CCG Locality meeting slide pack
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Future locality meetings
Wellbeing Service reminder
Dementia Audits
Flu vaccinations
Practice Information Support Pack – for information
PMS Review
Primary Care Strategy
Suffolk Federation Over 75 schemes
AOB
Future locality meetings
• To enhance each meeting with a ‘local’
focus, non-CCG GPs are invited to jointly
chair each meeting which takes place
every other month
• If you are interested, please either speak
to the CCG Chair, leave your details on
the evaluation form in your pack or email
emily.rawlinson@ipswichandeastsuffolkccg.nhs.uk
Suffolk Wellbeing Service
A Reminder
Service Offer For Patients with Depression or Anxiety
• Detailed assessment by telephone or face to face
• One to one Nice approved talking treatments, including Cognitive Behaviour Therapy,
counselling, Interpersonal Therapy
• Direct access to one off workshops on managing stress, improving sleep and mindfulness.
Workshops are more like going to a lecture or cinema. They do not involve sitting around in a
circle of chairs.
• 24/7 online support via the Big White Wall
• twitter: @NHSWellbeing, FaceBook : www.facebook.com/NHSWellbeing
How to Access
• There are no waiting lists
• GPs encouraged to support self referral either independently via the website or with support in the
practice
• Consider asking patients to self refer before you prescribe (obviously assessing severity and risk
and continuing to refer to Access and Assessment Team for patients with significant risk)
• Patients can phone to book workshops
• Able to self refer and access brilliant self help resources available via www.readytochange.org.uk
or call 0300 123 1781
3
Suffolk Wellbeing Service
A Reminder
Requests to Practices
• Please use the Wellbeing slides on your surgery amscreens (accessed via the CCG)
• Please link to the service on your website
• Suggest to patients that they may benefit from “talking treatment”
• Mention the brilliant workshops and a likely first intervention. The websites are regularly
updated with dates and times
• If you have a pharmacy or dispensary attached to your surgery, why not put a wellbeing leaflet
or card in every order that is given to a patient containing a box of SSRI’s
Effectiveness
• The CCG monitors and performance manages the effectiveness of the service on a monthly
basis
• Evidence shows the treatments offered are about as effective as giving an SSRI
• The workshops offer a rapidly accessible, very effective, entry into treatment, and often are the
only treatment that people need
• Workshops are backed up by written and DVD material that is given to patients
• Even patients who have had face to face counselling or CBT before find the workshops and
groups helpful
4
Dementia Audits
The issue
• IESCCG is committed to achieving a 67% diagnosis rate for people
with dementia in 2014/5 and as such has invested in increased
capacity and quality of memory assessment services in primary
care settings.
• Achieving the 67 per cent diagnosis rate is a 2014/15 Quality
Premium and achieving it is worth over £250k to the CCG
• As of end of 2013/14 the number of people recorded on the
dementia registers was 3061. This is equivalent to a diagnosis rate
of 51%. This is based on 2013/14 prevalence data.
• The target is to achieve a 67 per cent diagnosis of estimated
prevalence by the end of 2014/15.
• To achieve a diagnosis rate of 67 per cent would require a further
c900 people to be recorded on a dementia register.
• Evidence from elsewhere shows dementia is under recorded on
dementia registers. The CCG wants to ensure we are improving
coding and recording and subsequently improving outcomes for our
patients.
