Wirral GP Commissioning Consortium
Operational Commissioning Plan
2013-14
1
Introduction
From 1st April 2013, the NHS will see one of its biggest changes in recent history, with the replacement of Primary Care Trusts with
newly formed commissioning bodies, Clinical Commissioning Groups, which will take on the vision for the NHS set out within the
NHS Health and Social Care Bill, 2012, and outlined in further detail within the NHS Operating Framework for 2013-14.
Under these changes, NHS Wirral became NHS Wirral Clinical Commissioning Group (CCG) on the 1 st April, further to confirmation
from the Department of Health that it is now authorised to take on commissioning responsibility and budgets for the healthcare of
more than 330,000 patients. NHS Wirral CCG has developed a three-year strategic plan, setting out how it plans to meet the
requirements of the Health and Social Care Bill, and priorities set out within the NHS Operating Framework and Outcomes
Framework, setting out commissioning intentions and objectives, developed not only in response to these national drivers, but
through also assessing and identifying the needs of the Wirral patient population.
The NHS Wirral CCG Strategic Plan sets out priorities and objectives that are what we want to achieve for all Wirral patients.
However, the NHS Wirral CCG is a federated body, made up of three commissioning consortia, each of which has delegated
responsibility from the CCG to plan and commission healthcare services for the population of their constituent member GP
Practices. Each Consortium has developed its own commissioning plan for the forthcoming year, explaining how it will deliver the
CCG plan for the patients registered with its practices. This will take into account the different healthcare needs and the
inequalities that exist in different areas of the Wirral. It has been produced through assessing and identifying the needs of the
patient populations of each of the Consortia, and through consultation with GP Practices, and patients.
Whilst commissioning to meet local and national needs is clearly imperative, we must also be mindful of the financial challenge that
exists both at a national and at a local level. The NHS Operating Framework makes clear the required commitment to the QIPP
areas of Quality, Innovation, Productivity and Prevention, highlighting this as one of four essential themes for all NHS organisations.
This plan illustrates how each of the objectives identified is aligned to these QIPP principles, and provides assurance to our
stakeholders of the QIPP return on any decision and investment that we are planning to make.
2012-13 has been a challenging year, whilst the local health economy has tried to adjust to the new arrangements and prepared
itself for its new commissioning responsibilities. As the landscape settles within 2013-14, we are looking forward to embracing the
2
commissioning challenge with energy and optimism for the changes that we can work with our patients and partners to bring about.
We hope that this is captured within the objectives and outcomes that we are committed to achieve during the next twelve months.
3
Contents
Section 1
The Health Needs of our Population
1.1
WGPCC Profile
1.2
WGPCC Population
1.3
WGPCC Health Needs
1.4
WGPCC Activity Profile
Section 2
National & Local Context
2.1
NHS Health and Social Care Act
2.2
Operating Framework
2.3
NHS Wirral CCG Strategic Plan
2.4
Overall financial position and delegated authority
2.5
Quality Innovation Productivity Prevention (QIPP)
2.6
Local healthcare structure
2.7
Local Authority
2.8
Provider landscape
2.9
Any Qualified Provider Model
4
2.10
Provider collaboration
2.11
Working together within the CCG
2.12
Commissioning governance arrangements
2.13
WGPCC commissioning team
Section 3
Our Priorities
3.1
Strategic Vision and Organisational Objectives
3.2
National Drivers
3.3
Local Drivers
3.4
Member Practice engagement
3.5
Patient and Stakeholder engagement
3.6
Local Need
3.7
Strategic Drivers
3.8
Clinical Lead Framework and WGPCC Team Structure
3.9
Progress against objectives in 2012-13
3.10
Objectives and outcomes for 2013-14
Appendix One
WGPCC Member Practices
Appendix Two
Referrals to Wirral Hospital Trust per specialty, as at December 2012
5
Appendix Three
Unplanned Care Activity per WGPCC practice as at December 2012
6
Section 1
The Health Needs of Our Population
1.1
WGPCC Profile
Wirral GP Commissioning Consortium (WGPCC) represents 26 GP Practices (see Appendix One) that have come together to
commission healthcare services on behalf of their patient populations. Most of these Practices have been working together as a
group since 2006, and have developed a sound knowledge of the needs of their patients, and an understanding of how healthcare
locally can and should be improved. The Member Practices are supported by a small core team of staff whose primary role is to
support the Consortium in its role of one of the three divisions of the CCG, in supporting member practices to discharge their own
commissioning responsibilities, and in delivering this commissioning plan.
The NHS Wirral CCG Member Practices are illustrated within fig. 1, with WGPCC practices largely geographically distributed and
responsible for the patient populations of the Central and Eastern areas of Wirral. The CCG will take responsibility for meeting the
healthcare needs of any unregistered patients.
The three Consortia are:
Wirral GP Commissioning Consortium
Wirral Health Commissioning Consortium
Wirral Alliance Commissioning Consortium
7
Fig. 1 – NHS Wirral CCG practices
8
1.2
The WGPCC Population
At present the most complete analysis of the Wirral population’s needs that is available is the Wirral Joint Strategic Needs
Assessment (JSNA) (2008) which underpinned the NHS Wirral Strategic Plan (2009-13)1. At the time of writing, there is not a JSNA
available at individual Consortium level. This plan will be updated in line with further data at Consortium level as this becomes
available. However, we have selected areas that are broken down to Consortium level and may help us to further understand our
population.
Age
Fig. 2
WGPCC Age Profile March 2013
ONS Population projections: between 2008 and
2033 the total older Wirral population will
increase significantly, with a steep increase of
population above the age of 85:



Between the ages of 65-79 will increase
by between 25-32%
Between 80-84 will increase by 47%
Above the age of 85 is showing a
projected increase of 122%
(source: Wirral Compendium of Health Statistics,
2011).
(Source: Consortium Profile, Public Health Intelligence, 2011)
1
http://www.wirral.nhs.uk/aboutnhswirral/planspoliciesandpublications/strategicplans/
9
Ethnicity
Fig. 3
Publication of the 2011 Census data reveals a significant increase in the numbers of people identifying themselves as ‘white
other’. This is the second largest ethnic group on the Wirral after ‘White British’, followed by ‘White: Irish’, ‘Asian or Asian
British: Chinese’, ‘Asian or Asian British: Indian’, and ‘Asian or Asian British: Other Asian’
The JSNA indicates that some of the health and social issues facing BME communities, and therefore of relevance to
commissioners are:
-
High levels of unemployment
-
Poor levels of psychosocial wellbeing
-
Low levels of physical activity
-
High prevalence of obesity, diabetes, smoking, and increased weight circumference
The CCG is committed to ensuring equality of access to services, and identifying and addressing health needs that
may be specific to particular ethnic minority groups.
10
Life Expectancy
Life expectancy on the Wirral varies from 72.6 to 83.8 years of age. 7 of the 10 wards with the lowest life expectancy fall within
the WGPCC catchment area (source: ONS, 2008).
Deprivation
Fig. 4
The index of multiple deprivation ranks areas against a range of different indicators, including housing, income, employment,
crime rates, education, in order to produce a score per area. The higher the score, the higher the level of deprivation. 11% of
Wirral LSOAs are in the 3% most deprived LSOA in the country (LSOA is a unit of geography used to give a more refined
analysis than ward boundaries). See fig. 5 for WGPCC practices mapped against deprivation areas.
11
Fig. 5 – please note that Seabank and Earlston Road surgeries have now merged into one practice on the Earlston site.
12
Worklessness
WGPCC is responsible for the wards with the highest levels of
worklessness on Wirral, particularly amongst males. In January
2011, the number of claimants of jobseekers allowance in
Birkenhead ward stood at 15.2% of all males, compared to
6.5% in Wirral overall and 5.1% in the UK (source: Wirral
Compendium of Health Statistics, 2012).
