15 May 2014
Co-commissioning
Prescribing
Urgent care and Health & Independence
Update on RAIDR
CCG feedback
EPaCCs reminder

Co-commissioning
• Simon Stevens (NHS Chief Exec) has announced an option for CCGs to cocommission primary care services
• Expressions of interest are required by 20 th June 2014 (from interested CCGs)
• Largely relates to GP services
• Scope
– work with patients, Health and Wellbeing Board
– Designing local contracts, eg PMS
– Discretionary payments eg premises
– Managing resources
– Contractual performance
– Procurement for new services
• Key points
• Geography? Single CCG or joint with neighbouring CCGs?
• Benefits?
• Improved integration of health & care services and out of hospital care, mental health, community services etc
• Improved service quality
• Enhanced patient and public involvement in developing services
• Reducing inequalities

Co-commissioning - continued
• Any submission would require the CCG to identify the areas that it would wish to cover
• Spectrum of co-commissioning
– An Ipswich and East Suffolk bid or with West Suffolk ?
– Greater involvement in decisions made by Area Team
– Joint commissioning with Area Teams
– Delegated commissioning arrangements – CCG undertakes tasks on behalf of Area Team
• Expressions of interest would need to indicate the form and proposed timescales of the co-commissioning, extent of co-location of Area Team Staff and in particular how the CCG would deal with potential conflicts of interest.
• More detail is being worked up by the NHS Commissioning
Assembly

Co-commissioning – What next?
• Some proactive approaches from practices expressing interest that those involved in the delivery of primary care should be shaping primary care services.
• Before the CCG goes any further with thinking about this we want to ask you what you think. We will send Senior Partners a letter this week, requesting your practice’s view on:
– Option 1 - Supportive of a submitting a proposal to pursue these additional opportunities
– Option 2 – Do not support the option and wish to retain the status quo
• We will also be asking other partner organisations what they think, including the LMC.

Prescribing Budget update
• Current YTD position (up to and including Feb 14) £1.4m overspent
(3%)
Budget 14-15
• Based on forecast outturn 2013-14
• Same methodology as last year i.e. weighted ASTRO PUs taking into account deprivation
• Public Health drug spend will be top sliced as per last year
• Net uplift of 0.2% (1.9%* uplift - £1m QIPP saving)
Changes this year
• Spend on DN supply chain dressings will be top sliced
• Spend on drugs commissioned by NHSE will be top sliced
• Nationally allocation of ASTRO PUs has changed. Less weighting for patients aged ≥65 yrs.
*regionally recommended uplift

QIPP priorities
Project Description
BGTS
Pain
Wound care/stoma
/incontinence appliances
Implement guidance for type 2 patients, complete and implement guidance for type 1 patients
Implement pain guidelines, work with IHT for joined up approach to pregabalin, use most cost effective oxycodone and morphine brands
Update formularies and launch new ordering scheme to
Nursing Homes in July to ensure adherence to formulary and recommended quantities
Target saving
(Total £1m)
£170k
£50k
£55k
£50k Incontinence drugs Implement UI guidance and switch solifenacin to cost effective alternatives
Respiratory Promote asthma guidance - use of cost effective ICS/LABA inhalers. Review COPD guidance with IHT to include Relvar and look at shifting away from tiotropium as 1 st line LAMA.
Dietetics
Joint formulary
Specials
Revise infant formula guidance, stop prescribing soy and LF milks. Review gluten free guidance - reduce units for adults
Complete full joint formulary by end of 14/15
Other switches, restricted items, red drugs etc…
Switch to cost effective alternatives, create list of cost effective branded specials
Tech to continue wide range of switches, repatriation of Red drugs, house keeping, Optimise Rx as key enabler. Recruit new pharmacist to work out in practices reviewing complex/frail patients.
£85k
£20k
£160k
£20k
£390k