5
The Opportunity
Organisation Name
14 BURLINGTON ROAD
NORWICH ROAD IPSWICH
WICKHAM MARKET
HAVEN HEALTH
DERBY ROAD IPSWICH
HADLEIGH HEALTH CENTRE
SAXMUNDHAM
LEISTON
IXWORTH SURGERY
HOLBROOK
CHESTERFIELD DRIVE
IVRY STREET MEDICAL PRACTICE
BARRACK LANE MEDICAL CENTRE
ORCHARD MEDICAL PRACTICE
RAVENSWOOD MEDICAL PRACTICE
STOWHEALTH
COMBS FORD SURGERY
FRAMLINGHAM
AVERAGE
THE BIRCHES MEDICAL CENTRE
WALTON SURGERY
HAWTHORN DRIVE IPSWICH
EYE
CONSTABLE COUNTRY MEDICAL
CENTRAL SURGERY
2 DEBEN ROAD IPSWICH
WOODBRIDGE RD IPSWICH
LATTICE BARN
MARTLESHAM HEATH
HOWARD HOUSE FELIXSTOWE
ALDERTON
LITTLE ST JOHN ST WOODBRIDGE
DEBENHAM
THE GIPPING VALLEY PRACTICE
ORCHARD STREET MEDICAL CENTRE
MENDLESHAM
ALDEBURGH
THE COUNTRY PRACTICE
FRESSINGFIELD MEDICAL CENTRE
BILDESTON
FELIXSTOWE ROAD MEDICAL PRACTICE
FRAMFIELD HOUSE
6
Practice
List Size
Patients
in Care
16,888
9,822
9,472
6,820
16,247
14,712
8,896
6,643
9,116
7,865
14,513
11,026
15,755
13,365
15,066
17,759
9,944
9,255
8,097
4,195
7,735
5,836
10,986
14,564
7,829
11,844
13,339
5,892
7,036
3,879
6,365
8,526
1,658
5,108
7,050
3,960
12,657
4,975
6,727
10,765
11,808
224
27
97
42
146
100
76
99
72
110
121
113
48
37
46
156
176
95
30
44
55
48
151
9
60
63
15
128
14
68
23
2
9
15
64
154
13
29
39
112
QOF
Adjusted Dementia Dementia Dementia
Dementia Forecast
Gap
Gap (%) Diagnosis
Register
No with
(Num)
Rate (%)
Dementia
206
93
111
49
148
158
101
93
87
99
107
97
78
59
91
148
100
91
57
37
47
49
64
144
40
66
78
32
84
26
60
41
7
16
27
45
71
21
30
40
63
283
130
163
74
225
248
162
150
143
163
176
165
134
106
165
279
189
172
0
113
75
96
104
137
315
89
149
177
73
200
63
145
105
18
46
80
135
224
72
103
138
231
77
37
52
25
77
90
61
57
56
64
69
68
56
47
74
131
89
81
0
56
38
49
55
73
171
49
83
99
41
116
37
85
64
11
30
53
90
153
51
73
98
168
27.3
28.7
31.8
34.0
34.2
36.2
37.7
38.0
39.1
39.2
39.2
41.4
41.6
44.5
44.7
46.9
47.1
47.2
0.0
49.6
50.5
51.1
52.7
53.2
54.3
54.9
55.8
55.9
56.2
58.1
58.7
58.7
61.0
61.0
65.6
66.2
66.6
68.4
70.7
70.9
71.0
72.7
72.7
71.3
68.2
66.0
65.8
63.8
62.3
62.0
60.9
60.8
60.8
58.6
58.4
55.5
55.3
53.1
52.9
52.8
51.8
50.4
49.5
48.9
47.3
46.8
45.7
45.1
44.2
44.1
43.8
41.9
41.3
41.3
39.0
39.0
34.4
33.8
33.4
31.6
29.3
29.1
29.0
27.3
Dementia Diagnosis Rate
7
No of people undiagnosed
8
Influenza Season 2014/15
The issue
• Ipswich and East Suffolk CCG spent £2.4 million on hospital
admissions for influenza and pneumonia in 2013/14.
• This equated to 853 emergency admissions to Ipswich Hospital
Trust (IHT).
• The majority of the 853 people admitted were diagnosed with
pneumonia.
• The average LOS of people with influenza and pneumonia in IHT
was 9.3 days.
• This equates to 22 beds year round for people with influenza and
pneumonia in 2013/14 (that’s almost a ward).
