff model within the contract would enable both types of activity to be accurately recorded and funded.
80 The proposed service structure is summarised in Figure 13:
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Figure 13 – Proposed ELR CCG Extended Primary Care Delivery Model
Site Location Weekday Opening Weekend and Hours Bank Holiday Opening Hours Oadby Oadby Walk-in 8am – 9pm 8am – 8pm Centre Melton Mowbray Melton Hospital 6.30pm – 9pm 9am – 5pm
Oakham Rutland Memorial 6.30pm – 9pm 9am – 5pm Hospital Market St Luke’s Hospital 6.30pm – 9pm 9am – 5pm Harborough Lutterworth Feilding Palmer In-hours care via GP 9am – 5pm Hospital practice (as now). No evening service (as now)
North Blaby TBC 6.30pm – 9pm 9am – 5pm
11. Clinical engagement
81. ELR CCG is a clinically led organisation and our GP Board members have played an active part in the development of the service model. All practices have also had opportunities to input into the service model to ensure it works for both patients but also to support General Practice across the CCG, continuing to improve access to services for patients.
82. The development of the service specification has been led by an expert clinical reference panel. The clinicians involved in this process are not General Practitioners practising within Leicester, Leicestershire or Rutland or employees of any organisation able to bid for this procurement.
12. Health Overview and Scrutiny
83. The CCG’s proposals and plans for public engagement were presented to the Leicestershire Health Overview and Scrutiny committee on 30 May 2018 and Rutland Health Overview and Scrutiny Panel on 26 June 2018. There was support for the proposals and acknowledgement of the CCG’s plans to carry out public engagement.
The minutes of the meetings can be found here:
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Leicestershire Health Overview and Scrutiny http://politics.leics.gov.uk/documents/g5239/Printed%20minutes%20Wednesday%2030-May- 2018%2014.00%20Health%20Overview%20and%20Scrutiny%20Committee.pdf?T=1
Rutland Health Overview and Scrutiny https://rutlandcounty.moderngov.co.uk/documents/g1899/Public%20minutes%2028th-Jun- 2018%2019.00%20Adults%20and%20Health%20Scrutiny%20Panel.pdf?T=11
The Chairs of both HOSCs have received a verbal update from the CCG since the completion of the public engagement and a copy of the engagement report. Both have have written to the CCG to confirm their support.
13. Listening to the public
84.ELR CCG is committed to meeting our statutory duties for public and patient involvement and to listening to the views of the public to enable us to implement plans which ensure clinically appropriate, high quality and affordable care provision for individuals as close to home as possible.
85.This section details public involvement in development of our proposals, the process we have followed in engaging with the public and the feedback we have received.
Duty to involve – legal responsibilities
86.The law requires NHS bodies to involve members of the public before making decisions on changes to health services. For CCGs section 14Z2 of the NHS Act 2006 applies and requires the CCG to“make arrangements to secure that individuals to whom the services are being or may be provided are involved (whether by being consulted or provided with information or in other ways): (a) in the planning of the commissioning arrangements by the group, (b) in the development and consideration of proposals by the group for changes in the commissioning arrangements where the implementation of the proposals would have an impact on the manner in which the services are delivered to the individuals or the range of health services available to them, and (c) in decisions of the group affecting the operation of the commissioning arrangements where the implementation of the decisions would (if made) have such an impact.”
87.The CCG considered its legal duties in light of the proposals for change and designed an engagement process in line with procurement timelines to enable patients and stakeholders to be involved in development of a future model and for patients, public and stakeholders to contribute their views on the resulting proposals. The engagement was undertaken via a mixture of online, hard copy and face-to-face engagement..
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88. The CCGs also have legal duties under the Equalities Act 2010. These duties and how we have adhered to them are set out in Appendix B2, Equality Impact Assessment.
14. Overview of engagement process
89. The aim of the process was to ensure the CCG understands patient and stakeholder views influenced the future delivery of services and that the future service specification fully meets local needs.
90. The process followed is summarised below:
Phase One –discussions with the CCG’s GP localities, Patient Participation Group Network, Healthwatch Rutland and Healthwatch Leicester and Leicestershire to develop and seek feedback and views on proposals and where appropriate, engagement plan and methodology.
Phase Two – public facing engagement document and survey, use of listening booth, discussions at existing PPG and patient locality groups and engagement with hard to reach groups to ensure we understand the views of those covered by the nine protected characteristics of the Equality Act 2010. Briefings provided for key stakeholders. The views of neighbouring CCGs and key Leicester, Leicestershire and Rutland urgent care forums will also be sought. Engagement will be promoted via the media and social media and via existing networks. Public meetings in key locations.
Phase Three – analysis of engagement used to inform final model and development of service specification. Review of analysis to consider whether the findings of the engagement and any associated changes to the model require further engagement and/or consultation.
Engagement Phase 1 – developing our proposals
91. In developing the proposals for change the CCG:
held discussions with the CCG’s Patient Participation Group Network (which brings together the Chairs and Deputy Chairs of PPGs from across ELR) involved Healthwatch Rutland (who have also provided a link to Healthwatch Leicester and Leicestershire) as an active member of the working group who have developed the model reviewed patient feedback regarding current use of services reviewed the findings of previous engagement and consultation from 2012- 2014
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used the listening booth at Oadby Urgent Care Centre and undertaken surveys at Oakham, Melton Mowbray and Market Harborough to understand views on current services
92. Key themes arising from this work were the need for any model to: keep our current Minor Injury Unit access sites (Melton Mowbray, Oakham & Market Harborough) keep and build on the links with 111 services invest in primary care simplify services and reduce confusion clarify ‘in-hours’ and ‘out-of-hours’ improve communication with patients with a focus on what services are available
Phase Two – seeking views on proposals
93. The CCG ran a wider public engagement process from 20 June to 24 July 2018 which consisted of stakeholder, patient and public engagement.
94. The methods employed are summarised below:
A document outlining the CCG’s plans was made available on the website and in hard copy on request Details of the plans were posted on a dedicated webpage on the CCG’s website A questionnaire was made available on the CCG’s website and hard copies were distributed during face to face engagement and were also available on request from the CCG Face to face conversations took place at six engagement opportunities across East Leicestershire and Rutland using the CCG’s ‘listening booth’ Two public events were held – one in Blaby and one in Oakham The opportunity for the public to share their views was promoted though communication channels including stakeholder briefings, website, media and social media
Phase Three – engagement response, analysis and consideration of findings
Response
95. The CCG received a good response to the engagement with a total of 775 survey responses and 277 public contacts.
96. While the number of respondents is not statistically significant (as is the case with the majority of public engagement activities), the CCG was pleased to note responses from a good geographical spread across East Leicestershire and Rutland.
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97. Equalities questions enabled the CCG to determine the reach of the survey to those with protected characteristics (pages 40 – 43, Appendix A1).
Analysis
98. The CCG commissioned independent analysis of the engagement from Arden and GEM Commissioning Support Unit. The analysis provided a thematic review of feedback received during the engagement period.The analysis of the engagement findings is attached at Appendix A1.99. The findings highlighted support for some aspects of the proposals along with some concerns, particularly in relation to the proposed change in opening hours at weekends and on Bank Holidays.
100. The key considerations for the CCG arising from the analysis are as follows (p.5 and 6, Appendix A1):
Opening hours
While most respondents agreed to the logic behind removing the overlap in the opening hours and felt it would have no impact on them, the written comments show that there is concern from some respondents and these need to be considered.
Weekend and Bank Holiday access after 5pm is also important to a sizeable majority of respondents (60%)
Locating Urgent Care Centre (UCC) in Blaby
Residents are likely to use an urgent care centre sited in Blaby. However commissioners will need to consider in more detail where in Blaby they site the new UCC.
Signposting to alternative services
Respondents understand the importance of being seen by the most appropriate healthcare professional/service. However, there were concerns about being signposted elsewhere if attending a UCC. Concerns centres on:
Transport Older people and children Distance to travel Appropriate triage Time delay to treatment Concern that people may be referred on unnecessarily.
In addition, many respondents were particularly concerned about the impact on older patients and children. While others felt that if they had made the effort to attend a UCC, which is where they should be seen and possibly treated.
Future of out of hours services
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Commissioners will need to allay respondents' anxiety with regard to their perceived loss of urgent care services. This was particularly evident among residents of Lutterworth but was also mentioned in other areas. Their concern highlights the importance of ensuring robust communication around urgent care services so that residents are clear about what is available, when and where.
When planning the next steps for urgent care, commissioners could also consider expanding what is available to include, for example, mental health, sexual health services and home visits for older people.
101. Additional independent analysis was also commissioned from Leicestershire County Council to consider the findings in respect of proposals for a new site in the Blaby District area by postcode. This analysis is attached at Appendix A2.
15 Consideration of engagement findings
102. The CCG convened an Engagement Review Panel with representatives from the project group including Healthwatch Rutland (also on behalf of Healthwatch Leicester and Leicestershire), a practice manager, GP, commissioning representatives, communications and engagement lead and corporate governance lead.
103. The group considered the engagement findings (summary report and appendices containing all verbatim comments received in response to the survey questions) via a mixture of a face to face meeting and virtual discussion. The views of the group were then used to shape recommended next steps in relation to the proposed change. This included identification of any further requirements for engagement and/or consultation. Figure 15 summarises the CCG’s response to the engagement findings taking into consideration the views of the panel:
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Paper I ELR CCG Governing Body meeting 11 September 2018 Figure 15 - Summary of Response to Engagement Findings Proposed change Key considerations Response/next steps Change to opening hours at 46.93% of respondents felt there would be no No change to weekend and Bank Holiday weekends and on Bank impact on them; however, 38.69% of respondents opening hours at existing Urgent Care Holidays from 9am to 7pm felt the impact on them would be negative. In free Centres in Melton Mowbray, Market to 9am to 5pm text responses, concerns were expressed which Harborough and Oakham (so remaining included: open 9am to 7pm) as there is no o Concerns about urgent care needs arising alternative service available. outside the proposed hours o Further travel necessitated by reduced No change to weekend and Bank Holiday opening hours opening hours at the Urgent Care Centre o Growing demands on healthcare impacting in Oadby (remaining open 8 to 8pm as per on reduced opening hours original proposals). 63.1% of respondents felt it was very important for them to have access to an urgent care centre after Additional services to be provided in 5pm on bank holidays and at weekends. In the Lutterworth at weekends and on Bank written comments people expressed views Holidays (from the current appointment including: only out of hours GP available from 10am- o concern that if the service was reduced at 4pm to an Urgent Care Centre with walk- bank holidays and weekends it would lead in services and appointments available to further pressure on A and E services. between 9am and 7pm). o weekend and bank holiday services are viewed to be extremely important to those Additional service in Blaby District with an with young children and the elderly, Urgent Care Centre open at weekends o patients need to have confidence that urgent and Bank Holidays between 9am and care services were there when they needed 7pm (also see Blaby section below). them
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Change weekday Urgent The majority of respondents agreed that opening Proceed with change to improve Care Centre opening hours urgent care centres (apart from Oadby) on weekday continuity of care with people being seen from 5pm to 9pm to 6.30pm evenings from 6.30pm to 9pm would avoid the by own GP practice, to enable better use to 9pm to remove overlap in existing confusion (39.10% indicated that they of NHS resource and to reduce confusion opening times with GP agreed and 26.84% of respondents strongly over where people should go ‘in hours’ practices. agreed) and ‘out of hours’ People were asked if the impact on removing the overlap in opening hours would have a positive, CCG will invest in improving access to Invest in primary care to negative or no impact on them. 50.33% of people urgent/on the day appointments at all 30 ensure better access to on- said this would have no impact on them, 30.7% of ELR GP practices from April 2019 (to the-day appointments when people said it would have a negative impact on coincide with change in Urgent Care GP practices are open, them Centre hours) with a focus on access which includes the option People were given the opportunity to express their between 5pm and 6.30pm as part of the for people to book out-of- views on removing the overlap in hours in written delivery of Acute Access and GMS hours appointments at comments and in doing so 391 people shared their contract compliance. urgent care centres via their feedback. Some concerns were expressed which practice included: From April 2019, the CCG will require all By removing the overlap of opening hours practices to remain open until 6.30pm and some patients felt they would have less to ensure services to address patients’ choice in where to go on-the-day needs are available until Access was a concern for many patients with 6.30pm. some highlighting that their GP practice cannot see any patient after 5pm In the lead-up to the service change in Respondents felt that travel time and April 2019, the CCG will continue to work distance should be considered with patients and practices to ensure Some people felt a decision to remove the concerns regarding access are used to overlap of opening hours would mean a loss inform plans for urgent/on the day access of service during GP practice opening hours. This will include use of the listening booth, Confidence in healthcare professionals at an review of patient satisfaction/ experience 31
Urgent Care centre as opposed to a GP data and engagement with GP Practice practice was highlighted Patient Participation Groups. Some people took the opportunity to explain that although they welcomed the overlap in From April 2019, the CCG will monitor hours they felt that provision needed to be access to appointments/services at GP put in place to meet patient needs. practices with a particular focus on provision between 5pm-6.30pm
Opening an additional When asked how likely respondents were to use an Proceed with opening new service in Urgent Care Centre to urgent care centre in the Blaby district 44.43% of Blaby District with further public provide urgent care people said they were likely to some extent to use involvement to determine final location services in the Blaby District an urgent care centre in Blaby. 43.91% of and taking into consideration those things area on weekday evenings, respondents indicated they were not likely to use people have told us are important at weekends and on bank the centre holidays Additional analysis of results by postcode shows Clear communication of the fact this is an support of Blaby residents for a service within Blaby additional service and that the CCG will District continue to commission services at When asked to consider factors that would be existing sites in Oadby, Market important to them about the location of the urgent Harborough, Melton and Oakham to care centre in the Blaby district area, 42.8% (the ensure access to local services is highest number of respondents) felt that parking maintained was very important. More detail on other factors is available in the main report Additional services to be provided in People were asked if there was anything else they Lutterworth at weekends and on Bank considered to be important in the location of a Holidays (from the current appointment centre in the Blaby district area. This question was only out of hours GP available from 10am- answered by 427 respondents: 4pm to an Urgent Care Centre with walk- o 108 respondents highlighted what was in services and appointments available important to them when considering the between 9am and 7pm). location of a service in the Blaby district area (please see detail in the main 32
section of the report) o 155 respondents made other comments which included distance to travel; there are comments from respondents living outside Blaby district who remark on the relevance to them of this question, and comments relating to Lutterworth, Market Harborough and Oakham (please see the full detail in the questionnaire section of the report) o 101 respondents suggested a single location for an urgent care centre to be in the Blaby district area
Integrating two separate 68.96% of people strongly agreed that being seen Staffing model will be an integrated services (Out of Hours GP by the most appropriate healthcare professional in primary care team with GPs available and Nurse-led Urgent Care the right place for their needs was important to where they are currently situated in Service) to create one them. The second highest score was those who Oadby, Lutterworth and Oakham and primary care team agreed (27.53%) nurse-led services (as now) available in delivering a combined Most people indicated their support to being Market Harborough and Melton. An urgent care service signposted to another service or booked an additional nurse-led service will be appointment somewhere else if this was the most available in the Blaby district area. This Introducing clinical triage for appropriate way to treat their needs (29.73% means an increase overall in access to patients walking in to our strongly agreed and 40.16% agreed) both GPs and nurses across East urgent care centres to In the written comments to the question on Leicestershire and Rutland. improve outcomes for our signposting, the reasons some people gave for most complex patients and agreeing with being signposted appropriately was to help people access the they felt it would lead to a more efficient urgent care Patients attending a nurse-led centre will right care for their needs. service and better use of resources. However, the be able to see a GP at one of the other This could be signposting to majority of people indicated that they would want centres if the Advanced Nurse Practitioner 33 a pharmacist, booking an certain possible outcomes of signposting on to be feels this is clinically necessary. ANP will appointment with their GP considered. These included: also be able to contact a GP for clinical or referring to another part o Transport advice. of the health system o Older people and children o Distance to travel Clinical triage will be introduced as o Appropriate triage proposed with a clear focus on ensuring o Time delay to treatment every patient is treated in the right place o Concern that people may be referred on for their needs as quickly as possible. For unnecessarily. example, this could mean calling an ambulance, priority treatment within the The comments on signposting also gave reasons why Urgent Care Centre, being seen in order people did not agree with a signposting system, most of clinical need at the Urgent Care Centre, people making these comments felt that if they had booked an appointment with own GP chosen to attend an urgent care service, they expected practice if need is not urgent or referred to to be treated there. a pharmacy for over the counter medicine. All patients with an urgent need will continue to be treated as now.
To encourage appropriate use of services and further engagement/awareness raising with users of the Urgent Care Services and the public in lead up to service change and beyond.
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Paper I ELR CCG Governing Body meeting 11 September 2018 104. A paper detailing a revised model based on the findings of the public engagement, was considered at the CCG’s Integrated Governance Committee on 5th September 2018 along with the engagement analysis report, including full verbatim comments from the public. The Committee supported the proposals, noting the findings of the engagement on which they were based.
105. A summary of the recommended changes along with the engagement findings was presented to the CCG’s PPG Network meeting on 4 September 2018 where further consideration of public feedback and the proposed changes took place.
106. At this event, feedback was offered on both the engagement process and the revised, final service model.
107. Questions were asked about the engagement process focussing on the timescales used, the validity of the assessment of the response being “good” and how the CCG has used both the quantitative and the qualitative data to recommend changes to the proposed service model. The CCG’s responses to these queries were well received and attendees were assured by the CCG’s use of the qualitative information in particular to understand what would and would not work for patients.
108. The event attendees were supportive of the revised proposed service model. The potential service gap between 5pm and 6.30pm was addressed and the CCG explained the strategies associated with resolving these for EPC mobilisation (e.g. Acute Access) by 1 April 2019. The attendees also offered feedback to the CCG on the two potential sites for the new Blaby Urgent Care Centre and additional local intelligence to consider when making the final decision.
16 Revisiting the Equalities Impact Assessment
109. As part of the ongoing review of the proposals the original Equality Impact Assessment and Quality Impact Assessment was reviewed during August 2018. The initial assessments were completed during June 2018 (Appendix B1).
110. As a result of the patient engagement exercise and feedback received, together with comments received through the internal working party convened to develop the proposal and associated specification, the EIA and QIA were adjusted to take into account these comments. The assessments have been enhanced through additional focus within the age and deprivation sections and are found in Appendix B2.
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17 Final Proposed Model Following Public Engagement
The Contract
111. The commissioning of two separate primary-care based services has led to confusion and access problems for patients. The nurse practitioner service and GP service do not work as a cohesive team across the CCG area due to the contracting arrangements. Both services offer different opening hours and access routes leading to inequity of service across the CCG and confusion for patients. The CCG has therefore made the decision to procure a single Extended Primary Care service to replace the current two contracts from 1 April 2019. The model for this contract has been subject to public and stakeholder engagement and the findings have been used to shape the service specification.
A New Site
112. As referenced above the residents of the CCG localities of North Blaby and South Blaby & Lutterworth have supported the proposal for an additional site in the Blaby area. In practical terms there are four options to consider both in terms of pre-existing health premises or District Council premises suggested by Blaby DC. Feedback from the public engagement, both from completed questionnaires and from Blaby District Council has identified:
A large practice in Narborough; Narborough Health Centre, Thornton Drive, Narborough; Blaby District Council Offices, Desford Road, Narborough; Enderby Leisure Centre, Mill Lane, Enderby.
The engagement asked for views on what the public thought were key priorities when considering the new Blaby area site.
Figure 16 appraises the four options available for the new site.
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Paper I ELR CCG Governing Body meeting 11 September 2018 Figure 16 – New Site Options Appraisal
Narborough Narborough HC Blaby DC Offices Enderby Leisure Centre Practice Parking c900m2 735m2 plus limited on street 1,026m2 public car park 3,915m2 public car park parking Pharmacy On site - Brennans Brennans at The Limes (200m) Brennans at The Limes Enderby Pharmacy (350m) proximity Open 08:00 – 18:00 Open 08:00 – 18:00 (M-F) 13:00 (700m) Open 09:00 – 18:30 (M-F) (M-F) 13:00 (Sat) (Sat) Open 08:00 – 18:00 (M-F) 16:00 (Sat) The Village Pharmacy (90m) 13:00 (Sat) The Village Pharmacy Open 08:30 – 18:00 (M-F) 13:00 The Village Pharmacy (1,800m) Open 08:30 – (Sat) (550m) Open 08:30 – 18:00 18:00 (M-F) 13:00 (Sat) (M-F) 13:00 (Sat) Suitability of Current healthcare Current healthcare premises – no Not open or available out of Easily accessible and well building – premises – no access access issues hours known locally patients issues Suitability of Current healthcare Current healthcare premises still Not open or available out of Rooms available and building – clinical premises – CQC in use hours compliant. Development perspective identified as fit for opportunities for further purpose enhancements Public Transport Arrivabus 50 Arrivabus 50 Arrivabus 50 Arrivabus 50 Hinckleybus X84 Hinckleybus X84 Hinckleybus X84 Availability Could be open as Could be open as required. Closes after 18:00 and not Opening hours exceed required. open weekends those required. Other factors Lease arrangements Current building landlord needs to Lease arrangements and Lease arrangements and and rent payments be identified (thought to be LPT) rent payments would need rent payments would need would need agreement with BDC agreement with BDC agreement with TLMC
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Paper I ELR CCG Governing Body meeting 11 September 2018 113. Of the above four options the Blaby District Council offices can be discounted. This is principally due to availability as the Council building is closed during the hours required both in the evenings and at weekends. Of the two health premises, The large practice in Narborough did not volunteer their premises during a locality meeting where this was discussed. The practice has, however, been included the option appraisal for indicative purposes. Narborough Health Centre is still used during the day for clinics and, out of hours, would be an isolated location for staff to be based in. Enderby Leisure Centre offers a suitable environment that could be made compliant for patient services. The availability of Enderby Leisure Centre, however, cannot be confirmed prior to the end of September due to Blaby District Council being within a procurement exercise for their leisure services.
114. Whilst it is possible to rule out both Blaby DC offices (closed during the required hours) and the large Narborough practice (practice unwilling to participate at this point) it is not possible to recommend a preferred site before October. However, the two sites available are: Narborough Health Centre is a current health facility but is isolated out of hours. Enderby Leisure Centre is not a health facility currently but Blaby DC have a vision for daytime health promotion services (weight management, diabetes, smoking cessation, etc.) and are keen to encompass the urgent care centre into their plans. Blaby DC are currently in the process of re-procuring their Leisure Services and are keen to build this into their specification.
115. Further analysis and work with potential partners is required for both of these sites, along with further public engagement prior to any final decision.
Opening Hours & Access Routes
116. Opening hours vary across both current services. To address the resultant inequalities of access across the CCG, where possible and where demand is evident, we plan to ensure consistency of opening hours across all sites. The proposed opening hours are different to those currently in place. The CCG has engaged with the public on what the right opening hours will be.
117. The feedback from public engagement, and subsequent views of the Engagement Review Panel, can be examined in two parts:
Adjustment to the opening times during weekdays such that the Urgent Care Centres open at 6.30pm removing the 5pm to 6.30pm overlap. The CCG has carefully considered public views on this change and believes concerns raised about access to GP practices during these times will be addressed via investment into improved ‘in hours’ under Acute Access proposals which will require all Page 38 of 42
practices to remain open until 6.30pm and to ensure services are available to address the needs of patients until this time. The CCG proposes therefore to continue with this change.
