Full Business Case
Project name
Prime Ministers Challenge Fund
Unique reference
PMCF Jan2015
Clinical lead
Dr Naomi Katz; Dr Imran Sajid; Dr Maya Chowdhury
Implementation lead
Katrina Mindel and Farid Fouladinejad
Date approved
Signature
Name
Role
Counter signature (if applicable under detailed scheme of delegation)
Date
Signature
Name
Role
Document Information
Document Name
Version
Status
Author
Date created
Date last amended
Proposal for PMCF spend to enable Federation design and set
up and to enable network working
v.0.4
Draft
Katrina Mindel and Jude Channon
29th October 2014
14th January 2015
Version Control
Version
V.0.1
V.0.2
V.0.3
V.0.4
Release date
29.10.14
09.01.15
09.01.15
14.01.15
Description of changes
Amendments to additional business case
IT governance and monitoring arrangements added
Further IT governance and monitoring arrangements added
Minor edits for GB paper
Revision History
Version
v.0.1
Date
29.10.14
Reviewer name
Jude Channon
V.0.2
09.01.15
Jude Channon
V.0.3.
09.01.15
Jude Channon
Vo.4
14.01.15
Jude Channon
Role
PMCF project manager as per
Katrina Mindel, Head of Primary
Care Development
PMCF project manager as per
Katrina Mindel, Head of Primary
Care Development
PMCF project manager as per
Katrina Mindel, Head of Primary
Care Development
PMCF project manager
i
Contents
Strategic Objectives and Drivers for Change .........................................................................1
Proposed change (business option / solution) .......................................................................1
Economic Case .....................................................................................................................2
Options Appraisal ..................................................................................................................3
Commercial Considerations...................................................................................................4
Financial Case .......................................................................................................................4
Funding source ......................................................................................................................7
Overall Plans for Implementation ...........................................................................................7
Timescales ............................................................................................................................7
Risks ......................................................................................................................................7
Stakeholder Engagement ......................................................................................................8
Recommendation ..................................................................................................................8
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Strategic Objectives and Drivers for Change
The project mandate document contained information on the strategic objectives and the
drivers for change.
In this section please add any additional information that was not included in the project
mandate.
Please also describe any fundamental changes to the information supplied in the project
mandate.
From previous work, we know the services and types of access that are most important to
our patients are:
•
To access to an appropriate clinician, from 08:00-20:00, seven days per week
•
To access to telephone advice and triage
•
To have the opportunity for a same day appointments when appropriate
•
To interact with their Practice via a channel that is appropriate to their needs and
preferences
•
To receive coordinated care – not having to tell their story over and over again to
different clinicians
•
To receive care closer to home
West London CCG strives to improve access and choice for its patient population.
This will be supported within our member Practices in a number of ways namely:
Technologically through
•
Online appointment booking
•
E-prescriptions
•
Electronic sharing of patient records
•
Improving IT infrastructure needed to streamline appointment booking, broaden
access and enable networked working.
Proposed change (business option / solution)
The project mandate document contained information what the proposed project would
deliver i.e. what would be done to fix the problem and deliver the change.
In this section please add any additional information that was not included in the project
mandate
Please also describe any fundamental changes to the information supplied in the project
mandate.
1
For West London CCG we will consider increased access to patient consultations via new
technologies such as web based consultations and online appointment booking as well as
increased telephone access to clinicians and 7 day working. Included in the scope of this
project are all Practices migrating to EPS2 to facilitate improved electronic prescribing,
improved Practice websites enabling patients to access more information and interact with
the practices more, tablets for GP On-call home visits and enabling the GP Federation set
up to deliver Out Of Hospital services.
Economic Case
This section must be completed in conjunction with the CCG Head of Finance.
Some projects will have benefits that are not cash releasing but are never-the-less an
important consideration in the decision to make an investment.
In this section list and, as far as possible, quantity all of the non-cash releasing benefits for
the options that you have considered. The option that has the greatest economic benefit
should be strongly considered to be the preferred option, although other factors can be
taken into consideration in the next section. Detailed calculations should be shown as an
appendix to this document.