• In 2013/14 there were 73.6% of 65+, 48.3% of under 65 at risk and
48% of pregnant women vaccinated for influenza.
• No figures for pneumonia vaccination available.
9
What are the CCG doing to support increasing the uptake:
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Flu and Pneumonia vaccinations are included as part of the quality audit for the care
home contract.
Practices encouraged as part of their specific work for over 75s to ensure patients have
had their flu and pneumonia vaccinations in particular for the most vulnerable 2% of
patients and housebound patients.
Flu Clinic times/dates being collated. These will be advertised in the local press and on
CCG website.
Implement Flu Kills campaign (see appendix 1).
Flu and Pneumonia leaflets sourced (including foreign language). Could we highlight
that there is a myth buster for all on the flu protect website along with some other useful
information. http://flu-protect.co.uk/downloadable-materials/
Advertising free flu vaccination for primary carers.
The Area Team are commissioning a flu vaccination service from pharmacies. The
service is only available to the ‘at risk’ patients between 18 and 65 (not the over 65s).
Pharmacies will look to recruit patients that have not made arrangements for their
vaccination through Primary Care.
Information provided via Locality Meetings to promote use of pneumonia vaccination
opportunistically (see appendix 2).
Messages to be sent to Suffolk Family Carers, Parish magazines and CCG website.
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What are some practices doing to ensure their best possible take up?
Fressingfield
Advertise in practice and on website from August and in all September and October editions of parish
magazines plus handing out leaflets ● They do not write out individually to all patients to invite but will write
out to non-responders in October ● Walk in clinics during the week early morning and early evening for 2
weeks ● Very good at opportunistically grabbing people when they come in for something else
Alderton Surgery
Invite all eligible patients under 65 by letter or text ● Well publicised via posters, website, prescriptions ● 1
full open day at each site for drop in appointments (2 nurses) ● Regular clinics with bookable appointments
● Housebound and care home patients all systematically done by practice and SCH Re invite non
responders ● Prompt within SystmOne for anyone eligible so can be opportunistically done ● A marker added
against all patients eligible to help with reminding patients attending
Haven Health
Heavily publicised walk in clinics which are advertised well in advance year after year via posters, website
and on prescriptions ● Meeting with all staff at start of season so everyone knows all processes and how to
answer patient queries ● Write out late in to season to those who haven’t attended yet ● All nursing and
residential home patients systematically done ● Very efficient in arranging housebound patients to be done
with SCH ● Exception code refusals ● EMIS Web has slick clinical protocol for recording
GP practices are encouraged to put messages on TV screens within their own practice, on prescriptions and
website.
Other useful information can be found at: http://flu-protect.co.uk/flu-campaign-support/
11
Children to be offered flu vaccinations at school
A pioneering pilot programme to offer children flu vaccinations at school is
to be rolled out. For the first children in years 7 and 8 are being offered the
vaccination as part of a county-wide pilot scheme. As part of the
programme each child will be offered the vaccine as a simple nasal spray
which is painless and a quick alternative to an injection.
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Appendix 1 – Flu Kills Campaign
13
Appendix 2 – Pneumonia Vaccination
Cross matching reports of upcoming appointments vs. patients still needing a flu jab From the Green book
Chapter 25: Pneumococcal (December 2013)
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/263318/Green-Book-Chapter-25-v5_2.pdf
Dosage and schedule
Adults over 65 years and at-risk groups aged two years or over:
A single dose of 0.5ml of PPV23.
Administration
Vaccines are routinely given into the upper arm in children and adults or the anterolateral thigh in infants under one year of
age. This is to reduce the risk of localised reactions, which are more common when vaccines are given subcutaneously
(Mark et al., 1999; Diggle and Deeks, 2000; Zuckerman, 2000). However, for individuals with a bleeding disorder, vaccines
should be given by deep subcutaneous injection to reduce the risk of bleeding.