Adjustment of weekend and bank holiday opening from 7pm closure to 5pm closure. The CCG has carefully considered feedback from the public through the engagement which indicated the potential for negative impact on patients and service users if this change were to be enacted. Given the level of public concern and the lack of other alternative services in localities during these times, the CCG is, therefore, proposing that the current opening hours (9am to 7pm) at Market Harborough, Melton Mowbray and Oakham remain unchanged. The current arrangements will also remain unchanged in Oadby. The Urgent Care Centre in Lutterworth and the new site in the Blaby area will adopt the standardised opening times of 9am to 7pm at weekends and on Bank Holidays
A Single EPC Primary Care Team
118. The bringing together of both services offers an opportunity to commission and deliver the staffing model as a single, primary care multi-disciplinary team. The staffing model has been discussed with patients and service users through the public engagement process. While most people were supportive of seeing the most appropriate professional for their needs, concerns were expressed about perceived reduction in access to GPs or a ‘downgrading’ of the service. The proposed staffing changes integrate teams into one service and will not reduce change access to GPs or nurses (who will remain based at current sites). The CCG therefore proposes to proceed with this change. .
Appropriate Signposting & Booking
119. As mandated by the GP5YFV, out-of-hours primary care services are not just about meeting urgent care needs, but also about providing some elements of on-the-day care to patients who find it difficult to travel to their practice in core hours. The ELR direct booking offer (piloted during June and July 2018) will go live for all ELR patients on the 1 October 2018. The key learning from this service development were:
The complexities associated with balancing access to an additional service with the need to ensure clinical outcomes were not compromised as a result; The reticence on the part of patients to utilise a service run by nursing staff; The reluctance of patents to travel; Difficulties with the tested booking system.
The above have been built into the interim service from 1 September and also into the specification for the proposed contract from 1 April 2019. Specifically, the out of hours
39 appointments will be available with GPs, the booking system will be via telephone and the GP locations will be used for the out of hours appointments.
120. Appropriate triage has been a key part of the patient pathway booking into out-of- hours services. Appreciating the benefits to patients of access to all parts of the urgent care system, being booked into a service which is not a patient’s own GP for appointments which are likely to lead to complex diagnostic, two week wait or secondary care referrals adds inherit risk into our current system. This is also true for patients who require clinical support with a long term or complex condition where continuity of care directly contributes to the likelihood of a patient remaining at home. Triage will enable patients to be seen in order of clinical priority at the Urgent Care Centre they have accessed or to be referred to other more appropriate services (e.g. pharmacists, emergency social care services), quickly and at the first point of contact through appropriate, re-direction and appointment facilitation.
121. To that end, it is proposed that an element of clinical/appropriate triage is introduced as part of the new contract to supplement the current service model to improve outcomes for our most complex patients. This concept is aligned with AA which aims to improve access for complex patients to their own GP. A two tariff model within the contract would enable both types of activity to be accurately recorded and funded.
122. Triage/clinical assessment is particularly relevant to Oadby in-hours as early assessment and facilitated re-direction and signposting into their own practice where the presenting condition is best managed by their own GP. It is envisaged that this re- direction into general practice will be facilitated by the making of an appointment so the patient leaves with an outcome. Other potential signposting outcomes are escalation to higher levels of urgent care including ED, direction to pharmacy services and advice on general health and wellbeing. Out of hours will require similar signposting if the patient is inappropriate for the services offered within the UCC. However, the guiding principle is that the patient is seen and treated in order of clinical priority at the Urgent Care Centre they have accessed if this is appropriate for their needs, or re-directed and signposted to the most appropriate provider with, where possible, an appointment or directions and advice if this is the most appropriate outcome for their needs
40
The proposed service model is summarised in Figure 17.
Figure 17 – Proposed ELR CCG Extended Primary Care Delivery Model
Site Location Weekday Opening Weekend and Hours Bank Holiday Opening Hours Oadby Oadby Walk-in 8am – 9pm 8am – 8pm Centre Melton Mowbray Melton Hospital 6.30pm – 9pm 9am – 7pm
Oakham Rutland Memorial 6.30pm – 9pm 9am – 7pm Hospital Market St Luke’s Hospital 6.30pm – 9pm 9am – 7pm Harborough Lutterworth Feilding Palmer No evening service (as 9am – 7pm Hospital now)*
Blaby District TBC 6.30pm – 9pm 9am – 7pm
A weekday evening service has been considered for Lutterworth. Data analysis of local patient flow and demand is not currently sufficient to support the introduction of a service in Lutterworth. However, the CCG notes that the town is growing and that there may be a need for this service in the future.
Governance Plan
123. Subject to Governing Body approval, the procurement and governance plan to bring the service to market is as follows:
Sep 2018 Public Engagement Outcome GB approval Confidential final service specification GB approval Confidential final procurement papers GB approval
Nov 2018 Contract Award GB approval
41
Recommendations
124. The East Leicestershire and Rutland CCG Governing Body is requested to:
Note the proposed changes to the current service model and the findings of the public engagement on which they are based
Approve the direction of travel of the revised service model pending final approval at the Confidential Governing Body
Approve further public engagement to determine the site for the new sixth Urgent Care Centre
42
East Leicestershire and Rutland Clinical Commissioning Group
Urgent Care Engagement Report
August 2018
Urgent Care Engagement Report
August 2018
CSU Name: NHS Arden & GEM Commissioning Support Unit
Service lead Contact: Elise Barker Email Address: [email protected] Contact Telephone number: 07854 843 260
Arden GEM Contact Details: Andrea Clark [email protected] 07789 651 913
Version 11
Date 21 August 2018
Page | 2 NHS East Leicestershire and Rutland CCG Urgent Care Engagement Report 2018
1. Executive Summary:
1.1 Introduction
In 2014 NHS East Leicestershire and Rutland CCG consulted the public on changes to improve urgent care services in East Leicestershire and Rutland. Those changes, which received public support, were implemented in April 2015.
The CCG receives positive feedback about the services which offer a number of locality based services for patients for out of hours primary care and urgent care needs, with choices of care close to home.
The contracts put in place to support the model agreed after consultation are due to end in March 2019 and the CCG is keen to ensure that the services available to patients still meet public needs while providing high quality, cost effective care.
Following initial review work including conversations with patients, the CCG identified opportunities to enhance what is currently available with some investment and changes to the existing model of care.
In June and July 2018, NHS East Leicestershire and Rutland CCG undertook an engagement process with stakeholders, patients and the public to understand views on proposed changes.
1.2 The process
The engagement process ran from 20 June to 24 July 2018 and consisted of stakeholder, patient and public engagement. Engagement methods employed:
Communication channels including stakeholder briefings, website, media and a digital approach Survey - a questionnaire was made available on the website and hard copies were distributed during face to face engagement and also available on request. This resulted in the completion of 775 questionnaires Face to face conversations took place at six engagement opportunities using the ‘listening booth’ and two public events were held. This resulted in 277 patient and public contacts Plans were presented to the Leicestershire Health Overview and Scrutiny Committee and Rutland Health Overview and Scrutiny Committee.
1.3 Questionnaire response
775 people completed the questionnaire (Appendix A) between 20 June and 24 July 2018 (the number of respondents per question varies). The full details on answers to the questions are available in the main report:
Most respondents said they understood which service to use for their urgent care need (43.08% agreed and 39.82% strongly agreed) Over 98% of respondents had heard of NHS111 83.29% of respondents were aware they could access advice, and/or treatment from a healthcare professional at NHS111 The majority of respondents (59.30% agreed and 32.17% strongly agreed) were happy to see an alternative healthcare professional for their urgent care need if their own Practice was closed
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The majority of respondents agreed that opening urgent care centres (apart from Oadby where no change is proposed to opening hours) on weekday evenings from 6.30pm to 9pm would avoid the existing confusion (39.10% indicated that they agreed and 26.84% of respondents strongly agreed) People were asked if the impact on removing the overlap in opening hours would have a positive, negative or no impact on them. 50.33% of people said this would have no impact on them, 30.7% of people said it would have a negative impact on them People were given the opportunity to express their views on removing the overlap in hours in written comments and in doing so 391 people shared their feedback. Some concerns were expressed which included: o By removing the overlap of opening hours some patients felt they would have less choice in where to go o Access was a concern for many patients with some highlighting that their GP practice cannot see any patient after 5pm o Respondents felt that travel time and distance should be considered o Some people felt a decision to remove the overlap of opening hours would mean a loss of service o Confidence in healthcare professionals at a Urgent Care centre as opposed to a GP practice was highlighted o Although the overlap of hours was welcomed by some, it was felt that suitable alternative provision for urgent care needs to be in place.
Please see detail in the full section of the report.
If the opening hours were changed at bank holidays and weekends to between 9am and 5pm, 46.93% of respondents felt there would be no impact on them; however, 38.69% of respondents felt the impact on them would be negative. The opportunity was given for respondents to leave written comments. Although most people had said they felt they would experience no impact, the written comments relay some people’s concerns, these included: o Concerns about urgent care needs arising outside the proposed hours o Further travel necessitated by reduced opening hours o Growing demands on healthcare impacting on reduced opening hours 63.1% of respondents felt it was very important for them to have access to an urgent care centre after 5pm on bank holidays and at weekends. In the written comments people expressed views including concern that if the service was reduced at bank holidays and weekends it would lead to further pressure on A and E services. The comments indicate that weekend and bank holiday services are viewed to be extremely important to those with young children and the elderly, and that patients need to have confidence that urgent care services were there when they needed them When asked how likely respondents were to use an urgent care centre in the Blaby district 44.43% of people said they were likely to some extent to use an urgent care centre in Blaby. 43.91% of respondents indicated they were not likely to use the centre When asked to consider factors that would be important to them about the location of the urgent care centre in the Blaby district area, 42.8% (the highest number of respondents) felt that parking was very important. More detail on other factors is available in the main report People were asked if there was anything else they considered to be important in the location of a centre in the Blaby district area. This question was answered by 427 respondents: o 108 respondents highlighted what was important to them when considering the location of a service in the Blaby district area (please see detail in the main section of the report)
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o 155 respondents made other comments which included distance to travel; there are comments from respondents living outside Blaby district who remark on the relevance to them of this question, and comments relating to Lutterworth, Market Harborough and Oakham (please see the full detail in the questionnaire section of the report) o 101 respondents suggested a single location for an urgent care centre to be in the Blaby district area 68.96% of people strongly agreed that being seen by the most appropriate healthcare professional in the right place for their needs was important to them. The second highest score was those who agreed (27.53%) Most people indicated their support to being signposted to another service or booked an appointment somewhere else if this was the most appropriate way to treat their needs (29.73% strongly agreed and 40.16% agreed) In the written comments to the question on signposting, the reasons some people gave for agreeing with being signposted appropriately was they felt it would lead to a more efficient urgent care service and better use of resources. However, the majority of people indicated that they would want certain possible outcomes of signposting on to be considered. These included: o Transport o Older people and children o Distance to travel o Appropriate triage o Time delay to treatment o Concern that people may be referred on unnecessarily.
The comments on signposting also gave reasons why people did not agree with a signposting system, most people making these comments felt that if they had chosen to attend an urgent care service, they expected to be treated there. Full details are in the main section of the report.
When asked if there was anything respondents would like to be considered in plans for the future of out-of-hours services in East Leicestershire and Rutland, the following themes were apparent in the comments: o Appreciation of urgent care services and the on-going need for such services o Anxiety about a perceived loss of local urgent care centres, the most concern came from Lutterworth but other areas were also mentioned o The availability of GP appointments o The opening hours for urgent care services o Service provision to be considered as part of the urgent care service, such as mental health, sexual health services and home visits for the older people o The need for communication and publication of urgent care services.
Full details are given in the main section on questionnaire responses in the report.
1.4 Key points for consideration
The survey attracted a high number of respondents (775), suggesting a high level of local interest.
Opening hours
While most respondents agreed to the logic behind removing the overlap in the opening hours and felt it would have no impact on them, the written comments show that there is concern from some respondents and these need to be considered.
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Weekend and Bank Holiday access after 5pm is also important to a sizeable majority of respondents (60%)
Locating Urgent Care Centre (UCC) in Blaby
Residents are likely to use an urgent care centre sited in Blaby. However commissioners will need to consider in more detail where in Blaby they site the new UCC.
Signposting to alternative services
Respondents understand the importance of being seen by the most appropriate healthcare professional/service. However, there were concerns about being signposted elsewhere if attending a UCC. Concerns centres on:
Transport Older people and children Distance to travel Appropriate triage Time delay to treatment Concern that people may be referred on unnecessarily.
In addition, many respondents were particularly concerned about the impact on older patients and children. While others felt that if they had made the effort to attend a UCC, which is where they should be seen and possibly treated.
Future of out of hours services
Commissioners will need to allay respondents' anxiety with regard to their perceived loss of urgent care services. This was particularly evident among residents of Lutterworth but was also mentioned in other areas. Their concern highlights the importance of ensuring robust communication around urgent care services so that residents are clear about what is available, when and where.
When planning the next steps for urgent care, commissioners could also consider expanding what is available to include, for example, mental health, sexual health services and home visits for older people.
1.5 Recommendations
It is recommended that all feedback from the questionnaires, events and meetings is taken into consideration before a final decision is made. All supporting documents have been attached as appendices and include the additional comments made by patients, members of the public and voluntary groups throughout the engagement.
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2. Introduction
In 2014 NHS East Leicestershire and Rutland CCG consulted the public on changes to improve urgent care services in East Leicestershire and Rutland. Those changes, which received public support, were implemented in April 2015. The CCG received positive feedback about the services which offer a number of locality based services for patients for out of hours primary care and urgent care needs, with choices of care close to home.
The contracts put in place to support the model agreed after consultation are due to end in March 2019 and the CCG is keen to ensure that the services available to patients still meet public needs while providing high quality, cost effective care.
Following initial review work including conversations with patients, the CCG identified opportunities to enhance what is currently available with some investment and changes to the existing model of care.
In June and July 2018, NHS East Leicestershire and Rutland CCG undertook an engagement process with stakeholders, patients and the public to understand views on proposed changes.
2.1 Information to be explored during the engagement process
Following initial review work which included conversations with patients, it was identified that current urgent care services may benefit from enhancement via investment and changes to the existing model of service provision.
The CCG worked with representatives from GP practice Patient Participation Groups to understand what is important for our patients to help shape the proposals for change. An engagement process was then designed to enable the CCG to further understand the views of stakeholders, patients and the public on the following:
Procurement of a combined out of hours GP and urgent care service Some changes to opening hours and staffing models at existing services to reflect patient usage and need Introduction of clinical triage to ensure patients receive the right treatment quickly The opening of an additional site in one of the CCG localities to offer urgent care services where they don’t currently exist.
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3. The process
The engagement process consisted of stakeholder, patient and public engagement involving:
Communication channels via stakeholder briefings, website, media and a digital approach Survey - a questionnaire was made available on the website and hard copies were distributed during face to face engagement and were available in paper copy and other formats/languages on request from the CCG Face to face conversations took place with the use of the CCG’s listening booth at six locations across East Leicestershire and Rutland Two public events were held where participants could learn more about the proposals, ask questions and share their views Conversations with patient participation group members Stakeholder engagement included meetings with the Leicestershire Health Overview and Scrutiny Committee and Rutland Adults and Health Scrutiny Panel.
Details of the engagement activity are set out in the table below and throughout this section.
Feedback Number received Newspaper 4 newspaper articles articles and (Leicester Mercury, Melton Times, Rutland Times, Harborough Mail) patient responses Radio messages 1 (Rutland Radio) Emails 7 PPG comments Detailed in section 5.2 and meetings minutes External meeting Leicestershire - Wednesday 30 May 2018 minutes HOSC Rutland – Thursday 28 June 2018 Social media 66 on ELR CCG’s channels comments Drop-in session Detailed in section 5.1 verbal comments
Altogether, 31 GP practices in East Leicestershire and Rutland and 19 stakeholder organisations were invited to complete the survey and forwarded information regarding the engagement. This included community organisations representing the ‘nine protected characteristics’ outlined in equality law and ‘seldom heard’ groups.
3.1 Electronic mailings and distribution of letters/surveys
Audience and activity All stakeholders including groups representing the nine protected characteristics - (emailed a covering letter and link to survey to take part in the engagement (Appendix B) and Stakeholder toolkit (Appendix C) Details published on CCG website and social media sites (Facebook and Twitter). Press release issued to local news desks. Articles published in Leicester Mercury, Melton Times, Rutland Times, Harborough Mail. The story was also run in local broadcast media on Rutland Radio.
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3.2 Engagement activities and reach (meetings attended)
The Listening booth was used at six locations across East Leicestershire and Rutland Two public events held in Blaby and Rutland Over 277 contacts made across all events held.
Some attendees were also from the following groups and organisations:
Events/meetings attended Derbyshire Health United Healthwatch Leicester and Leicestershire Healthwatch Rutland Latham House Patient Reference Group LOROS Market Harborough and Bosworth Partnership Oakham Medical Practice
3.3 Face to face engagement
The Listening booth was used at six locations across East Leicestershire and Rutland: Uppingham Market, Melton Mowbray Market, Gates Garden Centre, Somerby, Lutterworth Market, Market Harborough Leisure Centre and Parklands Leisure Centre Oadby.
Two pubic information and engagement events took place during the engagement period, at Brockington College and VAR Rutland Community Hub.
In addition, information about the engagement was taken to meetings, discussed with PPG members and publicised on the CCG website.
Printed copies of the survey and supporting information were also made available at all events and meetings.
3.4 Media
One media release sent out publicising the engagement and offered interviews with the Clinical Vice-Chair, Dr Andy Ker - 20 July 2018: Patients asked to share views on out-of-hours healthcare services (Appendix D) This resulted in radio coverage on Rutland Radio on 21 July 2018 Local media coverage in Leicester Mercury, Melton Times, Rutland Times and Harborough Mail.
3.5 Websites
The CCG set up a dedicated webpage to publicise the engagement which received 1,286 page views and 1,094 unique page views. A second webpage detailing the press release was also set up which received 228 page views and 208 unique page views.
Throughout the five-week engagement period a graphic was also displayed on the homepage of the CCG website to signpost users to the main webpage and to encourage them to complete the survey.
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3.6 Social Media
A total of 12 facebook posts and 48 tweets were sent out by East Leicestershire and Rutland CCG during the engagement period 21,304 opportunities allowed for individuals to see tweets and 20,030 opportunities to see Facebook posts within this period 103 people clicked through to the webpage from Twitter 309 people clicked through to the webpage from Facebook.
During the engagement period, information was posted on Facebook at times that would enable people who may not access social media during normal working hours to share their views via the survey.
A digital communications toolkit was also produced and sent to all stakeholders to help them to promote the survey. The toolkit included a website article, localised social media graphics and suggested social media posts.
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4. Responses from organisations and other correspondence
A report on the proposed changes was shared with the Leicestershire Health Overview and Scrutiny Committee (30 May 2018) and Rutland Health Overview and Scrutiny Panel (28 June 2018).
The purpose of the report was to provide information about East Leicestershire and Rutland Clinical Commissioning Group’s (ELR CCG) plans to improve access to primary care and urgent care services for patients out of hours (evenings and weekends), and the associated procurement of a combined service for out of hours and urgent care, which is currently delivered as two separate services by different providers.
In this section, responses to the engagement are summarised. They include responses from Rutland County Council and Leicestershire County Council.
4.1 Meeting notes from Rutland Adults and Health Scrutiny Panel
The minutes of the discussion from the 28 June meeting can be viewed here: https://rutlandcounty.moderngov.co.uk/documents/g1899/Public%20minutes%2028th-Jun- 2018%2019.00%20Adults%20and%20Health%20Scrutiny%20Panel.pdf?T=11
The notes are set out below for ease of reference.
During discussion the following points were noted:
Patients were confused about what type of out of hours and urgent services were available and at what times The following changes to the service were being proposed: o That out of hours services would start at 6.30pm when GP surgery hours finished so that there was not an overlap as there was presently o That a mobile GP for the Rutland and Melton area which would provide a 24/7 Urgent Care Visiting Service and which could be accessed via 111, would be available o That there would be three points of access for a combined GP and nurse service. These would be; walk in at weekends and evenings, via 111 service or the GP practice could book you in National funding (the GP Five Year Forward View) would be used to ensure there was a greater level of access between 8am and 6.30pm Clinicians were supportive of the proposals as they felt they were the most pragmatic and integrated way of offering services Every patient who attended Oakham practice was coded and currently there were more people attending Oakham than going on to A & E 30% of the ELR patients attending Leicester Royal could have been seen in a primary care setting.
AGREED:
The Panel NOTED the plans for improved access to primary care and public engagement activity.
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4.2 Meeting notes from Leicestershire Health Overview and Scrutiny Committee
The minutes of the discussion from the 30 May meeting can be viewed here: http://politics.leics.gov.uk/documents/g5239/Printed%20minutes%20Wednesday%2030-May- 2018%2014.00%20Health%20Overview%20and%20Scrutiny%20Committee.pdf?T=1
The notes are set out below for ease of reference.
Arising from discussions the following points were noted:
The Committee endorsed the proposals particularly the procurement of a combined service for out of hours and urgent care ELRCCG reassured Members that County Councillors would be an important part of the engagement process and would be added to the list of consultees Members raised concerns regarding difficulties for patients in obtaining appointments at some GP Practices within 10 weeks which often lead to increased attendance at the out of hours service. Members asked that ELRCCG gave clear communication to GPs regarding the proposals and ensured that GP Practices adhere to the guidelines. It was noted that GP Practices could book patients into the out of hours service The timings for when GP Practices were open varied across the County and under the new proposals the timings would be standardised. All GP Practices would need to be open until 6:30pm under the new system There was a direct correlation between areas which did not have an out of hours service (such as Blaby and Rutland) and high attendance at Accident and Emergency Departments from patients who lived in those areas. Consideration was being given to a suitable venue for an out of hours service in Blaby district In response to a question regarding the closure of Fielding Palmer hospital in Lutterworth it was confirmed that there were no plans to move the out of hours service away from Fielding Palmer.
RESOLVED:
That the plans to improve access to primary care and urgent care services be supported.
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5. Responses from organisations and other correspondence
5.1 Meeting notes from Leicestershire Health Overview and Scrutiny Committee
A total of ten public opportunities to share views face to face took place during the engagement period.
Date & Time Venue Type 3 July 2018 (10am-12.30pm) Brockington College, Enderby Public Event 12 July 2018 (2pm-4.30pm) VAR, Rutland Community Hub Public Event 13 July 2018 (9am-1pm) Uppingham Market Listening Booth 17 July 2018 (9am-12pm) Melton Mowbray Market Listening Booth 18 July 2018 (12am-4pm) Gates Garden Centre, Somerby Listening Booth 19 July 2018 (9am-12pm) Lutterworth Market Listening Booth 20 July 2018 (9am-12pm) Market Harborough Leisure Listening Booth Centre 23 July 2018 (9am-11am) Parklands Leisure Centre Oadby Listening Booth
This resulted in 277 contacts with the public. The public meetings were attended by patients, members of the public, staff, and interested groups. All those who attended had the opportunity to fill out a questionnaire and take hard copies away. People spoken with at locations using the Listening Booth were given details of the proposals and had the opportunity to complete hard copy versions of the survey or were signposted to the online information and survey.
Blaby public event
The feedback from the meeting was:
It was felt that Blaby has a growing population and was the right choice for a new urgent care centre Existing healthcare buildings should be considered for the new urgent care centre as opposed to building a new site The current overlap of opening hours was unnecessary and needed reviewing Patients with complex needs should be seen by their own GP Standardised opening hours across all sites would provide more flexibility and better understanding of what services are offered where Patient would resent a service if they were turned away due to not being at the appropriate place for their health need.
A full list of all responses from this event is attached at Appendix E.
Rutland public event
The feedback from the meeting was:
Concern that it is currently difficult to get GP appointments in hours and if the opening hours of urgent care centres change would increase the pressure on A&E It was felt that 90% of appointments at Melton were used and should continue to be offered Some GP practices close earlier than 6:30pm leaving a gap in service More promotion required for the Rutland GP out of hours service Information should be clear without the use of jargon Concern over staffing the services.
