Download Primary Care Budget - NHS Canterbury and Coastal CCG

NHS Ashford CCG
and
NHS Canterbury & Coastal CCG
Primary Care Commissioning
Draft Annual Plan
2016/17
1. Introduction
1.1.
On 1 April 2016, NHS Ashford and NHS Canterbury and Coastal CCGs took on
responsibility for the delegated commissioning of Primary Medical Services. This paper sets
out our plans for the way in which we will use the freedoms and responsibilities available to
us to develop and improve primary care for residents of Ashford and Canterbury and
Coastal. Within the context of the national NHS Five Year Forward View, the national
General Practice Forward view and the local CCG Primary Care Strategy.
2. Strategic Vision for Primary Care
2.1. The NHS Five Year Forward View
2.1.1.
This restates the vision that the foundation of NHS care will remain list-based primary
care and sets the dynamic direction for the big changes needed in GP services:

It envisions breaking down the barriers in how care is provided between GPs and
hospitals, between physical and mental health and between health and social care.

It encourages the creation of new models of provision with groups of GPs combining with
nurses, other community health services, hospital specialists and perhaps mental health
and social care to create integrated out-of-hospital care – the Multispecialty Community
Provider.

It looks for urgent and emergency care services to be re-designed to integrate services
between A&E, GP out-of-hours, urgent care centres, NHS 111, and ambulance services.

It highlights growing demand, the need for further investment in primary care, new
options for the workforce and the importance of innovation to meet both growing demand
and financial efficiency imperatives.
2.1.2.
This is the direction that the CCG’s, together with other CCGs in East Kent, have chosen
to drive forward through their local strategic change programme. We will use the tools
provided through delegated commissioning to deliver these changes at pace.
2.1.3.
Our Primary Care Commissioning Plan also recognises the importance of the close
working relationship between the CCG’s and the local office of NHS England, the Kent,
Surrey and Sussex Area Team, to deliver the co-commissioning agenda and their annual
Business Plans (national and local).
2.1.4.
Our plan also acknowledges that much of the day-to-day work of commissioning Primary
Medical Services is determined by national, statutory requirements. We know that
national directions require interpretation in the light of local circumstances and priorities
NHS Ashford Clinical Commissioning Group and
NHS Canterbury and Coastal Clinical Commissioning Group
and this will be important in achieving many of the benefits of moving commissioning to
the CCG’s.
2.1.5.
Our approach to this will be shaped by our local Primary Care Strategy.
2.2. The Ashford and Canterbury & Coastal vision
2.2.1.
General practice has a central role within our vision for the next five years, providing care
alongside other NHS staff working in the community, voluntary sector organisations and
colleagues in social care.
2.2.2.
General practice delivers significantly more services than ten years ago and this trend
will continue with a proportion of this additional work transferred from traditional
community or hospital bases. General practice and wider primary care services in
England have a number of internationally recognised strengths:

Registered lists are a key tool in the co-ordination and continuity of care; the vast majority
of the population is registered with a general practice in the UK

There is a strong generalist tradition in the NHS; general practice is well placed to utilise
its knowledge of patients and their families in a local community gained from repeated
consultations over time to holistically improve physical, emotional and social wellbeing

General practice, plays a central role in the management of people with chronic disease
and identifies those at risk of worsening chronic ill health

General practice displays a highly systematic use of information technology to support
the management of long term conditions, track changes in health status and support
population health interventions such as screening and immunisation

