local professional networks assembly
DESCRIPTION
Local Professional Networks Assembly. 17 September 2013. The Right Honourable Earl Howe Parliamentary Under-Secretary of State for Quality . Opening of the LPN Assembly. Ann Sutton Director of Commissioning (Corporate) NHS England. National Ambition for the LPN’s. Mission Statement. - PowerPoint PPT PresentationTRANSCRIPT
Local Professional Networks Assembly
17 September 2013
NHS | Presentation to [XXXX Company] | [Type Date]2
The Right Honourable Earl Howe
Parliamentary Under-Secretary of State for Quality
Opening of the LPN Assembly
NHS | Presentation to [XXXX Company] | [Type Date]3
Ann Sutton
Director of Commissioning (Corporate)
NHS England
National Ambition for the
LPN’s
Mission Statement
“High quality care for all, now and for future generations.”
The Commissioning Landscape
• 211 - Clinical Commissioning Groups
• 151 - Local Authorities
• 27 - NHS England Area Teams
Improving outcomes ● Delivering equality ● Improving experience
Commissioning togetherNHS England commissioning Related commissioning
Essential and additional primary medical services through GP contract and nationally commissioned enhanced services
Out-of-hours primary medical services (where practices have retained the responsibility for providing OOH services)
Out-of-hours primary medical services (where practices have opted out of providing OOH services under the GP contract)
Community-based services that go beyond scope of GP contract (akin to current Local Enhanced Services) - CCG
Pharmaceutical services provided by community pharmacy services, dispensing doctors and appliance contractors
Meeting the costs of prescriptions written by member practices (but not the associated dispensing costs) - CCG
Primary ophthalmic services, NHS sight tests and optical vouchers Any other community-based eye care services and secondary ophthalmic services - CCG
All dental services, including primary, community and hospital services and including urgent and emergency dental care
Dental Public Health – Local Authority
Health services (excluding emergency care) and public health services for people in prisons and other custodial settings (adult prisons, young offender institutions, juvenile prisons, secure children’s homes, secure training centres, immigration removal centres, police custody suites)
Emergency care, including 111, A&E and ambulance services, for prisoners and detainees present in geographic area
Health services for adults and young offenders serving community sentences and those on probation
Health services for initial accommodation for asylum seekers - CCG
Health services for member of the armed forces and their families (those registered with DMS)
Prosthetics services for veterans(Primary care for member of the armed forces will be commissioned by
the Ministry of Defence)
Health services for veterans or reservists (when not mobilised) for whom normal commissioning responsibilities apply
Emergency care including A&E and ambulance services, for serving armed forces & families registered with DMS practice present in
geographical area - CCG
Public health services for children from pregnancy to age 5 (Healthy Child Programme 0-5), including health visiting, family nurse
partnership, responsibility for Child Health Information Systems
Healthy Child Programme for school-age children (5-19), including school nursing – Local Authority
National Screening & Immunisation programmes Sexual Health programmes – Local Authority
Public health care for people in prison and other places of detention
Sexual Assault Referral Services Sexual Health programmes – Local Authority
A wealth of clinical resources to support commissioning
• CCGs
• Clinical Senates
• Area Team Clinicians
• Public Health England
• H&WB Boards
• Strategic Clinical networks
• Local Professional Networks
• Academic Health Science Networks
National • Clinical Reference Groups
• National Clinical Directors
• Clinical Priorities Advisory Group
• Domain Leads
• Clinical Directorates
• Chief Professional Officers
Local
LPN Assembly Commissioning Assembly
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Dr David Geddes
Head of Primary Care CommissioningNHS England
National LPN Update
The journey so far….