Pneumococcal vaccines can be given at the same time as other vaccines such as DTaP/IPV/Hib, MMR, MenC, Hib/MenC
and influenza. The vaccines should be given at separate sites, preferably in different limbs. If given in the same limb, they
should be given at least 2.5cm apart (American Academy of Pediatrics, 2003) (see chapter 11). The site at which each
vaccine was given should be noted in the individual’s records.
Reinforcing immunisation
PPV23
Antibody levels are likely to decline rapidly in individuals with no spleen, splenic dysfunction or chronic renal disease
(Giebink et al., 1981; Rytel et al., 1986) and therefore re-immunisation with PPV23 is recommended every five years in
these groups. Revaccination is well tolerated (Jackson et al., 1999). Testing of antibody levels prior to vaccination is not
required.
Although there is evidence of a decline in protection with time (Shapiro et al., 1991), there are no studies showing
additional protection from boosting individuals with other indications, including age, and therefore routine revaccination is
not currently recommended.
Individuals who have previously received a 12- or 14-valent PPV should be immunised with PPV23 to gain protection from
the additional serotypes.
to encourage staff to vaccinate opportunistically.
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Appendix 3
Flu Vaccination rates for Over and Under 65s per Practice
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ALL AGES BY TFC
SPECIALTY
Contains:
ENT ACTIVITY
CARDIOLOGY ACTIVITY
UROLOGY ACTIVITY
OPHTHALMOLOGY ACTIVITY
GASTROENTEROLOGY ACTIVITY
RESPIRATORY ACTIVITY
GYNAECOLOGY ACTIVITY
ENT Activity
All Ages - ENT First Attends Outpatient GP Referrals only per 1,000 weighted
list - All IESCCG Practices 2014/15 Vs. 2013/14 YTD (April-June)
2013/14 Equivalent Activity YTD
2014/15 Activity YTD
CCG Average 2013/14
CCG Average 2014/15
0
Ravenswood
Ixworth
Chesterfield Dr
Needham
Birches
Constable Country
Martlesham
Combs Ford
Deben Rd
Felixstowe Rd
Little St Johns St
Woodbridge Rd
Hawthorn Dr
Framfield
Burlington Rd
Grove
Debenham
Solway & Whale
Alderton
Ivry Street
Norwich Rd
Lattice Barn
Fressingfield
Orchard Med
Barrack Ln
Haven Health
Barham & Claydn
Eye
Mendlesham
Saxmundham
Derby Rd
Stow Health
Hadleigh
Walton
Howard House
Leiston
Framlingham
Holbrook
Bildeston
Wickham Market
Aldeburgh
1
2
3
4
5
6
7
Cardiology Activity
All Ages - Cardiology First Attends Outpatient GP Referrals only per 1,000
weighted list - All IESCCG Practices 2014/15 Vs. 2013/14 YTD (April-June)
2013/14 Equivalent Activity YTD
2014/15 Activity YTD
CCG Average 2013/14
0
Constable Country
Fressingfield
Deben Rd
Hadleigh
Saxmundham
Woodbridge Rd
Norwich Rd
Combs Ford
Ravenswood
Little St Johns St
Grove
Hawthorn Dr
Holbrook
Aldeburgh
Howard House
Framfield
Alderton
Birches
Ixworth
Bildeston
Lattice Barn
Derby Rd
Felixstowe Rd
Debenham
Leiston
Needham
Martlesham
Orchard Med
Burlington Rd
Stow Health
Mendlesham
Chesterfield Dr
Walton
Barrack Ln
Haven Health
Barham & Claydn
Wickham Market
Framlingham
Solway & Whale
Ivry Street
Eye
1
CCG Average 2014/15
2
3
4
5
6
7
Urology Activity
All Ages - Urology First Attends Outpatient GP Referrals only per 1,000
weighted list - All IESCCG Practices 2014/15 Vs. 2013/14 YTD (April-June)
2013/14 Equivalent Activity YTD
2014/15 Activity YTD
