Briony Ladbury Safeguarding Children Lead NHS LondonDr Ruth Hallergan - GP December 2012

FundingAccountability

Local Health Watch

Local AuthoritiesHWB Boards

JSNA’sPublic Health

Parliament

Department of Health

Commissioning Board

professional senates

ClinicalCommissioning

Groups& Clinical Networks

Patients and Public – (adults and children)

Monitor Economic RegulatorIntegration

Patients interestsCompetition safeguards

Care Quality Commission

(Any Willing/Qualified)Provider

NHS Reforms

Accountability for results

licencing

contractLocal partnership

Public Health England

LSCB

CSS NTDA

1 NHS NATIONAL COMMISSIONING BOARD (NHS NCB)

NHS budget distributed from herePublic

Health EnglandPH budget distributed from

here

North South Mid East NCB Regional Offices replace

current clustered SHA areas

Regional 4 NCB Offices

Single

national operatingframework

Department of HealthPublic Health Budget NHS Budget

Local Area Offices (LAT)NCB Local Area Team (LAT)

Correspond to current PCT Clusters

Clinical Commissioning Groups (212)•May group into federation’s for commissioning health services across a population•CCGs to demonstrate local authority alignment•CCGs do not commission GP services done by NCB

LocalPublic Health Directorate

(Director of Public Health)

Located in Local Authority

In 2006 – 152PCT’s in England

NHS Reforms Commissioning/Accountability Structure

London

Commissioning Support Units

1 NHS NATIONAL COMMISSIONING BOARD (NHS NCB)

NHS budget distributed from here

Department of Health

London Clinical Commissioning Groups (CCGs)

May group into federation’s for commissioning health services across a population

CCGs to demonstrate local authority alignment

Access Commissioning Support

LONDON PH Public Health Directorate

(Directors of Public Health in each LA)

NHS – London Structure Sept 2012

Leadership for Safeguarding Chief Nurse

Leadership for Safeguarding London Region Chief Nurse &

Deputy Chief Nurse Safeguarding Children Lead & Safeguarding Children Doctor

Leadership for SafeguardingA CCG accountable officer (?GP)

Safeguarding Children ExpertiseDesignated Nurse & Doctor for

Safeguarding Children

PROVIDER TRUSTSPRIMARY CARE

Leadership for SafeguardingSafeguarding Trust Board LeadNamed Nurse and Named Dr for Safeguarding Children / Named

Midwife

LONDON NHS CB OFFICERegional & Local Area Team

ResponsibilitiesAlso NTDA

Leadership for Safeguarding

Named GP1 per LA?

Responsibilities London NHS CB

London Office Regional & Local Responsibilities•Improve quality and outcomes•Reduce health inequalities•Empower patients•Promote innovation

• Policy lead for safeguarding

• Annual assurance and peer review of primary care and directly commissioned services

• Specialist advice and support to NHS

• Work with CQC and Monitor on a joint information sharing protocol / MoU for areas of concern

• Authorisation and oversight of CCGs (and on-going development)

• Safeguarding responsibilities in directly commissioned services (primary care, specialised services – prison health (health visiting & family nurse partnership until 2015)

• Developing and sustaining effective partnerships (networks/ London SCB)

Responsibilities for CCGs

Commission services for registered and unregistered patients – but NOT primary care services

•Support quality improvement in primary care•Must meet safeguarding responsibilities as per authorisation guidance

• Safeguarding Training for staff• Clear lines of accountability in CCG governance arrangements • Co-operate with Local Authorities • Participate with and support the operation of LSCBs • Secure the expertise of a designated doctor and nurse for safeguarding children –

• clinical experts that must be embedded in the clinical decision making processes• given authority to influence and work across the whole health economy• Sit in CCGs (doctors in provider with SLA) NOT in CSU • Retain Local Authority alignment

• Secure the expertise of a designated doctor and nurse for LAC• Secure the expertise of a designated paediatrician for CDOP

London CCGs4.1 Clinical Commissioning Groups (CCGs)

•CCGs will need to demonstrate as part of authorisation that they have appropriate systems in place for discharging their responsibilities in respect of safeguarding (see the Draft Guide for Applicants for CCG Authorisation, 4.2.3 and 5.3),

•Where the designated professionals are currently employed within PCTs, it is expected that their employment will transfer to a CCG.

•Where the designated professionals (most likely the designated doctor) are employed within a provider organisation, the CCG will need to have an SLA with the provider organisation that sets out the practitioner’s responsibilities and the support they should expect in fulfilling their designated role.