Fig. 7 shows the % of young people not in education, higher
education or training. The Wirral average is 9.2%, against a
national average of 6.7%. This is in stark contrasts to the wards
in which WGPCC Member Practices are situated: Birkenhead –
17.6%; Bidston and St James – 17%; Rock Ferry – 18.8%
Gender
Fig. 7
Fig. 6 Young people not in education, employment or training, 2010-11
There are almost equal numbers of men and women currently
living on the Wirral. The age of the population is fairly evenly
distributed from birth to 69. Notably, a quarter of the population
is aged 60 or over.
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The WGPCC population challenge!
 Large increase in elderly population projected between 2008-2033
 Life expectancy lowest on Wirral
 Significant levels of deprivation
 High levels of male worklessness
 Inequalities of access to services
 Increasing ethnic population
 High numbers of young people not in employment, higher education or training
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1.3
WGPCC Health Needs
By reviewing the incidence of disease in our WGPCC area, and comparing this with the local and national average, we can develop
a better understanding of the areas in which we need to focus. For instance, the areas in which we have high disease prevalence
indicates the principal health issues faced by our population. If there are some areas in which we have significantly lower
prevalence than the national average, it may indicate that there is undetected disease, and that further work must be undertaken to
identify and engage with patients who may require intervention.
2010-11
WGPCC
(%)
Asthma
Atrial Fibrillation
Cancer
Cardiovascular Disease
Chronic Kidney Disease
Chronic Obstructive Pulmonary Disease
Coronary Heart Disease
Dementia
Diabetes
Epilepsy
6.1
Heart Failure
Hypertension
Hypothyroidism
Learning Disabilities
0.9
1.8
1.7
1.5
3.8
2.6
4.2
0.5
5.2
0.9
15.6
3.5
0.5
2011-12
WGPCC
(%)
6.3%
1.9%
1.9%
1.9%
4.8%
2.6%
4.1%
0.6%
6.6%
1.1%
0.8%
15.1%
3.6%
0.7%
2010-11
Wirral (%)
6.3
1.9
1.8
1.3
5.0
2.2
4.1
0.6
6.0
0.9
0.8
14.9
3.5
0.6
2011-12
Wirral
(%)
6.5%
2.0%
2.0%
1.9%
5.1%
2.3%
4.1%
0.6%
6.3%
1.0%
0.8%
15.0%
3.6%
0.6%
2010-11
England
(%)
5.9
1.4
1.6
1.2
4.3
1.6
3.4
0.5
5.5
0.8
0.4
13.5
3
0.4
2011-12
England
(%)
5.9%
1.5%
1.8%
1.7%
4.3%
1.7%
3.4%
0.5%
5.8%
0.8%
0.7%
13.6%
3.1%
0.5%
15
Mental Health
Obesity
Palliative Care
Depression
14.4
1.0%
14.6%
0.4%
14.2%
Stroke / Transient Ischaemic Attack
2.1
2.2%
1.1
12
0.3
14.4
0.9%
12.5%
0.4%
14.7%
2.2
2.3%
0.9
12.5
0.2
11.2
0.8%
10.7%
0.2%
11.7%
1.7
1.7%
0.8
10.5
0.2
Source: Information Centre
Fig. 8 – prevalence comparison – taken at the end of 2010-11 and 2011-12
The table above provides the prevalence of each disease area for the practices within this Consortium, the CCG and the country
(NHS Information Centre), as at 31st March 2012. We have also provided the same information for the same position at the
previous financial year, in order to identify any changes to the disease profile of our Consortium.
This prevalence is based on the data that is held in our GP Practices, and therefore we can only count those patients that have
engaged with their GP and been diagnosed with a particular condition. There are some diseases that we may expect to be more
prevalent in our patient population, because of our levels of deprivation and our levels of obesity. For instance, there is national
evidence that vascular disease (diabetes, high blood pressure, stroke) is higher in areas where there is significant deprivation and
worklessness. We may also expect a significant level of depression and mental health issues in areas where there is less
affluence. Given that most of our practices are in levels of high deprivation, we should therefore expect a higher than average level
of disease prevalence.
Where our prevalence levels are low for a particular disease, this may be because there are patients that have not yet been
diagnosed, and as a Consortium we need to focus on how we can encourage more patients to access their GP, and the support
that they may need in treating or managing their condition.
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The key points that this raises for the Consortium are:
-
Overall, there remains a high prevalence of vascular disease in relation to the local and national average. This is
what we would expect in an area of high levels of deprivation.
-
The WGPCC prevalence of depression has fallen – is this what we should expect when the Wirral and national rates
have risen?
-
Last year the prevalence of diabetes and CKD were lower than we would expect for a deprived population –
however there has been a significant increase in diagnosis last year. This could be due to the Healthchecks
programme and focus on screening.
-
In 2010-11 the prevalence of asthma was lower than the local average – due to the high prevalence of COPD, and
the level of deprivation, we had expected this to be higher. It is positive to note therefore that diagnosis rates have
risen, although it is not clear if these represent new patients, or those who have now been coded appropriately.
-
Our hypertension rates have fallen – is this due to better management?
(Insert data on screening rates once available)
We will continue to work with the practices to ensure data is coded appropriately wherever possible, and
to ensure that patients are diagnosed as early as possible, to ensure that they get the treatment and
management plan that they require.
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1.4
WGPCC Activity Profile
Monitoring the flow of activity from primary care and across the health economy helps to highlight areas that may require focus in
order to ensure most efficient use of resources and most appropriate and fastest access to services. The WGPCC is supported by
the Performance and Intelligence team through provision of a range of referral and activity data at a Consortium level. As well as
utilising this intelligence during service planning, the WGPCC also supports and enables its Member Practices to actively engage
with their referral activity data, in order to encourage further ownership of commissioning budgets, and focus their own practice’s –
and individual practice members’ – areas for development.
We can break this down into planned and unplanned activity:
Planned activity is appointments initiated by a GP or other healthcare professional referral, either for an opinion, or for a
procedure or investigation.
Unplanned activity is where a patient is seen without a referral, for instance, someone who attends A&E, or a walk-in centre.
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Planned Activity in 2012-13
At this point in 2011-12, we identified that our highest levels of planned activity (referrals and subsequent appointments) were in
these areas, which influenced some of the areas we chose to focus on during the past year.
Gynaecology
General Surgery
Trauma and Orthopaedics
Dermatology
Ophthalmology
General Medicine
ENT
Oral Surgery - GDP
Urology
Breast Surgery
-
New gynaecology service starting in April 2013, providing faster access to
opinions and procedures, and delivered in a community setting
-
Falls training across care homes
-
Introduced hip and knee replacement referral guidelines
-
Teledermatology, which provides access to a consultant opinion on a range
of skin conditions, from a doctor’s surgery, reducing the need for patients to
access hospital
-
Developed a specification for a GP-practice based ENT clinic, so that a
range of investigations and procedures could be done on the patient’s
doorstep
Further detail progress that we have made against each area is listed within section 3.
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Planned Activity in 2012-13
Whilst we are optimistic that the changes we have put into place will have a positive impact upon these areas, it is clear from
reviewing activity that has taken place during 2012-13 that there is still much to be done.
2012-13 has seen a significant rise in planned activity across each of the Wirral Consortia, including WGPCC (see Appendix 2).
The areas in which we have seen the most significant increase have been:
-
ENT
-
Diabetes and Endocrinology
-
Urology
-
Musculoskeletal
-
General Surgery
We are currently undertaking an independent investigation of our planned activity in order to determine the reasons for this shift.
We never assume that an increase in the number of referrals is something that is either incorrect or unnecessary – there are many
factors that may contribute towards this, for instance, changes in prescribing in care homes may lead to more falls, which may lead
to more musculoskeletal problems. This analysis will help us to focus our attention.
One possibility is that there are procedures that are being done in a hospital setting that could be easily done in the community, or
even in a GP practice. We have already gathered some of this information. Section 3 provides further information on
the work that we have planned in these areas to ensure that all referrals for these conditions are
appropriately made and, more importantly, to ensure that the patient’s journey is as smooth as it can be
through the different areas of the healthcare system.
