Local Professional Networks
Towards an LPN Operating Framework
Draft
Denise McLellan January 2013
“Clinical networks are an NHS success story.
Combining the experience of clinicians, the input
of patients and the organisational vision of NHS
staff, they have supported and improved the way
we deliver care to patients in distinct areas,
delivering true integration across primary,
secondary and often tertiary care.”
Sir Bruce Keogh, NHS
Medical Director and
Jane Cummings, Chief
Nursing Officer
2
NHS | Presentation to [XXXX Company] | [Type Date]
Context
• Securing Excellence in Commissioning Primary
Care ( para 3.36 NHS CB June 12) committed to
the development of local professional networks
• LPNS will facilitate clinical input and leadership in
service improvement and commissioning at local
level
• Cover pharmacy, dentistry and eye health
• Aligns to broader emphasis on clinical networks
Clinical networks in the new system
• Strategic Clinical Networks hosted by the NHS CB where
major cross sector organisational change is needed in cancer, CVD,
maternity and children and mental health/ dementia and
neurological conditions
• Operational Delivery Networks, hosted by providers,
where the main focus is management of patients across
organisational boundaries ie burns, trauma, neonatal, adult critical
care
• Local Professional networks, hosted by the NHS CB for
pharmacy, eye health and dental, focussed in providing clinic advice
to commissioning and developing local momentum for change
• Local Networks- variable, but as agreed between
commissioners and providers to meet local needs and priorities
Networks- common themes
• Based around patient pathways
• System wide: providers, commissioners, third
sector
• Clinical relationships and leadership at the core
• Strong patient engagement
• Support improvement in outcomes
• Need facilitation, robust governance and clear
leadership
Guiding principles
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Underpinned by NHS constitution
Outcome Framework driven
Operate System wide
Clinically led
Evidence based approach to improvement_
Use of NHS change model
• Robust governance
Network Benefits- the system
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Provide credible clinical advice to commissioners and providers
Support focussed and prioritised improvement activities
Support clinical handover between providers
Improve consistency of care across system and regardless of entry
point
Support learning, dissemination and spread of improvement
Route for patient engagement
Improve system working/ reduce fragmentation
Improve system resilience
Facilitate measurement and benchmarking
Entry point for other bodies- ie HWBs, PHE, LETb, HEE etc
How Networks support commissioners
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Needs assessment
Service Review
Prioritisation
Setting standards, and service models
Planning capacity and predicting demand
Monitoring and evaluation
NOT: Performance management or contract
sanctions or termination
How Networks support providers
• Specific programmes to improve outcomes,
particularly where there is system dependency
• Mechanism to share resources and risk
• Data sharing, benchmarking, standard setting
• Different perspectives and view will improve
local services
• Commissioners may require
• Career and professional development
Purpose of LPNs ( para 3.37)
• Support implementation of national strategy
and policy at local level
• Work with key stakeholders on local priorities,
some of which go beyond the scope of
primary care commissioning
• Provide local clinical leadership, with
professional line of accountability to NHS CB
Chief Professional Officers, through Area
Teams
Characteristics of LPNs ( para 3.39)
• Small clinically- led commissioning team at the
core
• Opportunities for more clinicians to be
involved in service improvement
• Engagement with the wider community of
practitioners, practice owners and others
involved in providing services
LPN functions- all professions (3.41)
• Support NHS CB in commissioning primary care with robust
clinical input
• Drive improvement in outcomes, in line with local and
national priorities
• Provide clinical leadership and facilitate wider engagement
• Mechanism for patient engagement
• Support other commissioners, ie CCGs, PH, LETB
• Advise and work with local Health and Wellbeing Boards
• Feed into other clinical networks
• Engage with local representative committees ( of
contractors)
• Additional Profession specific responsibilities
Functions: Dental- specific LPNs
• Cover the whole dental pathway, including
secondary care and out of hours
• Key role in agreeing quality measures for
dental secondary care, including CQUIN
payments
• Will need to work closely with local
authorities and Public Health England to
deliver and develop cohesive Oral Health
Strategies and associated commissioning plans
Functions: Pharmacy- specific LPNs
• Support local authorities who lead on the development
of the Pharmaceutical Needs Assessment which the
NHS CB will use in commissioning pharmaceutical
services
• A particular role is to support programmes of work
around self care and long term conditions
management in community pharmacy to achieve
Outcome 2
• Work with CCGs and others with regards to medicines
optimisation
• ‘Hold the ring’ on enhanced services ( PH/ CCG
commissioned)
Functions: Eye health specific
• Local needs assessment
• NHS sight tests and domiciliary services are
predominantly demand-led, hence more
emphasis on quality assurance
• Focus on improving services in line with 5
national eye health pathways: ocular
hypertension monitoring service; glaucoma;
referral refinement; low vision service for adults;
People with a Learning Disability (adults)
• Future work to reduce avoidable visual
impairment
Link to ‘national’ NHS CB
arrangements
• Single national Performers’ list with standard polices and
procedures across all primary care contractors, managed at
area team level
• National contracts and supporting policies
• National commissioning priorities annually
• National policy committee for each contractor group
• National Assembly of LPNs with links to CCG assembly
• Access to new Improvement Body and leadership academy