There are numerous examples of innovation in general practice leading to improvements
in quality of care and wider service transformation
2.2.3.
If we stand still, we will fail to progress and meet the evolving needs and expectations of
our population. Improving the quality of primary care services for our diverse population
is a priority for both CCGs, working in partnership with and in collaboration with patients,
our GP membership, our Health and Wellbeing Boards, local authorities, and other wider
stakeholders.
2.2.4.
For our Primary Care Strategy to realise its full potential, a number of changes in the way
in which general practice operates will need to occur. This may require moving away
from the current model of small, independently minded practices towards new forms of
organisation that enable practices to work together and with other providers to put in
place the networks of care that are required. Our approach to this issue is one of
proactive change, embracing the “New Models of Care” as set out in the Five Year
Forward View.
NHS Ashford Clinical Commissioning Group and
NHS Canterbury and Coastal Clinical Commissioning Group
2.2.5.
NHS Vanguard – Encompass
2.2.6.
Encompass – previously known as the Whitstable, Faversham and Canterbury
Community NHS Vanguard - seeks to deliver an integrated health and social care model
of care through the transformation of local services to deliver proactive care and support
focused on promoting health and wellness, rather than care and support that is solely
reactive to ill health.
2.2.7.
The MCP integrated model of care will deliver holistic health and social care services
through Community Hub Operating Centres (CHOCs) located in Whitstable, Canterbury,
Faversham and Sandwich. Each CHOC will support clusters of GP practices. Although
there will be room for local variation in each CHOC, to enable services to be tailored to
meet specific population needs. We are working to confirm the CHOC sites, with a view
to collocating them with existing community health facilities.
2.2.8.
Each hub will incorporate:
 General Practice
 Integrated nursing and social care (including domiciliary care)
 Functional therapy services
 Access to voluntary and community service via social prescribing
 Health promotion and prevention services
 Integrated mental health services
2.2.9.
Fast Follower – Ashford Community Providers
2.2.10. We also have the development in Ashford as a ‘fast follower’ with clinical lead from
Ashford Clinical Providers (ACP) now a member of Vanguard (Encompass) MCP
Steering Group.
2.2.11. Ashford Clinical Providers recognise that commissioning needs robust locality wide cost
effective alternatives to allow shift from hospital to community built on the strengths of
local Primary care. Shared early outcomes from key Vanguard projects have enabled
ACP to refresh their plans and adopt a similar integrated hub model approach across
three localities (Ashford South, North and Rural).
2.2.12. Herne Bay Integrated Care Centre
2.2.13. The vision for the Herne Bay Integrated Care Centre is to commission “A resource for the
community where primary and community care will work together to relieve pressure on
the local health economy by providing a wide range of services closer to patient’s
homes”, with the intention to base the centre at the Queen Victoria Memorial Hospital
(QVMH)
2.2.14. The ICC will act as a hub where patients will be able to access a range of urgent and
outreach services including access to diagnostics. This will include minor injury and
illness, urology, DVT,wound and day case clinics.
NHS Ashford Clinical Commissioning Group and
NHS Canterbury and Coastal Clinical Commissioning Group
2.2.15. Primary Care Workforce Strategy
2.2.16. This strategy articulates our challenges and how we aim to confront them. This means
not only delivering more healthcare in many areas, but transforming how we deliver
healthcare, using innovation where it demonstrates potential.
2.3. Strategy
2.3.1.
The underlying, principle of our five year vision is that care will be delivered as close to
where patients live as possible. The consequence of this is that patients will be able to
access a variety of services in a variety of locations within their local area –including their
own home, their pharmacy, the optometrist, their GP surgery, community hospitals as
well as acute hospitals.
2.3.2.
Our vision of community based networks will ensure the provision of healthcare services
to enable patients, with a long term health issue or post an acute intervention, to live an
independent life in the community or their homes. An essential element of this is closer
integration of services provided out of hospital, available 24/7, and co-ordinated with
specialist expertise in hospitals, among mental health providers and in related forms of
care. Increasing attention needs to be given to care that is preventive and proactive with
the aim of supporting people to remain independent for as long as possible and avoid the
inappropriate use of hospitals and care homes.
2.3.3.
In most cases, the community model would be led by GPs and would have freedom to
deliver the outcomes required to meet the needs of their specific population. This would
include the freedom to provide services directly or alternatively to arrange for them to be
provided by others.
2.3.4.
Whilst our priorities and plans are constructed locally, informed by wide stakeholder
consultation, they are underpinned by key national standards and objectives articulated
in published and emerging planning guidance and strategies such as:-