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Unplanned Activity in 2012-13
At the end of 2011-12, we had identified that there were:
-
-
So in 2012-13 we developed the following:
Avoidable admissions and readmissions
due to chronic diseases – principally
COPD
-
Patients that were attending A&E on
multiple occasions, often with very
complex needs
Minor injury and illness units now open in five WGPCC
practices. The unit based in Miriam MC is open during
weekends and bank holidays.
-
Multi-disciplinary team based in A&E that holds a case
conference every fortnight on those patients that attend
A&E most frequently, to put a joint care plan in place, and
try to reduce the number of attendances
-
Range of initiatives to support patients with COPD,
including practices undertaking medication reviews, and
reviewing patients following hospital discharge, and using
self-management plans with patients to reduce the
likelihood that someone’s condition will reach a crisis level.
-
Additional nursing hours into our Admissions Prevention
Service, a nurse-led service providing short-term crisis
intervention for patients at risk of a hospital admission.
-
High numbers of patients attending A&E
for minor illnesses and injuries
-
Patients attending A&E within general
practice opening hours
Whilst unplanned activity has increased slightly in 2012-13 (see Appendix 3), it has not done so at the same rate as the other
Consortia; we believe that the initiatives that we have put into place have made a significant contribution to this. See section 3
for how we plan to continue to focus on this area in 2013-14.
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1.5
Support to Practices
The data within Appendices two and three is just a snapshot of what we have available. Access to up-to-date referral data and
activity levels has been vital to enable practices to identify if:
-
referrals to particular specialties may be higher than others
-
referral levels are higher than those in other practices
-
referral activity differs significantly between GPs, highlighting requirement for training or education
-
some providers are being under or over-utilised, where there may be other options for referral available
-
an appropriate threshold for referral is applied
Practices have been working with their peers in order to identify and share good practice following analysis of the data in line with
the above questions, and as a Consortium we provide regular opportunities to promote sharing of good ideas.
The Performance and Intelligence team provides a range of data to practices so that they can drill down to patient level, and
explore why their levels of activity may be different to other practices. We are looking to support practices during 2013-14 with
more ‘hands-on’ analysts, who can undertake much of this investigation work for the practices, so that the clinicians and practice
staff are able to focus on their practice and patients.
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Section 2 - National and Local Context
2.1
Health and Social Care Act
The NHS Health and Social Care Act sets out the Government’s ambitious vision to safeguard and to modernise the NHS. It
describes an NHS that is led by clinicians, that is delivered in partnership with patients, and which strives for high standards of
quality and care against a backdrop of increasing financial pressures, and increasing challenges presented by a population with
increasingly complex and multiple healthcare needs.
Clinically led commissioning is the main key policy change within the Act, and one which has brought about the abolition of Primary
Care Trusts, and the emergence of new Clinical Commissioning Groups.
Each CCG has undergone a period of authorisation during 2012-13, through which their ability to taken on full healthcare
commissioning responsibility for their Member Practices, has been rigorously assessed. This assessment has taken place across
five key domains:






A strong clinical and professional focus which brings real added value;
Meaningful engagement with patients, carers and their communities;
Clear and credible plans which continue to deliver the QIPP (quality, innovation, productivity and prevention) challenge
within financial resources, in line with national outcome standards and local joint health and wellbeing strategies;
Proper constitutional and governance arrangements, with the capacity and capability to deliver all their duties and
responsibilities including financial control as well as effectively commission all the services for which they are responsible;
Collaborative arrangements for commissioning with other CCGs, local authorities and the NHS Commissioning Board
as well as the appropriate external commissioning support; and
Great leaders who individually and collectively can make a real difference.
NHS Wirral CCG was granted authorisation, and the ability to take on the commissioning responsibility and budgets for its patient
population, during March 2013. During the authorisation visit held in December 2012, the visiting external team praised the
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federated structure and the three consortia for the innovative approach that this model brings, and the ability to focus on the
different healthcare needs.
2.2
NHS Operating Framework
The NHS Operating Framework for 2013-14 describes how the new clinical commissioning groups will drive the delivery of an NHS
that is patient-focussed, and outcomes-driven, across the following five domains:
Fig. 9
The NHS Wirral CCG Strategic Plan describes how as a Wirral health economy the CCG intends to deliver outcomes in each of
these domains. The commissioning intentions of WGPCC, as set out in this document, are also clearly mapped to each of these
domains. It is important that anything we focus our resources and our energy on can clearly demonstrate
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that it intends to deliver one of these five outcomes, and that we understand how we are going to
measure this.
2.3
NHS Wirral CCG Strategic Plan
The NHS Wirral CCG Strategic plan has been developed during 2012-13, and describes the vision for healthcare on the Wirral
between now and April 2016. It builds upon the strategic plan that had been developed by NHS Wirral, and that developed by each
of the commissioning consortia in the previous year.
Clearly, there is much that we want to do, and that makes sense to do, on a Wirral-wide basis. The NHS Wirral CCG strategic plan
focuses on these areas. It sets out twelve areas that we are going to focus on across Wirral, objectives and outcomes in each of
these areas, and key pieces of work that will help to achieve this. Please see section 8 of the NHS Wirral CCG
Strategic Plan for more information.
However, one of the key factors behind the success of the federated CCG model is the ability of each of the Consortia to focus on
areas that meet the specific needs of their own patient populations. For instance, WGPCC has a high prevalence of alcohol misuse
and so it would be appropriate for it to invest more of its resources in services in this area, whereas WHCC, with a high proportion
of elderly patients, may have different priorities for investment and focus.
The consortia model also gives us the opportunity to test things on a smaller, pilot basis, to test if something is worth doing on a
larger, Wirral-wide scale.
So, whilst our own WGPCC plan has been developed to fit in with the overall CCG plan, there are some areas of work that are
unique to our Consortium and either meet our own patients’ unique needs, or represent an innovative idea that we are testing here
first.
You should read both plans in conjunction with each other, for a full picture of the changes that we want
to make for Wirral patients.
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2.4
Overall Financial Position and Delegated Authority
NHS Wirral CCG has been allocated a budget for discharging its statutory responsibilities for the patients of Wirral. Full detail of
this is provided within the NHS Wirral Strategic plan, within section 5.
The overall Wirral CCG budget is divided as follows (fig. 10):
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Each Consortium receives a share of this resource to be used to fulfil its delegated responsibilities for its own patient population,
which are set out within the NHS Wirral CCG Constitution. These include:
(hospital care, excluding mental health, which is commissioned Wirral-wide)
ry Care Incentive Schemes
of GP Practice staff
Consortium Workforce and Operating Costs
Consortium Service developments
In 2013-14, the Consortium will receive xxx to undertake the activities listed above, which is divided as
follows (insert once available):
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2.5
Quality Innovation Productivity Prevention (QIPP)
The Government has set a target for each health economy to make savings each financial year, which is known as the ‘QIPP
challenge’. In all that a CCG does, it must demonstrate that it:
-
Is contributing to an improvement in quality in the service delivered to Wirral patients
Is acting in a way that is innovative
Is increasing productivity – effectively doing more, for less
Is preventing harm, or working to prevent disease, health inequalities or deterioration in health
NHS Wirral CCG has been tasked by the Government with generating £20m worth of QIPP savings during 2013/14. The NHS
Wirral CCG has developed a plan, based on those schemes planned Wirral-wide, and by each of the Consortia, that sets out how
the CCG will meet this challenge. These savings will be made either by avoiding a cost, or by doing things in a different way and at
a lower cost.
The CCG and its Consortia will be under scrutiny as we move forward to measure the impact that we have on QIPP, so how will
we know if we’ve been successful in achieving what we set out to achieve?