•The CCG will need to ensure that its designated clinical experts are embedded in the clinical decision making of the organisation with the authority to work within local health economies to influence local thinking and practice.

•Where there is more than one CCG per LA/LSCB area, CCG can develop a lead/hosting arrangement for their designated team.

4.1.1 Commissioning support

•Whilst Commissioning Support Units or other commissioning support services will have a number of important roles to play in helping CCGs to commission effective services and assure themselves of the safety of those services, they are not considered as an appropriate vehicle for the ‘hosting’ of designated professionals

London CCGs4.1.2 Funding•CCGs should plan on the basis that running costs will be defined in the same way as PCT administration costs, which excludes any payments for the provision of healthcare or healthcare related services.

•CCGs, supported during the transition by PCT cluster finance staff, will need to exercise judgement in deciding what are healthcare related services. Current rules allow administration costs to exclude specific clinical advice where it relates to the care given to individual patients. Current advice indicates that designated professionals should fall within this definition.

•There are likely to be other costs associated with the safeguarding system, eg the local contribution to the operation of the LSCB, which will have to be met from within a CCG’s running cost allowance.

HEALTH WARNING - LACK OF DETAIL

Capacity, Seniority – competencies in new system?Clarity re Named GP role – responsibilities & authority?Effects of localism?

Will it change - is only interim guidance? What will appear in ‘Working Together’ ?

CCG Leads, Designated & Named Professionals & GP must be assertive & adept at horizon scanning to anticipate issues, assess &

articulate risk

Munro Review 2011

Named GP for City & Hackney

• Although not mandatory, registration with a GP is universally available to all children and is seen as an essential requirement to ensure effective delivery of health care and as a means of monitoring and supporting vulnerable children

Clinical Work

• Patients under 15 are seen in approximately 25% of GP consultations

• Children under 5 visit their GP on average 6 times per year

• Daily communication with a wide range of health care professionals

• Monthly ‘link’ meetings with health visitor and midwife

Local Safeguarding Children’s Board

• Present the GP viewpoint to other agencies• Executive Board• Child Death Panel• Serious Case Reviews; I’ll spend time in the GP

surgery creating a chronology of events relating to the child and their family

Training

• With the Designated Nurse and a social worker we deliver Level 3 Safeguarding Updates to practices in City & Hackney (45).

• Attended by frontline staff including GPs, Practice Nurses, reception and administrative staff

• We present clinical scenarios and encourage lively discussion

GP Networks

• GP Forum attended by 57 GPs with a focus on Looked After Children

• Monthly Safeguarding bulletin to all Practice Leads• GP booklet giving local guidance• Regionally, new Pan London Named GP group• Nationally, Primary Care Forum with biannual conferences

and email discussions on pertinent issues

Supervision

• Monthly meetings at the Tavistock Clinic• Attended by acute and community paediatricians, adult

and child psychiatrists and GPs• Work across from Royal London Hospital to Chelsea &

Westminster Hospital• Unique opportunity to learn from Primary to Secondary

to Tertiary Care

Miscellaneous

• Children’s Social Care, work together to streamline and improve communication between our agencies.

• Education, recent meetings with head teachers and GPs to share good practice.

• Email queries.

New challenges ahead

• The Named GP’s roles & responsibilities were omitted from the first version of 2012 ‘Working Together’

• Experienced & trusted Named GPs may decide not to continue with their role post March 2013

• 20% of posts for Designated Doctors remain unfilled nationally

New challenges ahead

• The named GP is aligned to the National Commissioning Board for directly commissioned services (including primary care)

• Designated Professionals will be employed by (or have SLA with) a Clinical Commissioning Group.

• The Clinical Commissioning Group Accountable Officer is likely to be a local GP who will have responsibilities for overseeing safeguarding quality in local GP practices.

• Will this be appealing?

My View

Really good safeguarding works when all the pieces of the jigsaw that encompass a child’s experience are skilfully and compassionately matched together by every agency that knows the child and their family.

I believe that our greatest challenge is to continue to champion communication, trust and effective safeguarding whilst working in new and unfamiliar structures.

Questions for discussion

• What would help to clarify and support the role and responsibilities of Named GPs locally?

• What could Named GPs do, to better safeguard children and young people in the new NHS Landscape?

• As members of the wider multi-agency safeguarding community how can you engage and support your named GP?