Everyone Counts: Planning for patients 2014/15 to 2018/19

The NHS belongs to the people – A Call to Action

NHS Five Year Forward View
2.3.5.
Within our plans for Ashford and Canterbury and Coastal are a number of supporting
sub-strategies.
2.3.6.
CCG’s Primary Care Strategy “under development”
2.3.6.1.
Our Primary Care Strategy was drawn up in early 2015 and was sufficient to
support our early thoughts on the future. It now requires major revision to reflect
the General Practice Forward View. This will be undertaken during the first half
NHS Ashford Clinical Commissioning Group and
NHS Canterbury and Coastal Clinical Commissioning Group
of 2016/17 and will sit as a sub-strategy within the overall CCGs
programme.
Over the next year we will work to improve the quality and consistency of
primary care, shift appropriate services out of hospital to community settings
and creating a wider range of services in the community. We will maintain a
focus on continuity of care for vulnerable patients/populations and asking
patients to take more responsibility for their own health. These priorities will
help to stabilise and improve local primary care and firm the foundations for
the more significant change to come.
2.3.6.2.
We intend to work with primary care providers, using the additional tools
available through co-commissioning, to develop the scope and range of
primary care services, provided “at scale”, to enable our vision of integrated
out-of-hospital care to become a reality. We do not see single-handed
practices/GPs working alone as part of this longer-term future and will work
to manage this change without significant disruption to continuity of care.
2.3.6.3.
2.3.7.
Primary Care Workforce Strategy
2.3.7.1. The Primary Care Workforce Strategy is part of the Primary Care
Strategy and is being developed in two parts. In the first iteration it will focus
on the short-term actions required to stabilise and support practices under
pressure from increasing demand and medical staffing shortages, including;

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
Support practices to assess models of primary care that make best use of existing
workforce in order to meet the needs of service provision
Support and extend the multi-disciplinary teams approach to delivering primary
care services
Supporting innovative solutions to local workforce recruitment and retention
Offer joint training and shared learning opportunities for the entire Primary Care
workforce
Second secondary care clinicians to primary care where appropriate (e.g.
geriatricians, nursing teams)
Ensure that the CCGs have greater influence over local GP training
2.3.7.2. As the models for integrated services emerge as part of the strategy
programme the second phase of the Primary Care Workforce Strategy will:

Identify the investment needed in primary care workforce to support new models
of care and shifts in care across settings;
NHS Ashford Clinical Commissioning Group and
NHS Canterbury and Coastal Clinical Commissioning Group


Explore new roles that sit across health and social care, hospital and out of
hospital care and in and out of hours; and
Look at the link between remuneration (1) for primary care and the new workforce
requirements to drive and enable change
2.3.7.3. These key initiatives will form the basis for our future decisions on
commissioning general practice services.:
2.3.8.
Primary Care Estates and IT Strategy
2.3.9.
The significant changes envisaged as part of the strategy will require changes to
the primary care estate to support the delivery of new models of care closer to
home.
2.3.10. Estimated current payments to practices are based on payments for capitation,
Quality and Outcomes Framework, Directed Enhanced Services and seniority.
These equates to £16m per annum for Ashford and £25m per annum for
Canterbury and Coastal CCG. Over time, we will explore different funding models
with longer term commitments to give greater certainty of payment enabling new
workforce models to be used.
2.3.11. We will also need significant changes in the IT infrastructure to support the closer
integration of hospital, community, primary and social care. Some changes are
already in motion; with the roll-out of the Medical Interoperability Gateway (MIG)
which support the ability to access patient records across primary care and health
and social care providers to support management of patient treatment plans.
2.3.12. Through the Digital Road Map (DRM) we will work with all partners to harness the
power of IT to make higher standards in care delivery a reality.
2.3.13. This will support the ability to:

Improve the ease of making appointments, ordering repeat prescriptions and
communicating securely with general practice, including through greater use of
online services.