Each idea that we have as a Consortium will need to demonstrate that it will contribute towards QIPP, and that
we have thought about how we are going to measure the impact that each scheme will have. We want to
demonstrate to our patients and stakeholders that what we have planned will have a positive impact upon our
patients or our health economy through QIPP.
Find out more: NHS Wirral Strategic Plan, p. 25.
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2.6
Local Health Care Structure
WGPCC is one of three Wirral Consortia, which together ensure complete coverage of the constituent Wirral patient population,
totalling 330,476 as at April 2013. The patient populations are split by Consortium as follows:
Wirral GP Commissioning Consortium
125,402
Wirral Health Commissioning Consortium
165,046
Wirral Health Alliance
40,024
Fig. 12
There are 61 GP Practices in total on the Wirral. The list of GP Practices under WGPCC is within Appendix One.
In addition to the GP Practices, there are:
•
33 contracted ophthalmic opticians and branches
•
94 Pharmacies
•
46 Dental Practices (including 6 orthodontic practices)
The contracts for these services, along with the contracts with GP Practices to deliver their core GP services, are held by the
National Commissioning Board.
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2.7
Local Authority
The three Consortia cover a patient population that is coterminous with that of the Local Authority, Wirral Borough Council. The
Local Authority and the CCG work together through the Health and Wellbeing Board, which brings together a range of stakeholders
who are responsible for the health and wellbeing of Wirral residents. They are working together to develop a Joint Health and
Wellbeing Strategy, which will reflect the work within the CCG plan, but also take into account the contribution of the wider health
and social care system. The Local Authority and the CCG have agreed on three main priority areas, reflecting the needs of our
population:
-
Elderly care
Alcohol
Mental health
The Health and Wellbeing strategy will set out further detail of how we will work together with the Local Authority in these areas.
There are already examples of good joint-working between the CCG and the Local Authority – see the NHS Wirral Strategic Plan
for more details.
2.8
Provider Landscape
The CCG, and the commissioning Consortia, commission services from a range of NHS, and non-NHS providers.
The three main contracts, shared across the Consortia, which account for the majority of Consortium commissioning budgets are
as follows:
Provider
Total Contract Value
30
2013/14 (£000)
Wirral University Teaching
Hospital Foundation Trust
Wirral Community NHS Trust
Cheshire and Wirral
Partnership NHS Foundation
Trust
£212,406,195
£46,024, 983
£33,921,238
Fig. 13
In line with the Operating Framework and the Health and Social Care Act, we are committed to ensuring improved choice and
access for our patients, and have a track record of working with alternative providers, both inside and outside the NHS, in order to
secure plurality of provision, and to drive up quality and safety standards, for our patients.
Other local providers delivering healthcare to our patients include Peninsula Health LLP, Spire Murrayfield, Mental Health Concern
Oakdale and One-to-One Midwives: as with the four providers above, the Consortium will be at the forefront of monitoring contracts
held with these providers to ensure that patients receive consistently high standards of care and service, irrespective of the
provider.
2.9
Any Qualified Provider model
During 2011-12 and 2012-13, WGPCC has made use of the Any Qualified Provider procurement model, which has facilitated the
entry of new providers onto the landscape, and has enabled patients to benefit from enhanced choice and new, different and
innovative service delivery models, whilst ensuring transparent flow of resources for commissioners. For instance, our patients and
GPs were telling us that the waiting times for an appointment for gynaecology, podiatry and physiotherapy were too long. So, we
have gone out to tender using an Any Qualified Provider route, which invites a number of providers to deliver a service to our
patients, as long as they can demonstrate that they are able to meet our specification and a range of standards including quality,
safety and financial management. The new podiatry and gynaecology services will commence during 2013-14. The new
Physiotherapy services were launched in 2012-13, and we have seen a fantastic reduction in waiting times for our patients, the
majority of whom are seen in 2 weeks, when previously people were waiting up to three months to be seen. These new providers
are delivering services on patients’ doorsteps, and patient feedback has been fantastic.
31
We are committed to improving patient choice and access to services wherever possible and whilst we will always strive to work
with our existing providers to improve services, we will also explore alternative options if it is in the best interests of our patients.
We believe that by asking providers to compete on quality, rather than price, we will drive up standards for Wirral healthcare.
2.10 Provider Collaboration
Whilst WGPCC is committed to service redesign and stimulation of the local marketplace where appropriate, it is also cognisant of
the pressures faced by existing providers, the intelligence and input to be offered by providers, and the need to support continued
stability for patients. We will therefore work with existing providers to review and redesign services wherever possible, even if a
service is to be extended to a wider marketplace, rather than decommissioning or destabilising. We will also work closely with
neighbouring Consortia to ensure that any commissioning intentions that could have an impact on local providers are developed in
collaboration wherever possible, to ensure coherence and reduce provider pressure.
Provider collaboration will be enacted through the following routes:
-
Consortia leading contract monitoring and negotiation meetings with providers
-
The Wirral CCG Assurance Framework requires that any risks for providers that could result from any Consortium’s
intentions or decisions will be identified through an equality impact assessment, and will need to be brought to the Governing
Body for consideration.
-
WGPCC will continue to work with clinicians representing local providers on a Wirral-wide basis through the Wirral QIPP
teams, and through its own working groups.
-
The WGPCC Communication and Engagement strategy provides further detail on how the Consortium will ensure that it
communicates with and involves local stakeholders – including providers
2.11 Working Together within the CCG
32
As a Consortium we accept that in many instances it makes sense to work with our other consortia to either deliver a joint solution,
or to share best practice and ideas. Each Consortium works together through the QIPP team structure.
The QIPP teams represent each of the priority areas within the Strategic plan, and are responsible for delivering the objectives in
each of these areas. Each team is led by a GP from one of the CCG Member Practices, and membership includes GPs from
across the CCGs, clinicians and managers from our provider organisations, and representatives from the Local Authority and
Voluntary Sector. These teams give the opportunity to share what we are doing as a Consortium, and to pick up ideas that are
taking place in other areas, which may be of benefit to our patients.
2.12 Commissioning Governance Arrangements
Whilst it has delegated autonomy to act on behalf of its Member Practices, the Consortium must operate within the statutory
framework of NHS Wirral CCG and its constitution. As such, it is part of the CCG Governance and reporting structure, and has its
own internal structure that will provide both internal and external assurance that the decisions that we take are evidence-based,
provide value for money, and meet the needs of our patients. The CCG Governance structure is as follows:
33
Fig. 14
34
The WGPCC Executive Board is a Committee of the CCG Governing Body, and has the authority to make decisions in relation to
the responsibilities that have been delegated to WGPCC. Full details of the membership and responsibilities of the Board, and the
Consortium’s Governance structure, are within the WGPCC Terms of Reference.
WGPCC is a membership organisation, made up of its Member Practices. These Member Practices have
elected members to represent their interests, and make decisions on their behalf, both on the WGPCC
Executive Board, and on the Governing Body of the CCG.
We not only represent our practices, but also our patients.
Please see section 3.5 for the way in which we ensure that the voice of our patients is represented in the
plans that we make, and the decisions that we take.
Section 3
35
Our Priorities
3.1
Strategic Vision and Organisational Objectives
This plan has been developed ensuring that the overarching vision and values of NHS Wirral CCG is reflected within each of the
commissioning intentions. The strategic vision of the CCG is:
“Wirral Clinical Commissioning Group commits to continue to improve health
and reduce disease by working with patients, public and partners, tackling
health inequalities and helping people take care of themselves”
Its strategic aims are to:
•
•
•
•
•
•
Improve the health of all Wirral citizens.
Target inequalities in health experiences and outcomes amongst sections of our population
Deliver needs based healthcare of the highest quality to all our resident population.
Promote maximum self-care by involving and including our patients in all decisions made about them.
Reduce waste and inefficiency and duplication within the patient journey and between partners
Be a high performance, high reputation organisation with ambition.
The Consortium will be held to account by the CCG, its Board, its stakeholders and its patients if it does not operate in line with
these strategic objectives.