Electronic prescribing (EPS2) allows the transmission of digitally-signed prescriptions
instantly from GPs via the Spine to pharmacists. This means that less time is spent in
Practice by receptionists and GP’s in printing and administering prescriptions. This would
free up valuable time to spend with patients or deal with other patient queries. Whilst the
technical side of EPS2 is funded by NHS England as part of the IT allocation, take up is low
due to the increased initial administrative burden required of practices during training and
start up of the process.
7 day working is a key objective of the Prime Ministers Challenge Fund. This will facilitate
more convenient care for patients wishing to access Primary Care outside of core Primary
Care hours. In order to enable sharing of the patient record across the hubs where 7 day
working will be commissioned, an Out of Hours module for SystmOne be used.
Improved Practice websites and enabling patient access to online appointment booking will
greatly improve access for patients as it will reduce the need for the patient to call the
Practice and remain on hold until a receptionist can deal with their query. By booking
appointments online, the patient does not have to wait for the Practice to be open to speak
to someone, they can do this from a convenient location and at a time that suits them.
Furthermore, Practice receptionists will have a percentage of their time freed up from
answering the telephone to be able to focus on other patient needs.
Patients signed up to online access would also have the ability to access their own
summary care records and further down the line, their patient notes.
Improved access to clinical triage for those patients that need it will also feel different from a
service user perspective. Improved telephone access and triage systems will mean that
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those patients with urgent care needs will be able to talk to a clinician promptly and only
need to come in to the surgery if clinical appropriate / necessary. This will also enable an
appointment to be given to patients urgently that day if appropriate with a view to avoiding
UCC/A&E attendances.
Equipping GP practices with tablets and related software will enable better continuity of
care for individuals who are house-bound. It will mean that the on call GP visiting those
house bound patients will have instant access to that patient’s notes and results and will be
able to update their records there and then.
Offering patients the choice of a remote face to face consultation will improve access for
those patients who cannot attend the surgery for an appointment. Patients can have their
consultation from wherever they are, with the added advantage of being able to see their
clinician thereby aiding communication between the patient and the clinician.
In order to achieve many of the future objectives around access and care provision in West
London, it is imperative that our GP’s work collaboratively for population coverage in
delivery of services. To facilitate this, they are forming themselves into a GP Federation.
The PMcF bid involved providing additional funds in order to them to do this. Set up costs
and initial running costs for 6 months (including Business Manager). This funding would
cover Federation legal set up costs, Accountancy costs, CQC registration, business
registration costs, OOH module; community module; Indemnity insurance, a short term
business manager and related costs.
Options Appraisal
In this section please describe the options that are available for achieving the desired
outcome. This should include: a summary of the economic assessment of the various
options (as above), details on how the options were evaluated, why they were discounted
and the process by which the selection process was followed. This should include factors
such as financial; legal or reputational risk criteria that impacted these decisions.
It must evidence that alternative approaches were considered, evaluated and
dismissed for sound reasons.
The options appraisal should include the formal evaluation of “doing nothing”.
The options considered have been identified from recommendations submitted by the IT
team. PMcf monies are only available until end March 2014, the West London GP Provider
Federation is not yet a formal legal entity and is only anticipated to be such by February
2015, it is imperative that this work begins now. The lead time for much of this work to begin
is 8 weeks. If the CCG waited for The GP Provider Federation to be formed, this would take
us over the timescale of the 31st March 2015 to meet the objectives of the Prime Ministers
Challenge Fund.
The option of doing nothing and keeping the status quo has been discounted because the
WLCCG has committed to is to improve the current system of access to Primary Care
services for its patients through the Prime Ministers Challenge Fund.