Increase the use and volume of telephone consultations

Support e-booking to ensure that our patients are able to book their hospital
appointments easily
NHS Ashford Clinical Commissioning Group and
NHS Canterbury and Coastal Clinical Commissioning Group

Use technology to access advice from health professionals

Increase use of technology to support monitoring of patients with long term
conditions

Further develop the use of shared care plans
2.4. Primary Care Contracting Framework
2.4.1.
We recognise that to transform the way in which primary care is delivered we also
need to change the way in which our payments and contracting arrangements
work for primary care services. Over the next two years we will develop our
contracting framework so that they support the changes we are driving forward.
2.4.2.
As the Five Year Forward View models are developed we would expect to move
away from a complex mixture of capitation and itemised payments and towards a
fully specified service with a simplified, longer term payment system for services,
rewarding delivery of standards and outcomes for populations.
3. Our Local Context – Ashford CCG and Canterbury and Coastal CCG
3.1. The local track record of Primary Care provision is largely positive. There is room for
improvement but levels of satisfaction of patients surveyed last year compared
favourably with the national picture, with the CCG’s practices generally scoring
above the national average on most indicators. Within this broad picture there is still
unexplained variation; both between practices overall and against individual
indicators. We have analysed these results to identify where performance is more
than 10% above or below the national average to focus attention on practices with
greater scope for enhancement and those who can help share best practice to lift
performance across their locality and the CCG.
3.2. The population we serve is diverse:
Ashford: registered population as at 31/12/2014 was 126,400
The average life expectancy is 82.5 years, making it the highest of all Kent CCGs.
This varies by ward from 79.1 years in Aylesford Green to 87.7 in Weald North.
Canterbury: registered population as at 31/12/2014 was 215,285
The average life expectancy is 81.9 years, varying from 85.6 years in Blean Forest
to 78.1 in Heron. There is a significant transient student population leading to a
much larger percentage of 15-24 year olds compared to the England average.
NHS Ashford Clinical Commissioning Group and
NHS Canterbury and Coastal Clinical Commissioning Group
3.3. Within both CCGs, the trends for population aged over 65 and over 85 show a
gradual increase over the next 24 years. Both CCG areas have some deprivation,
and both urban and rural communities. There is a history of financial challenge and
the need for significant Quality, Innovation, Prevention and Productivity (QIPP)
programmes and the most recent financial allocations have brought limited growth
monies, the current year sees investment in both out-of-hospital services from the
Better Care Fund but also a challenging savings target of £9.5m for Ashford and
£11.5m For Canterbury and Coastal CCGs. Value for money and efficiency will be
key to our approach to commissioning primary care, as it is with all commissioned
services.
3.4. However, the strategic approach set out above must involve investment in primary
and community services, so we anticipate a greater proportion of our total spend
being focused on out-of-hospital services over the coming five-year period. This
investment will be increasingly strategic in nature (e.g. in community hubs of
practices) and not necessarily in keeping with the existing pattern of general
practices.
3.5. The nationally set Business Rules for finance apply to primary care, whereby a 1%
surplus must be generated. The practical implications of this will be worked through,
as we understand better the opportunities and risks associated with our delegated
powers.
3.6. Like elsewhere, our General Practices are under increasing pressure, as workload
increases and practice incomes and profits have fallen back to below pre-2004
levels. There are some difficulties in recruitment and retention of GPs and practice
nurses, and some premises are below standard. Practices deploy different
appointment systems, which meet with different levels of patient satisfaction, and
have different Information Management Technology systems, with varying degrees
of interoperability.
3.7. Our strategic approach to these challenges is set out above but this needs to be
firmly grounded in the increasingly difficult day-to-day reality that many practices
face.
4. Ashford and Canterbury and Coastal CCG’s Plans for 2016/17
4.1. This is the first year of assuming responsibility for delegated commissioning of
primary Medical Services and in addition to the core plans set out in the NHS
England Business
NHS Ashford Clinical Commissioning Group and
NHS Canterbury and Coastal Clinical Commissioning Group
4.2. Plan, the CCG will use this year to build the foundations for major change to support
our wider strategic change programme and deliver benefits for patients and
practices through the use of co-commissioning freedoms:

Reducing/simplifying administration;

Investing strategically and more flexibly in primary care;

Laying foundations for delivering new models of care with greater emphasis on
multi-disciplinary working; and
Improving the quality and consistency of primary care.

Delivering benefits for Ashford and Canterbury and Coastal CCGs Patients
through the use of Co-commissioning Freedoms
4.3. During the first year of the CCG’s plan is to ensure a safe transfer of commissioning
to the CCG and to put in place the short-term improvements that will both benefit
patients and reduce bureaucracy, freeing up practice time to focus on patient care
and strategic change:
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Ensure a safe and efficient handover and transfer of skills from NHS England to
the CCG delegated commissioning function;
Simplify and Reduce Practice Administration;
Directed Enhanced Services (DES)/Locally Enhanced Services (LES)
reporting/payments;
Clearer, focused Performance Management from CCG; and
More effective, less fragmented commissioner/provider relationship with
practices.
4.4. We will also undertake the foundation work to drive forward the longer-term strategic
changes underpinning the wider CCG strategy.
Using Co-commissioning to help deliver new models of out-of-hospital care
(Reshaping Primary Care Services and aligning to the CCG’s objectives)
4.5. During 2016/17 we will focus on joining up incentives and payments to practices
made under the national contract (DES and Quality and Outcomes Framework
[QOF]) and locally commissioned schemes to simplify arrangements for practices,
create greater coherence and drive forward change. We will ensure that the patients
of all practices have access to all services through “buddying” arrangements. We
will:

Prioritise DES/LES/QOF areas to reshape primary care services and align to the
CCGs objectives;
NHS Ashford Clinical Commissioning Group and
NHS Canterbury and Coastal Clinical Commissioning Group



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Plan investment in Primary Care Workforce increases to deliver new models of
care;
Develop our premises strategy and development plan aligned with new service
models (Premises and IT Strategy);
Link Inequalities monies to new models of care; and
Explore the possibility of commissioning new model GMS services and whether
these can be provided by Federations (rather than individual practices).
Improve the quality and consistency of Primary Care
4.6.
Whilst primary care services within both CCG areas compare favourably to the national
average there are significant variations in performance between practices. We aim to work
with practices to understand and share best practice and to provide focused support to
practices whose performance is significantly below the average. This will include:

Developing integrated processes to improve quality. (Our Primary Care
Commissioning Operational Group together with our Nursing and Quality team
will lead this work.);

Engaging Practices in Training and Education. (We have been working with
Health Education Kent, Surrey and Sussex and local workforce tutors to increase
the number of practices involved in GP and nurse training as a means of raising
standards, improving the quality of care and supporting recruitment.);