3.2
National Drivers
36
Section 2 provides detail on the context in which the CCG and Consortium are operating, and some of the national drivers which
direct their work, which include:
-
NHS Health and Social Care Act 2012
-
NHS Operating Framework 2013/14
In addition to these system-wide drivers, there are also requirements and guidance that drive developments in relation to specific
disease areas, such as:
-
National Service Frameworks
-
Professional guidelines
-
NICE Quality Standards, Guidance and Technology Appraisals
As far as possible the plan will indicate where intentions have been developed on the basis of, or will ensure compliance with, key
national drivers.
3.3
Local Drivers
In line with the Operating Framework, clearly WGPCC will need to ensure that its commissioning activities are in line with local
need. The Consortium has developed a structure that facilitates not only clinically-led commissioning, but ensures that all that we
do takes into account the factors that are going to ensure that the services for our patients are in line with the commissioning aims
an vision of the CCG.
The four key elements that shape our priorities are as follows:
37
Strategic
Drivers
Local needs,
eg JSNA
Priority
Member
Practice
engagement
Patient and
Stakeholder
engagement
Fig. 15
3.4
Member Practice Engagement
38
As a commissioning group that has been established for more than five years, we have developed and cemented relationships and
structures that facilitate strong and meaningful engagement with our GPs and GP Practice Staff.
Practice Engagement
Gathering ideas
•Practice visits
•Online Forum
•Website
•Members' Forum
•GP Forum
•Practice Manager Forum
•Nurse Forum
•Interface forms
Involvement in
commissioning
Decision-making
• GP and Practice Manager members
•8 GPs, 1 Practice Manager and 1
on contract monitoring and
Practice Nurse on Executive Board
negotiation meetings
•All key decisions regarding
• Portfolio of practice member
Consortium to be made by
interests, so members are called for
Members' Forum
involvement in areas that are of
particular interest
• clinicians involved in development
of service specifications
•clinicians involved in QIPP teams
Fig. 16
This structure ensures that the input from our practice staff forms our priorities, and it enables continual testing of pathways and
services.
3.5
Patient and Stakeholder engagement
39
Ensuring that our commissioning priorities reflect the needs and the interests of our patients is vital, and embedded in all that we
do. Since becoming a pathfinder organisation, we have focussed on developing a structure that enables patients to become
involved in commissioning at a level that is suited to them, but that patients’ interests are represented at every level.
:
Fig. 17
40
This model not only enables messages and information to flow from the Consortium, but provides a mechanism for feedback from
the patients themselves. The challenge as we move forward is to ensure that the feedback that we gather is equally representative
of our wider patient population, both by developing more easy and accessible engagement mechanisms, and also that those
patients who do attend the Patient Council and Executive Board are able to represent the interests of their patient communities.
Patient Engagement is an area that we feel we have made significant progress and impact during 2012/13. During this past year
we have:
-
Designed and implemented a campaign to reduce the number of missed / cancelled appointments – following patient
feedback
Given our patients the opportunity to put their questions ‘live’ to the Chief Executives of the local hospital and community
Trusts
Put in place new podiatry and physiotherapy services, after our patients told us waiting times were too long
Involved our patients in decision-making groups around new services, for instance, on the panel for the new podiatry
providers, and to assess where new minor injury and illness services should be based.
Sent a newsletter to all patient households, outlining how to get involved and what the Consortium has achieved.
Our engagement strategy provides more detail of our achievements to date, and the way in which we plan to make it easier than
before for our patients to not only feed into our commissioning plans, but to hold us to account on their delivery.
3.6
Local Need
As outlined within section 1, as a Consortium we are representing patients that have a very challenging set of health and wellbeing
needs, and it is crucial to ensure that the services and pathways that we commission are reflective of these. Our biggest challenge
is to address the health inequalities that exist between our practices and the remainder of the Wirral and beyond, but also to take
into account the difficulties that some of our patients may face with regard to accessing services. We must concentrate more and
more on not only commissioning pathways and services, but on outcomes, if we are to make a difference in addressing the
disparity that exists for our patients.
41
Whilst sources such as the Joint Strategic Needs Assessment are invaluable in painting the long-term picture of health needs, they
also enable us to focus on areas where we need to invest now in order to ensure a healthier future for our population; we therefore
require that all of our commissioning priorities reflect actual and identified need, not just aspirational intention.
3.7
Strategic drivers
National strategies such as the NHS Operating Framework, and the NHS Outcomes Framework, provide an essential reference
point for ensuring that our priorities are in line with the national direction of travel, and also set meaningful targets and key
performance indicators for our providers to ensure that our patients receive a consistent and high quality standard of care.
3.8
Clinical Lead Framework and WGPCC Team Structure
In order to ensure true clinically-led commissioning, we have assigned each of our GP Board Members with an area of clinical
responsibility, aligned with their own personal areas of interest and expertise. Supported by the core Consortium team, these
Leads are responsible for agreeing and driving the agenda within these areas.
42
Chair
Planned Surgical
Planned
Surgical
Dr
Kershaw
Planned
Medical
Professional
Engagement
Unplanned
Care
Chronic
Disease
Management
Cancer /
Diagnostics
Community /
Provider
Services / IT /
Medicines
Management
Mental Health
Dr Hare
Specialist Surgical
ENT –
Dr Neil
Dr Ali
Ophthal – Dr Kershaw
Specialist Medical
Gastroenterology
Dr Srivastava
Dr Makin
Neurology
Dermatology
Dr Murughesh
Dr Srivastava
Dr Gregson
Dr Hughes
Dr Srivastava
Dr Karyampudi
Dr Gee
Dr Pleasance
Dr Karyampudi
Dr Brodbin
Dr Pleasance
Dr Delaney
Dr Pleasance
Practice Manager
Forum
Karen Hornby
Dr Shetty
Urology – Dr Hare
General Surgical
GP Forum
Obs / Gynae /
Dr Davies
Paeds
Lysa Morton
Practice
Nurse
Forum
Admissions
Prevention / Urgent
Care / Minor Illness
/ DME
Dr McKay
Cancer / End of
Life / Palliative
Care
Complex
Cases
Community
Mental Health /
Psychiatry
Dr Earl
Dr
Wright
Dr Oates
DrRadiology
Hughes /
Diagnostics
Dr J Harris
Dr Hare
Dr Quinn
Ann Riley
Professional
Education
Dr Lee
Dr Kershaw
Dr B Ali
Dr Kershaw
Dr Pereira
Lysa Morton
Dr A Jones
Dr Makin
Dr A Clark
Dr Fletcher
Dr J Fletcher
Dr Hughes
Dr Brodbin
Dr Fletcher
Dr Quinn
Respiratory
IT
Karen Hornby
Alcohol /
Julie McKeown
Substance
Misuse
Pam Davies
Dr Quinn
Alman
Mark Deevey
Rebecca Monaghan
(Ham) / CVD
Cardiology
Dr Oelbaum
Learning
Disabilities –
Dr Janikiewicz
Dr Chesters
Dr Bates
Dr Jones
Dr Prakash
Kay Lochhead Dr Larkin
Dr Edwards
Dr LeePotts
Philomena
Dr Prakash
Dr Taylor
Dr Lockyer
Dr Kini
Dr Ravichandran
Diabetes / CKD
Kim Robinson
Dr Martin
Orthopaedics /
Dr Syed
Rheumatology
Dr Lee
Dr Hill
Dr Delaney
Philomena Potts
Dr Lee
Dr Ali
Dr Alam
Philomena Potts
Medicines
Management
Dr Lee
Janine
Community
Keegan /
Provider Services
Karen Hornby
Dr Hughes
Tracey Clampitt
Anna Commander
Karen Hornby
Lysa Morton
Dr Raymond
Kay Lochhead
Dr Clark
Dr Pereira
Dr Mahai
Dr Abraham
Dr Shah
Dr Green
Kim Robinson
Dr Alman
Mark Deevey
Dr Srivastava (CKD)
Dr Fraser
Dr Sloan
Dr Mantgani
Rebecca Monaghan
43
(Fig. 18)
We have asked our practice staff to advise us of their clinical areas of interest, in order that they may be aligned within this clinical
lead structure. We recognise that some clinicians may wish to lead in some areas, whereas some may prefer to be ‘task and finish’
clinicians – only taking a role with specific pieces of work.