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A full list of all responses from this event is attached at Appendix F.
Listening booth events
The feedback from face to face conversations with the listening booth was:
Current services provided at Oadby and Lutterworth hospital are very good Expand services and offer more beds at Fielding Palmer Hospital Health services should reflect the population numbers for each area Keep services local More promotion required to highlight which Urgent Care Services are available More information for patients living outside geographical areas.
5.2 Patient Participation Group (PPG) Meeting
A Patient Participation Group/Patient Reference Group network meeting took place on 1 June 2018 and the urgent care engagement was an agenda item. As part of the overall presentation the presenter posed two questions to the members:
1. What works now and what aspects of the current service do we need to keep/protect? 2. What does not work and what needs to change?
All attendees contributed to the discussion and the following feedback was recorded:
Areas to protect
The current Minor Injury Units in Melton, Rutland and Market Harborough The Melton model is an example of how a successful service should run The use of a single telephone number e.g. 111 is positive and reduces confusion The work with long term conditions should remain.
Areas to change and suggestions
More information required highlighting what services are available and where Allow more Urgent Care Centres to invest in diagnostic equipment e.g. x-ray Improve communications between all Urgent Care Centres e.g. when transferring x- ray results For the terms ‘in hours’ and ‘out of hours’ to be clarified to members of the public who may not be familiar with Urgent Care Centres To consider the Urgent Care needs for those areas where the population/housing is increasing To consider any previous pilot schemes that may have taken place with GP practices to improve weekend services.
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6. Responses from organisations and other correspondence
A total of 775 completed questionnaires were received. The survey also collected information from respondents for equality monitoring purposes.
Question 1
Thinking about the following statement: “I understand which service I should use if I have an urgent care need when my GP practice is closed”. Please indicate your level of agreement.
Answer Choices Responses Strongly agree 39.82% 305 Agree 43.08% 330 Neither agree nor disagree 5.61% 43 Disagree 9.01% 69 Strongly disagree 2.48% 19 Answered 766 Skipped 9
Thinking about the following statement: “I understand which service I should use if I have an urgent care need when my GP practice is closed”. Please indicate your level of agreement. 50.00% 40.00% 30.00% 20.00% Responses 10.00% 0.00% Strongly agree Agree Neither agree Disagree Strongly nor disagree disagree
43.08% agreed that they understand which service to use for their urgent care needs if their GP practice is closed. This was followed by the second highest result of (39.82%) strongly agreeing. Overall (9.01%) disagreed and (2.48%) strongly disagreed. Of the 766 respondents completing the survey, nine skipped this question.
Page | 15 NHS East Leicestershire and Rutland CCG Urgent Care Engagement Report 2018
Question 2
Have you heard of the NHS 111 service?
Answer Choices Responses Yes 98.19% 759 No 1.29% 10 Not sure 0.52% 4 Answered 773 Skipped 2
Have you heard of the NHS 111 service?
120.00%
100.00%
80.00%
60.00% Responses
40.00%
20.00%
0.00% Yes No Not sure
The majority of respondents (98.19%) stated that they have heard of the NHS 111 service compared to (1.29%) stating that they have not heard of this service. Some respondents (0.52%) were not sure and two respondents skipped this question.
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Question 3
If yes, did you know that when you call NHS 111, you are able to access advice and/or treatment from a GP or another healthcare professional?
Answer Choices Responses Yes 83.29% 643 No 10.75% 83 Not sure 5.96% 46 Answered 772 Skipped 3
If yes, did you know that when you call NHS 111, you are able to access advice and/or treatment from a GP or another healthcare professional? 90.00% 80.00% 70.00% 60.00% 50.00% 40.00% Responses 30.00% 20.00% 10.00% 0.00% Yes No Not sure
The majority of respondents (83.29%) were aware that they could access advice and /or treatment from a healthcare professional by calling NHS 111.However, 10.75% did not know this and a further 5.96% were not sure. This question was not answered by three respondents.
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Question 4
Thinking about the following statement: “If I need care when my GP practice is closed, I don’t mind which clinician (doctor or nurse) I see as long as the healthcare professional has the appropriate skills to treat my urgent care condition.” Please indicate your level of agreement.
Answer Choices Responses Strongly agree 59.30% 459 Agree 32.17% 249 Neither agree nor disagree 4.01% 31 Disagree 3.23% 25 Strongly disagree 1.29% 10 Answered 774 Skipped 1
70.00%
60.00%
50.00%
40.00%
30.00% Responses
20.00%
10.00%
0.00% Strongly agree Agree Neither agree Disagree Strongly nor disagree disagree
The majority of respondents (59.30%) strongly agreed with this statement followed by (32.17%) agreeing. Some respondents (3.23%) disagreed and (1.29%) strongly disagreed. This question was answered by 774 respondents of the 775 in total of which (4.01%) neither agree nor disagree.
Page | 18 NHS East Leicestershire and Rutland CCG Urgent Care Engagement Report 2018
Question 5
Patients tell us they’re confused about where to access out-of-hours appointments on weekday evenings when GP practices and urgent care centres are both open from 5pm to 6.30pm. We want to reduce confusion and make best use of NHS resources by removing this overlap of opening hours. Under our plans, urgent care centres (excluding Oadby Urgent Care Centre) would open on weekday evenings from 6.30pm to 9pm.
a) To what extent do you agree that this change would help to reduce confusion over where people should go for urgent care needs?
Answer Choices Responses Strongly agree 26.84% 208 Agree 39.10% 303 No opinion 8.39% 65 Disagree 15.10% 117 Strongly disagree 10.58% 82 Answered 775 Skipped 0
45.00%
40.00%
35.00%
30.00%
25.00%
20.00% Responses
15.00%
10.00%
5.00%
0.00% Strongly agree Agree No opinion Disagree Strongly disagree
This question was answered by all 775 respondents of which 39.10% of respondents agreed with this statement followed by 26.84% strongly agreeing. This question also recorded that (15.10%) disagreed and a further (10.58%) strongly disagreed. Some respondents (8.39%) did not have an opinion on this.
Page | 19 NHS East Leicestershire and Rutland CCG Urgent Care Engagement Report 2018
b) If we were to remove this overlap of opening hours on weekday evenings, what impact would this have on you?
Answer Choices Responses Positive impact 19.61% 150 No impact 50.33% 385 Negative impact 30.07% 230 Please give the reason for your answer. 391 Answered 765 Skipped 10
If we were to remove this overlap of opening hours on weekday evenings, what impact would this have on you? 60.00%
50.00%
40.00%
30.00% Responses 20.00%
10.00%
0.00% Positive impact No impact Negative impact
The majority of respondents (50.33%) stated that removing the overlap of opening hours would have no impact on them, the second highest result (30.07%) indicated that it would have a negative impact followed by (19.61%) confirming it would have a positive impact. This question was not answered by 10 respondents.
Page | 20 NHS East Leicestershire and Rutland CCG Urgent Care Engagement Report 2018
c) Please give the reason for your answer:
This question also allowed respondents to leave reasons for their answer and 391 respondents took this opportunity to share feedback. Please see below some of the concerns relayed in the comments:
By removing the overlap of opening hours it was felt that patients have less choice in where to go Access was a concern for many patients with some highlighting that their GP practice cannot see any patient after 5pm Travel time and the distance patients would need to travel should be considered The decision to remove the overlap of opening hours would result in a loss of service for many patients Confidence in healthcare professionals at an Urgent Care centre as opposed to a GP practice was highlighted Although removing the overlap of hours was welcomed by some, it was felt that suitable alternative provision for urgent care needs to be in place.
A full list of the responses to this question is attached at Appendix G.
Page | 21 NHS East Leicestershire and Rutland CCG Urgent Care Engagement Report 2018
Question 6
Our research shows that people are not regularly using our urgent care centres in Melton Mowbray, Market Harborough and Oakham between 5pm and 7pm at weekends and on bank holidays. This means that over one-third (36%) of available appointments are not being used across our sites between these hours. We are considering changing the opening hours at weekends and on bank holidays to 9am to 5pm to make services easier to navigate and make best use of NHS resources.
a) If the opening hours were to change in this way, what impact would this have on you?
Answer Choices Responses Positive impact 14.38% 110 No impact 46.93% 359 Negative impact 38.69% 296 Please give a reason for your answer. 427 Answered 765 Skipped 10
50.00%
45.00%
40.00%
35.00%
30.00%
25.00% Responses 20.00%
15.00%
10.00%
5.00%
0.00% Positive impact No impact Negative impact
46.93% felt that the change would have no impact on them, however the second highest figure of 38.69% felt it would have a negative impact compared to the 14.38% having a positive impact.
Page | 22 NHS East Leicestershire and Rutland CCG Urgent Care Engagement Report 2018
b) Please give the reason for your answer:
This question also allowed respondents to leave reasons for their answers which included the following:
As a result, patients would need to travel further at a time when they are in need of urgent care Patients could need urgent care at any time and should always be available despite time pressures/overlapping in opening times The travel time/distance for some patients would increase significantly, which at a time of requiring urgent care would be an issue More information is required on the times services run and how to access them With a growing demand of healthcare services, urgent care should be ‘more available’ not less.
A full list of the responses to this question is attached at Appendix H.
Page | 23 NHS East Leicestershire and Rutland CCG Urgent Care Engagement Report 2018
c) How important to you is having access to an urgent care service after 5pm at weekends and on bank holidays?
Answer Choices Responses Very important 63.13% 488 Important 24.45% 189 Slightly important 8.02% 62 Unimportant 1.81% 14 No opinion 2.59% 20 Please give the reason for your answer. 399 Answered 773 Skipped 2
How important to you is having access to an urgent care service after 5pm at weekends and on bank holidays? 70.00% 60.00% 50.00% 40.00%
30.00% Responses 20.00% 10.00% 0.00% Very Important Slightly Unimportant No opinion important important
The majority of respondents (63.13%) felt it was very important to have access to an urgent care service after 5pm at weekends and on bank holidays followed by (24.45%) stating it was important. Some respondents (8.02%) felt it was slightly important and (1.81%) felt it was unimportant. A further (2.59%) had no opinion and two respondents did not answer this question.
Page | 24 NHS East Leicestershire and Rutland CCG Urgent Care Engagement Report 2018
d) Please give the reason for your answer:
This question allowed respondents to leave reasons for their answers of which 399 comments were made. Please see insights into the comments below:
Urgent care services should always be available as an emergency could strike at any time If Urgent Care services reduced there would be more pressure on A&E services Urgent Care services are extremely important to those with young children and the elderly Patients should have confidence in health services, in particular at time of need.
A full list of the responses to this question is attached at Appendix I.
Page | 25 NHS East Leicestershire and Rutland CCG Urgent Care Engagement Report 2018
Question 7
Our research shows that there is significant demand for services in the Blaby district area when GP practices are closed. If we were to open an urgent care centre in the Blaby district area open on weekday evenings, at weekends and on bank holidays, how likely is it that you would use the service?
Answer Choices Responses Very likely 28.44% 217 Likely 15.99% 122 Not likely 43.91% 335 Not sure 11.66% 89 Answered 763 Skipped 12
50.00%
45.00%
40.00%
35.00%
30.00%
25.00% Responses 20.00%
15.00%
10.00%
5.00%
0.00% Very likely Likely Not likely Not sure
43.91% stated that they would not use an urgent care centre in the Blaby district compared to (28.44%) that would. A further (11.66%) were not sure and 12 people did not answer this question.
However, 28.44% of respondents said they were very likely to use an urgent care centre in the Blaby district and 15.99% said they were likely to use such a centre. Therefore, overall more people are likely to some extent to use an urgent care centre in the Blaby district area than not likely.
Page | 26 NHS East Leicestershire and Rutland CCG Urgent Care Engagement Report 2018
Question 8
Considering the following access factors, what would be important to you about the location of the urgent care centre in the Blaby district area:
Slightly Factor Very important Important important Not important No opinion Total Parking 42.82% 322 21.54% 162 4.79% 36 4.39% 33 26.46% 199 752 Accessible by public transport 23.31% 172 15.99% 118 10.57% 78 21.54% 159 28.59% 211 738 Service is provided from an existing healthcare facility (such as a GP practice) 17.74% 132 18.95% 141 8.74% 65 24.46% 182 30.11% 224 744 There is a pharmacy open at the same time nearby 44.21% 332 23.44% 176 5.46% 41 3.46% 26 23.44% 176 751 Skipped 18
The highest number of respondents per factor for this question varies as (42.82%) felt parking was very important, (28.59%) had no opinion on the matter of services being accessible by public transport, (30.11%) had no opinion on the matter of services provided from an existing healthcare facility and (44.21%) selected that it would be very important if there is a pharmacy open at the same time nearby. This question was not answered by 18 people. Question 9
Is there anything else you consider to be important in the location of a service in the Blaby district area?
This question was answered by 427 respondents.
124 respondents said No, they do not consider anything else to be important in the location of a service in the Blaby district area 40 respondents felt this question was not applicable to them 155 respondents made other comments (please see below) 108 respondents highlighted what was important to them when considering the location of a service in the Blaby district area (please see below).
Of the 155 other comments, the following areas were highlighted:
Distance
It is felt that the distance from the Blaby district area to other areas such as Lutterworth, Market Harborough, Oakham and Rutland is excessive and that it would not be an option for patients to travel this far. Further comments were also made that it would be easier to access services at the Kettering hospital, Rugby hospital and Loughborough urgent care centre as opposed to Blaby.
In favour of the proposal
Although the suggestion of a new urgent care centre in the Blaby district was welcomed some respondents highlighted concerns that this question should only be aimed at those residents living in the Blaby district as it was not relevant to others. However, respondents did agree in saying that if this proposal supported the people of Blaby then it would be seen as a good suggestion.
Other suggestions
A number of comments suggested that more beds should be available at the Fielding Palmer Hospital in Lutterworth and for this new service to be within the current hospital setting. This was seen as a more convenient location for others living in Lutterworth, Market Harborough, Oakham and Rutland.
Many respondents also highlighted that they were not sure where the Blaby district is and so could not comment on any new service in the area.
Of the 108 responses highlighting other areas of importance the following should be considered include:
To be an easy accessible site for all Using existing NHS buildings Good transport links to the new site An onsite pharmacy to collect prescriptions Specialist support for palliative and end of life patients Good disabled access Accessible to the majority from the centre of Blaby Be able to be seen quickly and for the service to have ample appointments Greater awareness and promotion of where the new service is based Suitably staffed Adequate car parking
Good signposting around Blaby to the new service Access for the ageing population of Blaby Longer opening hours Have a GP on site.
A full list of the 108 responses to this question is attached at Appendix J.
Page | 29 NHS East Leicestershire and Rutland CCG Urgent Care Engagement Report 2018
Question 10
If you have any suggestions as to where a new service in the Blaby district area should be located, please let us know here:
This question was answered by 353 respondents.
101 respondents suggested a single location for an urgent care centre to be located in the Blaby district area. Full details are at Appendix K 27 respondents suggested multiple locations in their answer. Full details are at Appendix K 80 respondents did not have any suggestions 57 respondents felt this question was not applicable to them 17 respondents were unsure respondents felt the service should not be in the Blaby district 28 respondents left other comments not necessarily suggesting a location (please see below).
The 28 other comments included:
For the new site to be accessible from the A426 for those residents living in Lutterworth Concerns as to why this service was proposed in the Blaby district as opposed to Lutterworth Concerns that residents of the Blaby district currently have access to the Leicester Royal Infirmary and so would not require additional services Concerns of cost to build/run a new service when there are current services available For any decision to be based on where there is a clear need for a new urgent care service as other areas may be in more need For the new site to have good transport links particularly by bus for those who cannot drive.
A further 41 respondents suggested an area in Lutterworth (including Lutterworth Health Centre and Fielding Palmer hospital). Comments indicated a concern that the urgent care service in Lutterworth would be removed due to the new urgent care service proposed in the Blaby district. Comments included:
Lutterworth is growing rapidly with more homes planned yet no additional health facilities Fielding Palmer hospital would be seen as the ideal location with good parking and close to a further two GP surgeries Fielding Palmer hospital due to its central location and currently provides a good out of hours service.
Page | 30 NHS East Leicestershire and Rutland CCG Urgent Care Engagement Report 2018
Question 11
Triage (assessment of a patient’s condition and needs) is widely used in the health system to support patients with complex needs and to ensure people access the right care at the right place.
a) Thinking about the following statement: “Being seen by the most appropriate healthcare professional in the right place for my needs is important to me.” Please indicate your level of agreement
Answer Choices Responses Strongly agree 68.96% 531 Agree 27.53% 212 Neither agree nor disagree 2.47% 19 Disagree 0.52% 4 Strongly disagree 0.52% 4 Answered 770 Skipped 5
80.00%
70.00%
60.00%
50.00%
40.00% Responses 30.00%
20.00%
10.00%
0.00% Strongly agree Agree Neither agree Disagree Strongly nor disagree disagree
The majority of respondents (68.96%) strongly agreed with this statement followed by (27.53%) agreeing and (2.47%) neither agreeing nor disagreeing. The number of respondents that disagreed and strongly disagreed were equal at (0.52%) for each. This question was not answered by five people.
Page | 31 NHS East Leicestershire and Rutland CCG Urgent Care Engagement Report 2018
b) Thinking about the following statement: “If I walked in for treatment at an urgent care centre, I would support being signposted to another service or booked an appointment somewhere else if this was the most appropriate way to treat my needs.” Please indicate your level of agreement
Answer Choices Responses Strongly agree 29.73% 228 Agree 40.16% 308 Neither agree nor disagree 13.56% 104 Disagree 11.21% 86 Strongly disagree 5.35% 41 Please give the reason for your answer. 333 Answered 767 Skipped 8
45.00%
40.00%
35.00%
30.00%
25.00%
20.00% Responses
15.00%
10.00%
5.00%
0.00% Strongly agree Agree Neither agree Disagree Strongly nor disagree disagree
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c) Please give the reason for your answer
In the comments written in response to this question the main reasons people gave for agreeing with the statement were that it would enable a more efficient urgent care service which allowed the best use of resources:
A more efficient urgent care service
It would relieve the pressure on the services This would help to make sure treatment was being given to urgent patients and other problems directed to the most suitable out of hours service If it is not appropriate to be treated at an urgent care centre, then it is only a waste of the patient and staff members’ time - as you will probably have to follow up another route of care after being seen if the result was inconclusive. I believe that insisting on being treated somewhere just because you are there (providing another service is reasonably accessible) is counter intuitive for both my own treatment and the pressures on the service provider. It goes without saying that if my condition requires more specific treatment I should go where that can be provided. Conversely, if I am bottlenecking a service with problems of a less serious or specialist nature that can be better dealt with elsewhere and would relieve pressure on the service, logic dictates that this also is the appropriate route to take.
Best use of resources
It stops abuse of the system, so if people walk in instead of getting a planned appointment with their GP they don’t get fast tracked I agree, to make the best use of NHS care Best use of resources plus better use of my time to be treated by the right service I would hope that if my ailment was minor enough to be dealt with by, say, a pharmacist, I would be signposted there freeing up healthcare professionals’ time, likewise if it was serious enough to be sent to the LRI, I would hope that would be signposted too.
Many people’s comments explained that their level of agreement/disagreement would depend on certain concerns they had being considering. These included; transport if signposted to another service or a booked appointment, appropriate triage, possible time delay to treatment, concern that people would be referred on unnecessarily.
Transport
People were concerned about how they would travel to an alternative service or booked appointment if they were signposted somewhere else. People were particularly concerned about the elderly and those with children. Distance to travel was also a concern. Please see an example of comments below:
Transport
I may need public transport to get there which may not be easy Depends entirely on location of alternative – no transport Do not strongly agree as transport is an issue and I would rather be able to use my LOCAL urgent care centre.
Page | 33 NHS East Leicestershire and Rutland CCG Urgent Care Engagement Report 2018
Older people and those with children
Depending on age of the patient this could prove difficult particularly if a longer journey already has been undertaken by public transport Travelling to another site would be inconvenient if I had brought my baby to a centre for care but for myself I wouldn’t mind If the suggested service is, indeed, the most appropriate it is hard to disagree. Age and mobility considerations are still important. If a patient presents at the urgent healthcare site with an urgent need, something needs to be in place to facilitate transfer Fine for people with cars and support. Perhaps not so easy for elderly or vulnerable people and those who are less mobile. Also I would want to be reassured that my needs were really best served elsewhere, rather than it just being cheaper to treat me elsewhere With small children it is hard to take them to different places if they are ill or in pain and wastes time; would rather be seen in one place.
Distance to travel
Depends how far away it was and how to get there It depends how far away this service is and how accessible for the service user as sometimes, when poorly, you go to be seen and get it wrong and sending them away further may not be the best thing for the patient.
Appropriate triage
Appropriate triage was a concern expressed in the written comments. Please see an example of the comments below:
As long as the person in charge of the triage was competent and fully qualified, I would have confidence in them assessing my situation and forwarding me on to the appropriate person Only if a qualified healthcare professional was involved in this decision As long as the person was suitably qualified to make that decision e.g. not the receptionist Triage effectiveness would need to be very closely monitored.
Time delay to treatment
As long as it was an appropriate service and that the waiting times were within a short period of time As long as I come to no harm by the delay. In principle, it is better to be seen by the appropriate service than to be seen quickly. As long as the delay is not detrimental As long as the 'signposting' service included booking an appointment, and as long as the booked appointment was appropriate and guaranteed to be timely. I would be happy for the Urgent Care Centre to book me in with my GP surgery on the next working day, for example.
Concern that people may be referred unnecessarily
It depends if I feel that I am just being got rid of because they are too busy It would depend on whether I agreed that the condition could wait. I’d be concerned that to keep the process running smoothly that referring a person on could be seen as a resolution to the service but not to the individual. This would need to be monitored!
Page | 34 NHS East Leicestershire and Rutland CCG Urgent Care Engagement Report 2018
I am happy to be referred on if it is genuinely for better treatment/service rather than just being fobbed off.
The written comments also tell us that some respondents are not in favour of a triage approach and expect to be seen at the urgent care centre if they have made a decision to attend:
I would not have gone to an urgent care centre if I didn't think it was necessary; I would have accessed another service/appointment. The patient should not be sent somewhere else but treated there I feel that the required staff should be in place in order for me to be treated first time, first place. Moving poorly, PST is not acceptable. I feel all sites should be staffed with a minimum of two clinicians. At least one, a prescriber to make each site safe and manageable. I also feel that we should utilise St Luke’s fantastic new x-ray machine at evenings and weekends. Depends on when you were given an appointment. If immediately, fine, and fine if in same location. But that’s not the suggestion here If I have made it to an urgent care centre that is where I want to be treated or seen, not sent to elsewhere Too complicated and frustrating. People want to be seen quickly not signposted on.
Full comments can be seen Appendix L.
Page | 35 NHS East Leicestershire and Rutland CCG Urgent Care Engagement Report 2018
Question 12
Is there anything you would like us to consider in our plans for the future of out-of-hours services in East Leicestershire and Rutland?
Answered 478 Skipped 297
In the written comments people have taken the opportunity to express their appreciation of and the ongoing need for urgent care services in their area, the comments also relay a level of anxiety for people who believe they may lose their local urgent care service.
People are also concerned about the impact of the increasing population in their local area and the impact this is having on availability of GP appointments as well as the availability of GP appointments in general. This perceived situation seems to be a consideration in some cases as people comment on the opening hours for the urgent care service, although people also make unrelated comments on opening hours for the urgent care services.
Some people have indicated that they would like particular service provision to be considered as part of the urgent care services; for example, mental health service provision and sexual health services. A couple of people also ask for a home visiting service to be considered for older people.