Safeguarding. (Safeguarding is firmly embedded within the wider duties of all
organisations across the health system but most notably providers’
responsibilities are to provide safe and high quality care and support, and
commissioners’ responsibilities are to assure themselves of the safety and
effectiveness of the services they have commissioned. The wider context
continues to change in response to the findings of large scale inquiries, such as
Francis inquiry and Lampard inquiry and new legislation, such as the Care Act
2014. Under delegated arrangements, CCGs will be responsible for ensuring that
the GP services commissioned have effective safeguarding arrangements and
are compliant with the Mental Capacity Act.)
Looking Ahead to 2017-18 and 2018-19
4.7.
Whilst the emphasis in 2016/17 will be on establishing a new team with new skills and on
baseline setting, the emphasis for the following two years will be on delivery. This year will
see us develop local policies as an expression of national policies (e.g. for performance
management) and local strategies as an expression of national regulations (e.g. premises).
NHS Ashford Clinical Commissioning Group and
NHS Canterbury and Coastal Clinical Commissioning Group
4.8.
The next two years will see us make those a reality in our prioritisation and decision making.
As stated above we will work with practices to ensure robust applications are made to
NHSE to access transformational resources to, such as the Estates and Transformation
Fund (formally Primary Care Transformation Fund) to create longer term sustainable
solutions to enable us to achieve multi-agency, multi-disciplinary working, in and out of
hours, providing proactive and urgent care – in line with our strategy.
4.9.
A key developing strand of this is workforce. As we blur the boundaries between health and
social care and in and out of hospital care, professionals and others with new skills will be
needed. The current year will involve setting baselines and improving recruitment to existing
roles in primary care. The next two financial years will see us develop new roles and the
devolution of tasks to other staff members, moving towards GPs being “consultants in
primary care”.
4.10. The guidance on co-commissioning referred to the possibility of the further devolution of
responsibility for additional primary care services, such as community pharmacy and
optometry to CCGs. We hope and trust that we will be given responsibility for these and
would focus our early efforts on:

Refocusing Medicines Use Reviews on agreed cohorts of patients within the
context of our Medicines Optimisation Strategy (copy available on request);

Using the New Medicines Service to support early effective discharge

Refreshing our existing portfolio of Locally Commissioned Services for community
optometry and exploring new areas of shift/re-provision along agreed care
pathways.
5. Aims and Objectives for 2015/16 – NHS England Kent, Surrey and
Sussex Area Team
5.1.

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
In taking responsibility for delegated commissioning we recognise the need to work closely
with the Kent, Surrey and Sussex Area Team to deliver their aims and objectives, which
closely align with those of the CCG to deliver:
A common, core offer for patients of high quality patient-centred primary care
services;
Continuous improvements in health outcomes and a reduction in inequalities
Patient engagement and empowerment, with clinical leadership and engagement
visibly driving the primary care commissioning agenda;
The right balance between standardisation/consistency and local empowerment/
flexibility;
To ensure that all primary care NHS service provision demonstrates value for
money in line with QIPP plan principles; and
NHS Ashford Clinical Commissioning Group and
NHS Canterbury and Coastal Clinical Commissioning Group