CCG Average 2013/14
0
Birches
Hawthorn Dr
Hadleigh
Deben Rd
Martlesham
Grove
Combs Ford
Constable Country
Norwich Rd
Lattice Barn
Ravenswood
Ixworth
Stow Health
Alderton
Felixstowe Rd
Burlington Rd
Holbrook
Barham & Claydn
Barrack Ln
Needham
Ivry Street
Woodbridge Rd
Little St Johns St
Chesterfield Dr
Debenham
Wickham Market
Framfield
Saxmundham
Framlingham
Derby Rd
Mendlesham
Orchard Med
Solway & Whale
Fressingfield
Howard House
Leiston
Haven Health
Walton
Eye
Bildeston
Aldeburgh
1
2
CCG Average 2014/15
3
4
5
6
7
8
9
Ophthalmology Activity
All Ages - Ophthalmology First Attends Outpatient GP Referrals only per
1,000 weighted list - All IESCCG Practices 2014/15 Vs. 2013/14 YTD (AprilJune)
2013/14 Equivalent Activity YTD
2014/15 Activity YTD
CCG Average 2013/14
CCG Average 2014/15
0
Barham & Claydn
Chesterfield Dr
Alderton
Birches
Haven Health
Fressingfield
Lattice Barn
Martlesham
Hawthorn Dr
Burlington Rd
Needham
Norwich Rd
Constable Country
Holbrook
Ravenswood
Leiston
Eye
Debenham
Deben Rd
Felixstowe Rd
Hadleigh
Barrack Ln
Ivry Street
Wickham Market
Solway & Whale
Framfield
Woodbridge Rd
Derby Rd
Combs Ford
Mendlesham
Aldeburgh
Ixworth
Orchard Med
Howard House
Framlingham
Grove
Bildeston
Stow Health
Saxmundham
Walton
Little St Johns St
0.5
1
1.5
2
2.5
3
3.5
4
Gastroenterology Activity
All Ages - Gastroenterology First Attends Outpatient GP Referrals only per
1,000 weighted list - All IESCCG Practices 2014/15 Vs. 2013/14 YTD (AprilJune)
2013/14 Equivalent Activity YTD
2014/15 Activity YTD
CCG Average 2013/14
CCG Average 2014/15
0
Alderton
Barham & Claydn
Martlesham
Grove
Constable Country
Ravenswood
Birches
Burlington Rd
Ixworth
Needham
Hawthorn Dr
Mendlesham
Framlingham
Walton
Deben Rd
Little St Johns St
Felixstowe Rd
Debenham
Woodbridge Rd
Framfield
Derby Rd
Saxmundham
Haven Health
Bildeston
Holbrook
Wickham Market
Chesterfield Dr
Leiston
Norwich Rd
Hadleigh
Barrack Ln
Aldeburgh
Orchard Med
Ivry Street
Stow Health
Lattice Barn
Eye
Fressingfield
Combs Ford
Solway & Whale
Howard House
1
2
3
4
5
6
Respiratory Medicine Activity
All Ages - Respiratory Medicine First Attends Outpatient GP Referrals only
per 1,000 weighted list - All IESCCG Practices 2014/15 Vs. 2013/14 YTD
(April-June)
2013/14 Equivalent Activity YTD
2014/15 Activity YTD
CCG Average 2013/14
0
Little St Johns St
Felixstowe Rd
Bildeston
Woodbridge Rd
Constable Country
Ixworth
Martlesham
Ravenswood
Hawthorn Dr
Aldeburgh
Hadleigh
Haven Health
Holbrook
Framfield
Norwich Rd
Needham
Framlingham
Mendlesham
Chesterfield Dr
Ivry Street
Debenham
Leiston
Wickham Market
Orchard Med
Derby Rd
Barrack Ln
Deben Rd
Saxmundham
Howard House
Burlington Rd
Combs Ford
Lattice Barn
Solway & Whale
Barham & Claydn
Grove
Fressingfield
Alderton
Stow Health
Birches
Walton
Eye
0.5
CCG Average 2014/15
1
1.5
2
2.5
3
3.5
Gynaecology Activity
All Ages - Gynaecology First Attends Outpatient GP Referrals only per 1,000
weighted list - All IESCCG Practices 2014/15 Vs. 2013/14 YTD (April-June)
2013/14 Equivalent Activity YTD
2014/15 Activity YTD
CCG Average 2013/14
CCG Average 2014/15
0
Barrack Ln
Hawthorn Dr
Chesterfield Dr
Birches
Burlington Rd
Orchard Med
Haven Health
Barham & Claydn
Woodbridge Rd
Needham
Leiston
Norwich Rd
Ravenswood
Derby Rd
Felixstowe Rd
Solway & Whale
Martlesham
Grove
Lattice Barn
Deben Rd
Debenham
Framfield
Stow Health