The written comments also request communication and publication of the location and opening hours for the urgent care services.
Please see below examples of comments relating to the themes outlined above:
Appreciation of urgent care services and the on-going need for such services
The Market Harborough service is good and keeps people out of hospital especially with asthma, falls etc. I have needed Rutland memorial hospital urgently over the last few months - if it wasn't there I wouldn't be Use and promote the brilliant services already in town The importance of it to local people Oakham walk in centre is invaluable in such a rural location. Should be open at all times please Urgent care centres are a useful and important supplement to normal GP services. On the occasions that I and my family have needed to use them, they are invaluable and the saving of time and distress to individuals - particularly children - needs to be considered as part of the case of retaining them for the community and not just treating it like a business case with vacant appointments equalling low sales. There is a definite well-being benefit to the local community that must be considered We definitely need out of hours services as a lot of people are unable to obtain transport Just to remember, it is a really valuable service that everyone needs to know about. Keep it going please, we have a massive ranging population and a massive increase in young people too Don't forget that for people who live in Lutterworth and don't drive...we do not have a bus service after one on a Saturday and nothing in a Sunday so unable to access anywhere, this will then fall in 999.
Page | 36 NHS East Leicestershire and Rutland CCG Urgent Care Engagement Report 2018
Comments relaying anxiety about loss of local urgent care centre:
Please save the fielding palmer hospital in Lutterworth. This is much needed. It needs to be expanded to cater for the growing population of Lutterworth Keep service in Market Harborough Keep Lutterworth Fielding Palmer Hospital open. It is treasured by Lutterworth people and a comfort to know it is there if urgent care needed and for caring for its local people and for ease of access rather than having to travel to big town or city hospitals Rutland services should be provided in Rutland not Blaby, 36 miles from my home The current service in Oakham, Rutland is beyond excellent - I cannot recommend it highly enough. If the service was reduced in Rutland I believe it would be to the detriment of Rutland residents (myself included) as we are so far away from any other health services. This is a retrograde step Our GP and A&E services are already over stretched. Closing down a local facility will only add to this pressure on our local NHS centre and jeopardise the quality of service received East Leicestershire and Rutland is a huge rural area and is under-funded as it is. By cutting urgent care services in existing areas does not make sense. I do agree that now Blaby needs to have the same level of options as other areas.
Much of the anxiety around a perception that local services will be lost is underpinned by lack of transport and distance to travel to another service:
We definitely need out of hours services as a lot of people are unable to obtain transport Transport out of Rutland is very difficult and a problem, particularly, for example, to Blaby and Loughborough.
The availability of GP appointments
I'd like you to take into account the fact that it is becoming increasingly difficult to book a GP appointment where I live (Kibworth) due to the huge influx of new residents, and this will only get worse over the next few years Improving rather than removing the memorial hospital Oakham. Ensuring doctor availability in Oakham by building a new surgery to cater for the many new homes. People would not have to resort to out of hours services if they could see a doctor before the matter became urgent With more houses being built in Harborough, getting a Doctors apt will be so difficult then the urgent care centres will probably see an increase of patients, not a cut!! I think it is important to appreciate future growth in areas. Broughton Astley will be bigger than Lutterworth soon and Lutterworth will also have East Lutterworth to support. On top of this, you may also have a requirement from Magna Park, especially as it may expand Rising population and supporting facilities in existence such as the Cottage Hospital in Lutterworth with the possibility of extension More surgeries with more appointment Make the appointment in the evening pre-bookable, like GP appointments.
The opening hours for urgent care services
Patients can’t see GPs at the moment so how do you even consider changing hours in urgent clinics. You can only do it if access to see GPs are easier It would be great if the GP opening times were longer to help with people working and to be able to see a familiar face for out of hours appointments
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Improved GP access and appointment times suitable to the modern working world not related to the current times Keep the existing hours at Luke's No reduction in hours Out of hours care should mean from when GPs close to when they reopen.
A few people ask for certain service provision to be considered as part of the urgent care service
Access to mental health services and advice after hours Mental health provision (including for children) It seems like a good time to consider how sexual health provision could be linked to urgent care, seeing as sexually transmitted diseases are on the rise Allow home visits for those who cannot get to the out of hours clinics.
The need for communication and publication of urgent care services
Better publication of services and location. Might be a good idea to put it on notices in and outside GP surgeries Whatever is decided should be communicated to the local community Advertising how it should be used Notifying patients of all out of hours services with phone numbers for those not on the internet and of any changes.
A full list of the comments is at Appendix M.
Page | 38 NHS East Leicestershire and Rutland CCG Urgent Care Engagement Report 2018
Question 13
Are you responding on behalf of an organisation?
Answer Choices Responses Yes 0.52% 4 No 99.74% 763 If yes, please state the name of the organisation. 5 Answered 765 Skipped 10
Are you responding on behalf of an organisation? 120.00%
100.00%
80.00%
60.00% Responses
40.00%
20.00%
0.00% Yes No
The majority of respondents (99.74%) were patients completing the survey followed by (0.52%) responding on behalf of an organisation of which the organisations include:
ELRUC CCSVL.org OOHs.
Page | 39 NHS East Leicestershire and Rutland CCG Urgent Care Engagement Report 2018
Questions about you
To help us understand whether views differ by location, please tell us your postcode. This information will only be used for analysis purposes and will not be linked to you personally.
Answered 744 Skipped 31
This question was answered by 744 respondents of which full details can be seen at Appendix N.
Are you registered with a GP practice in East Leicestershire and Rutland?
Answer Choices Responses Yes 86.09% 650 No 7.68% 58 Not sure 6.23% 47 If yes or not sure, please provide the name of your practice. 325 Answered 755 Skipped 20
Are you registered with a GP practice in East Leicestershire and Rutland? 100.00% 90.00% 80.00% 70.00% 60.00% 50.00% Responses 40.00% 30.00% 20.00% 10.00% 0.00% Yes No Not sure
The majority of respondents (86.09%) confirmed that they are registered with a GP practice in East Leicestershire and Rutland compared to (7.68%) who are not. A further (6.23%) were not sure and left the name of their practice along with those that are registered. A full list of these details can be seen at Appendix O.
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What is your gender?
Answer Choices Responses Male 19.87% 152 Female 77.78% 595 Prefer not to say 2.35% 18 Answered 765 Skipped 10
Has your gender (sex) changed since birth?
Answer Choices Responses Yes 0.26% 2 No 97.78% 748 Prefer not to say 1.96% 15 Answered 765 Skipped 10
Are you pregnant or have you given birth in the last 26 weeks?
Answer Choices Responses Yes 2.22% 17 No 95.82% 734 Prefer not to say 1.96% 15 Answered 766 Skipped 9
What is your age?
Answer Choices Responses Under 16 0.00% 0 16 - 24 1.69% 13 25 - 34 14.17% 109 35 - 59 51.63% 397 60 - 75 25.10% 193 76+ 4.16% 32 Prefer not to say 3.25% 25 Answered 769 Skipped 6
Page | 41 NHS East Leicestershire and Rutland CCG Urgent Care Engagement Report 2018
Do you consider yourself to have a disability or suffer from poor health?
Answer Choices Responses Yes, I have a disability 7.85% 60 Yes, I am in poor health 6.81% 52 Neither 78.53% 600 Prefer not to say 6.81% 52 Answered 764 Skipped 11
If you have selected ‘yes’, please tell us which condition:
Answer Choices Responses Physical 21.05% 40 Partial or total loss of vision 1.05% 2 Learning disability/ difficulty 1.05% 2 Partial or total loss of hearing 1.05% 2 Mental health condition or disorder 14.74% 28 Long standing illness or disease 22.63% 43 Speech impediment or impairment 0.53% 1 Other medical condition or impairment, please tell us here: 37.89% 72 Answered 190 Skipped 585
What is your ethnicity?
Answer Choices Responses African 0.00% 0 Arab 0.13% 1 Bangladeshi 0.00% 0 Caribbean 0.00% 0 Chinese 0.00% 0 Gypsy/ Traveller 0.00% 0 Indian 0.78% 6 Irish 0.26% 2 Pakistani 0.00% 0 Polish 0.26% 2 Somali 0.00% 0 White British: English, Northern Irish, Scottish, Welsh 90.85% 695 Prefer not to say 5.49% 42 For mixed or other ethnicities, please tell us here: 2.22% 17 Answered 765 Skipped 10
Page | 42 NHS East Leicestershire and Rutland CCG Urgent Care Engagement Report 2018
What is your religion or belief?
Answer Choices Responses No religion 35.84% 272 Bha’i 0.00% 0 Buddhist 0.66% 5 Christian 50.33% 382 Hindu 0.26% 2 Jain 0.00% 0 Jewish 0.26% 2 Muslim 0.26% 2 Sikh 0.26% 2 Prefer not to say 10.28% 78 Other, please tell us here: 1.84% 14 Answered 759 Skipped 16
What is your sexual orientation (preference)?
Answer Choices Responses Bisexual (relationship with either sex) 1.59% 12 Gay (male to male relationship) 0.40% 3 Heterosexual (male to female relationship) 84.92% 642 Lesbian (female to female relationship) 0.66% 5 Prefer not to say 11.24% 85 Other, please tell us here: 1.19% 9 Answered 756 Skipped 19
Page | 43 NHS East Leicestershire and Rutland CCG Urgent Care Engagement Report 2018
7. Key points for consideration
The survey attracted a high number of respondents (775), suggesting a high level of local interest .
Opening hours
While most respondents agreed to the logic behind removing the overlap in the opening hours and felt it would have no impact on them, the written comments show that there is concern from some respondents and these need to be considered.
Weekend and Bank Holiday access after 5pm is also important to a sizeable majority of respondents (60%)
Locating UCC in Blaby
Residents are likely to use an urgent care centre sited in Blaby. However commissioners will need to consider in more detail where in Blaby they site the new UCC.
Signposting to alternative services
Respondents understand the importance of being seen by the most appropriate healthcare professional/service. However, there were concerns about being signposted elsewhere if attending a UCC. Concerns centres on:
Transport Older people and children Distance to travel Appropriate triage Time delay to treatment Concern that people may be referred on unnecessarily
In addition, many respondents were particularly concerned about the impact on older patients and children. While others felt that if they had made the effort to attend a UCC, that is where they should be seen and possibly treated.
Future of out of hours services
Commissioners will need to allay respondents' anxiety with regard to their perceived loss of urgent care services. This was particularly evident among residents of Lutterworth but was also mentioned in other areas. Their concern highlights the importance of ensuring robust communication around urgent care services so that residents are clear about what is available, when and where.
When planning the next steps for urgent care, commissioners could also consider expanding what is available to include, for example, mental health, sexual health services and home visits for older people.
Page | 44 NHS East Leicestershire and Rutland CCG Urgent Care Engagement Report 2018
8. Recommendations
It is recommended that all feedback from the questionnaires, events and meetings is taken into consideration before a final decision is made. All supporting documents have been attached as appendices and include the additional comments made by patients, members of the public and voluntary groups throughout the engagement.
Page | 45 NHS East Leicestershire and Rutland CCG Urgent Care Engagement Report 2018
Further information: Andrea Clark Head of Engagement, Communications and Marketing NHS Arden and Greater East Midlands Commissioning Support Unit Westgate House Market St Warwick CV34 4DE
Telephone: 01216 110 611 Mobile: 07789 651 913
Page | 46 NHS East Leicestershire and Rutland CCG Urgent Care Engagement Report 2018
Appendix A
Survey on improving access to urgent care in the community
NHS East Leicestershire and Rutland Clinical Commissioning Group is looking at ways to improve access to care for minor injuries and illness when GP practices are closed during weekday evenings, at weekends and on bank holidays.
We want to hear your views on our plans to help shape services. Please read the document ‘Improving access to urgent care in the community’ or visit our website eastleicestershireandrutlandccg.nhs.uk to find out more before answering the following questions.
Details of where to post your completed survey can be found at the end of this document.
1) Thinking about the following statement: “I understand which service I should use if I have an urgent care need when my GP practice is closed”. Please indicate your level of agreement.
Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree
2) Have you heard of the NHS 111 service?
Yes No Not sure
3) If yes, did you know that when you call NHS 111, you are able to access advice and/or treatment from a GP or another health care professional?
Yes No Not sure 4) Thinking about the following statement: “If I need care when my GP practice is closed, I don’t mind which clinician (doctor or nurse) I see as long as the health care professional has the appropriate skills to treat my urgent care condition.” Please indicate your level of agreement.
Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree
5) Patients tell us they’re confused about where to access out-of-hours appointments on weekday evenings when GP practices and urgent care centres are both open from 5pm to 6.30pm. We want to reduce confusion and make best use of NHS resources by removing this overlap of opening hours.
Under our plans, urgent care centres (excluding Oadby Urgent Care Centre) would open on weekday evenings from 6.30pm to 9pm.
a) To what extent do you agree that this change would help to reduce confusion over where people should go for urgent care needs?
Strongly agree Agree Disagree Strongly disagree No opinion
b) If we were to remove this overlap of opening hours on weekday evenings, what impact would this have on you?
Positive impact No impact Negative impact
c) Please give the reason for your answer:
………………………………………………………………………………………… …………………………………………………………………………………………
6) Our research shows that people are not regularly using our urgent care centres in Melton Mowbray, Market Harborough and Oakham between 5pm and 7pm on weekends and on bank holidays. This means that over one-third (36%) of available appointments are not being used across our sites between these hours. We are considering changing the opening hours at weekends and on bank holidays to 9am to 5pm to make services easier to navigate and make best use of NHS resources.
a) If the opening hours were to change in this way, what impact would this have on you?
Positive impact No impact Negative impact
b) Please give the reason for your answer:
……………………………………………………………………………………………… ………………………………………………………………………………………………
c) How important to you is having access to an urgent care service after 5pm at weekends and on bank holidays?
Very important Important Unimportant Very unimportant
d) Please give the reason for your answer:
………………………………………………………………………………………… …………………………………………………………………………………………
7) Our research shows that there is significant demand for services in the Blaby district area when GP practices are closed. If we were to open an urgent care centre in the Blaby district area open on weekday evenings, at weekends and on bank holidays, how likely is it that you would use the service?
Very likely Likely Not likely Not sure
8) Considering the following access factors, what would be important to you about the location of the urgent care centre in the Blaby district area:
Parking Not important Slightly important Important Very important No opinion
Accessible by public transport Not important Slightly important Important Very important No opinion
Service is provided from an existing healthcare facility (such as a GP practice) Not important Slightly important Important Very important No opinion
There is a pharmacy open at the same time nearby Not important Slightly important Important Very important No opinion
9) Is there anything else you consider to be important in the location of a service in the Blaby district area?
……………………………………………………………………………………………
10) If you have any suggestions as to where a new service in the Blaby district area should be located, please let us know here:
……………………………………………………………………………………………
11) Triage (assessment of a patient’s condition and needs) is widely used in the health system to support patients with complex needs and to ensure people access the right care at the right place.
a) Thinking about the following statement: “Being seen by the most appropriate healthcare professional in the right place for my needs is important to me.” Please indicate your level of agreement.
Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree
b) Thinking about the following statement: “If I walked in for treatment at an urgent care centre, I would support being signposted to another service or booked an appointment somewhere else if this was the most appropriate way to treat my needs.” Please indicate your level of agreement.
Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree
c) Please give the reason for your answer:
……………………………………………………………………………………………… ……………………………………………………………………………………………
12) Is there anything you would like us to consider in our plans for the future of out-of-hours services in East Leicestershire and Rutland?
………………………………………………………………………………………………… ………………………………………………………………………………………………… ………………………………………………………………………………………………… …………………………………………………………………………………………………
13) Are you responding on behalf of an organisation?
Yes No
If yes, please state the name of the organisation:
…………………………………………………………………………………………………
If no, and you are responding as an individual, please move on to the next section.
Questions about you Please complete as much of the information about yourself as you feel comfortable with, as this helps us to ensure we have captured views from a wide range of people who may have different needs and who may experience different barriers when accessing urgent care. The information you provide will be kept in accordance with the terms of the Data Protection Acts 1998 and 2000 and will be used for monitoring purposes and questionnaire analysis.
Q1). To help us understand whether views differ by location, please tell us your postcode. This information will only be used for analysis purposes and will not be linked to you personally.
The area you live in
Q2. Are you registered with a GP practice in East Leicestershire and Rutland?
Yes No
a) If yes, please provide the name of your practice:
Your GP practice
Q3. What is your gender? ☐ Female ☐ Male ☐ Prefer not to say Gender
Q4. Has your gender (sex) changed since birth? ☐Yes ☐No ☐Prefer not to say
Gender reassignment
Q5. Are you pregnant or have you given birth in the last 26 weeks? ☐Yes ☐No ☐Prefer not to say Pregnancy/maternity
Q6. What is your age? ☐ Under 16 ☐ 16 - 24 ☐ 25 - 34
☐ 35 - 59
☐ Age 60 - 75 ☐ 76+ ☐Prefer not to say Q7. Do you consider yourself to have a disability or suffer from poor health? ☐Yes, I have a disability ☐Yes, I am in poor health ☐Neither
☐Prefer not to say Disability Q8. If you have selected ‘yes’, please tell us which condition: ☐Physical ☐Partial or total loss of vision ☐Learning disability/ difficulty
☐Partial or total loss of hearing
☐ Mental health condition or disorder ☐Long standing illness or disease ☐Speech impediment or impairment Condition ☐Other medical condition or impairment, please tell us here:
Q9. What is your ethnicity? ☐African ☐Arab ☐Bangladeshi
☐Caribbean
☐ Race Chinese ☐Gypsy/ Traveller ☐Indian ☐Irish ☐Pakistani ☐Polish ☐Somali ☐White British: English, Northern Irish, Scottish, Welsh ☐Prefer not to say
For mixed or other ethnicities, please tell us here:
Q10. What is your religion or belief? ☐No religion ☐Bha’i ☐Buddhist
☐Christian
☐ Hindu Religion or belief ☐Jain ☐Jewish ☐Muslim
☐Sikh ☐Prefer not to say ☐Other, please tell us here:
Q11. What is your sexual orientation (preference)? ☐Bisexual (relationship with either sex) ☐Gay (male to male relationship) ☐Heterosexual (male to female relationship) ☐Lesbian (female to female relationship) ☐Prefer not to say Sexual orientation ☐Other, please tell us here:
Thank you for your sharing your views.
Please return your completed survey by Tuesday 24 July 2018 to the freepost address below (no stamp is required). Please ensure you write the address on one line using the appropriate capital letters as below: Freepost NHS QUESTIONNAIRE RESPONSES
Or, you can complete this survey online at: surveymonkey.com/r/ELRurgentcare18
You can also contact us if you would like this information in another language or if you have another specific request.
0116 295 3405 Appendix B
Dear stakeholder,
NHS East Leicestershire and Rutland Clinical Commissioning Group is asking for public views on proposals to improve out-of-hours healthcare services in our area. The services, known as urgent care services, offer GP and nurse appointments when GP practices are closed on weekday evenings, at weekends and on bank holidays. We are proposing changes, which include plans to open a new urgent care centre in the Blaby district area and to revise opening hours of existing urgent care services, to make services easier to navigate for patients and make best use of NHS resources. Full details of our proposals and survey can be found on our website. The survey will close on Tuesday 24 July 2018. People can also find out more and give feedback by attending one of our information events. You can book a place or advise us of any access requirements by clicking the links below:
Tuesday 3 July, 10am to 12.30pm at Community Lounge, Brockington College, Blaby Road, Enderby, Blaby LE19 4AQ Thursday 12 July, 2pm to 4.30pm at Conference Room, Rutland Community Hub, Voluntary Action Rutland, Lands End Way, Oakham LE15 6RB
If you have any questions or wish to request this information in another language or format, please email us at: [email protected] or call us on 0116 295 3405. We welcome opportunities to come out and talk with groups and organisations regarding the proposals so please get in touch if you feel this would be of interest or benefit. Appendix C
Improving access to urgent care in the community comms toolkit NHS East Leicestershire and Rutland Clinical Commissioning Group (ELR CCG) is seeking patients’ views on proposed changes to urgent care services, which offer GP and nurse appointments when GP practices are closed on weekday evenings, at weekends and on bank holidays.
The five-week engagement period takes place from Wednesday 20 June until Tuesday 24 July 2018. We would really welcome your support in helping to promote the engagement via your communication channels.
This toolkit provides communications resources based on the locations affected by the changes, including: Blaby, Lutterworth, Melton, Rutland, Market Harborough, Oadby and Wigston. The toolkit includes the following resources: a website news article outlining the changes suggested social media posts based on location for Facebook and Twitter social media graphics based on location for Facebook and Twitter
You can find out more about the changes on our website. The survey is available to complete here.
If you have any queries about this toolkit, please contact the Communications Team at [email protected].
Website news story copy Patients asked to share views on out- of-hours healthcare services
Patients in East Leicestershire and Rutland are being asked for their views on out-of- hours healthcare services, as the local NHS looks to make improvements to the services.
The services, known as urgent care services, offer GP and nurse appointments when GP practices are closed on weekday evenings, at weekends and on bank holidays.
NHS East Leicestershire and Rutland Clinical Commissioning Group (ELR CCG) is proposing the changes as the contracts for the services come to an end in March 2019.
The changes, which include plans to open a new urgent care centre in the Blaby district area and revise opening hours of existing urgent care services, are designed to make services easier to navigate for patients and make best use of NHS resources.
There are currently three nurse-led urgent care centres in East Leicestershire and Rutland which offer walk-in services and pre-booked appointments by calling NHS 111. These include Melton Mowbray, Oakham and Market Harborough, which are open on weekday evenings from 5pm to 9pm and at weekends and on bank holidays from 9am to 7pm.
A walk-in service is available at the urgent care centre in Oadby on weekday evenings from 8am to 9pm and at weekends and bank holidays from 8am to 8pm.
Patients can also access an out-of-hours GP service by calling NHS 111 at two sites in Oakham and Lutterworth. The service offers GP appointments at weekends and on bank holidays from 8am to 9pm in Oakham and from 10am to 4pm in Lutterworth.
Housebound patients can access a 24/7 urgent care visiting service by calling NHS 111.
Feedback from patients has shown that people are confused about what service is available when, especially when out-of-hours services overlap with GP practice opening hours. Patients have also said they are confused about how to access urgent care services, whether they are walk-in, available by appointment only or booked by calling NHS 111.
The new proposals aim to make services easier to navigate for patients and make best use of NHS resources. The plans outline combining the current out-of-hours GP service with the nurse-led urgent care service, keeping services in the same location but making opening hours consistent across most of the sites. Currently, the services operate under different contracts so patients can face difficulty accessing one service from another.
Figures show urgent care centres in East Leicestershire and Rutland are not widely used on weekday evenings from 5pm to 6.30pm when GP practices are still open. Half (51%) of appointments at urgent care centres in Melton Mowbray (50%), Oakham (65%) and Harborough (38%) are not used during these periods. The new proposals include opening urgent care centres from 6.30pm to 9pm on weekday evenings to avoid the overlap with GP practice opening hours and reduce confusion over where people should access services.
Patients have told ELR CCG they find it confusing that urgent care centres in East Leicestershire and Rutland are open at different times. In response to this, ELR CCG is considering standardising opening hours across most urgent care centres at weekends and on bank holidays from 9am to 5pm so that services are easier to navigate for patients and make best use of NHS resources. Although usage varies at different urgent care centres in the area, over one-third (36%) of appointments available at urgent care centres in Melton Mowbray (10%), Oakham (68%) and Harborough (28%) are not used at weekends and on bank holidays between 5pm and 7pm. ELR CCG wants to hear patients’ views on whether standardising opening hours across most of the sites will meet patients’ needs locally.