5.2.
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5.3.
That high quality, evidence- based cost effective services are delivered
In addition to the CCG’s priorities set out in our strategies above, the CCGs will also work to
deliver the NHS England national Commissioning Intentions for 2016/17, which will be
pursued through co-commissioning:
Adopt and align with local frameworks the national contract performance
assessment frameworks;
Ensure safeguarding systems are embedded in primary care and test for
evidence that they are operating;
Working with practices in the active pursuit of parity of esteem for mental and
physical health; and
Plan for continued improvement in patient satisfaction of primary care services.
These are core requirements that we will deliver through the management of the contracts
in place for Ashford and Canterbury and Coastal CCG practices on 1 April 2016.
NHS Ashford Clinical Commissioning Group and
NHS Canterbury and Coastal Clinical Commissioning Group
6. Primary Care Quality, Innovation, Prevention and Productivity (QIPP)
Programmes
6.1.
For 2016/17 the CCG has identified a number of QIPP initiatives in primary care that will
enable and support the delivery of savings primarily across the Proactive Care and Elective
Care programmes. These are summarised in the table below:
Scheme Name
Scheme Description
Agree criteria for
housebound patients
The current criteria will be reviewed to ensure that it is explicit
particularly in relation to reducing home visits to non-housebound
patients.
Review phlebotomy service
required and develop
venepuncture service using
technician
Data analysis will be undertaken to define service needs. Variance
will be identified across practices in relation to which tests are
requested. Implementing a technician service will reduce the need
for trained staff to undertake bloods
Implement shared wound
care clinic within networks
This will support the MDT approach
Community Nursing
Productivity and Efficiency
This is in line with the development of MCPs
Musculoskeletal (MSK)
This scheme has a number of components:
1. Continuation and development of triage to reduce referrals
into secondary care.
2. Full implementation of back pain pathway including
reduction of spinal injections undertaken in secondary care
3. Review of AQP Physiotherapy
4. Addressing variation of referrals for MRI
Development of advice and guidance pilots to assess their impact
on reducing referrals to secondary care. If successful these will be
rolled out across all practices
There are currently 3 schemes for primary care to contribute to the
reduction of unscheduled care admissions:
1. Age UK Living Well Programme – the project looks at reducing
reliance upon health and social care through promotion of
wellbeing. This is achieved by taking a cohort of patients over
65 years, with 2 or more long term conditions, who have had 1
unplanned hospital admission in the last 12 months and a high
likelihood of another; and providing a period of intensive
support to them through Living Well Coordinators to help them
achieve identified health and wellbeing goals.
2. Over 75s Practice Incentive Scheme - providing and facilitating
pro-active support for patients with a high frailty score following
a PRISMA assessment who are more at risk of an emergency
admission
3. East Kent Integrated Urgent Care Service (IUCS) – One of the
planned impact of integrating the 111 service and the Primary
Care OOH service is a reduction in the unscheduled care
admissions
Dermatology
Reduction in Unscheduled
Care Admissions
NHS Ashford Clinical Commissioning Group and
NHS Canterbury and Coastal Clinical Commissioning Group
Scheme Name
Scheme Description
Elective Demand
Management
Within elective demand management across all specialties there
are two main components within the QIPP programme:
1. Use of desktop Referral Support Tools to support the
implementation of referral and treatment criteria (RaTC)
2. Use of GP Elective Referral Variation data
At specialty level consideration will be given to developing further
community services if it is demonstrated they will make a positive
impact on reducing secondary referrals.
The following specific projects are in development:
1. Intermediate Ophthalmology service including advice and
guidance – Canterbury CCG (Development of service
currently provided by Northgate Medical Practice)
2. Consultant Led Community Urology Service – Ashford CCG
(Development of service currently provided by Charing
Medical Practice)
3. Increasing capacity of ENT GPSI – Canterbury CCG
7. Monitoring the performance of Primary Care Services
7.1.
In addition to our locally developed Quality Assessment Tool (QAT), we will also work with
NHS England to monitor and report on the key indicators against the targets that form part
of their performance framework.
Metrics
7.2.
Key indicator targets for primary care improvement - to be developed
8. Primary Care Budget
8.1.
In The delegated primary care budget for Ashford CCG and Canterbury and Coastal CCGs
has yet to be confirmed by NHS England Area Team but is expected to be in the order of
£16m for Ashford and £26m for Canterbury and Coastal.
NHS Ashford Clinical Commissioning Group and
NHS Canterbury and Coastal Clinical Commissioning Group
9. Summary
Ashford and Canterbury and Coastal CCGs Primary Care Co-Commissioning
Team Priority Work Streams 2016/17
Objective
Actions
By when
Safe and efficient
handover/transfer
of skills from NHS
England to CCGs
Simplify practice
administration
Build the team – capacity, knowledge
Review performance and progress at months 3 and 6 –
survey practices
30 June 2016
30 Sept 2016
DES/LES reporting/payments
 Identify priority areas for reducing practice effort
in claims/assurance
 Set clearer expectations/standards and
performance monitoring
30 July 2016
Clearer, focused Performance Management from CCG
31 Oct 2016
31 Oct 2016