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Commercial Considerations
Outline all of the commercial considerations in taking forward this project. This should
include as a minimum:







Procurement route
TUPE implications
Premises
Contracting mechanisms (including proposed payment mechanism)
Length of contract
Exit strategy
Legal implications
All costs will be directly invoiced for from their source and be paid for form the PMCF
budget. There are no commercial consideration s that apply at this stage due to the caveats
around the funding that has been identified via the PMCF bid.
The Investment Committee had previously raised concerns around governance and
monitoring issues around the IT spend of PMCF monies, specifically with regards to EPS2
and the purchasing of tablets. These issues are addressed below.
EPS2
Governance arrangements:
There is a specific EPS2 programme board across CWHHE with a diverse membership
including practice managers, GPs, pharmacies.
The minutes and dashboard is circulated more widely.
An EPS2 highlight report is provided to each CCG IT committee and is reviewed.
The EPS2 PID has been to every CCG IT committee and has been approved.
Monitoring Costs:
The costs of the EPS2 are tracked in detail and are separate from all other associated
costs. PMCF monies are also reported as a separate budget line against IT spend
Tablets
The chosen model will be encrypted and have smartcard accessibility this will be in line with
all existing IT hardware used in practices. The tablet is not an ipad.
The tablets will be expected to have an asset tag and be part of an asset register managed
by the Practice and thereby covered by the Practice’s insurance for loss or damage.
Financial Case
This section must be completed by the CCG Head of Finance.
Outline and summarises the financial impact of the project.
4
For a service redesign programme set out what the current cost of the service is. Using
standard activity growth assumptions forecast what the service will cost over the next three
years.
Set out how the recurrent service cost will change as a result of the project, stating the
recurrent cost of the new service, the recurrent cost any residual elements of the old service
and any recurrent savings. Underpin all financial assumptions with activity flows.
Present a three year financial model which includes the non-recurrent set up costs to
demonstrate financial viability of the overall investment plan.
For an invest to save project present a three year financial model which includes the nonrecurrent set up costs to demonstrate financial viability of the overall investment plan.
Clearly demonstrate where the investment will deliver cash-releasing savings.
For all types of project or investment:
1) Provide a sensitivity analysis and payback calculation.
2) Split out capital investment and include the revenue implication of this in the
recurrent cost.
3) Include detailed financial costings and workings in an appendix to this document.
Detail and estimated costs are:
Spend Required
for:
What it will do
How much it will
cost
What PMCF objective
this will meet
EPS2 Roll out
Currently we are rolling out EPS2
via the CCG IT allocation. It pays for
Practices to enable EPS 2 on
SystmOne. Using PMCF funding
would allow for better use of the
EPS2 functionalities, data quality
checking and training for best use.
It is unrealistic to expect all 52
Practices to have been migrated to
EPS2 by 31st March 2015. It is
realistic however to expect that 35
Practices are migrated in this time
frame.
£122,500 (made
up of £3.5K per
PracticeX35
Practices)
Meets the
convenient care
objective of eprescriptions
available at all
Practices
7 day working
module per hub
Enable those hubs that will offer 7 day
working to manage patient’s records
and real time consultation notes
effectively. This funding pays for the
initiation and set up of the module. It
does not cover licence fees for the
year and this cost with be covered in
the service costings.
Enabling the functionality on system
£15,000 (made up of
£5K X3 hubs)
Meets the convenient
care objective of
Access to General
Practice 8am-8pm
(Mon-Fri) and
6hrs/day during
weekend
£39,000 (made up of
Meets the convenient
Online access to
5
notes and
summary care
record
one and signing people up to record
sharing
£750 per Practice
X52 Practices)
care objective of
Patients given online
access to their own
records
Practice Website
updates and
standardisation
Practice websites are the calling card
of General Practice. This funding is for
websites to be updated to enable
patients to make better use of online
facilities through the websites, find
patient self-management information
and provide up to data information
around opening times, network
working and services offered. These
will be standardised across the patch
to ensure that patients all have the
same access to information regardless
of where they are registered.
This funding covers the cost of the
table itself, 1 year licence,
configuration of tablet and training.
Estimated at 1 tablet per Practice plus
5 spare tablets should they be needed.