In the plans, ELR CCG proposes to open a new urgent care centre in the Blaby district area, recognising there is patient demand for a service in the area. Figures show over one-quarter (26%) of out-of-hours appointments at Oadby Urgent Care Centre are used by people who live in the Blaby district area. The exact location for the new site is yet to be determined and patients are being asked for their views on what is important to them.
ELR CCG recognises patient concerns around availability of appointments at GP practices. As part of the plans, patients will be able to pre-book weekday evening, weekend and bank holiday appointments at urgent care centres via their GP practice from September 2018. And, there will be increased investment in weekday access for on-the-day appointments at GP practices.
The plans will also ensure patients can continue to access urgent care services outside of East Leicestershire and Rutland in neighbouring areas, for example in Stamford, Rugby, Grantham and Corby.
Dr Andy Ker, Clinical Vice-Chair at ELR CCG said: “We are keen to ensure that our urgent care services continue to meet people’s needs while providing high-quality, cost-effective services. We believe the plans we’ve set out will reduce some of the confusion around accessing out-of-hours GP and nurse appointments in East Leicestershire and Rutland; will reduce inefficiencies around having separate services and will ultimately ensure patients have access to high-quality services which are easy to navigate and make best use of NHS resources.
“We would encourage all patients to share their views on the plans with us so we can better understand their needs and how any changes might impact them.”
The survey is available to complete online at: surveymonkey.com/r/ELRurgentcare18
People are also invited to attend two information events to find out more about the plans. Events will take place on Tuesday 3 July from 10am to 12.30pm at Community Lounge, Brockington College, Blaby Road, Enderby, Blaby LE19 4AQ and on Thursday 12 July from 2pm to 4.30pm at Conference Room, Rutland Community Hub, Voluntary Action Rutland, Lands End Way, Oakham LE15 6RB.
Patients are asked to register for the Blaby event here and the Rutland event here.
The survey will close on Tuesday 24 July 2018. The findings will be considered and used to help shape services.
Notes to editors What are urgent care centres? Urgent care centres treat patients for injuries and illnesses that require immediate attention, but are not life threatening.
They offer more choice and increased access to healthcare on weekday evenings, at weekends and on bank holidays. This means patients can be seen and treated quicker than ever before.
Patients can be treated for a range of minor illnesses and injuries including, lacerations, stomach upsets, burns and strains. They will be seen by an experienced nurse, without an appointment. X-ray is available at some locations.
Background During 2013 and 2014 ELR CCG undertook extensive engagement and consultation with the public on services for people who need care for minor illnesses and injuries.
What does this mean for Blaby? ELR CCG plans to open a new urgent care centre in the Blaby district area. Under the plans, which are subject to the views of patients, the centre will be open on weekday evenings from 6.30pm to 9pm and at weekends and on bank holidays from 9am to 5pm. Patients will be able to walk-in to access healthcare, and appointments will be offered to those calling NHS 111 if their symptoms require it. Patients will also be able to pre-book weekday evening, weekend and bank holiday appointments via their GP practice from September 2018.
The new centre will mean patients living in the district will be able to access out-of- hours services closer to home, reducing the need to travel. Currently, 26% of out-of- hours appointments at Oadby Urgent Care Centre are used by people who live in the Blaby district area.
The exact location for the site is currently being considered, however it is likely to be based at an existing healthcare premises.
What does this mean for Lutterworth? The out-of-hours GP service at Lutterworth Feilding Palmer Hospital is currently open at weekends and on bank holidays from 10am to 4pm. Under the plans, which are subject to the views of patients, the service will operate extended opening hours, at weekends and on bank holidays from 9am to 5pm.
Patients will be able to walk-in to access healthcare, and appointments will be offered to those calling NHS 111 if their symptoms require it. Patients will also be able to pre-book weekday evening, weekend and bank holiday appointments via their GP practice from September 2018.
What does this mean for Melton Mowbray? The urgent care centre at Melton Mowbray Hospital is currently open on weekday evenings from 5pm to 9pm and at weekends and on bank holidays from 9am to 7pm. Under the plans, which are subject to the views of patients, the urgent care centre’s revised opening hours will be weekday evenings from 6.30pm to 9pm, and at weekends and on bank holidays from 9am to 5pm. This is because urgent care centres are not widely used on weekday evenings from 5pm to 6.30pm when GP practices are still open. And, in response to feedback from patients, ELR CCG is considering standardising opening hours across most urgent care centres at weekends and on bank holidays from 9am to 5pm so that services are easier to navigate for patients and make best use of NHS resources. ELR CCG wants to hear patients’ views on whether standardising opening hours across most of the sites will meet patients’ needs locally.
Patients will be able to walk-in to access healthcare, and appointments will be offered to those calling NHS 111 if their symptoms require it. Patients will also be able to pre-book weekday evening, weekend and bank holiday appointments via their GP practice from September 2018.
What does this mean for Rutland? The nurse-led urgent care centre at Rutland Memorial Hospital is currently open weekday evenings from 5pm to 9pm and at weekends and on bank holidays from 9am to 7pm. There is also a GP out-of-hours service from the same site which is currently open at weekends and on bank holidays from 8am to 9pm. The two services are currently run by different providers under separate contracts which means patients can face difficulties accessing one service from another.
Under the plans, which are subject to the views of patients, the two services will be combined and will open on weekday evenings from 6.30pm to 9pm, and at weekends and on bank holidays from 9am to 5pm. The revised opening hours are because urgent care centres are not widely used on weekday evenings from 5pm to 6.30pm when GP practices are still open. And, in response to feedback from patients, ELR CCG is considering standardising opening hours across most urgent care centres at weekends and on bank holidays from 9am to 5pm so that services are easier to navigate for patients and make best use of NHS resources. ELR CCG wants to hear patients’ views on whether standardising opening hours across most of the sites will meet patients’ needs locally.
Patients will be able to walk-in to access healthcare, and appointments will be offered to those calling NHS 111 if their symptoms require it. Patients will also be able to pre-book weekday evening, weekend and bank holiday appointments via their GP practice from September 2018.
What does this mean for Market Harborough? The nurse-led urgent care centre at St Luke’s Treatment Centre in Market Harborough is currently open on weekday evenings from 5pm to 9pm and at weekends and on bank holidays from 9am to 7pm. Under the plans, which are subject to the views of patients, the urgent care centre’s revised opening hours will be on weekday evenings from 6.30pm to 9pm, and at weekends and on bank holidays from 9am to 5pm. This is because urgent care centres are not widely used from 5pm to 6.30pm on weekdays when GP practices are still open. And, in response to feedback from patients, ELR CCG is considering standardising opening hours across most urgent care centres at weekends and on bank holidays from 9am to 5pm so that services are easier to navigate for patients and make best use of NHS resources. ELR CCG wants to hear patients’ views on whether standardising opening hours across most of the sites will meet patients’ needs locally.
Patients will be able to walk in to access healthcare, and appointments will be offered to those calling NHS 111 if their symptoms require it. Patients will also be able to pre-book weekday evening, weekend and bank holiday appointments via their GP practice from September 2018.
What does this mean for Oadby? The Oadby Urgent Centre will remain open as normal on weekday evenings from 8am to 9pm and at weekends and on bank holidays from 8am to 8pm. People are able to walk-in for care and appointments are also offered to those calling NHS 111. Patients will be able to walk-in to access healthcare, and appointments will be offered to those calling NHS 111 if their symptoms require it. Patients will also be able to pre-book evening, weekend and bank holiday appointments via their GP practice from September 2018.
About East Leicestershire and Rutland Clinical Commissioning Group East Leicestershire and Rutland Clinical Commissioning Group (ELR CCG) was created under the Health and Social Care Act 2012. The ELR CCG represents 31 GP practices serving more than 325,000 patients in Melton, Rutland, Market Harborough, Blaby District, Lutterworth, and Oadby and Wigston. CCGs plan and purchase acute and community hospital care along with mental healthcare and other allied services. NHS England plans and purchases GP services, pharmacies, dentists, opticians and specialised commissioning services. From 1 April 2015 East Leicestershire and Rutland CCG has shared some of the commissioning responsibilities for its local GP services with NHS England.
Social media graphics
Social media posts
Location Facebook post Tweets
Blaby The local NHS .@NHSELRCCG is planning @NHSELRCCG is to open a new urgent care planning on opening a centre in the Blaby district new urgent care centre in area. Would you use the the Blaby district area service? and wants to hear your views on the plans. Read more about the plans Where would you like it to online: be? https://eastleicestershireandr utlandccg.nhs.uk/get- Find out more on their involved/surveys/urgent-care- website at: services-changing/ https://eastleicestershirea ndrutlandccg.nhs.uk/get- [insert Blaby locality graphic] involved/surveys/urgent- care-services-changing/
[insert Blaby locality graphic] The local NHS @NHSELRCCG is considering opening an urgent care service in the Blaby district area. Where would you like it to be? Share your views with them at: surveymonkey.com/r/ELRurg entcare18
[insert Blaby locality graphic] [For use up until Tuesday 3 July]
Find out more about @NHSELRCCG’s plans to open a new urgent care centre in the Blaby district area by registering to attend an information event on Tuesday 3 July at Brockington College at 10am. Read more at: https://eastleicestershireandr utlandccg.nhs.uk/get- involved/surveys/urgent-care- services-changing/
[Blaby locality graphic] Rutland The local NHS .@NHSELRCCG is holding @NHSELRCCG is an information event on considering changes to Thursday 12 July at 2pm at urgent care services in Rutland Community Hub in Rutland. Oakham if you want to find out more about the CCG’s People are invited to find plans for urgent care out more about the plans services. at an information event on Thursday 12 July at To register and find out more, 2pm at Rutland visit: Community Hub in https://eastleicestershireandr Oakham. utlandccg.nhs.uk/get- involved/surveys/urgent-care- To register and read services-changing/ more, visit: https://eastleicestershirea [insert Rutland locality ndrutlandccg.nhs.uk/get- graphic] involved/surveys/urgent- care-services-changing/
[insert Rutland locality graphic] There are plans to combine two services at Rutland Memorial Hospital to make services easier to navigate for patients and make best use of NHS resources.
Find out more online: https://eastleicestershireandr utlandccg.nhs.uk/get- involved/surveys/urgent-care- services-changing/
[insert Rutland locality graphic] Share your views on @NHSELRCCG’s plans to change urgent care services in #Rutland. Take part in the survey here: surveymonkey.com/r/ELRurg entcare18
[insert Rutland locality graphic] Harborough The local NHS .@NHSELRCCG wants to @NHSELRCCG would hear your views on its plans like to hear people’s to change the opening hours views on plans to change to the urgent care services at urgent care services. St Luke’s Treatment Centre.
The plans include Find out more about the changing opening hours plans at: at the urgent care centre https://eastleicestershireandr at St Luke’s Treatment utlandccg.nhs.uk/get- Centre to make services involved/surveys/urgent-care- easier to navigate for services-changing/ patients and make best use of NHS resources. [insert Harborough graphic]
Find out more about the plans online: https://eastleicestershirea ndrutlandccg.nhs.uk/get- involved/surveys/urgent- care-services-changing/
[insert Harborough graphic] Under plans to make urgent care services easier to navigate for patients, @NHSELRCCG wants to make out-of-hours appointments at St Luke’s Treatment Centre able to be pre-booked via your GP practice.
Read more and share your views online: https://eastleicestershireandr utlandccg.nhs.uk/get- involved/surveys/urgent-care- services-changing/ Lutterworth The local NHS .@NHSELRCCG plans to @NHSELRCCG has extend the opening hours of announced plans to the out-of-hours GP service extend the opening hours at Feilding Palmer Hospital. of the out-of-hours GP Is this something you’d service at Feilding welcome? Share your views Palmer Hospital. online: https://eastleicestershireandr Under the plans, the utlandccg.nhs.uk/get- service will be open at involved/surveys/urgent-care- weekends and on bank services-changing/ holidays from 9am to 5pm, an increase of two [insert Lutterworth graphic] hours per week. It’ll also be easier to access the service.
What do you think about the plans? Have your say in this survey: surveymonkey.com/r/ELR urgentcare18
[insert Lutterworth graphic] Have you used the GP out-of- hours service at Feilding Palmer Hospital? @NHSELRCCG is considering extending the opening hours.
Share your views with them in this survey at: surveymonkey.com/r/ELRurg entcare18
[insert Lutterworth graphic] Melton The local NHS is The local NHS has considering making announced plans to make changes to the opening changes to the urgent care hours of the urgent care centre at Melton Hopsital. centre at #Melton Find out more about the Hospital to make services plans on @NHSELRCCG’s easier to navigate for website: patients and make best https://eastleicestershireandr use of NHS resources. utlandccg.nhs.uk/get- involved/surveys/urgent-care- Find out more about the services-changing/ plans on their website: https://eastleicestershirea [insert Melton locality graphic] ndrutlandccg.nhs.uk/get- involved/surveys/urgent- care-services-changing/
[insert Melton locality graphic]
The opening hours of the urgent care centre at #Melton Hospital could be changing.
Have your say on the plans: surveymonkey.com/r/ELRurg entcare18
[insert Melton locality graphic] Oadby There are plans to make Do you use Oadby Urgent services easier to access Care Centre? at Oadby Urgent Care @NHSELRCCG is planning Centre. Under the plans, improvements to out-of-hours you will be able to see a services. Patients will be able nurse or doctor by to pre-book appointments at walking-in, calling NHS Oadby via your GP practice. 111 or by having an Opening hours will remain the appointment pre-booked same. in advance via your GP practice. Find out more online: https://eastleicestershireandr There aren’t any plans to utlandccg.nhs.uk/get- make changes to the involved/surveys/urgent-care- opening hours. services-changing/
Find out more online: [insert Generic CTA] https://eastleicestershirea ndrutlandccg.nhs.uk/get- involved/surveys/urgent- care-services-changing/
[insert Generic CTA] Evening, weekend and bank holiday appointments at Oadby Urgent Care Centre will be able to be pre-booked via your GP practice, under plans to improve services.
Read more and have your say online: https://eastleicestershireandr utlandccg.nhs.uk/get- involved/surveys/urgent-care- services-changing/
[insert Generic CTA] Week Five [To post on Tuesday 17 [To post on Tuesday 24 July 2018] July 2018] (Final reminder to complete Final week to have your Today is the final day to have survey) say on changes to urgent your say on care services in East @NHSELRCCG’s plans to Leicestershire and improve local urgent care Rutland. services.
@NHSELRCCG wants to Share your views online: hear from as many surveymonkey.com/r/ELRurg people as possible on entcare18 how the changes might impact you. [insert Generic call to action graphic] Share your views online: surveymonkey.com/r/ELR urgentcare18
[insert Generic call to action graphic] Today is the final day to have your say on the plans to improve urgent care services in East Leicestershire and Rutland.
The plans are designed to reduce some of the confusion around accessing out-of-hours GP and nurse appointments by making services easier to navigate and make best use of NHS resources.
Take part online: [insert Generic call to action graphic] Generic posts Do you use your local urgent care centre? @NHSELRCCG is planning to make changes to the services to make them easier to navigate for patients and make best use of NHS resources.
Read more online: https://eastleicestershireandr utlandccg.nhs.uk/get- involved/surveys/urgent-care- services-changing/
[insert Generic call to action] You’ve got until Tuesday 24 July to share your views on the plans to improve urgent care services in East Leicestershire and Rutland.
Have your say and read more about the plans online: https://eastleicestershireandr utlandccg.nhs.uk/get- involved/surveys/urgent-care- services-changing/
[insert Generic call to action graphic]
Appendix D
Media release Date: Wednesday 20 June 2018 Interview opportunity with Dr Andy Ker on Thursday 21 June from 9.15am to 10.15am. Contact [email protected] or call 0116 295 6965 to confirm.
Patients asked to share views on out-of- hours healthcare services
Patients in East Leicestershire and Rutland are being asked for their views on out-of-hours healthcare services, as the local NHS looks to make improvements to the services.
The services, known as urgent care services, offer GP and nurse appointments when GP practices are closed on weekday evenings, at weekends and on bank holidays.
NHS East Leicestershire and Rutland Clinical Commissioning Group (ELR CCG) is proposing the changes as the contracts for the services come to an end in March 2019.
The changes, which include plans to open a new urgent care centre in the Blaby district area and revise opening hours of existing urgent care services, are designed to make services easier to navigate for patients and make best use of NHS resources.
There are currently three nurse-led urgent care centres in East Leicestershire and Rutland which offer walk-in services and pre-booked appointments by calling NHS 111. These include Melton Mowbray, Oakham and Market Harborough, which are open on weekday evenings from 5pm to 9pm and at weekends and on bank holidays from 9am to 7pm.
A walk-in service is available at the urgent care centre in Oadby on weekday evenings from 8am to 9pm and at weekends and bank holidays from 8am to 8pm.
Patients can also access an out-of-hours GP service by calling NHS 111 at two sites in Oakham and Lutterworth. The service offers GP appointments at weekends and on bank holidays from 8am to 9pm in Oakham and from 10am to 4pm in Lutterworth.
Housebound patients can access a 24/7 urgent care visiting service by calling NHS 111.
Feedback from patients has shown that people are confused about what service is available when, especially when out-of-hours services overlap with GP practice opening hours. Patients have also said they are confused about how to access urgent care services, whether they are walk-in, available by appointment only or booked by calling NHS 111.
The new proposals aim to make services easier to navigate for patients and make best use of NHS resources. The plans outline combining the current out-of-hours GP service with the nurse- led urgent care service, keeping services in the same location but making opening hours consistent across most of the sites. Currently, the services operate under different contracts so patients can face difficulty accessing one service from another.
Figures show urgent care centres in East Leicestershire and Rutland are not widely used on weekday evenings from 5pm to 6.30pm when GP practices are still open. Half (51%) of appointments at urgent care centres in Melton Mowbray (50%), Oakham (65%) and Harborough (38%) are not used during these periods. The new proposals include opening urgent care centres from 6.30pm to 9pm on weekday evenings to avoid the overlap with GP practice opening hours and reduce confusion over where people should access services.
Patients have told ELR CCG they find it confusing that urgent care centres in East Leicestershire and Rutland are open at different times. In response to this, ELR CCG is considering standardising opening hours across most urgent care centres at weekends and on bank holidays from 9am to 5pm so that services are easier to navigate for patients and make best use of NHS resources. Although usage varies at different urgent care centres in the area, over one-third (36%) of appointments available at urgent care centres in Melton Mowbray (10%), Oakham (68%) and Harborough (28%) are not used at weekends and on bank holidays between 5pm and 7pm. ELR CCG wants to hear patients’ views on whether standardising opening hours across most of the sites will meet patients’ needs locally.
In the plans, ELR CCG proposes to open a new urgent care centre in the Blaby district area, recognising there is patient demand for a service in the area. Figures show over one-quarter (26%) of out-of-hours appointments at Oadby Urgent Care Centre are used by people who live in the Blaby district area. The exact location for the new site is yet to be determined and patients are being asked for their views on what is important to them.
ELR CCG recognises patient concerns around availability of appointments at GP practices. As part of the plans, patients will be able to pre-book weekday evening, weekend and bank holiday appointments at urgent care centres via their GP practice from September 2018. And, there will be increased investment in weekday access for on-the-day appointments at GP practices.
The plans will also ensure patients can continue to access urgent care services outside of East Leicestershire and Rutland in neighbouring areas, for example in Stamford, Rugby, Grantham and Corby.
Dr Andy Ker, Clinical Vice-Chair at ELR CCG said: “We are keen to ensure that our urgent care services continue to meet people’s needs while providing high-quality, cost-effective services. We believe the plans we’ve set out will reduce some of the confusion around accessing out-of-hours GP and nurse appointments in East Leicestershire and Rutland; will reduce inefficiencies around having separate services and will ultimately ensure patients have access to high-quality services which are easy to navigate and make best use of NHS resources.
“We would encourage all patients to share their views on the plans with us so we can better understand their needs and how any changes might impact them.”
The survey is available to complete online at: surveymonkey.com/r/ELRurgentcare18
People are also invited to attend two information events to find out more about the plans. Events will take place on Tuesday 3 July from 10am to 12.30pm at Community Lounge, Brockington College, Blaby Road, Enderby, Blaby LE19 4AQ and on Thursday 12 July from 2pm to 4.30pm at Conference Room, Rutland Community Hub, Voluntary Action Rutland, Lands End Way, Oakham LE15 6RB.
The survey will close on Tuesday 24 July 2018. The findings will be considered and used to help shape services.
Notes to editors What are urgent care centres? Urgent care centres treat patients for injuries and illnesses that require immediate attention, but are not life threatening.
They offer more choice and increased access to healthcare on weekday evenings, at weekends and on bank holidays. This means patients can be seen and treated quicker than ever before.
Patients can be treated for a range of minor illnesses and injuries including, lacerations, stomach upsets, burns and strains. They will be seen by an experienced nurse, without an appointment. X- ray is available at some locations.
Background During 2013 and 2014 ELR CCG undertook extensive engagement and consultation with the public on services for people who need care for minor illnesses and injuries.
What does this mean for Blaby? ELR CCG plans to open a new urgent care centre in the Blaby district area. Under the plans, which are subject to the views of patients, the centre will be open on weekday evenings from 6.30pm to 9pm and at weekends and on bank holidays from 9am to 5pm. Patients will be able to walk-in to access healthcare, and appointments will be offered to those calling NHS 111 if their symptoms require it. Patients will also be able to pre-book weekday evening, weekend and bank holiday appointments via their GP practice from September 2018.
The new centre will mean patients living in the district will be able to access out-of-hours services closer to home, reducing the need to travel. Currently, 26% of out-of-hours appointments at Oadby Urgent Care Centre are used by people who live in the Blaby district area.
The exact location for the site is currently being considered, however it is likely to be based at an existing healthcare premises.
What does this mean for Lutterworth? The out-of-hours GP service at Lutterworth Feilding Palmer Hospital is currently open at weekends and on bank holidays from 10am to 4pm. Under the plans, which are subject to the views of patients, the service will operate extended opening hours, at weekends and on bank holidays from 9am to 5pm.
Patients will be able to walk-in to access healthcare, and appointments will be offered to those calling NHS 111 if their symptoms require it. Patients will also be able to pre-book weekday evening, weekend and bank holiday appointments via their GP practice from September 2018.
What does this mean for Melton Mowbray? The urgent care centre at Melton Mowbray Hospital is currently open on weekday evenings from 5pm to 9pm and at weekends and on bank holidays from 9am to 7pm. Under the plans, which are subject to the views of patients, the urgent care centre’s revised opening hours will be weekday evenings from 6.30pm to 9pm, and at weekends and on bank holidays from 9am to 5pm. This is
because urgent care centres are not widely used on weekday evenings from 5pm to 6.30pm when GP practices are still open. And, in response to feedback from patients, ELR CCG is considering standardising opening hours across most urgent care centres at weekends and on bank holidays from 9am to 5pm so that services are easier to navigate for patients and make best use of NHS resources. ELR CCG wants to hear patients’ views on whether standardising opening hours across most of the sites will meet patients’ needs locally.
Patients will be able to walk-in to access healthcare, and appointments will be offered to those calling NHS 111 if their symptoms require it. Patients will also be able to pre-book weekday evening, weekend and bank holiday appointments via their GP practice from September 2018.
What does this mean for Rutland? The nurse-led urgent care centre at Rutland Memorial Hospital is currently open weekday evenings from 5pm to 9pm and at weekends and on bank holidays from 9am to 7pm. There is also a GP out-of-hours service from the same site which is currently open at weekends and on bank holidays from 8am to 9pm. The two services are currently run by different providers under separate contracts which means patients can face difficulties accessing one service from another.
