Download Service Specification - City and Hackney CCG

2015/16 - Service Specification.
1. Context
Improving our cancer care for our patients in City and Hackney is a priority for the CCG.
Every hour, three more Londoners are diagnosed with cancer. On average, one of them will
die within 12 months, one will live with their cancer for the rest of their life, and only one will
beat it. Despite all the advances in successfully treating the disease, Londoners still have a
poorer chance of beating their cancer than elsewhere in the country and we need to close
that gap. Tackling the reasons behind late diagnosis of cancer is key to making
improvement, as well as addressing the unacceptable variations across in screening rates
and access to treatment.
The NHS has also recently launched a new independent taskforce to develop a five-year
action plan for cancer services and a major new programme to test innovative ways of
diagnosing cancer more quickly at over 60 sites in the country, working jointly with Cancer
Research UK and Macmillan Cancer Support.
During the last year the Planned Care Board has worked with Cancer Research UK (CRUK)
to deliver an Early Detection and Diagnosis initiative in Primary Care. This is funded and
delivered by CRUK Primary Care Facilitator and is supported by the CCG Cancer Clinical
Lead reporting into the Planned Care Board. The project works directly with practices in
enabling improvements through the use of reflective audit on the cancer diagnosis cases
and implementing best practice processes and procedures. Engaging with the project and its
recommendations is currently voluntary and practice participation can be hampered by the
competing demands on practices’ time.
The Planned Care Board now wishes to build on this local focus and to drive more quality
improvements in patient care and experience. Formal commissioning of primary care to
support the CRUK programme is in line with the national agenda and additional time to
support a diagnosis of cancer seeks to provide extra capacity in primary care for GPs to
have the opportunity to support their patients in a more meaningful way.
2.) Contractual Framework
As part of the CCG Long term conditions contract, the CCG wishes to commission the GP
Confederation to provide the following:
2.2) Increase uptake of bowel screening through outreach and endorsement
All practices will instigate the systems and participate with the promotion of patient
participation in national bowel screening programme.
 All practices to receive electronic results of bowel screening via lablinks
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Check bowel cancer screening participation opportunistically at consultations with people
aged 59 to 75 (pop-up reminder to be included in EMIS); endorse and support screening
uptake
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use CEG search to identify people due for screening invitations (60th birthday pending) or
DNA result in last 4 weeks
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Practices to write to, telephone and provide standardised GP endorsement and
information to
o people aged 60 due to be invited (1,600 p.a.) for bowel screening for the first time
o people aged 61 – 74 who were invited and failed to participate in bowel screening
(11,500 p.a)
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Contact to non-returners of the bowel screening kit to offer an explanation and support
complete the test
Practices to consider and make additional efforts for patients with difficulties that could
include language, literacy, physical disabilities, learning difficulties or who are profoundly
deaf
Protocol, standardised endorsement letters and health promotion script for calling can be
provided to practices by the CCG Cancer Clinical Lead
Costs include stationery, postage, list management, telephone costs, calling by
advocates
Engage through PPI groups to support work to develop patient literature and other
communication materials to encourage bowel screening uptake
Full payment will be made at year-end based on the proportion of eligible patients
spoken to over the phone, or contacted by letter or if not possible
Payments based on practice target population size (60 – 74 year olds)
2.3) Referral “safety-netting”
With continued support from the CCG Cancer Lead and the CRUK Primary Care
Engagement Facilitator, the GP Confederation will ensure that all practices will:
 Have a system to ensure the dispatch of all 2 week wait referrals within 24 hours of the
patient consultation;
 Have a system to make all diagnostic referrals where cancer is suspected within 24
hours of the patient consultation;
 Ensure that all 2 week wait referrals are routinely coded;
 Ensure that the practice has a safety net process for follow-up of all 2 week wait referrals
 Practices will be provided with a template for routine recording of this information
 Ensure that information on 2 week wait referral pathways, diagnostic testing and local
pathways is available to locums and new registrars
2.4) Time to talk for cancer patients via extended practice consultations.
This service will be primarily focused on patients diagnosed with cancer, some of which may
need more than one consultation because of more complex existing health conditions which
have been further complicated by a diagnosis of cancer. Ten minute consultations already
exist within QOF therefore the CCG will commission the GP Confederation to ensure that all
patients on the QOF Cancer register are offered an additional 20 minutes consultation time.