for tools and support
• Plus PHE and HEE to determine national public health and
educational priorities
• National professional leads ie Keith Ridge, Barry Cockcroft
LPN Geography
• Assumption is that LPN geography will be aligned
to that of the area team to facilitate
commissioning advice
• Local option for Area Team to vary LPN geography
based on clinical relationships, clinical flows and
issues prioritised
• LPNs may wish to work together for given issues
• All LPNs should be aligned to a named senate and
it should be exceptional that senate and LPN
boundaries do not align
Membership
• Clinical Chair ( sessional appointment made by Area
Team medical director with multi-professional input)
• Patient representative (s)
• Local clinicians as agreed to form clinical majority
• Other specialists such as public health as agreed
• Senior Commissioning Manager from Area Team who is
also responsible for ensuring adequate administrative
input
• Membership is not representative; Appointed for the
quality of leadership, credibility and knowledge
Governance
• National standard terms of reference and accountability
agreement with some opportunity for local modification
• Clear policy on managing conflict of interest, based on
national CCG models
• Annual accountability agreement and workplan need to be
agreed with LPN members and Area Team
• Chair is accountable to Area Team Medical Director ( as the
local clinical leader) , with national ( profession specific)
professional input if required
• Access to Chair of local clinical senate to request issues
raised or a response ie system wide impact of change
Annual Workplan
• Implications of national clinical commissioning priorities
and policies
• Local priorities for improvement based on local outcomes
• Review of effectiveness of network itself and priorities for
improvement
• Year one: Each LPN to have a clinical leadership
development strategy
• Description of core resources and links to other parts of the
system
• Description of PPE support arrangements
• National template will be made available
• Complete by February for the following year
Hosting and support, including finance
• Hosted by primary commissioning team of Area Team
of NHS CB
• Access to all NHS CB matrix support arrangements ie
intelligence, financial expertise etc
• £120k pa identified within core Area team funding to
resource local clinical and administrative resource for
network, though may be supplemented from other
sources
• Area Team to determine best local fit arrangements;
local structures will not all be the same
Illustrative use of AT funds
1 day per week manager @8b
1 day per week admin @ 3
Non pay
LPN Chair 1day/week@8d
LPN Chair 1 day/week @£400/day
LPN Chair 0.5day/week @8d
95-158 clinical days across 3 LPNs
@£300-£500 per day
Total pa
£12000
£ 4300
£10000
£17000
£20800
£ 8500
£47400
£120000
Alignment with the new system
• Will need to work with CCGs, PHE, LAs, health watch,
Health and Wellbeing boards, Health Education
England and regulators ( Monitor and CQC)
• Will need links to local clinical networks and senates
and academic health science networks
• Will need to work with improvement body and
leadership academy and Local education and training
boards
• Will need to work with local PPE arrangements
• Workplans will need to describe how these
relationships operate locally
HR issues
• Assumed that core managerial and admin
team will be employed within the NHS CB
primary care commissioning team
• Assumed that clinical staff will be employed
on a sessional basis, not by NHS CB
• Careful attention will need to be paid to
previous PCT clinical advisors to make best use
of knowledge and expertise
• All appointments overseen by NHS CB HR
Communications and engagement
• National distribution of slide set for comment
and local area presentations- January 13
• Slides will be developed into national
operating framework for NHS CB exec team
approval and then NHS CB website Feb 13
• National development conference for LPNs
with improvement body and leadership body
input Feb 13
Review of LPN testing
• General positive feedback about the benefits
of working in networks
• Concern over resources, though recognised
that much can be done with relatively small
amount of resource
• Need for national direction and clear system
of prioritisation recognised to ensure
effectiveness and reduce variability
Next steps for Area Teams
• Meet members of any local networks that exist
and review testing-asap
• Agree local arrangements for LPNs - Jan 13
• Appoint chairs and core team-Jan 13
• Appoint other members- Feb 13
• Agree outline work plan- Feb 13
• Agree local relationships- March 13
• LPNs operational- April 13
• Ongoing development and refinement 13/14
Next steps- National work
• Draft accountability agreement, terms of ref, workplan
template, Patient engagement model and conflict of
interest policy- end of Jan 13
• LPN Operating Framework final draft – Jan 13
• Agreement of Operating Framework NHS CB exec teamFeb 13
• Agreement of input from national bodies such as
improvement body, leadership academy, national
information centre, etc March 13
• Set up LPN Assembly March 13
• Agree scope of and set up clinical policy groups Feb 13
• Communication and engagement plan- Jan 13
FAQs
• Q:Much less resource than expected? A:Testing has shown
that much can be achieved on a relatively small amount
with the right leadership and prioritisation
• Q:Does this cover investigation of poorly performing
practitioners? A:No, separately funded
• Q:Does this cover specialist pharmaceutical advice to area
teams- inc C/Drugs? A:No, separate proposal
• Q: The time scale looks tight? A: Agreed, but it is possible
and the alternative, for commissioning not to be clinically
informed is not attractive
• Q: Professional advice for contract conflict resolution?: may
need to be more independent and separately resourced
Further questions?
• Local Area Team Director of commissioning ,
Medical Directors or head of primary care
commissioning
• David Geddes- David.Geddes@nyypct.nhs.uk
NHS CB Head of primary care commissioning
• Denise McLellan- DeniseMcLellan@nhs.net
Transitional lead for networks and senates,
NHS CB Operations Directorate