Our commissioning intentions for 2013-14 are structured within these areas, which in turn map with the CCG Strategic Plan areas.
The Commissioning Managers within WGPCC work alongside the Clinical Leads to deliver the workstreams and objectives within
the commissioning plan. The internal Consortium team is as follows:
Fig. 19
Christine
Campbell
Chief Officer
Sarah Quinn
Kerry Hogan
Commissioning
Manager
Commissioning
Manager
Paul
McGovern
Carol
Diamond
Commissioning
Manager
Comissioning
Manager
Anita Fletcher
Administration
Jordan Lane
Administration
44
It will be imperative to support our GP practices in order to ensure that the necessary infrastructure is in place facilitate the access
to services within primary care. One of the primary ways in which the Consortium will support its practices is through education and
training, to ensure that the primary care workforce is suitably competent and confident to deal with a growing range and variety of
patients and conditions within a primary care setting. To support this aim, the Consortium has undertaken the following during
2012-13, and will continue to do so during 2013-14:
-
devolved a dedicated training budget to each general practice
-
bursary for primary care clinicians to undertake specific training courses that will benefit the practice and WGPCC
populations
-
protected learning time events to release staff in order to undertake education and training
rolling programme of training for administrative staff, practice nurses and GPs in key disease and general practice
management areas
45
3.9
Progress against objectives in 2012-13
We have made significant progress against some of the areas that we had set out to achieve during 2012-13. We want to be
transparent with our patients and if something hasn’t worked, or we haven’t been able to do something yet, we will be honest about
that. In some areas this is because it is something that is continuing into 2013-14. However, in some areas, the priorities that we
had set out for ourselves as a Consortium are ones that have been considered to be of benefit Wirral-wide, and so are now being
looked at by the QIPP teams. We have tried to put as much information as possible against each of our original objectives so that
you may understand our progress.
Planned Surgical Care
Objective
Action to achieve Objective
Progress
Improve patient outcome by speeding up
recovery times post-surgery
Education and training for practices on existing
enhanced recovery (ERP) pathways to be delivered by
WUTH
Training delivered through our GP
Forum
Implementation of further ERP initiatives including
patient preparation for surgery, shared decision making
and extension of enhanced recovery initiatives for all
surgery (elective and non elective) and where
appropriate medical pathways
Is now a priority for the Planned
Surgical QIPP Team
Improve access to advice, diagnosis and
treatment for patients with
gastroenterological conditions
Identify conditions that could be managed via a shared
care arrangement and agree pathway between primary
and secondary care
Is now a priority for the Planned
Medical QIPP Team
Improve access to Surgical Appliances
Revise service specification for Surgical Appliance Unit,
The existing provider was not
46
with KPIs, and vary contract with existing provider
able to deliver the specification,
so this service is going out to
tender during 2013/14
Improve access for patients requiring minor
surgical procedures
Review current provision of minor surgery to determine
conditions that could be offered within a primary care
setting
New service starting in April 2013
in two GP Practice locations
Improve access to chronic pain service
Review current provision of chronic pain interventions to
determine if any could be offered within a primary care
setting
Working with Walton to expand
the current neurology service
within Birkenhead, to include
chronic pain
Improve access to advice and treatment for
patients with urological conditions
Review pathway for primary care management of Botox
for overactive bladder, integrating with the community
continence service
Is now a priority for the Planned
Surgical QIPP Team
Ensure that referrals for hip and knee surgery Design referral form and guidance for hip and knee
are clinically appropriate and ensure access
referrals from primary care and roll out across general
to surgery for those with most clinical need
practices
This has been rolled out to all
Wirral practices
Planned Medical Care
Objective
Action to achieve Objective
Progress
Support patients with dermatological
symptoms and conditions to be diagnosed
and managed in the community, avoiding
inappropriate hospital attendances
Purchase dermatoscopy equipment and establish
community dermatoscopy service
Teledermatology service in place
Roll-out dermatology training to practices
Dermatology guidelines rolled out to all
practices
47
Increase confidence and competence in
diagnosing and managing skin conditions in
primary care
Clinical training session arranged for July
2013
Support patients with neurological symptoms Undergo procurement process to commission epilepsy
and disorders to be diagnosed and managed nurse against an agreed service specification
in the community, avoiding inappropriate
hospital attendances
Work with Walton Neurocentre to identify neurological
conditions that could be treated within the community
Community Neurology service in place,
delivered from Birkenhead Medical
Building. Currently working with Walton
to expand this service to include other
neurology conditions
Support patients with gynaecological
symptoms and conditions to be diagnosed
and managed in the community, avoiding
inappropriate hospital attendances
Write specification for community gynaecology service
Community Gynaecology service
commencing during April 2013
Support patients with rheumatological
symptoms and conditions to be diagnosed
and managed in the community, avoiding
inappropriate hospital attendances
Review provision of rheumatology within acute trust
with a view to delivering services within the community
wherever appropriate
Review currently being undertaken Wirralwide by the QIPP Planned Medical Team
Include vaccination as a KPI for hospital and
community midwives within provider contracts
This is now a KPI within the contracts
Commission paediatric insulin pump service via an
AQP procurement process
This is being explored by the Planned
Medical QIPP Team
Optimise the proportion of pregnant women
receiving flu vaccination
Improve access to insulin pump service for
paediatric diabetic patients
Commission community gynaecology service via AQP
procurement process
48
49
Urgent Care
Objective
Action to achieve Objective
Progress
Ensure that GP Out of Hours is delivered in line
with QIPP objectives and meets the needs of our
population
Review GP Out of Hours in line with requirements
for the implementation of NHS 111
This has been reviewed and
changes made to implement NHS
111
Monitor usage of admissions prevention service
to ensure capacity remains adequate to meet the
objectives of preventing hospital admissions and
facilitating discharge
Use service as a vehicle to build upon
collaboration with local authority and secondary
care
Implement revised service specifications with KPIs
Service continues to be
commissioned and has had a
fantastic impact on admissions to
hospital. We are reviewing the
service specification to see what
else the service can deliver.
Improve access to unplanned care services
during the weekend
Commission additional opening hours of the Minor
Injuries Services provided by Miriam MC at a
minimum of one site
Service delivered at Miriam MC is
now open on weekends and bank
holidays, and this will continue in
2013/14
Enhance medical support for older people within
the community who may otherwise by likely to
require a hospital admission, enabling them to
stay within their own home or residential care
wherever possible and appropriate.
Implement a community geriatrician service and
monitor outcomes in partnership with WUTH
clinical directors
WGPCC practices and patients
now have access to a community
geriatrician
Complete review
This is being led by the Urgent
Care QIPP Team, with
recommendations to be made
during 2013/14
Complete review of primary and secondary care
urgent care services on the Arrowe Park Hospital
site. Likely to lead to:
Service to increase capacity in order to increase
discharge facilitation statistics
Consult on options
Agree options

Redesign initial assessment on the Arrowe
Park Hospital site

Redesign medical assessment on the Arrowe
Park Hospital site
50
Ensure that the CCG is engaged in the
implementation of NHS 111
Contribute to sub-regional procurement and
engagement process
NHS 111 to be launched in Wirral
during April 2013/14
Develop Directory of Service and work with
providers to ensure it is accurate and regularly
updated
51
Mental Health and Substance Misuse
Objective
Action to achieve Objective
Progress
To ensure local pathways for people with
dementia are NICE Compliant
Task and finish group to review future demand and
establish plan for shared care protocol
Shared care arrangement with Wirral GPs
now in place. Pathways are NICE compliant.