Urgent Care
Key messages from GPs at December Education Event
• Urgent care services need to be where the patients are
/ go to currently
• Integrated urgent service at the front door of A&E, including primary care, with senior leadership
• Increase patient awareness and understanding of selfcare options
• Discharge planning on arrival
• Up-skill staff
• Ensure access to other urgent services including diagnostics

To boldly go…
Vision of the Urgent Care System
Diagram provided by Dr Imran Qureshi

Proposed Overall Urgent Care System Model for Suffolk

Components
NHS 111 and Care
Coordination Centre
Urgent Care Services in the community, including travelling to patients
Urgent Care Services colocated with A&E facilities
Key Services and Functions
• NHS 111 is part of National Mandate – compulsory for local
NHS
• Where patients can phone to get urgent care advice, including
111 service, out of hours service, community health
• Used by health and social care professionals to access specialist urgent care advice, arrange dispatch of services (e.g. to relieve paramedics)
• Refer patients into Integrated Neighbourhood Networks or
Urgent Care Services that travel to patients, are based in community locations away from the two main hospitals, or referral to Urgent Care facilities co-located with A&E facilities.
• Directory of Services
• Community based locations serving urgent care needs
• Step-up beds
• Explore access to diagnostics and minor injuries
• Co-located at Acute Trusts
• Sees all unannounced arrivals previously seen by A&E and referrals from professionals.
• Primary Care, commissioned specialty input, diagnostics, minor injuries and transfer to community-based services
• A&E for the ‘genuine emergency’

Date
February 2014
Key Milestones
Clinical commissioner work on development of strategic commissioning intentions including consideration of the reports from stakeholder events
Design of outline service model March-April 2014
May 2014
June-August 2014
Receipt and approval of outline service model by statutory bodies
Formal public engagement
Further system work on the detailed service specification including financial modelling
Evaluation of responses August-September 2014
September 2014 Formal approval of service specification and agreement to start procurement by statutory bodies
October 2014-February 2015 Formal procurement and evaluation of bids
March 2015
April-September 2015
Statutory bodies approve letting of contract(s)
Mobilisation of new contract

Update on RAIDR
The RAIDR (Reporting Analysis & Intelligence Delivering
Results) system is being offered to practices as of now.
The first wave of practices have been contacted and are already starting to receive training on the system. It is anticipated that all practices will be able to receive the training and use the tool by the end of June.
RAIDR will be able to support the NHS England
Admissions Avoidance DES, Over 75s work, MDTs.

CCG Feedback raised at April education event
To raise a query, you can email iesccg.gp-contract-queries@nhs.net
The mailbox is monitored twice daily, issues are then logged and a response should be available within 20 working days.
Issue/Query
Practices are having issues with contacting the CCC (Care Coordination
Centre), with the service having no capacity and asking practices to call back
Practices are having problems getting hold of the RAAC
Practices have not been given enough time with the Suffolk Federation to discuss the Over 75s work
Outcome/Update
This has been raised with the Contracts Team at the CCG, however the team will need specific examples in order to investigate. If practices continue to experience this, please email iesccg.gp-contract-queries@nhs.net
with the detail.
This has been raised with the Contracts Team at the CCG, however the team will need specific examples in order to investigate. If practices continue to experience this, please email iesccg.gp-contract-queries@nhs.net
with the detail.
At the next event (25 th June) at Trinity Park, the Federation will hold a meeting afterwards at 5:15pm to give practices the opportunity to meet with them.
OA Knee referrals are going to the
Nuffield due to patient choice (C&B) and
T&O consultants are advising this to patients and encouraging them to go through C&B
The CCG is aware of this issue and working closely with consultants to ensure this does not continue. If practices find that this is still happening, please email specific examples to iesccg.gp-contract-queries@nhs.net
SERCO contract and query around workforce numbers
– GPs would like to see a new map of where Serco is now compared to where they were at the start of the contract (to include a skill mix)
We are working with the Contracts team to supply this information to practices
Admission Avoidance DES – practices would like help and support for templates and coding. It would also be useful to have templates attached to LES’ and
DES’ when they are issued.
The CCG has received the final specification for this DES from NHS England and are currently reviewing the content. Further updates and any necessary supportive documentation will follow.
GMS/PMS contractual changes – practices would like to work closely with each other and the CCG on this
The CCG will continue to offer support to practices and is happy to work with practices taking into account the CURRENT commissioning environment