The extended consultation of up to 30 minutes with the patient’s GP will
 Cover issues of multi-morbidity, multiple medications, their interactions and possible
side-effects
 Discuss the cancer diagnosis in context of existing illness both psychological and
physical
Consultations will be offered to appropriate patients in any of the following circumstances:
Once a City and Hackney registered patient has a confirmed diagnosis of cancer notified by
secondary care:
 The practice will identity the named GP for the patient who will provide
continuity of care to the patient;
 The practice will offer the patient an extended consultation to come in to see
their named GP on receipt of the diagnosis;
Once a City and Hackney registered patient has had one of the following:
 A planned inpatient episode (e.g. surgery) for management of cancer;
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The first of a planned programme of radiotherapy or chemotherapy;
An unplanned emergency hospital admission;
Completed a course of radiotherapy/chemotherapy;
Been discharged from hospital care (including patients discharged in line with
risk stratified pathways – breast pathway will be the initial patient group)
The GP will keep an overview of each patient’s care and referrals and, where clinically
appropriate, proactively organise a consultation to review or discuss the care plan.
The extended consultations could cover:
 Reviewing the patient’s condition, current health status and recent history;
 Reviewing the patient’s care plan and ensuring that this reflects their wishes;
 Discussing the diagnosis, tests and treatment options that have been
suggested including potential side effects and what the NHS will provide;
 Ensuring that the patient and their carers have access to emotional support
and other local voluntary sector support groups, access to patient information
and information about local resources;
 Reviewing any lifestyle issues as appropriate
 Arranging annual immunisations and the relevance of involvement in future
screening programme activity (and where necessary making arrangements
for the patient to be excluded);
 Undertaking a medication review;
 Assessment of the carer and their needs;
For patients finishing treatment and moving onto self-management:
 Ensuring they have been offered an individualised Health and Wellbeing
event by their cancer care provider as part of the Recovery Package
 Ensuring they understand warning signs which necessitate representation to
secondary care
For patients in the palliative phase of their illness:
 Discussing end of life issues and facilitating advanced directives where
appropriate, including development of a Coordinate My Care plan;
 Ensuring both patient and carer are clear about any alarm signs and know
when and who to contact if a crisis occurs.
3.
Key performance indicators and outcomes
Bowel screening – quarterly reports
 % of men and women contacted around their 60th birthday by
telephone and offered health promotion to encourage uptake of bowel
screening
 % of men and women in the above group sent endorsement letter by
practice if not reached by telephone
 % of men and women aged 61 – 70 who have not participated in
bowel screening in the last 3 months contacted by telephone and
offered health promotion to encourage uptake of bowel screening
 % of men and women in the above group sent endorsement letter by
practice if not reached by telephone
 Increase in bowel screening uptake across City and Hackney
practices
2 week waits – quarterly reports
 Numbers made by practice
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Numbers of DNAs/delays where the practice took action
Time to talk – quarterly reports
 % of appointments offered by practice
 % of appointments taken up by practice
 Annual patient experience survey/questionnaire
5.
Pricing
Bowel Screening
11,500 patients @£5 per patient
Improvement payment – (payable six months
in arrears)
5% improvement in C&H average (deducted
if not achieved)
10% improvement in C&H average
(deducted if not achieved)
Two week wait referral processes
One clinical session per practice per quarter
Time to Talk
Extended session of 20 minutes per patient
on QOF register (440 patients) @£35 per
patient
Total
£57,500
£6250
£6250
£51,600
£15,400
£137,000
6.) Contractual Framework - Part two
As part of the CCG Clinical Commissioning and Engagement contract the CCG will
commission directly with practices to undertake the following activities. RCGP/SEA audit will
be commissioned as one of the pan Hackney audits within the CCG Clinical Commissioning
and Engagement contract. Attendance at two education events will also be included in this
contract within the education domain. These are therefore already funded and included in
the global sum for the contract.
6.1) Engagement with two educational events
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All practices to send a representative of clinical/non-clinical staff to relevant
educational events
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Participation in Training/education on the use of cancer Risk Assessment
Tools/Macmillan electronic Clinical Decision Support tool or Qcancer within
consultations to assess patients in whom there is a possibility of a cancer diagnosis
6.2) Reflection on referrals
Supported by the Cancer Lead and CRUK Primary Care Engagement Facilitator as
above: included in the Clinical Commissioning contract as the pan Hackney audit
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Each practice to undertake RCGP audit of new cancer diagnoses
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Each practice to meet to discuss Significant Event Analysis on any delayed diagnosis
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Participate in an annual meeting of the practice with the CRUK Primary Care
Engagement Facilitator or CCG Cancer Lead to discuss and share ideas on:
 practice profiles;
 audit results and reflection on patient management;
 referral dilemmas;
 quality of referrals and improving referral practice;
 cancer significant event analysis;
 comparative practice referral rates for diagnostics & screening
 formulate a practice action plan
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Participate in an annual feedback meeting at consortium level to share results of
audits and SEAs and examples of good practice
7). Key performance indicators and outcomes
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Evidence in the tracker of attending relevant education events and audits complete –
assessed as part of mid-year review and in line with payment protocol for this
contract.
Cancer Clinical Lead and CRUK facilitator will be circulated with copies of the
RCGP/SEA audits by all practices. Report to include actions taken by practices as
result of the audit.