Continue with implementation of Wirral Memory
Assessment Service.
Develop Shared Care Protocol with Primary Care.
Improve quality of care for dementia
patients in the Acute Hospital
Monitor and Review Dementia Clinical Pathway
(WUTH) via WUTH contract monitoring process
Requirement in contract with hospital trust to
assess over 65s for dementia, and to put a
care and discharge plan in place for those
with suspected dementia.
Monitor implementation of National CQUIN Scheme
All people with dementia who are receiving
antipsychotic drugs should receive a
clinical review to ensure that their care is
compliant with current best practice and
guidelines and that alternatives to
medication have been considered
Continue with Community Pharmacist Antipsychotic
Medication review project in care homes to reduce
inappropriate prescribing of antipsychotic drugs.
Increase awareness and management of
people with dementia, through training and
awareness sessions
Continue with training and awareness sessions
commissioned from Wirral Alzheimer’s Society
Anti-psychotic medication review has been in
place in care homes in 2012/13, and will
continue into 2013/14.
In-patient wards (MH and Acute) review medication
on admission and discharge.
52
Improve access to Psychological
Therapies for minority ethnic groups, older
people and people with LTC and achieve
IAPT KPIs
Review IAPT service provision via formal contract
monitoring process.
Improve access to mental health services
for military veterans
Ensure that patients have access to
primary care mental health services that
are IAPT compliant
Ensure quality service provision for
patients with ADHD
Promote use of Military Veterans’ pilot IAPT service
both within general practice and patient population
Review IAPT service provision via formal contract
monitoring process and forecast demand to determine
future funding requirement
Develop and implement diagnosis and management
pathway for children, young people and adults with
ADHD
Develop and implement diagnosis and management
pathway for children, young people and adults with
Autism Spectrum Condition
Establish database to monitor and flag potential
problem patients
Ensure quality service provision for
patients with Autism Spectrum Condition
Increase identification of previously
unknown patients with potential alcohol
problems
Utilise support of regional IAPT via IAPT
Collaborative Forum
IAPT service monitored on a monthly basis
and action plan in place where KPIs are not
being met. Kerry Hogan has been attending
the IAPT forum and using their support
around the delivery of the contract.
Service promoted to GPs and to IAPT
providers.
This is done routinely through contract
managing.
This is being dealt with through the Mental
Health QIPP team
This is being dealt with through the Mental
Health QIPP team
This is dealt with through the Alcohol DES.
53
Chronic Disease Management
Objective
Action to achieve Objective
Progress
Increase number of diabetic patients
receiving their diabetes care within the
community, and reduce unnecessary
hospital admissions and attendances
Commission community diabetes service
Specification has been developed,
to be commissioned during
2013/14
Support patients with diabetes to take an
active role in managing their care, and
improve compliance with care plans
Ensure that diabetes care delivered in
general practice complies with the
associated NICE Quality standards
Develop and launch patient self-care packs, in
conjunction with clinician training
Self-care packs have been rolled
out to WGPCC practices
Review Diabetes LES and general practice diabetes
care provision to ensure that it supports compliance
with the appropriate NICE QS standards
LES is currently being reviewed by the
Planned Medical QIPP team in time for
2013/14.
Ensure that patients with diabetes receive
access to structured education
Review current provision of diabetic education with a
view to implementing a revised service specification
that meets national requirements
Review to take place during 2013/14
Ensure that patients at risk of developing
diabetes are identified and risk is reduced
Review current delivery of IGT testing and determine
most appropriate mechanism
This will be part of the LES review
Ensure that patients that have had a TIA
are identified and treated appropriately
Review TIA referral protocol and relaunch to practices
This has been relaunched to all Wirral
practices
Ensure access to neuropsychology and
acquired brain injury services to all
appropriate patients
Launch service to GPs
This service has been relaunched
Implement service specification for DSNs with specific
remit to support practice staff
Continue to review access to service to ensure
pathways working appropriately
54
Ensure that patients who have
experienced a stroke, and their carers,
receive appropriate support within the
community
Ensure value for money from intermediate
heart centre
Review Stroke support worker and social worker posts
to determine future commissioning responsibilities
These posts have been reviewed and
will remain in place throughout 2013/14
Introduce a cost-per-case tariff for diagnostic tests
carried out within the intermediate service
This has not been done in 2012/13, and
we will aim to do this in 2013/14.
Ensure compliance with Heart Failure
pathways
Heart Failure educational event for clinicians to
relaunch pathways and identify and address any
issues
This will form part of WGPCC clinical
training programme in 2013/14
Increase access to cardiac rehabilitation
Review current provision with view to redesign
This is being undertaken by the
Planned Medical QIPP team
Support systematic approach to the
identification, diagnosis and optimal
management of patients with AF to reduce
their risk of stroke
Roll out GRASP-AF toolkit across all WGPCC
practices and audit compliance and outcomes
There has not been much uptake from
WGPCC practices to date, but this will
be relaunched during 2013/14
55
Cancer and End of Life
Objective
Action to achieve Objective
Progress
Support the number of patients who indicate
they wish to die at home to fulfil this wish,
increasing number of patients dying at home
(should they wish) by 10%
Commission Hospice at home service for
WGPCC patients
Hospice at Home service has been
commissioned for all Wirral patients
Continue to educate practice staff to
support patients at end of life, through
training and LES
Implement Locality End of Life register
All WGPCC practices have undertaken the
End of Life LES
Increase access to diagnostics within the
community
Commission diagnostics through an any
qualified provider process
New diagnostics providers in place following
an AQP process
Increase early diagnosis of cancer rate
through improving access to screening
programmes
Support Public Health in delivery of their
cancer prevention strategy
WGPCC Macmillan GP has undertaking
practice visits to ensure practices are
increasing uptake of screening programmes
Continue to monitor CCO to ensure
delivery of extended breast screening
programme
Commission further cancer screening
equipment within the community
Improve management of patients with cancer
and at the end of life within primary care
Hold educational event for GPs and
Practice Nurses on management of
cancer in primary care
New breast screening unit at St Catherine’s
Hospital
Cancer educational event held in February
2013 for all WGPCC GP Practices
56
Community Services
Objective
Action to achieve Objective
Progress
Review Community Equipment service to
ensure greater value for money
Improve access to and quality of podiatry
services
Implement revised service specification
New service specification is written and in
place
AQP process has been undertaken; new
providers will start in July 2013
Improve access to and quality of
physiotherapy services
Community Nursing
Design a revised specification for community
podiatry, and undertake an AQP procurement
process
Undertake an AQP procurement process for
community physiotherapy
Develop new outcome based specification
and KPIs and develop long term condition
currencies
Ensure greater value for money and access
to services provided at Wirral Intermediate
Heart Centre
Intention to consider introducing a tariff to
replace the current block purchasing
arrangement
This has not yet been done, but will be
undertaken during 2013/14
Improve access to and value for money
from Wheelchair service
Design a revised specification for Wheelchair
services, and undertake an AQP
procurement process
The AQP procurement process is currently
underway
AQP process has been undertaken and new
providers started in 2012/13
New specification will commence 1st April 2013
3.10 Objectives and Outcomes for 2013-14
57
Building on the work that we have started during 2012-13, this operational plan is designed to provide our stakeholders with an
overview of what we would like to achieve through commissioning, during 2013-14, driven by Wirral GP Commissioning Consortium
staff, data, Member Practices, and patients.
These areas of work will continue to be led by our clinical lead GPs, and will be reviewed throughout the year, and evaluated to
determine whether they have achieved what we set out to do. Please read this in conjunction with the NHS Wirral CCG Strategic
Plan, for a complete picture of what you can expect for our patients over the coming twelve months. We have mapped our areas of
work across the CCG Strategic plan areas.
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NHS Wirral CCG
Strategic Plan
Priorities
WGPCC-specific
Priorities
Delivering high
quality planned
care (including
care of older
people)
-
Community Urology
-
Community ENT
Managing urgent
care
What will we do during 2013-14?