The tablets would be used to facilitate
better working for home visits for the
on-call GP enabling real time access to
patients’ notes, test results and
facilitating continuity of care for
patients. All tablets will be smart card
enabled which should to ensure
patient information security issue and
form part if the Practices inventory of
goods, thereby making the Practice
responsible for replacement for loss or
damage, much as kit like Spirometers
etc are now.
This funding would cover piloting
remote face to face consultations to
enable additional access for patients
who wish to use this technology. It is
estimated that this would be piloted in
4 Practices by 31st March 2015. Central
London CCG have already completed a
pilot in one of their Practices on this.
For Federation set up to cover legal
costs, Accountancy costs, CQC
registration, business registration
costs, OOH module; community
module; Indemnity insurance.
Contribution to office and staff costs.
£112,800 (£1400 per
Practice X52
Practices + £40K
project management
charge for
implementation)
Meets the convenient
care objective of
Online appointment
booking, Online
access to selfmanagement advice,
support and service
signposting.
£57,000 (made up of
£1000 per tablet X
52 Practices plus 5
spares)
Meets the continuity
of care objective of
everyone who has a
care plan will have a
named care coordinator who will be
part of response team
when patient requires
a crisis plan. This is
particularly for house
bound patents and
the on call GP who
responds to them at a
time of crisis.
£13,200 (Made up of
£3.300X4 Practices)
This meets the
convenient care
objective of access to
General Practice 8am8pm (Mon-Fri) and
6hrs/day during
weekend
£280,000
Meets convenient and
urgent care objectives
as an enabler for
population coverage
for primary care
services.
Tablets
Remote
consultations
Set up costs and
initial running
costs for 6 months
(including
Business
Manager)
6
Funding source
Outline all sources of funding for the project including non-recurrent, recurrent and capital.
Consider the application route for sources of funding that are outside CCG allocations, for
example, capital requirements.
Funding will be set against the Prime Ministers Challenge fund budget.
Overall Plans for Implementation
This section builds on the resources and cost of delivery section included in the project
mandate.
Outline the costs to deliver all phases of the project, to include both planning and delivery
(phases A-D). Consider procurement cost, legal costs, project management time, the
completion of capital bids, stakeholder engagement, equipment and overheads. These
costs should also be included in the non-recurrent costs in the financial case.
Also consider the cost of slippage in delivery of the project and the inclusion of a
contingency.
Timescales
Building on the timescales section in the project mandate, provide here a detailed project
plan including key milestones and decision points.
This project will need to be completed by the 31st March 2015. There is no support or
funding in place after that date. Any unspent monies will need to be returned to NHSE.
Risks
Build on the key risks identified in the project plan to provide an initial risk register to be
used at the commencement of the project. This will become the live risk register and will
form a separate document. Include a detailed list of risks, scores and mitigations in the
appendix of this document.
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Biggest risk is time. This needs to be approved asap. Delays in the process would mean
that the project deadline of 31st March will slip and PMCF monies will be clawed back by
NHSE. This can be mitigated by ensuring ample resources are dedicated to the project to
deal with any potential problems quickly.
Stakeholder Engagement
Include here a summary of the stakeholder engagement plan, highlighting particular
interdependencies. This should be a summary of the communication plan to support project
delivery.
Initial discussions with regards to new ways of accessing services have been presented to
the WLCCG patient reference group as well as the ‘Hear women now’ group. Further
information sharing with the WLCCG patient reference group took place on 06/11/2014. As
each stage of the implementation phase progresses, we will engage with the patient
reference group and seek volunteer patients to test the new services. The funding
requested also includes funding large scale marketing events for the wider patient
population.
As each stage of the implementation phase progresses, we will engage with the patient
reference group and seek volunteer patients to test the new services.
Recommendation
Include here an outline of the key decisions that the reviewer (s) of this business case are
required to make.
Reviewers of this business case are required to:
 Approve the business case
 Approve the release of Funds from PMCF budget
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