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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; 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: 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 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. 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. 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