Issue/Query
Palliative Care patients
– lack of co-ordination between the
Hospice, IHT and Hospice at
Home. Oncology and the
Hospice also appear to be
‘pushing back’ which is leading to acute admissions
Outcome/Update
Inpatient beds are for patients who have specialist palliative care needs (uncontrollable symptoms, complex psycho social issues etc) and so a hospice bed cannot always be offered as a choice for patients. However, if a patient is referred they will ensure they have a package of hospice care, which may be hospice at home, day care etc.
Oncology will also prioritise their beds for oncology patients (especially patients requiring active treatment) by default their beds get used as palliative care beds but again capacity is limited. The CCG will take the issue of co-ordination to the next end of life network where all providers are present to discuss further
The CCG has noted this query however requires more detail in order to be able to investigate fully. Please email iesccg.gp-contract-queries@nhs.net
with full details so that we can investigate.
Palliative Care patients
– patients are being admitted to nursing homes as services are not available for patients at home. GPs are not being funded to look after these patients.
IHT forms – can these be standardised with SystmOne and EMIS?
All referral forms which are issued from IHT (via the CCG) should be made available in
EMIS and SystmOne formats. Many forms can be found on the CCG website in the
Members area. If you are using a form which is not on the website, please email the form to ipswichandeastsuffolk.ccg@nhs.ne
t and we will look into it.
ALL Spinal and MRI referral forms
Problems with Neurology not seeing patients
REMINDER: the ALL spinal form and MRI referral forms are available and can be downloaded from the CCG website. The latest version of the ALL spinal form has been included within the delegate packs.
There are issues with under staffing in Neurology at IHT. The CCG is aware of the issue and working with IHT to solve the problem. If practices encounter any further issues, please email iesccg.gp-contract-queries@nhs.net
with the detail.

Hospital Ambulance Liaison Officer (C)
• Collaborative working
• Supported 7 day working
• 65% fewer delays reported
• Positive patient outcomes in handover and response times
•
Reduction of financial consequences
Community Escalation Beds and Primary Care Contract
Discharge Planning Nurses
(AA/C/ESD)
• Supported 7 day working
• Positive patient outcomes, being treated in the right place
• Collaborative working
•
Reduced patient length of stay in hospital
• Used by 218 patients
• Average length of stay 9 days
COPD (AA)
•
Positive patient outcomes
• Reduced respiratory admissions
• 2,253 patient contacts by Primary Care
• 1,407 prescriptions issued
• 24% reduction in COPD admission than last year (Jan- March)
• 4% reduction in overall respiratory admissions than last year (Jan- March)
Weekend Diagnostic,
Therapies and Pharmacy
(AA/C/ESD)
• 4% increase in weekend dispensing
• Supported 7 day working
• Positive patient outcomes
• Collaborative working
• 12% of patient seen by therapies were discharged the same day
• 58% of patients seen by therapies were discharged at the weekend
Top 5 Patient Flow
Winter Schemes
2013-14
Evaluation Based
Additional Consultant hours in ED, EAU and Capel Ward
(AA/C/ESD)
• Positive patient outcomes
• Supported 7 day working
• Reduced waiting times for patients
• Improved patient flow
• Senior clinical decision making
• 20% additional weekend discharges on
Capel Ward than before consultant
• 95% year end ED performance met
(AA) Admission Avoidance | (C) Capacity | (ESD) Early Supported Discharge

EPaCCS Reminder
• EPaCCS (Electronic Palliative Care Coordination
System) went live on the 6 th May
• Practices need to create EPaCCS records for patients on End of Life registers.
• Supportive documents to help practices do this is available on the Ipswich & East CCG Palliative Care web pages
• An FAQ has been included within the delegate packs
• EPaCCS is a national requirement