NHS Swindon CCG
Appendix A
Ref:
PROJECT BRIEF/OUTLINE BUSINESS CASE
PROJECT NAME
Facilitating Primary Care at Scale through investment in GP IT infrastructure
Type of Project
Request for investment
Invest to save
Decommissioning of services
Service redesign (transfer or reduction in
activity)
Yes/No
Yes
Yes
No
No
Support for Project
Whole CCG
Locality(specify which)
Combination of CCG
Name
Scope of the Work
This Outline Business Case (OBC) details the contents of a recent bid for funding through the
Primary Care Transformation Fund to promote Primary Care at Scale by seeking investment in
suite of technology developments to encourage shared and standardised functionality and
reduce unnecessary administrative burden on Primary Care. The bid has been submitted to
NHS England for consideration, but is likely to experience considerable delays in decision
making.
The purpose of this OBC is to secure interim funding through the CCG’s own financial sources
pending agreement by NHSE so that implementation of these initiatives can commence, and
their potential benefits to both patients and the wider Swindon Health Economy in terms of
operational effectiveness realised.
Funding sought is detailed as follows:
Item to be funded
Detail and implications
Interim funding sought (£)
Single Domain Infrastructure
Server and Window licences
17,000
including networked dictation to support single domain and
dictation
Networked Dictation
Software and Hardware for
15,000
Hardware and Software
the CCG RMC and at least
one volunteer practice to pilot
networked dictation as a
prelude to encouraging all
practices to IVR dictate letters
directly to RMC
Shared Care Record for
Shared Health Care Record
43,876
Swindon
for 40 sites including primary,
secondary and community
care (hospice and nursing
homes)
Total to be funded
75,876
Brief Description of Scheme Objectives, Desired Benefits and the Expected Outcomes
Page 1 of 7
NHS Swindon CCG
Appendix A
Ref:
In alignment with national policy including the Five Year Forward View and Forward View for
General Practice, Swindon CCG have submitted a series of bids to secure funding from the
Primary Care Transformation Fund (PCTF) 16/17 to facilitate the development and delivery of
Primary Care at Scale through the implementation of systems to improve interoperability across
the Swindon Health Economy.
The bids cover a series of infrastructure elements including:
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Development of a Swindon Health Record.
Digital Dictation
Development of one domain
These developments (detailed below) will collectively enable the provision of a single shared
network, encouraging co-operation at scale whilst maintaining individual practices access to a
private network.
Development of a Swindon Shared Health Record and File Sharing will be enabled by the
implementation of the new software model ERA (new version of the Black Pear Software).
Providing the ability for GP Practices to contribute to the Swindon Shared Health Care Record
by utilising the same software platform, ERA will enable organisations within the Swindon Health
Economy to view relevant patient information including shared care plans at the point of contact.
Aligned with the development of our digital roadmap, the facilitation of interoperability offered by
this software will enable near instant transmission of structured clinical data (past medical
history, medication, allergies etc.) from one clinical system to any other clinical system to
support the delivery of urgent and clinical care throughout the Swindon Health Economy
including, Primary Care, Great Western Hospital Foundation Trust, Swindon Community
Services Provider including OOH (currently SEQOL), South West Ambulance Trust, Prospect
Hospice , NHS 111 and a selection of Nursing Homes.
The key benefits of this software as are follows:
∂
∂
∂
∂
∂
Improve access to patient care and provision of timely advice based on current clinical
information available;
Meet the national aims including increased capacity for Primary Care Services out of
Hospital, improving seven-day access to effective care, reduce unplanned admissions to
hospital;
Reduced readmissions
Reduced admissions (e.g. End of Life when patients have expressed a preference to die
at home)
Continuity of care across multiple providers
The CCG are seeking investment to utilise the EPAC system within the Black Pear (now ERA)
Software to create, record and securely share information regarding Long Term Conditions
(LTCs) and End of Life (EOL) Care between care providers including Primary Care, Acute and
Routine Secondary Care, Hospice, Community Services, Urgent and Emergency Care and Out
of Hours.
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NHS Swindon CCG
Appendix A
Ref:
The EPAC system is pivotal to the development of Swindon’s Digital Road map, as it will enable
practices to contribute and share pertinent details of patients who have LTC’s including
Diabetes, Respiratory and Dementia as well as those who require End of Life Care.
The EPAC system will also enable practices to share End of Life Treatment Escalation Plans
(TEP) data including preferred place of death, thus helping the Swindon Health Economy
ensure arrangements are in place to meet the individual patient requirements and wishes.
The benefits of this EPAC system are as follows:
∂
∂
Facilitate multiple health and social care providers to access up to date and
sensitive patient information for patients with LTCs or at EOL, improving
streamlined care provision and potentially reducing the risk of admission or readmission as providers will be able to act on the patient information available with
confidence.
Promote and facilitate the delivery of seven day access to effective care.
In line with key outcomes from the Sustainability and Transformation Plan (both locally and at a
footprint level), a bid has been submitted to the national Estates, Technology and
Transformation Fund (ETTF) for investment in technology to simplify and standardise back office
processes and systems to enable greater operational efficiency across the Swindon Health
Economy. The key benefits of this investment would be:
∂
∂
∂
Simplification of processes
Cut down delays of information processing
Release resources within primary care for alternative utilisation and improved
access to health care by changing skill mix.
In addition, plans are to implement a single networked dictation system which will provide a
centrally hosted solution for single site, multi-branch or CCG wide deployment to share referral
data and typing resources. Involving fully integrated speech recognition (IVR) functionality,
clinicians will be able to “speak” their consultations rather than relying on them being typed and
create their own referral letters.
This facility would enable efficient transcription with an opportunity to future pool and share staff
responsible for typing information. Furthermore, this facility could promote and encourage the
use of the Electronic Referral System (eRS) which will ensure that the CCG meets national
goals and standards in the utilisation of the national referral system and reduce the number of
referrals that are sent elsewhere leading to increased non contracted activity.
Encouraging referral letters (including 2 week wait referrals) to go directly to RMC requires the
following
1. Fast, reliable clinical letter transcription (IVR should assist with this)
2. Reliable and secure delivery (due to the urgency of the referral) directly to RMC.
Key Risks and Dependencies to delivery of this project
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NHS Swindon CCG
Appendix A
Ref:
The key risks of all the schemes above can be summarised as follows:
∂ Delay in receipt of funding from ETTF will delay implementation of shared care
plans for patients with chronic disease management including Diabetes and
Respiratory conditions, both of which are key health priorities in the Swindon and
Shrivenham Health Economy.
∂ Financial risks associated with delivery of transforming Primary Care at Scale
within a given financial envelope;
∂ Engagement and Timelines – the implementation of technological solutions to
improve back office functions across Primary Care will need lead in time
investment and piloting to encourage cultural change and secure agreement to
standardise particular processes.
Key Stakeholders
The stakeholders of these developments are members and contributors to the Swindon and
Shrivenham Health Economy and include:
∂
∂
∂
∂
∂
∂
∂
∂
∂
∂
Population of Swindon and Shrivenham
Primary Care Providers
Great Western Hospital Foundation Trust
SEQOL (or Community Service Provider)
Swindon Borough Council
Avon and Wiltshire Mental Health Partnership Trust
South West Ambulance NHS Trust
Prospect Hospice
NHS 111, Out of Hours (via Adastra)
Nursing Homes
Key Project Milestones (to include initial start date and main delivery points)
Milestone
Milestone
Date
Descriptor
Single Domain
Implementation of single domain infrastructure
2 months
Networked Dictation RMC receiving network dictated letters from pilot
3 months
practice
Shared care records Implementation of shared care records system for
4 months
system for Swindon Swindon
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NHS Swindon CCG
Appendix A
Ref:
Indicate which domain in the Outcomes Framework will this project support (tick as
appropriate)