Under the plans, which are subject to the views of patients, the two services will be combined and will open on weekday evenings from 6.30pm to 9pm, and at weekends and on bank holidays from 9am to 5pm. The revised opening hours are because urgent care centres are not widely used on weekday evenings from 5pm to 6.30pm when GP practices are still open. And, in response to feedback from patients, ELR CCG is considering standardising opening hours across most urgent care centres at weekends and on bank holidays from 9am to 5pm so that services are easier to navigate for patients and make best use of NHS resources. ELR CCG wants to hear patients’ views on whether standardising opening hours across most of the sites will meet patients’ needs locally.
Patients will be able to walk-in to access healthcare, and appointments will be offered to those calling NHS 111 if their symptoms require it. Patients will also be able to pre-book weekday evening, weekend and bank holiday appointments via their GP practice from September 2018.
What does this mean for Market Harborough? The nurse-led urgent care centre at St Luke’s Treatment Centre in Market Harborough is currently open on weekday evenings from 5pm to 9pm and at weekends and on bank holidays from 9am to 7pm. Under the plans, which are subject to the views of patients, the urgent care centre’s revised opening hours will be on weekday evenings from 6.30pm to 9pm, and at weekends and on bank holidays from 9am to 5pm. This is because urgent care centres are not widely used from 5pm to 6.30pm on weekdays when GP practices are still open. And, in response to feedback from patients, ELR CCG is considering standardising opening hours across most urgent care centres at weekends and on bank holidays from 9am to 5pm so that services are easier to navigate for patients and make best use of NHS resources. ELR CCG wants to hear patients’ views on whether standardising opening hours across most of the sites will meet patients’ needs locally.
Patients will be able to walk in to access healthcare, and appointments will be offered to those calling NHS 111 if their symptoms require it. Patients will also be able to pre-book weekday evening, weekend and bank holiday appointments via their GP practice from September 2018.
What does this mean for Oadby? The Oadby Urgent Centre will remain open as normal on weekday evenings from 8am to 9pm and at weekends and on bank holidays from 8am to 8pm. People are able to walk-in for care and appointments are also offered to those calling NHS 111. Patients will be able to walk-in to access healthcare, and appointments will be offered to those calling NHS 111 if their symptoms require it.
Patients will also be able to pre-book evening, weekend and bank holiday appointments via their GP practice from September 2018.
About East Leicestershire and Rutland Clinical Commissioning Group East Leicestershire and Rutland Clinical Commissioning Group (ELR CCG) was created under the Health and Social Care Act 2012. The ELR CCG represents 31 GP practices serving more than 325,000 patients in Melton, Rutland, Market Harborough, Blaby District, Lutterworth, and Oadby and Wigston. CCGs plan and purchase acute and community hospital care along with mental healthcare and other allied services. NHS England plans and purchases GP services, pharmacies, dentists, opticians and specialised commissioning services. From 1 April 2015 East Leicestershire and Rutland CCG has shared some of the commissioning responsibilities for its local GP services with NHS England.
Notes to editors
About East Leicestershire and Rutland Clinical Commissioning Group East Leicestershire and Rutland Clinical Commissioning Group (ELR CCG) was created under the Health and Social Care Act 2012. The ELR CCG represents 31 GP practices serving more than 327,000 patients in Melton, Rutland, Market Harborough, Blaby District, Lutterworth, and Oadby and Wigston. CCGs plan and purchase acute and community hospital care along with mental healthcare and other allied services. NHS England plans and purchases GP services, pharmacies, dentists, opticians and specialised commissioning services. From 1 April 2015 East Leicestershire and Rutland CCG has shared some of the commissioning responsibilities for its local GP services with NHS England. For more information please contact: Mike Wood – Communications and Engagement Officer Tel: 0116 295 6965 Email: [email protected]
Appendix E
Improving access to urgent care in the community - Blaby event feedback
Topic One – new site for Blaby The population of the north Blaby area is significant and has large population so the site should be there Makes sense for the urgent care centre to be at an existing healthcare site so as not to build a new site and waste resources that could be spent on doctors and nurses Public transport is not an issue because most people will have to travel by car to get to them anyway People don’t care about the quality of the building it’s the quality of the service Closer to main roads the better so it’s more accessible, near Fosse Park. However traffic could be an issue on the inner ring road, especially Christmas opening Should consider parking on site and the potential impact on local residents
Topic Two – opening hours The overlap with in-hours primary care is a waste of resources Consider seasonal differences in opening hours Like the idea of appointments booked in advance via GP practice Standardised opening hours across all sites would make it easier for patients to understand Weekend opening hours would make it more equitable
Topic Three – clinical triage Complex patients should see their own GP Patients would resent being signposted to somewhere else Patients don’t understand what triage is – less use of jargon People are getting more used to seeing prescribing nurse rather than GP, however there still can be stigma Patients would not like having to do be referred back to their practice after attending an urgent care centre. However – if the marketing of the service is right then patients know what to go where Appendix F
Improving access to urgent care in the community - Rutland event feedback
Changes to opening hours It’s difficult to get a GP appointment in hours – these changes to reduce the opening hours of some urgent care centres is going to increase the pressure on A & E 90% of appointments are used at weekends and bank holidays at Melton so why close it – should not have a one size fits all approach On the changes to weekday opening hours, for young children you don’t want to have to wait until 6.30pm to get help GP practices don’t always open until 6.30pm anyway
Why should Oakham have a GP when Melton is the busiest?
Oakham The Rutland GP out of hours service has been poorly publicised since it was launched – hence why the usage data is low
Misc Confused public perception of services – need to remove the jargon Concern over continuity of care at urgent care centres with your health record Concern over staffing the services Patients are only interested in their own local urgent care centre – not the ELR picture NHS 111 is a positive service but needs to be promoted better Appendices G, H, I, J, L, M, N
Appendices with raw source data are not included in this file. Please note that consideration of the engagement findings by the CCG included review of all data and comments in addition to the thematic analysis.
For enquiries about the raw source data and verbatim comments, please contact the CCG via our enquiries team:
Email: [email protected]
Telephone: 0116 295 3405
Improving access to urgent care in the community Engagement report: Ad-hoc analysis
Strategic Business Intelligence Team 6 August 2018
Strategic Business Intelligence Team Leicestershire County Council Improving access to urgent care in the community – Engagement report: Ad-hoc analysis
Alistair Mendes-Hay Research and Insight Officer
Strategic Business Intelligence Team Strategy Business Intelligence Branch Chief Executive’s Department Leicestershire County Council County Hall, Glenfield Leicester LE3 8RA
Tel 0116 305 6801 Email [email protected]
Produced by the Strategic Business Intelligence Team at Leicestershire County Council.
Whilst every effort has been made to ensure the accuracy of the information contained within this report, Leicestershire County Council cannot be held responsible for any errors or omission relating to the data contained within the report.
Published 6 August 2018 2 Improving access to urgent care in the community – Engagement report: Ad-hoc analysis
Methodology
An engagement process concerning urgent care services was undertaken with stakeholders, patients and the public in June and July 2018 by East Leicestershire and Rutland (ELR) CCG. In total, 775 responses were received to the engagement survey.
The main analysis report of these responses was provided by Arden & GEM.
This report concentrates on the results of an ad-hoc locality-focused analysis of two survey questions:
Q9: Our research shows that there is a significant demand for services in the Blaby district are when GP practices are closed. If we were to open an urgent care centre in the Blaby district area on weekday evenings, at weekends and on bank holidays, how likely is it that you would use the service?
Q10: Considering the following access factors, what would be important to you about the location of the urgent care centre in the Blaby district area?
A respondent-level dataset was provided by ELR CCG. Locality information was supplied within the dataset, based on the postcode sector of the respondent.
Chi-square tests were used to detect any significant differences in responses between respondents from different localities.
Charts are used to assist in the explanation of the analysis.
Published 6 August 2018 3 Improving access to urgent care in the community – Engagement report: Ad-hoc analysis
Analysis
Q9: Our research shows that there is a significant demand for services in the Blaby district are when GP practices are closed. If we were to open an urgent care centre in the Blaby district area on weekday evenings, at weekends and on bank holidays, how likely is it that you would use the service?
The response to this question was split: nearly half of all respondents (44%) said they were likely to use the Urgent Care Centre in Blaby if open on weekday evenings, at weekends and on bank holidays. Equally, nearly half (44%) said they were not likely to use such as service.
Splitting the responses by patient locality revealed some notable but understandable differences. Patients living closer to or within Blaby district were more likely to use an Urgent Care Centre located in the area, than those living further away.
Significantly more of the residents in the localities of North Blaby (95%), Oadby and Wigston (78%), and South Blaby (69%) said they would use an Urgent Care Centre in Blaby, compared to patients living elsewhere in ELR CCG (3-9%).
Published 6 August 2018 4 Chart 1: Q9 - Our research shows that there is a significant demand for services in the Blaby district are when GP practices are closed. If we were to open an urgent care centre in the Blaby district area on weekday evenings, at weekends and on bank holidays, how likely is it that you would use the service?
Likely 44% 16% 28%
Not sure 12% 12% Response Very likely Not likely 44% 44% Likely Not sure Base = 763 Not likely
Chart 2: Q9 - Our research shows that there is a significant demand for services in the Blaby district are when GP practices are closed. If we were to open an urgent care centre in the Blaby district area on weekday evenings, at weekends and on bank holidays, how likely is it that you would use the service? (split by locality)
Locality Base
N. Blaby 116 1%4% 95%
O&W 9 22% 78%
S. Blaby 213 21% 10% 69%
Harborough 132 76% 15% 9%
Rutland 119 75% 23% 3%
SLAM 43 81% 14% 5%
Response Likely 44% 12% 44% Overall 763 Not sure Not likely Q10: Considering the following access factors, what would be important to you about the location of the urgent care centre in the Blaby district area?
The majority of respondents said a pharmacy open at the same time nearby (72%), parking (70%), and accessibility by public transport (50%) were important factors when considering the location of the Urgent Care Centre in Blaby district. Just under half of respondents (46%) said the service being provided from an existing healthcare facility (such as a GP practice) was an important factor.
Similar to Q9, patients living closer to Blaby district were more likely to deem the factors to be important. The majority of patients in South Blaby and Oadby & Wigston localities considered all four factors to be important. Notably, significantly higher proportions of patients in South Blaby felt all four factors were important, compared to the average.
Similarly, significantly higher proportions of patients in North Blaby felt three of the four factors were important, compared to the average. Notably however the proportion in this locality that said the service being provided from an existing healthcare facility (such as a GP practice) was not an important factor (49%) was significantly higher than the average (24%).
Accessibility by public transport appeared to polarise patients living within Blaby district. As noted above, the proportion of patients in North Blaby (59%) and South Blaby (65%) to consider the factor to be important was significantly higher compared to the average (50%). Also however, the proportions in both localities that did not consider public transport accessibility to be important (34% and 26%) was also significantly higher than the average (22%).
Despite patients in more proximal localities to Blaby district placing greater importance on the listed factors, a pharmacy being open at the same time nearby was considered to be the most important factor by five of the six localities (97% of North Blaby patients felt parking to be more important).
In contrast, the service being provided from an existing healthcare facility (such as a GP practice) was considered to be the least important factor by five of the six localities (37% of Harborough patients felt the service being accessible by public transport to be less important). Chart 3: Q10 - Considering the following access factors, what would be important to you about the location of the urgent care centre in the Blaby district area? Option Base
There is a pharmacy open at the same time nearby 751 3% 23% 5% 23% 44%
Parking 752 4% 26% 5% 22% 43%
Accessible by public transport 738 22% 29% 11% 16% 23%
Service is provided from an existing healthcare facility (such as a GP practice) 744 24% 30% 9% 19% 18%
Response Very important Important Slightly important No opinion Not important
Chart 4: Q10 - Considering the following access factors, what would be important to you about the location of the urgent care centre in the Blaby district area? There is a pharmacy open at the same time nearby (split by patient locality) Locality Base
S. Blaby 211 1%5% 94%
O&W 9 11% 89%
N. Blaby 116 6% 94%
Harborough 127 5% 30% 65%
SLAM 42 48% 52%
Rutland 118 5% 64% 31%
Response Overall 751 3% 23% 73% Important No opinion Not important
Improving access to urgent care in the community – Engagement report: Ad-hoc analysis Chart 5: Q10 - Considering the following access factors, what would be important to you about the location of the urgent care centre in the Blaby district area? Parking (split by patient locality) Locality Base
N. Blaby 114 3% 97%
O&W 9 11% 89%
S. Blaby 209 2% 7% 91%
Harborough 130 8% 38% 53%
SLAM 42 2% 57% 40%
Rutland 118 6% 65% 29%
Response Important Overall 752 4% 26% 69% No opinion Not important
Chart 6: Q10 - Considering the following access factors, what would be important to you about the location of the urgent care centre in the Blaby district area? Accessible by public transport (split by patient locality) Locality Base
O&W 9 11% 11% 78%
SLAM 42 2% 55% 43%
S. Blaby 205 26% 9% 65%
N. Blaby 111 34% 6% 59%
Rutland 118 9% 64% 27%
Harborough 126 24% 39% 37%
Response Important Overall 738 22% 29% 50% No opinion Not important
Published 6 August 2018 8 Improving access to urgent care in the community – Engagement report: Ad-hoc analysis
Chart 7: Q10 - Considering the following access factors, what would be important to you about the location of the urgent care centre in the Blaby district area? Service is provided from an existing healthcare facility (such as a GP Practice) (split by patient locality) Locality Base
SLAM 43 5% 56% 40%
S. Blaby 208 29% 9% 62%
Harborough 128 16% 42% 42%
O&W 9 33% 11% 56%
Rutland 116 8% 66% 26%
N. Blaby 113 49% 8% 43%
Response Important Overall 744 24% 30% 45% No opinion Not important
Chart 8: Q10 - Considering the following access factors, what would be important to you about the location of the urgent care centre in the Blaby district area? (% respondents who said ‘important’, split by patient locality) Locality / Base Harborough N. Blaby O&W Rutland S. Blaby SLAM Option 130 116 9 118 211 43
There is a pharmacy open at the same time 65% 94% 89% 31% 94% 52% nearby
Parking 53% 97% 89% 29% 91% 40%
Accessible by public transport 37% 59% 78% 27% 65% 43%
Service is provided from an existing 42% 43% 56% 26% 62% 40% Rank healthcare facility (such as a GP practice) 1 0% 50% 100% 0% 50% 100% 0% 50% 100% 0% 50% 100% 0% 50% 100% 0% 50% 100% 2
% respondents who said % respondents who said % respondents who said % respondents who said % respondents who said % respondents who said 3 'Important' 'Important' 'Important' 'Important' 'Important' 'Important' 4
Published 6 August 2018 9
Strategic Business Intelligence Team Strategy and Business Intelligence Branch
Chief Executive’s Department Leicestershire County Council County Hall Glenfield Leicester LE3 8RA [email protected] www.lsr-online.org
Leicester City Clinical Commissioning Group West Leicestershire Clinical Commissioning Group East Leicestershire and Rutland Clinical Commissioning Group
2018/2019 Outline Business Case
Project title: General Practice Support and Investment Programme (GP SIP) CCG project impact: NHS ELR CCG Lead CCG for the project Tim Sacks, Chief Operating Officer Project manager: Paula Vaughan, Deputy Chief Operating Officer Clinical lead: Dr Andy Ker, ELR CCG Board Member SRO: Tim Sacks, Chief Operating Officer Finance lead: Richard George Activity lead: Primary Care Operations Team, ELR CCG Project start date: June 2018
1) Aim and objectives of the project (Short overview of the project. What does the project aim to achieve) The project aims to recommission Extended Primary care services across ELR with the intention of:
Reducing confusion for patients Providing a service more integrated across localities Providing a locality-based approach to service provision Providing a service in which the right clinical staff want to work Providing a service which is a vital part of the wider LLR Urgent Care services Delivering a service which supports core primary care and contributes to the sustainability of ELR practices Builds on the excellent service we already provide to do the above.
2) Background (What factors influence your project choice?)
The drive for change has come from patient feedback over the past 12 months.
1 We have worked with our Patient Participation Groups to understand what is important for our patients to help shape our plans. Additionally, a pilot is currently underway in Syston, Long Clawson, Melton, Oakham and Market Harborough which will see patients who cannot be seen during GP opening hours, booked an appointment at Oakham (weekends) or Market Harborough (evenings) out of hours by their practice. The findings from the pilot, which includes reviewing patient experience, will be used to influence the roll out of this service enhancement later this year. Further enhancements in access are then expected to follow.
2 Patient feedback on current services has been consolidated from patient surveys, individual Patient Participation Groups (PPGs) meetings and group development sessions with the Chairs of each of the PPGs. In addition, the CCG’s Listening Booth has been to our most used site in Oadby to talk to patients directly about their experiences in accessing both Primary and Urgent Care.
3 The information the CCG has been given is that in core hours, patients either perceive or know there is not enough capacity within Primary Care and so they travel to use walk-in services such as in Oadby as an alternative. This is also a key theme in the patient survey results and from the PPGs.
4 Patients have also told us that they are confused about what is available when, (especially when out-of-hours services overlap with core GP opening times) and about how to access services (are services walk-in or bookable).
5 Patients also tell us that they are less likely to travel to use acute services if there are accessible, easily to use services in their immediate vicinity (or locality). They also tell us that the reduction in public transport makes living in some of our localities more difficult to access services and that the retention of local sites is important to them.
6 This important information has helped to decide the aspect of the current service which the CCG needs to address and look to improve.
Both current contracts come to an end of 31 March 2019 and recommissioning of the service is now required to ensure there is no gap in service.
Since April 2015, ELR CCG has delivered an exemplary Urgent Care service for its patients. For the past 3 years, the CCG has delivered a community-based face to face Urgent Care service which supports both patients in receiving care closer to home and the sustainability of general practice.
The service has delivered over 100,000 primary care appointments to ELR patients since its inception providing out of hours care closer to home. The service has also supported over 32,000 non-ELR patients with face to face consultations in the community as an alternative to accessing Acute services and as an essential part of the wider LLR Urgent Care system.
ELR CCG is changing its approach to the commissioning of community-based urgent care. Extended Primary Care (EPC) has previously been proposed as the ELR solution to the out-of-hours aspect of the ELR CCG Community Urgent Care service model. The service will be developed and delivered as part of the CCG’s response to the requirements of the GP5YFV and will also provide the ELR out-of-hours community base service as part of the wider LLR Integrated Urgent Care system.
Significant engagement, consultation and service design work was undertaken between 2012 and 2014 which procured and implemented a new urgent care service from April 2015. The CCG was nominated for an HSJ award for this work and its approach to patient centred commissioning.
Patient and CQC satisfaction with the current urgent care service is high, but confusion remains for some patients where service overlap exists or access routes differ across the CCG. The opportunities to further improve on the current model have been reviewed and appraised over the past year improving access to out-of-hours primary care services for even more ELR patients.
3 Strategic context (E.g. Linkages to STP, Operational Plan, 5 Year Forward View, RightCare)
The GP SIP contributes to the following: ELR CCG Operational Plan GP 5 year Forward View Addressing National and Local clinical priorities Integrated Teams and a locality based approach to commissioning
4) Alignment with STP priorities (please appropriate box) New models of care focused on prevention, moderating demand growth. YES Service configuration to ensure clinical and financial sustainability. YES Redesign pathways. N/A Operational efficiencies. YES Getting the enablers right. YES 5) Has the RightCare Commissioning for Value Pack been considered for this project? Y/N? Please provide details of areas covered/addressed?
No. This project is linked to the CCG’s requirement to deliver the key standards within the GP5YFV.
6) Alignment to QIPP (Demonstrate how the project delivers against QIPP) Quality: The service provided is currently is already of a high quality and project builds on this and the need to retain service quality.
Innovation: The delivery at a locality level strengthens the new structure and gives the CCG a basis on which to commission other services in the future.
Prevention: By meeting primary care urgent need and demand, the service will play a vital role within the vital LLR UC system, reducing the pressure on primary care and acute services.
Productivity This capacity is over and above the GP5YFV recommendations and requirements, but offer best access for ELR patients.
18/19 £s 19/20 £s 20/21 £s
Gross Investment Net Gross Investment Net Gross Investment Net Savings Savings Savings Savings Savings Savings £2,242,665 £2,298,732 £2,298,732 £ £ £ £
18/19 Activity Reduction 19/20 Activity Reduction 20/21 Activity Reduction
Not part of the financial envelope requirements. Any shift from ED will be additional system QIPP.
7) Measures of success (What are your key performance indicators? Do you have a baseline in which to measure improvement?) I.e. reduction in activity, waiting times, improved patient choice and outcomes.
Key performance indicators and metrics to be measured will be included within the final service specification.
They will include measures in the fields of:
Patients service satisfaction Waiting times Slot availability and delivery of capacity Referral rates back into primary care Prescribing and medicines management Use of triage and signposting service/tariff
8) Project costs (What are the costs associated with the project? Are they recurrent (ongoing, year on year) or non-recurrent (time limited, e.g. set-up costs, pump-priming)?
Recurrent CCG investment of £2.2M
9) Project timescales (When will the project start? Are there any phasing requirements? Is there recruitment involved?) Will the project have a part year effect?
This is a 5 year project and a 3+2 contract will be offered. Implementation date is 1 April 2019.
10) Impact on current contracts (Activity and Cost. What contracts will the projects implementation have an impact on? How has this been considered?) Has it been agreed? If so, where? Where have decisions been made? Has there been engagement with all relevant parties?
The cost pressure on the current financial envelope is £174K.
This has been agreed by the ELR CCG June GB and will be met from the GP5YFV investment pot.
The agreement of a 5 year contract and a competitive procurement process has been made by the Feb 2018 LLR CPC and agreed by the ELR CCG June GB.
11) Competition and procurement considerations (How will the project be implemented? E.g. pilot, extension of current service provision? Have initial discussions been held with Competition and Procurement Committee (CPC) Dates? Supporting papers?
Appendix A template Vs 15 OCTOBER 2016 - CPC April 18.docx
12) What potential project risks and unintended consequences have been identified and what mitigations will be put in place?
Further mitigations and risk management to the contract term are suggested in the inclusion of various caveats within the specification which enable change without penalty to the CCG.
Whilst we need to consider flexibility we must be mindful that if the specification and/or tender/procurement is too vague which could have implication on the number of bids we may receive as the contract can become unattractive if it is too vague, we should be able to test out in the tender/procurement how bidders could respond to changes and their ability to remain flexible and be open to changes if there are reconfigurations in the system.
The key here would be to be upfront about it and include it in the specification, test it out at market engagement event and during the tender/procurement and ensure that this is then captured in the contract with the preferred bidder/successful provider so that there are no issues in terms of contracting later on and decrease the risk of challenges if contract variations are issued in the future.
East Leicestershire & Rutland Clinical Commissioning Group
Quality Impact Assessment and Equality Impact Assessment
Title and lead for scheme: Extended Primary Care
Brief description of the scheme: The project aims to recommission Extended Primary care services across ELR with the intention of:
Reducing confusion for patients Providing a service more integrated across localities Providing a locality-based approach to service provision Providing a service in which the right clinical staff want to work Providing a service which is a vital part of the wider LLR Urgent Care services Delivering a service which supports core primary care and contributes to the sustainability of ELR practices
Builds on the excellent service we already provide to do the above.
Commissioning Strategy Does the proposal support Y/N Does the proposal support the Y/N Question the CCG’s Vision and Question CCG’s Commissioning Yes Yes Strategic Goals? Intentions?
Quality Impact Assessment (QIA)
The QIA tool will require judgement against the ‘Duty of Quality’ outlined by the 5 domains included within the NHS Outcomes Framework. Each business case or project lead will need to assess whether the proposal being considered will result in a positive or adverse impact for patients and/or staff. If an adverse impact is identified in any area this will result in the need to calculate the overall risk of implementing the proposal using the CCG Risk Matrix (Appendix 1).