Little St Johns St
Combs Ford
Constable Country
Ivry Street
Walton
Saxmundham
Hadleigh
Bildeston
Howard House
Alderton
Holbrook
Ixworth
Framlingham
Wickham Market
Mendlesham
Fressingfield
Eye
Aldeburgh
1
2
3
4
5
6
7
8
PMS Review
25
Suffolk PMS Review
Update
• Meetings taken place between the Area
Team, LMC and two Suffolk CCGs looking
at: principles of the review; value of the
development framework; and updates to
the development framework
• Meeting with local MPs
• Meeting between the two CCGs and LMC
GPs to discuss the development
framework
26
PMS Review –
Development Framework
Refresh
• Core requirements section removed
• Targets/language updated e.g. PCT to Area
Team
• Development indicators updated in new
sections
•
•
•
•
•
•
27
Access
Public Health (Vacc & Imms, screening etc)
Prescribing
Use of NHS resources
Collaboration
Other (moved from core section e.g. community liaison,
winter and disaster planning)
PMS Review
Next Steps
• Letter from Area Team describing the offer under
Option 3 scheduled to be sent on 10th September.
• CCGs, LMC and Area Team meeting to review the
refreshed Development Framework being scheduled.
• NHS England Executive meeting on 11th September to
discuss PMS Reviews across the country. This may
result in area and local agreements being subject to
regional and national moderation.
• Subject to outcome of above meeting, local objective
remains for practices to have all necessary information
on Option 2 and 3 to make choices by 10th October.
28
Primary Care Strategy
Update
29
Purpose and Process
Purpose:
• To develop an ambitious and achievable framework for primary care
commissioning and delivery for the next ten years.
Process:
• A group of local GPs and others have reviewed national and local
approaches as well as qualitative and quantitative information on
issues and opportunities for primary care in Suffolk. The output has
been reviewed and refined by an external stakeholder group
• Notes sent out via Inbox to all - some feedback ...more welcome.
• Next steps: opportunity for individual practice feedback by email, in
next practice link visits and at a dedicated group debate at the
November training and education event.
Interim aims identified
• Consistent high quality care
• Leadership and co-ordination of integrated
healthcare for local communities.
• Delivery of all forms of care other than those
which must be provided in an alternative care
setting (acute, MH, community) for safety or other
reasons.
• Organisational forms capable of delivering
excellence at practice level, 'locality' level and
CCG or Suffolk wide level, (as appropriate to
service)
Action Plans being
developed relating to;
•
•
•
•
Recruitment and retention
Commissioning service models
Sustainable organisational forms
Infrastructure and implementation support
including IT, estates, shared services,
pathway implementation
If you have any comments, questions or points you
wish to make after the locality meeting please
forward them by e-mail;
Louise.hardwick@ipswichandeastsuffolkccg.nhs.uk or
David.brown2@ipswichandeastsuffolkccg.nhs.uk or
Mark.shenton@nhs.net
Any other business
• Is there anything else you would like to
discuss?
• Do you have any ideas about future
agenda items for your locality?
• If so, please raise now or add a comment
to the evaluation form in your pack