Preventing people from dying

Enabling quality of life for people with long term conditions

Helping people to recover from episodes of ill health or following injury

Ensuring that people have a positive experience of care

Treating and caring for people in a safe environment and protecting them from
avoidable harm
Detail which CCG Strategic Objectives this project will support?
∂ Contribute to the delivery of the Five Year Forward View locally, including the
development and delivery of a Sustainability and Transformation Plan;
∂ Address sustainability and quality of general practice ;
∂ Contribute to the delivery of National Constitutional Access Standards including 4 hour
wait;
∂ Delivery of Seven Day Services;
∂ Contribute to the integration of health and social care services across Swindon and
Shrivenham.
Estimation of Resources required and Associated Savings generated (approximate
amount)
Provider(s)
Investme Month to
Investment to be released
affected
nt
release
(monthly/quarterly/block)
required investment
(£)
Investment
CCG and
£75,876
July 2016
One initial payment to allow
stakeholders
implementation pending
identified
NHSE funding.
Savings
CCG and
Savings
Savings potential from the
Stakeholders yet to be
following areas:
identified
quantified
Networked Dictation –
NCA referrals for letters not
going via RMC
Higher proportion of letters
going via the contracted
route.
Shared Care Record –
Reduced admissions
including EOF where
patient has expressed a
preference to die at home.
Reduced Admissions for
Chronic Conditions (
improved communication
Page 5 of 7
NHS Swindon CCG
Appendix A
Ref:
between Primary and OOH
Care)
Improved communication
between teams across the
health economy – reducing
number of visits.
Activity Impact ( if any)
Name of the
None specifically identified to date, although in the longer term,
Provider
reductions are expected across the health and social care economy as
patients are managed appropriately at point of contact from which ever
care provider they have sought support.
Please tick the activity it will impact and indication if it will increase or decrease
Outpatient
Decrease
Non elective
Decrease
Elective
Higher proportion of referrals to go via the contracted route
Community
Desired Benefits, Outputs and Criteria for Success
Shared Care plans for patients with long term conditions and who are being provided with End
of Life Care will be viewable and contributed to by multiple providers
∂ Primary Care Providers
∂ Great Western Hospital Foundation Trust
∂ SEQOL (or Community Service Provider)
∂ Swindon Borough Council
∂ Avon and Wiltshire Mental Health Partnership Trust
∂ South West Ambulance NHS Trust
∂ Prospect Hospice
∂ NHS 111, Out of Hours (via Adastra)
∂ Nursing Homes
Practices will benefit from being able to access a single secure shared network infrastructure
(one domain). This will facilitate closer cooperation e.g. secure file sharing between practices.
The feasibility of networked dictation with direct transmission of referrals to the Referral
Management Centre as a prelude to inviting all practices to send all referrals to the RMC will
have been piloted.
Additional Resources Required (contribution required from CCG – Matrix working)
These could be:
∂ IT
∂ Finance
∂ Primary Care Team (CCG)
∂ Quality
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NHS Swindon CCG
Appendix A
Ref:
∂
Communications
Name of the person completing the form: Amanda du Cros
Contact number and email address: Amanda.ducros@swindonccg.nhs.uk
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