Equality Impact Assessment (EIA)
The general equality duty that is set out in the Equality Act 2010 requires public authorities, in the exercise of their functions, to have due regard to the need to:
Eliminate unlawful discrimination, harassment and victimisation and other conduct prohibited by the Act. Advance equality of opportunity between people who share a protected characteristic and those who do not.
Foster good relations between people who share a protected characteristic and those who do not.
The purpose of the EIA tool is to identify if the proposal being considered will affect people who share relevant protected equalities characteristics in different ways to people who do not share them. Please include actions to mitigate any risks identified.
Please ensure you are familiar with the Due Regard guidance before completing the equality analysis
Leicester City Clinical Commissioning Group West Leicestershire Clinical Commissioning Group East Leicestershire and Rutland Clinical Commissioning Group
QUALITY IMPACT ASSESSMENT
Please tick (√) response to each clinical quality consideration in the appropriate box. *On completion please calculate risk score if adverse impact identified using the CCG Risk Matrix.
Domain Detail No Impact Positive Adverse Level of Risk Impact Impact* 1. Impact on quality of Has the scheme been risk assessed for the likely Low – build services impact on the quality of services? on current services and improve access 2. Ability to deliver Has a risk assessment been carried out to ascertain Larger and the likelihood of overall scheme delivery? longer contract – more appealing to the market 3. Impact on staff Has a risk assessment been undertaken to assess Better working the impact the implementation of the scheme will within the new have on staff? service and supports primary care 4. Assessment of Has as assessment of the likelihood of any Building on unintended unintended consequences as a result of the scheme current consequences being implemented? services – no substantial change and service developed with both HW and patients
5. Contingency plans for Has the scheme been assessed for any unforeseen Has been unforeseen consequences that may arise as a result of its undertaken – consequences implementation? risk associated with longer procurement process is public engagement results requires consultation – contract extension possible as a mitigation Overall summary and Risk Score (if applicable)
Date of Assessment 1 9 0 6 1 8 Name of Individuals Paula Vaughan, Deputy Chief Operating Completing the Assessment: Officer EQUALITY IMPACT ASSESSMENT a) Would the service be aimed at any b) Would the service potentially c) Would the service potentially have d) Are there any known barriers particular equality group? exclude any of the equality groups? a negative impact on any of the which could obstruct access to Yes or No Yes or No equality groups? the benefits of the service? Equality Group Yes - No Yes – No If yes, please provide a brief explanation If yes, please give any evidence of the If yes, please detail action plan to Barriers could be physical, why particular group(s) would be targeted mitigating circumstances e.g. services address the current identified negative geographical or communication. If may be for males only and therefore the impact yes, explain what you intend to do to gender box be ticked “yes” with remove these barriers. evidence below on why females would be excluded Age No overall scheme is aimed at all ages Yes as already described and is the No. The service is being No. The service is being but very young children may be case with the current service. Based commissioned to respond to the commissioned to respond to the directed to a GP to ensure right care on clinical need of the patient. urgent care needs of all patients. urgent care needs of all patients. first time
Disability No the overall scheme is aimed at all Yes in terms of being able to travel to No the overall scheme is aimed at all Yes in terms of being able to patients and those with a disability the service sites. 111/CNH offer patients and those with a disability travel to the service sites. would not be excluded or affected by triage over the phone as a mitigation would not be excluded or affected by 111/CNH offer triage over the this scheme. Mobility issues may mean and are able to book these patients this scheme phone as a mitigation and are some patients find it difficult to travel to into a face to face consultation with able to book these patients into a the service delivery sites. the UCVS as an additional mitigation. face to face consultation with the UCVS as an additional mitigation.
Gender No the overall scheme is aimed at all No the overall scheme is aimed at all No the overall scheme is aimed at all No the overall scheme is aimed at reassignment patients and those with a gender patients and those with a gender patients and those with a gender all patients and those with a reassignment would not be excluded reassignment would not be excluded reassignment would not be excluded gender reassignment would not or affected by this scheme or affected by this scheme or affected by this scheme be excluded or affected by this scheme
a) Would the service be aimed at any b) Would the service potentially c) Would the service potentially have d) Are there any known barriers particular equality group? exclude any of the equality groups? a negative impact on any of the which could obstruct access to Yes or No Yes or No equality groups? the benefits of the service? Equality Group Yes - No Yes – No If yes, please provide a brief explanation If yes, please give any evidence of the If yes, please detail action plan to Barriers could be physical, why particular group(s) would be targeted mitigating circumstances e.g. services address the current identified negative geographical or communication. If may be for males only and therefore the impact yes, explain what you intend to do to gender box be ticked “yes” with remove these barriers. evidence below on why females would be excluded
Marriage and No the overall scheme is aimed at all No the overall scheme is aimed at all No the overall scheme is aimed at all No the overall scheme is aimed at civil partnership patients and marriage and civil patients and marriage and civil patients and marriage and civil all patients and marriage and civil partnership would not be excluded or partnership would not be excluded or partnership would not be excluded or partnership would not be affected by this scheme affected by this scheme affected by this scheme excluded or affected by this scheme
Pregnancy and No the overall scheme is aimed at all No the overall scheme is aimed at all No the overall scheme is aimed at all No the overall scheme is aimed at Maternity patients and pregnancy and maternity patients and pregnancy and patients and pregnancy and all patients and pregnancy and would not be a reason to be excluded maternity would not be a reason to maternity would not be a reason to maternity would not be a reason or affected by this scheme be excluded or affected by this be excluded or affected by this to be excluded or affected by this scheme scheme scheme
Race No the overall scheme is aimed at all No the overall scheme is aimed at all No the overall scheme is aimed at all No the overall scheme is aimed at patients and race would not be a patients and race would not be a patients and race would not be a all patients and race would not be reason to be excluded or affected by reason to be excluded or affected by reason to be excluded or affected by a reason to be excluded or this scheme this scheme this scheme affected by this scheme
Religion and No the overall scheme is aimed at all No the overall scheme is aimed at all No the overall scheme is aimed at all No the overall scheme is aimed at belief patients and religion and belief would patients and religion and belief would patients and religion and belief would all patients and religion and belief not be a reason to be excluded or not be a reason to be excluded or not be a reason to be excluded or would not be a reason to be affected by this scheme affected by this scheme affected by this scheme excluded or affected by this scheme
a) Would the service be aimed at any b) Would the service potentially c) Would the service potentially have d) Are there any known barriers particular equality group? exclude any of the equality groups? a negative impact on any of the which could obstruct access to Yes or No Yes or No equality groups? the benefits of the service? Equality Group Yes - No Yes – No If yes, please provide a brief explanation If yes, please give any evidence of the If yes, please detail action plan to Barriers could be physical, why particular group(s) would be targeted mitigating circumstances e.g. services address the current identified negative geographical or communication. If may be for males only and therefore the impact yes, explain what you intend to do to gender box be ticked “yes” with remove these barriers. evidence below on why females would be excluded
Sex (gender) Positive impact across all age groups Positive impact across all age groups Positive impact across all age groups Positive impact across all age in that all ages groups are considered in that all ages groups are in that all ages groups are groups in that all ages groups are considered considered considered
Sexual No the overall scheme is aimed at all No the overall scheme is aimed at all No the overall scheme is aimed at all No the overall scheme is aimed at orientation patients and sexual orientation would patients and sexual orientation would patients and sexual orientation would all patients and sexual orientation not be a reason to be excluded or not be a reason to be excluded or not be a reason to be excluded or would not be a reason to be affected by this scheme affected by this scheme affected by this scheme excluded or affected by this scheme
Social Exclusion Yes the scheme would aim to address No the overall scheme is aimed at all No the overall scheme is aimed at all No the overall scheme is aimed at and economic access issues for those patients living patients and those from excluded or patients and those from excluded or all patients and those from the locality currently without an EPC deprived areas would not be a deprived areas would not be a excluded or deprived areas would deprivation site. reason to be excluded or affected by reason to be excluded or affected by not be a reason to be excluded or this scheme this scheme affected by this scheme
a) Would the service be aimed at any b) Would the service potentially c) Would the service potentially have d) Are there any known barriers particular equality group? exclude any of the equality groups? a negative impact on any of the which could obstruct access to Yes or No Yes or No equality groups? the benefits of the service? Equality Group Yes - No Yes – No If yes, please provide a brief explanation If yes, please give any evidence of the If yes, please detail action plan to Barriers could be physical, why particular group(s) would be targeted mitigating circumstances e.g. services address the current identified negative geographical or communication. If may be for males only and therefore the impact yes, explain what you intend to do to gender box be ticked “yes” with remove these barriers. evidence below on why females would be excluded e) Please confirm you will collect personal data (in line with CCG information governance policies) to N/A ensure your service is targeted at the right people. Yes - No
Appendix 1
RISK RATING MATRIX
ACTUAL RISK OUTCOME
LOW MODERATE SIGNIFICANT HIGH (Green) (Yellow) (Amber) (Red)
CONSEQUENCE LIKELIHOOD INSIGNIFICANT MINOR MODERATE MAJOR CATASTROPHIC 1 2 3 4 5 ALMOST 5 10 15 20 25 CERTAIN (Yellow) (Amber) (Red) (Red) (Red) 5 4 8 12 16 20 LIKELY 4 (Yellow) (Amber) (Amber) (Red) (Red) 3 6 9 12 15 POSSIBLE 3 (Green) (Yellow (Amber) (Amber) (Red) 2 4 6 8 10 UNLIKELY 2 (Green) (Yellow) (Yellow) (Amber) (Amber) 1 2 3 4 5 RARE 1 (Green) (Green) (Green) (Yellow) (Amber)
RISK LIKELIHOOD TABLE - Guidance
1 2 3 4 5
Descriptor Rare Unlikely Possible Likely Almost
Expected to Expected to Not expected Expected to Expected to Frequency occur at occur at to occur for occur at least occur at least least daily years monthly least weekly annually < 1% 1-5% 6-29% 21-50% >50% Will only More likely Reasonable occur in to Probability Unlikely to chance of Likely to exceptional occur than occur occurring occur circumstances not
Consequences descriptor table (source: Risk Management Strategy and Policy)
a b c d e f
Actual or Actual or The potential for Quality Service Litigation Potential Potential financial loss continuity /
Impact on Impact on flexibility individual the Descriptor
s and organisatio Directorate Level service n’s Corporate reputation / credibility 1 Negligible Minimal No Less Less Minor non No impact Potential for Near immediate than than compliance on services litigation misses risk to £500 £10,000 although it Departmen organisation has potential t / investigatio n 2 Minor Short term Minimal risk £500 - £10,000 Single Minor impact Minor cost injury / to £5,000 - failure to on services Court damage organisation £100,00 meet attendance Cuts / Local press 0 internal bruises < 1 days standard < 7 days coverage absence 3 Moderate Semi- RIDDOR £5,000 - £100,00 Repeated Loss of Civil action permanent reportable £12,000 0 - failure to some local defensible injury / MDA £250,00 meet service HSE damage reportable 0 internal improvemen Significant Need careful standards t notice impact on PR care Local media > 7 days < 7 days absence coverage 4 Major Permanent Trust £12,000 £250,00 Failure to Loss of Civil action injury / investigation - 0 - meet service no defence damage Service £25,000 £500,00 contract affecting HSE Critical closure 0 quality more than Prohibition impact on RIDDOR standards one notice care reportable department Reportable Long term to HSE sickness Need PR National media < 7 days coverage 5 Catastroph Life Trust > > Failure to Major Criminal ic threatening investigation £25,000 £500,00 meet disruption to prosecution Fatality Regulator 0 National Trust investigation and National Profession media > 7 al days standards coverage HSE investigation MP Concern
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Scheme : Extended Primary Care Quality Impact Assessment (QIA) Date of QIA: June 2018 Review Date: End April 2019
Scheme Name: Extended Primary Care
The project aims to recommission Extended Primary care services across ELR with the intention of:
Reducing confusion for patients Providing a service more integrated across localities Overview of Scheme: Providing a locality-based approach to service provision Providing a service in which the right clinical staff want to work Providing a service which is a vital part of the wider LLR Urgent Care services Delivering a service which supports core primary care and contributes to the sustainability of ELR practices Builds on the excellent service we already provide to do the above.
Clinical Lead: Dr Girish Purohit, ELR CCG Board Member
Project Lead: Paula Vaughan, DCOO Area: Primary Care
Risks to Patient Safety: Details (include mitigation) Consequence Likelihood Score Does the scheme minimise harm & risk to patients? 0
Is there any impact to vulnerable patients? Yes positive impact on vulnerable patients due to Yes positive impact increased focus in long term conditions identification Y treatment and management.
15
Will the scheme impact on the safeguarding of Adult or Potential positive impact in that there will be increased Children? opportunities to identify vulnerable adults and ensure that timely referrals and support can be implemented. Y Responsibility to do this will form part of the service specification.
Is patient safety in any way compromised by the There should be increased safety due to improved scheme? patient involvement in care and early identification and N patient education.
Is there any impact on the processes for preventing Healthcare Associated Infections or other related harm? Y To form part of the service specification. (e.g. MRSA / CDI, falls etc)
Risks to Clinical Effectiveness: Details (include mitigation) Consequence Likelihood Score Is the scheme the application of best knowledge, derived from research? 0
Does the scheme result in shorter lengths of hospital stay? N N/A for this scheme
Does the scheme improve the patient's clinical For urgent care needs, this is one of the key outcomes. Y outcome? Does the scheme result in a higher likelihood of For urgent care needs, this is one of the key outcomes. Y recovery? Does the scheme provide better access to wider care pathways? N Not applicable for this group of patients.
Risks to Patient Experience: Details (include mitigation) Consequence Likelihood Score Will the scheme offer a positive experience of care? 0
Increase in urgent care and care closer to home. Does the scheme result in a more positive experience Y but Potential perspective that service has been lost and for patients? less access. Improved access across the whole CCG and Does the scheme result in better access to services for standardised hours and access pathways. Y patients?
16
Does the scheme require any level of public and/or Public engagement commenced 19.6.18 for 5 weeks. Y patient engagement? Does the scheme require patients or their carers to N N/A travel further to access services? Will there be any impact on cleanliness and general N All standards maintained via the service specification. environmental standards?
Details (include mitigation) Consequence Likelihood Score Risks to Staff experience 3 3 9
Current staff will Tupe across to a new provider. Y Is there a likely impact on staff? Does the scheme require any level of public and/or Public engagement commenced 19.6.18 for 5 weeks. Y patient engagement?
Has engagement been factored into project planning? Y As above.
Details (include mitigation) Consequence Likelihood Score Risks to Disinvestment & Contingency Plans 3 3 9
If the plans include disinvestment what is the likely N N/A clinical effect? Is there sufficient evidence that unintended consequences have been assessed including patient experience and staffing? Y Building on current service so risk understood and low. Example impact on Prescribing?
In terms of contract extension for an additional year in Are there contingency plans for unforeseen Y case of need to publically consult on changes. consequences?
Have clinical outcomes for each QIPP scheme been identified and are mechanisms in place to monitor N N/A progress.
17
Details (include mitigation) Consequence Likelihood Score Evidence Base 0
Do the clinical QIPP plans describe robust evidence N N/A base for the initiative and the potential outcomes? Are the plans underpinned by National evidence based guidance such as NICE or supported by NHS Right care N N/A (CV4)? Does the scheme maximise value (personalisation or N N/A added population benefit)?
Details (include mitigation) Consequence Likelihood Score Interdependencies - Predicted v Actual Savings 0
Has sustainability been assessed and have actions
been identified to enable maintaining the service? Y 5 year contract. Will sustainability be assessed at each quarter including impact on staffing costs if discontinued, if applicable? N N/A Is there evidence of clinical buy-in and support? Yes via locality leads, GB and locality meetings. Y
At what point do savings reside at a saturation level and has there been some modelling around this? N N/A
What is the predicted return on investments? N N/A Is the scheme interdependent upon previous years initiatives? N N/A If so, Was the scheme assured by NHSE?
Does the CCG have a track record of delivery in QIPP? Y Previous 4 years achieved.
18
Details (include mitigation) Consequence Likelihood Score Governance 0
Have the named clinical leads e.g. Medical and Chief Nurses with the responsibility for patient safety and N N/A quality signed off the QIPP plans?
Have appropriate discussions been had with secondary care providers and agreement reached about sign off N N/A with medical and nursing directorates within secondary care? Has the Equality Impact Assessment been completed? Y See above
Has the Privacy Impact Assessment been completed? N Daljit looking into this as not on all forms
Have QIPP plans been shared with stake holders? N N/A
Overall Risk Score 9 (highest from above quality domains)
Sign Off Signature Date Head of Finance Head of Quality Head of Corporate Governance Head of Primary Care Head of Strategy and Planning Head of Performance and QIPP Head of Communications
19
Head of Contracting
Consequences scores: 1 Insignificant, 2 Minor, 3 Moderate, 4 Major, 5 Severe Likelihood scores: 1 Rare, 2 Unlikely, 3 Possible, 4 Likely, 5 Almost
20
QUALITY IMPACT ASSESSMENT
Please tick (√) response to each clinical quality consideration in the appropriate box. *On completion please calculate risk score if adverse impact identified using the CCG Risk Matrix.
Domain Detail No Impact Positive Adverse Level of Risk Impact Impact* 1. Impact on quality of Has the scheme been risk assessed for the likely Low – build on services impact on the quality of services? current services, expand sites, standardise hours of avialability and improve access 2. Ability to deliver Has a risk assessment been carried out to ascertain Larger and the likelihood of overall scheme delivery? longer contract – more appealing to the market 3. Impact on staff Has a risk assessment been undertaken to assess Better working the impact the implementation of the scheme will within the new have on staff? service and supports primary care 4. Assessment of Has as assessment of the likelihood of any Building on unintended unintended consequences as a result of the scheme current services consequences being implemented? – no substantial change and service developed with both HW and patients through independently evaluated engagement exercise
5. Contingency plans for Has the scheme been assessed for any unforeseen Has been unforeseen consequences that may arise as a result of its undertaken – consequences implementation? risk associated with longer procurement process is public engagement results requires consultation – contract extension possible as a mitigation Overall summary and Risk Score (if applicable)
Date of Assessment 2 3 0 8 1 8 Name of Individuals Paula Vaughan, Deputy Chief Operating Completing the Assessment: Officer Chris Lyon, Commissioning Manager
Revised 23 August 2018 - CL
EQUALITY IMPACT ASSESSMENT
a) Would the service be aimed at any b) Would the service potentially c) Would the service potentially have d) Are there any known barriers particular equality group? exclude any of the equality groups? a negative impact on any of the which could obstruct access to Yes or No Yes or No equality groups? the benefits of the service? Equality Group Yes - No Yes – No If yes, please provide a brief explanation If yes, please give any evidence of the If yes, please detail action plan to Barriers could be physical, why particular group(s) would be targeted mitigating circumstances e.g. services address the current identified negative geographical or communication. If may be for males only and therefore the impact yes, explain what you intend to do to gender box be ticked “yes” with remove these barriers. evidence below on why females would be excluded Age No, overall scheme is aimed at all Yes as already described and is the No. The service is being No. The service is being ages but very young children may be case with the current service. Based commissioned to respond to the commissioned to respond to the directed to a GP if clinically appropriate on clinical need and clinical safety of urgent care needs of all patients. urgent care needs of all patients. either within the urgent care service or the patient. via an appointment with their own GP to ensure right care first time
Disability No, the overall scheme is aimed at all Yes in terms of being able to travel to No, the overall scheme is aimed at all Yes in terms of being able to patients and those with a disability the service sites. 111/CNH offer patients and those with a disability travel to the service sites. would not be excluded or affected by triage over the phone as a mitigation would not be excluded or affected by 111/CNH offer triage over the this scheme. Mobility issues may mean and are able to book these patients this scheme phone as a mitigation and are some patients find it difficult to travel to into a face to face consultation with able to book these patients into a the service delivery sites. the UCVS as an additional mitigation. face to face consultation with the UCVS as an additional mitigation.
Gender No, the overall scheme is aimed at all No, the overall scheme is aimed at all No, the overall scheme is aimed at all No, the overall scheme is aimed reassignment patients and those with a gender patients and those with a gender patients and those with a gender at all patients and those with a reassignment would not be excluded reassignment would not be excluded reassignment would not be excluded gender reassignment would not or affected by this scheme or affected by this scheme or affected by this scheme be excluded or affected by this scheme
Revised 23 August 2018 - CL
a) Would the service be aimed at any b) Would the service potentially c) Would the service potentially have d) Are there any known barriers particular equality group? exclude any of the equality groups? a negative impact on any of the which could obstruct access to Yes or No Yes or No equality groups? the benefits of the service? Equality Group Yes - No Yes – No If yes, please provide a brief explanation If yes, please give any evidence of the If yes, please detail action plan to Barriers could be physical, why particular group(s) would be targeted mitigating circumstances e.g. services address the current identified negative geographical or communication. If may be for males only and therefore the impact yes, explain what you intend to do to gender box be ticked “yes” with remove these barriers. evidence below on why females would be excluded
Marriage and No, the overall scheme is aimed at all No, the overall scheme is aimed at all No, the overall scheme is aimed at all No, the overall scheme is aimed civil partnership patients and marriage and civil patients and marriage and civil patients and marriage and civil at all patients and marriage and partnership would not be excluded or partnership would not be excluded or partnership would not be excluded or civil partnership would not be affected by this scheme affected by this scheme affected by this scheme excluded or affected by this scheme
Pregnancy and No, the overall scheme is aimed at all No, the overall scheme is aimed at all No, the overall scheme is aimed at all No, the overall scheme is aimed Maternity patients and pregnancy and maternity patients and pregnancy and patients and pregnancy and at all patients and pregnancy and would not be a reason to be excluded maternity would not be a reason to maternity would not be a reason to maternity would not be a reason or affected by this scheme be excluded or affected by this be excluded or affected by this to be excluded or affected by this scheme scheme scheme
Race No, the overall scheme is aimed at all No, the overall scheme is aimed at all No, the overall scheme is aimed at all No, the overall scheme is aimed patients and race would not be a patients and race would not be a patients and race would not be a at all patients and race would not reason to be excluded or affected by reason to be excluded or affected by reason to be excluded or affected by be a reason to be excluded or this scheme. Specifically, the this scheme. Specifically, the this scheme. Specifically, the affected by this scheme. identified CCG localities of highest identified CCG localities of highest identified CCG localities of highest Specifically, the identified CCG deprivation and diversity have an deprivation and diversity have an deprivation and diversity have an localities of highest deprivation unchanged offer (Oadby and Wigston) unchanged offer (Oadby and unchanged offer (Oadby and and diversity have an unchanged or a new site (North Blaby). Wigston) or a new site (North Blaby). Wigston) or a new site (North Blaby). offer (Oadby and Wigston) or a new site (North Blaby).