Perform practice quality visits, combining
performance in Primary Care, contract delivery,
prescribing, performance in enhanced services
and commissioning role.
 Improve coherence between different CCG
initiatives in relation to Primary Care, focusing on
improving service to patient and use of practice
time in line with the GP forward view
Improve links with practices
 Agree and implement plan to streamline contact
and communication points re. GP contracts and
all enquiries
 Understand practice view of CCG cocommissioning performance via 3 and 6 month
survey
Use delegated
commissioning to
help deliver new
models of out-ofhospital care
(reshaping primary
care services and
aligning to Ashford
and Canterbury &
Coastal CCGs)
Improve quality and
consistency in
Priority DES/LES/QOF areas to reshape primary care
services and align to Ashford and Canterbury CCG
objectives
Project planning for priority areas:
 Avoiding Unplanned Admission DES, Over 75’s
Proactive and Reactive Care Planning and Care
home
 Enhanced Services, QIPP projects;
 Move towards outcome based payments for these
schemes.
Develop the Primary Care Workforce to deliver new
models of care in line with Primary Care Workforce
Strategy and Ashford and Canterbury New Models of
Care
Develop premises strategy and development plans
aligned with new service models (Premises and IT
Strategy).
Develop Improving Quality Plan
 Build on the Quality Assurance tools available to
NHS Ashford Clinical Commissioning Group and
NHS Canterbury and Coastal Clinical Commissioning Group
1 April 2016
30 Oct 2016
30 Sept 2016
31 Mar 2017
TBC
30 Nov 2016
Objective
Actions
Primary Care
identify small number of important quality markers
and practices who are outliers and develop a
primary care quality dashboard
 Understand actions and investments needed to
improve the performance of outliers, share
learning and improve clinical practice
 Incentivise improvement in line with
commissioning intentions and our primary care
strategy
 Provide clinical leadership and support for
practice improvement plans
Engaging Practices in Training and Education
 Continue to improve the content and quality of
Membership Engagement and Protected Learning
Training sessions
 Use Workforce Tutor and Primary Care
Commissioning plan to increase number of
practices involved in medical and practice nurse
training
 Develop programme of GP education sessions to
underpin core GP work and linked to new models
of care pathways and out-of-hospital care and
commissioning intentions
Safeguarding
 All GP practices to have a named lead for
Safeguarding Adults and Children and share with
Designated Nurses and are appropriately trained
 All staff to have access to safeguarding training
(to include Domestic Violence, Prevent) and
evidence of updating
 Ensure that practices have access to the pan
Kent procedures and understand their
responsibility and how to raise a safeguarding
concern
 Ensure all updated procedures are available in all
practices
Work with NHS England to support the development of
primary care strategies to support improved access and
the provision of primary care at scale including new
models of care.
Work with NHS England to increase the number of GP
referrals to be sent electronically to providers
Work with NHS
England on the
development of
local primary care
strategies to reflect
national priorities
outlined in the GP
forward view
Development of the GP workforce planning with CCGs,
Health Education KSS and the Community Education
Provider Network (CEPN)
Review evidence of a robust reporting system in place for
reporting quality concerns (SIs), never events and for
sharing learning from significant events
To identify and support practices with severe ‘difficulties’
to ensure continuity of patient care.
Support practices with the further implementation of and
spread of online service
NHS Ashford Clinical Commissioning Group and
NHS Canterbury and Coastal Clinical Commissioning Group
By when
31 Mar 2017
30 Sept 2016
Ongoing
31 Mar 2017
31 Mar 2017
31 Mar 2017
31 Mar 2017
30 Sept 2016
31 Mar 2017
Objective
Actions
By when
Work towards 7 day working in general practice as part
of primary care strategies.
Working with CQC in relation to the inspection of
independent contractors and support for failing practices.
Working with CQC in relation to the inspection of
independent contractors and support for failing practices.
Ensure there is demonstrable evidence of improved
patient satisfaction of primary care services, working
closely with patient representative and voluntary
organisations
Ongoing
NHS Ashford Clinical Commissioning Group and
NHS Canterbury and Coastal Clinical Commissioning Group
Ongoing
Ongoing
Ongoing