Why have we chosen these priorities?
See if there are any urological or ENT
procedures or tests that could be carried out in
the community instead of hospital and develop
a specification for a provider to do this for our
patients.
Data shows a lot of investigations / procedures are
carried out in hospital that could be carried out in the
community, which would reduce waiting times for
those that really need hospital care.
- over 65s review
Practices will continue to deliver healthchecks
to patients aged 65 and over. We will evaluate
the impact of this throughout the year.
- minor injury and
illness clinics
Continue to deliver these clinics across a range
of GP Practice sites. We’ll review usage to see
if opening hours remain appropriate, and see if
these sites could provide a wider range of
service than they do now.
- patient feedback for these services is excellent and
utilisation rises year on year
- admissions
prevention service
Develop the admissions prevention service so
that it focuses on supporting discharge from
hospital as well as preventing admissions.
- excellent patient and practice feedback;
demonstrable reduction in number of admissions
Support our GP Practices to review patients
within two weeks of hospital discharge, to
make sure people understand their discharge
- Wirral has the highest rate of readmissions in the
North West. Data from other areas suggests that
reviewing patients within two weeks of discharge
- review of patients
discharged from
hospital within two
Our Patient Council suggested that this could increase
our knowledge of patients with potential dementia and
who may need additional support at home.
59
weeks
plan and have sufficient support at home.
Engage more with our patients to find out if
there are any barriers to accessing our adult
mental health services.
can significantly reduce the likelihood of
readmission.
Adult Mental
Health and
learning disability
services
- reducing waiting lists
for primary care
mental health by
reducing the
number of DNAs
and cancelled
appointments
- whilst our DNA rate has reduced, we would like to
focus on this more, to see if there is anything we
can do to reduce waiting times further.
Children’s Mental
Health and
learning disability
services
All planned activities to improve children’s mental health are Wirral-wide.
Dementia
All planned dementia activities are Wirral-wide. The Patient Council could support us in promoting the Dementia Friends campaign
– www.dementiafriends.org.uk
Medicines
Management
-
Medicines Waste
campaign
Use Patient Council support to design and
deliver a campaign with the aim of reducing
the amount of wasted medicines.
-
WGPCC Medicines
Management plan
The Commissioning Support Unit has worked
with WGPCC GPs to produce a targeted plan
for WGPCC practices, to focus on areas that
could make a difference for our patients and
make the best use of our resources.
Our Patient Council highlighted the need to reduce
waste in use of medicines.
Our practices greatly value the focus that the
Medicines Management support provides, and a plan
will help us to monitor the impact that has been made.
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Improving access
to community
services
-
community dietetics
-
Public Health
Community
Programme
-
Management of
long term
conditions
Directory of Services
-
Community diabetes
service
-
diabetes education
Continue to commission additional sessions of
dietetic support for patients with diabetes, and
evaluate this through robust evaluation.
There has previously been insufficient resource to
enable all diabetic patients to have one-to-one dietetic
support. The Consortium had some additional
resources in 12/13 and has invested in additional
dietetics to help to educate diabetic patients in how to
manage their condition.
Review use of community programme to
identify any barriers for using these services
There are many community services available to
support smoking cessation, weight loss etc but we have
no data on how many of our patients access these –
want to understand if there’s enough in place, or if
people know what’s available.
-
Develop an online resource pack for practices
to act as a handbook for the services that are
available.
GPs and Nurses have asked for more information on
services that are available in the community,
particularly for new or locum staff, to reduce
unnecessary referrals to hospital, and ensure we make
the most out of the wide range of services available.
Commission a community diabetes service to
focus on patients with complex type 2
diabetes, patient education and insulin
initiation.
Data shows that too many patients with Type 2
diabetes are going to hospital, when they could be
easily managed by a nurse in the community
Review access to the existing diabetes
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- COPD and asthma
self-management
Improving cancer
and end of life
care
-
-
Women’s and
children’s services
preferred place of
death
cancer screening
rates
Community
Gynaecology
education programme and try to identify
barriers for people to attend, and what could
be done to improve this and support as many
people to have education as possible.
There are too few patients accessing education – we
need to understand why, and what we can do to
improve. Our Patient Council has asked for education
to be one of our main focuses during this year.
Work with the WGPCC COPD group to develop
a COPD plan for 2013-14, setting out how we
will support patients to manage their
condition, increase effective diagnosis and
prescribing, and reduce emergency activity for
this group of patients.
There is a very high rate of emergency admissions for
patients in WGPCC with COPD. We want to support
patients to manage their condition more confidently
when they have an exacerbation.
MacMillan Cancer and End of Life facilitator
supporting practices to increase number of
patients dying in preferred place of death.
Education sessions and reviews of cancer
diagnoses and deaths to explore what could
have been done differently.
Data indicates that too few patients are being
supported to die in their identified preferred place of
care.
Work with public health to find which areas
WGPCC should focus on to improve cancer
screening rates, and if the Patient Council
could be used to support engagement in this
area.
Screening rates for WGPCC practices are usually lower
than the Wirral average, and we want to increase our
rate of screening and diagnosis.
Community Gynaecology service starting April
Our GPs complained of very high waiting times for
2013. We will evaluate this during 2013-14 to
gynaecology services in hospital, which was supported
see if it could be expanded to include any other by data showing large amounts of simple investigations
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Improving primary
care services
within GP
Practices
-
-
DNA campaign
Practice training
conditions.
carried out in hospital. Lots more could be done in the
community and even in GP Practices, which will reduce
waiting times, and relieve pressure on hospital services
for more complex cases.
Continue the WGPCC DNA campaign,
evaluating its impact on DNA rates.
Our Patient Council highlighted the waste of NHS
resources through DNAs
Continue to deliver and evaluate the training
programme for practice nurses and non-clinical
staff. Set up a training forum, where all staff
groups are represented, to ensure that training
topics remain relevant.
Continue to offer training budget and clinical
bursary to GP Practice staff.
Practices explained it was difficult to organise training
for individual practices, so we have designed a training
programme for economy of scale and support practices
to do more in the community.
Please also see:
WGPCC Communication and Engagement Strategy for more details on our planned engagement work in
2013-14
WGPCC Medicines Management Plan
NHS Wirral CCG Strategic Plan
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Appendix One – WGPCC Member Practices
Senior Partner
Practice Name
Senior Partner
Practice Name
Dr B Quinn
Blackheath Surgery
Dr C Raymond
Parkfield Medical Centre
Dr J Melville
Cavendish Medical Centre
Dr E Hawthornthwaite
Parkfield Medical Centre
Dr D Patwala
Church Road Medical Practice
Dr Murugesh
Prenton Medical Centre
Dr C Brodbin
Commonfield Road Surgery
Dr N Alam
TG Medical Centre
Dr J Bates
Devaney Medical Centre
Dr M Salahuddin
Teehey Medical Centre
Dr A Mantgani
Earlston Road Surgery
Dr A Lee
Townfield Health Centre
Dr C Jayaprakasan
Hamilton Medical Centre
Dr P Larkin
Upton Group Practice
Dr P Srivastava
Holmlands Medical Centre
Dr N Cookson
Villa Medical Centre
Dr A Ali
Hoylake Road Surgery
Dr R Edwards
Vittoria Medical Centre
Dr D Kershaw
Kings Lane Surgery
Dr S Murty
Vittoria Medical Centre
Dr A Mantgani
Miriam Medical Centre
Dr C Pleasance
Whetstone Medical Centre
Dr R Alman
Moreton Cross Group Practice
Dr M Martin
Woodchurch Medical Centre
Dr J Wright
Moreton Health Centre
Dr A Pereira
Moreton Medical Centre
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Appendix Two
WGPCC Referrals to Wirral Hospital Trust per specialty, as at December 2012
65
Appendix Three
Unplanned Care Activity per WGPCC practice as at December 2012
66
67