Religion and No, the overall scheme is aimed at all No, the overall scheme is aimed at all No, the overall scheme is aimed at all No, the overall scheme is aimed belief patients and religion and belief would patients and religion and belief would patients and religion and belief would at all patients and religion and not be a reason to be excluded or not be a reason to be excluded or not be a reason to be excluded or belief would not be a reason to be
Revised 23 August 2018 - CL
a) Would the service be aimed at any b) Would the service potentially c) Would the service potentially have d) Are there any known barriers particular equality group? exclude any of the equality groups? a negative impact on any of the which could obstruct access to Yes or No Yes or No equality groups? the benefits of the service? Equality Group Yes - No Yes – No If yes, please provide a brief explanation If yes, please give any evidence of the If yes, please detail action plan to Barriers could be physical, why particular group(s) would be targeted mitigating circumstances e.g. services address the current identified negative geographical or communication. If may be for males only and therefore the impact yes, explain what you intend to do to gender box be ticked “yes” with remove these barriers. evidence below on why females would be excluded affected by this scheme affected by this scheme affected by this scheme excluded or affected by this scheme
Sex (gender) No, the overall scheme is aimed at all No, the overall scheme is aimed at all No, the overall scheme is aimed at all No, the overall scheme is aimed patients and gender would not be a patients and gender would not be a patients and gender would not be a at all patients and gender would reason to be excluded or affected by reason to be excluded or affected by reason to be excluded or affected by not be a reason to be excluded or this scheme this scheme this scheme affected by this scheme
Sexual No the overall scheme is aimed at all No the overall scheme is aimed at all No the overall scheme is aimed at all No the overall scheme is aimed at orientation patients and sexual orientation would patients and sexual orientation would patients and sexual orientation would all patients and sexual orientation not be a reason to be excluded or not be a reason to be excluded or not be a reason to be excluded or would not be a reason to be affected by this scheme affected by this scheme affected by this scheme excluded or affected by this scheme
Social Exclusion Yes the scheme would aim to address No, the overall scheme is aimed at all No, the overall scheme is aimed at all No, the overall scheme is aimed and economic access issues for those patients living patients and those from excluded or patients and those from excluded or at all patients and those from deprivation the locality currently without an EPC deprived areas would not be a deprived areas would not be a excluded or deprived areas would site. Specifically, the identified CCG reason to be excluded or affected by reason to be excluded or affected by not be a reason to be excluded or localities of highest deprivation and this scheme. Specifically, the this scheme. Specifically, the affected by this scheme. diversity have an unchanged offer identified CCG localities of highest identified CCG localities of highest Specifically, the identified CCG (Oadby and Wigston) or a new site deprivation and diversity have an deprivation and diversity have an localities of highest deprivation (North Blaby). unchanged offer (Oadby and unchanged offer (Oadby and and diversity have an unchanged Wigston) or a new site (North Blaby). Wigston) or a new site (North Blaby). offer (Oadby and Wigston) or a new site (North Blaby).
Revised 23 August 2018 - CL
a) Would the service be aimed at any b) Would the service potentially c) Would the service potentially have d) Are there any known barriers particular equality group? exclude any of the equality groups? a negative impact on any of the which could obstruct access to Yes or No Yes or No equality groups? the benefits of the service? Equality Group Yes - No Yes – No If yes, please provide a brief explanation If yes, please give any evidence of the If yes, please detail action plan to Barriers could be physical, why particular group(s) would be targeted mitigating circumstances e.g. services address the current identified negative geographical or communication. If may be for males only and therefore the impact yes, explain what you intend to do to gender box be ticked “yes” with remove these barriers. evidence below on why females would be excluded e) Please confirm you will collect personal data (in line with CCG information governance policies) to Yes via pseudonamised random ensure your service is targeted at the right people. Yes - No sampling at each site in conjunction with the appointed provider.
Revised 23 August 2018 - CL
J Blank Page Paper J ELR CCG Governing Body Meeting 11th September 2018
EAST LEICESTERSHIRE AND RUTLAND CLINICAL COMMISSIONING GROUP GOVERNING BODY MEETING
Front Sheet
REPORT TITLE: ELR CCG GP Locality Meeting Themes August 2018
MEETING DATE: Tuesday 11th September 2018
REPORT BY: Becky Hunt, Operations Support Officer
SPONSORED BY: Jamie Barrett, Head of Primary Care
PRESENTER: Dr G Purohit, GP Locality Lead MRH Dr Nick Glover, GP Locality Lead, Blaby & Lutterworth Dr Vivek Varakantam, GP Locality Lead OW, ELR CCG
EXECUTIVE SUMMARY: The purpose of this report is to provide an overview of the monthly GP Locality meetings held across Blaby and Lutterworth, Oadby and Wigston and Melton, Rutland and Harborough. These meetings are key to the CCG development and allow member practices an opportunity to debate current general practice and highlight themes they wish to inform the Board.
RECOMMENDATIONS: The East Leicestershire and Rutland CCG Governing Body is requested to: RECEIVE the report.
REPORT SUPPORTS THE FOLLOWING STRATEGIC AIM(S) 2018 – 2019: Transform services and enhance quality of Y Improve integration of local services Y life for people with long-term conditions between health and social care; and between acute and primary/community care. Improve the quality of care – clinical Y Listening to our patients and public – Y effectiveness, safety and patient experience acting on what patients and the public tell us. Reduce inequalities in access to healthcare Y Living within our means using public Y money effectively Implementing key enablers to support the strategic aims (e.g. constitutional and governance Y arrangements, communications and patient engagement).
EQUALITY ANALYSIS An Equality Analysis and due regard to the positive general duties of the Equality Act 2010 has not been undertaken in the development of this report as it is judged that it is not proportionate on the basis that on the basis that this purely an information summary of discussions which has occurred.
This completes the due regard required.
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Paper J ELR CCG Governing Body Meeting 11th September 2018
RISK ANALYSIS AND LINK TO BOARD ASSURANCE FRAMEWORK: The content of the report identifies BAF 6 action(s) to be taken / are being taken to mitigate the following corporate BAF 10 risk(s) as identified in the Board Assurance Framework:
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Paper J ELR CCG Governing Body Meeting 11th September 2018
EAST LEICESTERSHIRE AND RUTLAND CLINICAL COMMISSIONING GROUP GOVERNING BODY MEETING
GP Locality Meetings – August 2018
11th September 2018
INTRODUCTION
1. The 31 GP practices across the CCG are split into 6 geographical localities, Blaby and Lutterworth, Oadby and Wigston, Syston Long Clawson and Melton, Rutland and finally Harborough. The purpose of the locality structure is to provide a forum for member practices to feed into the CCG, feedback to their practices and discuss key issues and concerns. In addition the locality structure provides:
• Meetings held monthly, 12 times a year, either in these localities or as a wider locality • A promotion of two-way discussion on all business and a mechanism for GPs to be updated on CCG matters to inform commissioning and planning processes. • Share learning from adverse events e.g. safeguarding issues etc. • Opportunities for clinical discussion and education • Monitoring of performance and quality through the sharing of benchmarked data and information.
LOCALITY MEETING CONTENT
These meetings are represented by each practice across the CCG. In the month of August there were six locality meetings, North Blaby, South Blaby and Lutterworth, Oadby & Wigston, Rutland, SLAM and Harborough. The themes for the August 2018 meetings can be split up as the following:
Clinical Topics Direct Booking into OOH Services (All localities) INR/Yellow Books (OW Only) Demand Management Review of locality data (Rutland) Clinical Research Network (Rutland and Harborough) Second Blood Collection (All localities either as AOB or on agenda) Community Services Redesign (All localities either as AOB or on agenda) Referral Support Service (All localities either as AOB or on agenda) GPTeamNet Demonstration (NB only)
Other Agenda Items Locality/ Joint Working (All localities) Single AO and Shared CCG Senior Team Update (All localities) ILLT updates (varies across localities) Governing Body Update (Rutland only and sent out after meeting to other localities) AOB
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Paper J ELR CCG Governing Body Meeting 11th September 2018
LOCALITY THEMES
The sections below represent the key themes from the Localities for the month of August 2018.
3. MELTON RUTLAND AND HARBOROUGH LOCALITIES Clinical Chair: Dr Girish Purohit (SLAM), Dr Anuj Chahal (Harborough) and Dr Rysz Bietzk (Rutland)
August 2018
SLAM
3.1 First SLAM only LILT meeting – GSP informed members that the first LILT meeting had taken place earlier in the day with representation from Adult Social Care and Melton Borough Council. The remit of the ILT and roles of organisations was discussed and to aid understanding a Venn diagram will be provided for the next meeting. There is no requirement for the locality to attend the LILT meetings currently but this may change in future.
3.2 Transformation plans – Home Visiting Service – Members discussed that they would see benefit in an extended home visiting service with different criteria. Discussions revealed that each practice deals with home visiting and Care home visiting in different ways, It was agreed that consistency , integration of staff delivering the service into the practice and having skilled staff would be important. Rob Haines from DHU attended the meeting with three proposed models to discuss with members. The members will take the proposals back to practice and discuss options with partners.
3.3 Second Blood Collection – Members were updated on the decision by CCB to decline the proposal for the CCG to pay for a second blood collection for practices in ELR. There is still an option for a second collection at a cost of £15k in total. If practices wish to take this up the cost could be split between the practices taking part. The locality expressed interest in a second collection but noted that their decision would be based on what time the collections would be.
HARBOROUGH
3.4 Single AO - To register and flag up the concern within the locality the implications of moving to a single AO on the locality investment.
3.5 Clinical Research Network - The Harborough locality intends to work together as a locality on clinical research following the presentation on CRN earlier in the meeting.
3.6 PLT Events - Suggest locality based Protected Learning Time events possibly in conjunction with MRH. Practice based PLTs are useful but locality based PLTs are seen as important for sharing best practice and learning.
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Paper J ELR CCG Governing Body Meeting 11th September 2018
3.7 Physiotherapy - Feedback to GB about the appointment of a first contact physiotherapy partner within the locality to run the pilot phase from 1 October to 31 March.
RUTLAND
IAPT- The membership had received an email from the CCG regarding promotion of the IAPT service, however there was some concern over promotion of a service that GPs feel is clearly struggling. GPs shared their experiences and highlighted that there is an excessive delay being seen by the service after the initial telephone appointment. They also felt that the quality and quantity of the interventions offered are of concern. Before raising patient expectations the membership would like assurance that the service can manage a potential increase in demand and also assurance that measures are in place to address their concerns around quality and quantity and length of wait.
Demand Management – The GP Federation gave a useful presentation on Demand Management which highlighted various areas that would be worth investigating and sharing processes and knowledge to ensure that referrals are appropriate and there is more consistency across the patch. The locality moved forward to agree areas of focus - Dermatology, ENT and Ophthalmology initially with scope for more in future - These were chosen because they were areas with the most variations between practices in the patch. GPs commented that they do not know all of the pathways available and cited PRISM as a valuable resource but one that is difficult to use as the indexing and logic is lacking in the integrated versions making it difficult to locate the pathways needed. The locality were keen to work together to understand the variations and assist each other where possible to improve referrals.
Acute Access- The locality have been moving forward with Acute Access plans with an acknowledgement that the plan needs to respond to challenges raised by the CCG. The Rutland HealthCare Steering Group had put together a proposal which was accepted by the membership at the meeting and will be taken to individual practice meetings for feedback. The plan would be for each individual practice to write their own Acute Access plan but also to produce a collective Rutland Acute Access Plan. The available £4.47 per patient would be divided, with £3 to practices for their individual plans and the other £1.47 to the locality for the Rutland plan.
4. BLABY AND LUTTERWORTH – Chair Dr Graham Johnson & Dr Simon Vincent
August 2018
NORTH BLABY HUB – Chair Dr Simon Vincent
4.1 Locality Integrated Leadership Team (LILT) – The team had a constructive discussion around the Social Prescribing and Community Services Integration PID for the transformation plan which was then signed off by the group.
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Paper J ELR CCG Governing Body Meeting 11th September 2018
Issues highlighted by the group included the lack of integration of systems. Community nurses do not have access to PRISM or ICE, and have limited views on SystmOne of care planning information. This needs to be resolved to allow better integrated working and communication between practices and community nurses as well as improving services for patients.
4.2 GPTeamNet – James Stephenson presented a webinar on the software package called GPTeamNet which can act as a central repository for locality practice policies and other information. The members were very impressed with the capabilities of the product and its ability to like with appraisal and training software.
4.3 Transformation Planning – The group reviewed the acute access project options and agreed that for the transformation funding most of funding would go to the employment of para medical staff to release GP capacity.
4.4 Community Services Redesign – Dr Simon Vincent presented the slides for the community services redesign and asked for members to respond to the key questions. There was complete agreement that the services needed to be properly funded new model as the past 10-15 years it had been a poor service due to under resourcing. Primary care were under a great deal of pressure to see increasing numbers of complex patients who needed longer than a 10 minute slot and caring for patients who were discharged too early vastly increases that pressure.
SOUTH BLABY AND LUTTERWORTH PARTNERSHIP HUB – Chair Dr Graham Johnson
4.5 Transformation Planning – The group had a discussion around the acute access work stream of the plan and agreed to go forward with an ANP model pilot. Potentially this would be an ANP each for the north and the south of the locality with Northfield and Hazelmere sharing a nurse and Lutterworth practices and Countesthorpe sharing the other.
4.6 Locality Integrated Leadership Team (LILT) – The team had a constructive discussion around frail and housebound patients not being in receipt of attendance allowance and how could asking the question be incorporated into the pathway earlier.
4.7 Further discussion around the Daltaparin issue; housebound patients needing two injections a day and not able to inject themselves didn’t have a service in the community to accommodate the second injection; this is currently being picked up by ICS, which is not a service for planned care and an expensive resource. Another issue that was highlighted that community nurses cannot install PRISM on their systems, for effective integration this needs to be address; particularly to allow them to access the Transferring Care Safely system. Community Services Redesign – The locality received the presentation and briefly discussed the key questions.
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Paper J ELR CCG Governing Body Meeting 11th September 2018
4.8 Second Blood Collections – Tracey Knight updated the group on the decision of the Collaborative Commissioning Board not to fund a second pathology collection for LLR. The pathology service is prepared to provide the service to practices if they are willing to pay for it. There was general support from practices to fund, although very disappointed that central funding wasn’t agreed. Practices felt that the additional collection would free up practice nurse time and room utilisation and more importantly improve the service offered to patients.
5. OADBY AND WIGSTON – Chair Dr Vivek Varakantam
August 2018
5.1 Update on Single AO and shared CCG Senior Team- Richard Palin updated the locality on the current position regarding a single accountable officer and shared senior team and the potential risks locally to the CCGs if progressions in these directions are not made. Practices raised concerns around funding models and whether the two county CCGs could come together. NHS England will be supporting the CCGs over the next couple of months with a further update expected in late autumn.
5.2 Joint Working: - Project leads were invited to update the locality on the agreed project areas. Good progress has been made, and there was continued enthusiasm to engage with transformation. Practices were encouraged to seek clarification from partners around the project developments
5.3 INR Yellow books: - Concerns were raised following the update at the last meeting. LPT have switched on electronic notification in addition to the yellow books currently. Notification of dual process hasn’t been clear and there are concerns around the pilot protocols.
Recommendation:
The East Leicestershire and Rutland CCG Governing Body are requested to:
RECEIVE the report
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K Blank Page Paper K East Leicestershire and Rutland CCG Governing Body meeting 11 September 2018
EAST LEICESTERSHIRE AND RUTLAND CLINICAL COMMISSIONING GROUP GOVERNING BODY MEETING
Front Sheet
REPORT TITLE: Summary Report from the Public Commissioning Collaborative Board (CCB) – August 2018 MEETING DATE: 11 September 2018
REPORT BY: Jayshree Raval, Commissioning Collaborative Support Officer ELR CCG SPONSORED BY: Karen English, Managing Director
PRESENTER: Dr Richard Palin, Clinical Chair of CCB
PURPOSE OF THE REPORT: This report is from the Commissioning Collaborative Board (CCB); which is a joint committee of NHS East Leicestershire and Rutland CCG, NHS West Leicestershire CCG and NHS Leicester City CCG. The CCB supports joint decision making and undertakes collective strategic decisions on those areas where authority has been delegated by the respective CCG Governing Bodies.
RECOMMENDATIONS: The East Leicestershire and Rutland CCG Governing Body is requested to:
• RECEIVE the first report from CCB
Page 1 of 3 Paper K East Leicestershire and Rutland CCG Governing Body meeting 11 September 2018
EAST LEICESTERSHIRE AND RUTLAND CLINICAL COMMISSIONING GROUP GOVERNING BODY MEETING 11 September 2018
Highlight Report from the Public Commissioning Collaborative Board (CCB) – August 2018 Introduction
1. The purpose of this report is for Commissioning Collaborative Board (CCB) to provide the Governing Body with an update of decisions made and escalate risks and issues identified.
2. CCB is a joint committee of NHS East Leicestershire and Rutland CCG, NHS West Leicestershire CCG and NHS Leicester City CCG. CCB’s role is to:
• Support CCGs to create a financial sustainable health system in Leicester, Leicestershire and Rutland (LLR); • Ensure clinically led co-design of service models for health services within LLR are safe, effective and efficient; • Provide a forum where commissioners can agree and align priorities and identify opportunities for further collaboration and consistency; and • Provide onward assurance to the respective Governing Bodies.
3. Key areas of discussion and outcomes from the August 2018 meeting are summarised below.
4. Progress on LLR Programme Management Office (PMO) and Finance QIPP Report: CCB received an update which indicated that at month 4 the LLR CCGs are forecasting full delivery on the QIPP plan for 2018/19 of £58.2m. CCB noted that a QIPP recovery plan is being developed with the aim of ensuring full delivery of the total QIPP plan is achieved.
5. CCB noted that further progress had been made in regards to completion of the QIPP schemes documentation to obtain confidence in delivery on a number of schemes. It was noted that the LLR CCGs QIPP plans are under close scrutiny by NHS England with further meeting to take place in August 2018 between the LLR CCGs and NHS England.
6. CCB members noted progress to date with further work underway in developing a QIPP recovery plan to achieve the delivery of the financial target. CCB members requested further update to be presented at the September 2018 meeting.
7. Safeguarding Report: It was reported that the Children’s Act 2004 has been superseded by the Children and Social Work Act 2017. This has resulted in the current Local Safeguarding Children’s Boards (LSCBs) to be disestablished and to be replaced by the new Safeguarding Partners.
8. In the new arrangements the CCGs will have a pivotal role along with the Local Authorities and the Police as the new Safeguarding Partners. CCB noted that the government has published a transitional guidance for all the organisations involved
Page 2 of 3 Paper K East Leicestershire and Rutland CCG Governing Body meeting 11 September 2018 to instigate the required changes by September 2019. Further update to be provided once the changes have taken place.
9. Lessons Learnt to Improve Care Clinical Quality Audit: CCB noted that in 2014 the Leicester, Leicestershire and Rutland (LLR) Clinical Commissioning Groups (CCGs), along with the University Hospitals of Leicester (UHL) and Leicestershire Partnership Trust (LPT) undertook a clinical audit to examine the quality of care provided to a particular group of patients. A joint action plan was put in place to address the areas of improvement identified as a result of this audit.
10. A follow up audit was undertaken in April 2017. This time the Mazars, an international, and independent organisation specialised in audit, were commissioned to develop an audit tool. At the end of the audit, recommendations were provided by the Mazars. CCB noted that the recommendations have been reviewed and have identified some key themes to consider as the key strategic areas for improvement. CCB supported the action plan and implementation via some of the work-stream work.
11. Community Services Redesign: Following the previous report, CCB noted that a communication and engagement plan is now in place, with further GP engagement taking place via the locality meetings. It was reported that work is underway in regards to reviewing the capacity and demand modelling which will influence in determining the future model. CCB was informed that the plans for the three Multi- Disciplinary Team (MDT) early implementer sites have been agreed to test out once the model has been agreed.
RECOMMENDATIONS
East Leicestershire and Rutland CCG Governing Body is requested to:
• RECEIVE the Commissioning Collaborative Board report.
Page 3 of 3 L Blank Page Paper L ELR CCG Governing Body meeting 11 September 2018
EAST LEICESTERSHIRE AND RUTLAND CLINICAL COMMISSIONING GROUP GOVERNING BODY MEETING
Front Sheet REPORT TITLE: Summary report from the Primary Care Commissioning Committee (PCCC) on 4 September 2018
MEETING DATE: 11 September 2018
REPORT BY: Amardip Lealh, Corporate Governance Manager
SPONSOR: Mr Clive Wood, Deputy Chair and Independent Lay Member
PRESENTER: Mr Clive Wood, Deputy Chair and Independent Lay Member
PURPOSE OF THE REPORT: This report provides a summary of the key areas of discussion and outcomes from the Primary Care Commissioning Committee meeting held on 4 September 2018; and items for escalation and consideration by the Governing Body ensuring that the Governing Body is alerted to emerging risks or issues.
RECOMMENDATIONS: The East Leicestershire and Rutland CCG Governing Body is requested to:
• RECEIVE the report.
REPORT SUPPORTS THE FOLLOWING STRATEGIC AIM(S) 2018 – 2019: Transform services and enhance quality of Improve integration of local services between life for people with long-term conditions health and social care; and between acute and primary/community care. Improve the quality of care – clinical Listening to our patients and public – acting effectiveness, safety and patient on what patients and the public tell us. experience Reduce inequalities in access to Living within our means using public money healthcare effectively Implementing key enablers to support the strategic aims (e.g. constitutional and governance arrangements, communications and patient engagement).
EQUALITY ANALYSIS An Equality Analysis and due regard to the positive general duties of the Equality Act 2010 has not been undertaken in respect of this report.
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EAST LEICESTERSHIRE AND RUTLAND CLINICAL COMMISSIONING GROUP
GOVERNING BODY MEETING 11 September 2018
Summary Report from the Primary Care Commissioning Committee (PCCC) Meeting held in September 2018
1. Since the last report to the Governing Body in August 2018, the PCCC meeting was held in public on 4 September 2018. The key areas of discussion and outcomes from these meetings are summarised below.
2. The key areas of discussion and outcomes from this meeting are summarised below.
3. Committee Work Programme – The Committee reviewed and agreed its work programme for 2018-19, noting that this will continue to be updated in line with any further delegations assigned to it as part of the co-commissioning delegated function.
4. Primary Care Finance Report 2018-19 (Month 4 – July 2018): – the Committee received its regular monthly financial report and noted the annual budget for 2018-19 for Primary Care Services for Month 4 totals £95.9m; a year to date overspend of £1.1m and an outturn overspend of £3.8m is being forecast. The Committee were informed of significant cost pressures within the budget, mainly due to the ongoing costs of NCSO drugs, Category M drug prices, Delegated Co-Commissioning, and Primary Care QIPP.
5. Overview of Primary Care Contracting Policies – Update September 2018 – The Committee received an update on all NHS England Policies and Local Guidelines, which had been previously adopted in 2015 in line with the CCG delegated responsibility. It was noted that NHS England had reviewed a number of policies and guidelines; the majority of which have been incorporated into the Primary Medical Care Policy and Guidance Manual (PGM) that was published by NHS England in November 2017.
(https://www.england.nhs.uk/publication/primary-medical-care-policy-and- guidance-manual-pgm/).
6. It was noted that existing procedures will continue to be used for the following documents as these had not been incorporated into the Primary Medical Care PGM to date:
• Managing the end of time limited contracts;
• Patient registration: Standard Operating Principles for Primary Medical Care (General Practice);
• Framework for patient and public participate in primary care commissioning.
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7. The Committee approved:
• the continuation of documents not incorporated within the Primary Medical Care PGM and to refer to current versions until revised documents have been issued;
• that for all reference to merger applications, the CCG will make reference to both the ‘Application for Proposed Practice Mergers’ (local procedure) and the national policy under the Primary Medical Care PGM;
• the revised review dates for the following local policies as September 2019 due to no changes to the existing policies:
- Agreed Financial Assistance for Practices Experiencing the Impact of Dispersed Lists
- Application for Proposed Practice Mergers.
8. Sustainability and Transformational Partnership (STP): GP Programme Update – a progress report in relation to the STP GP Work Stream, which included the tracker for the GP Programme Board and the GP Retention Plan, was received.
9. It was noted that following the submission of a high level workforce plan in June 2018 to access additional funding to support the GP Retention Plan, an allocation of £142,393 has been awarded across Leicester, Leicestershire and Rutland (LLR), which is lower than anticipated. Work is also underway in order to evaluate GPs across the CCG who currently form part of the GP Retention Plan.
Recommendation:
10. The East Leicestershire and Rutland CCG Governing Body is requested to:
• RECEIVE the report.
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