You said…we did from last LPN AssemblyEssentials you said we must do What we’ve done
Get the right Chair in place •Comprehensive job descriptions•Robust recruitment processes
Draw up competence framework for Chairs and other LPN leaders
•Discussion of the training & development toolkit are underway
Planned development programme for Chairs & LPN leaders
•NHSIQ are here today and development work will continue following today’s Assembly
Build on existing groups and networks •People already involved encouraged to remain on the steering groups
•Newsletter•Website
Clarity on governance & accountability •Single operating model published
Recruitment update
• 81 positions in total for LPN Chairs across England• 18 have been confirmed as filled or interim• 63 are vacant (some are out to advert)
Ambitions for today’s LPN Assembly
Launch of the LPN Website
http://www.england.nhs.uk/ourwork/d-com/primary-care-comm/lpn/
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Local Ambition for LPN’s
PharmacyDental
Eye Health
Dr Jill LoaderRegional PharmacistNHS England South
Pharmacy LPNs
HWB/Local Authorities
Clinical Commissioning Groups
Strategy, policy, contract, procedure and assurance of achievement of outcomes
Implementation and development plans to reflect local circumstances
Local intelligence, clinical expertise, innovation and development of integrated care pathways
Peer support, peer review and benchmarking
Maximising performance
LPN Assembly
NHS England regional/
central
Area Teams
Local professional networks
Informing needs, demand, supply in primary, community and secondary care
Aggregation of need and assurance of performance
HEE/LETBs
LPNs working as an integral part of NHS England Area Teams, developing close local working relationships
Pre April 2013
PCT
Medicines optimisation
Consultation with LPC
Pharmaceutical Needs Assessment
Complaints
Accountable officer for Controlled Drugs and LIN
Public Health
Waste medicines
Patient engagement
Clinical leadership and engagement
Pharmaceutical Applications
Medicines strategy
Medicines QIPP
Accreditation
Fraud
Poor performers
Contract monitoring
Commissioning essential, advances and enhanced Pharmaceutical services Medicines safety
Transfers of care
Care Homes
Access to medicines out of hours
Post April 2013
NHS England
Medicines optimisation
Consultation with LPC
Pharmaceutical Needs Assessment (H&W Boards)
Complaints
Accountable officer for Controlled Drugs
Public Health
Waste medicines
Patient engagementClinical leadership and engagement
Pharmaceutical Applications
Medicines strategy
Medicines QIPP
Accreditation
Fraud
Poor performers
Contract monitoring
Commissioning essential, advanced and enhanced Pharmaceutical services
Medicines safetyTransfers of care
Care Homes
Access to medicines out of hours
Quality improvement CCGs
Direct commissioning of public health services from pharmacy
Contract monitoringLAs
Commissioning services direct from pharmacy e.g. minor ailments, palliative care medicines
Safe use of controlled drugsPatient pathwaysNetworks
Primary care prescribing
Local Professional Networks for PharmacyClinically-led commissioning ensuring a coherent offer for public from multiple commissioners of services from community pharmacy informed by patient and public engagementQuality improvement support continuous improvement in quality of pharmaceutical services provision locally.Pharmaceutical Needs Assessment advise H&W Boards in producing a robust local PNAOutcomes Framework contribute to every domain through effective joined up work on medicines optimisation and support for healthy living through community pharmacy – CCGs, NHS England, Local Authorities, Public Health England, Health Education England
Communication
Medicines Optimisation Principles
Chair: Clare Howard
• Supporting the development of Local Professional Networks and sharing best practice
• Supporting the development and implementation of national strategy and policy
• Working with key stakeholders on the development and delivery of national priorities
• Providing clinical leadership
Pharmacy LPN Steering Group
Ensure contribution of LPNs in each AT is maximised to improve outcomes and reduce inequalities
Getting Medicines Right at Discharge• Integrated care around the patient• Cross sector working - NMS, tMURs• Improve safety, reduce readmissions• Effective communication• On-going monitoring• Understanding which medicines have been stopped and started
and why.• Support for medicines-taking• Joint decision making – plan when to take, when to stop, when
monitoring needed, when to review, outcomes, side effects
Effective Patient Involvement
• Clearly define remit of each member of group
• What is needed and why and what they will get out of it
• Make sure patient reps are properly prepared
appropriate background to LPNs,
a good pre-brief (include roles, jargon, expectations, behaviours)
opportunity to ask questions in a non threatening environment
• Ensure support available from both an NHS buddy and another patient rep
• Be clear about training provided, claiming expenses etc.
• Keep engaged and give regular feedback re the difference their contribution is making
Serbjit KaurDeputy Chief Dental Officer NHS England LPN (Dental) Steering Group Chair
Dental LPNs
Key Aims and Objectives for Dentistry
• Implementation of SEICD• To improve oral health and reduce inequalities• To improve access to high quality dental services• To Improve the outcomes for patients• To provide seamless delivery of care across all dental specialties• To integrate dental services within wider NHS• To develop meaningful quality metrics • Getting value for money without compromising clinical quality.
The big issues
• To reduce oral health inequalities with respect to access to services and outcomes for patients
• To develop patient pathways to ensure patients can access appropriate care, dependent on need, regardless of the setting within which this care is developed
• To develop a service with a greater focus on prevention• To develop a service that meets patients expectations
Directly Commissioned
Services Committee
Primary CareOversight
Group
National Dental
Commissioning Group
National LDN Steering group
Oral and maxillofacial
surgery
Vulnerable people
Advisory
Report to
National Dental Commissioning Group Relationships
Clinical Priority Advisory Group
Report to
National Dental Commissioning Group
Aims:• To ensure a holistic approach to commissioning• To work with all key stakeholders to lead the transformation
of dental services required to deliver SEICD
Key Objectives:• To develop a comprehensive dental commissioning strategy• To oversee the delivery of a single operating model• To encourage innovation and creativity and identify best
practice• To encourage active dialogue on issues and challenges
relating to dental services
National Dental Commissioning Group
• Chief Dental Officer • Head of Primary Care Commissioning, NHS England • Assistant Head of Primary Care Commissioning, NHS England• Head of Primary Care and Commissioning Outcomes, NHS
England • Dental Policy DH• Deputy Chief Dental Officer• Dental Commissioning lead for Public Health England• 2 Dental Commissioners for each region nominated by the
regional lead• Health Education England - Post Graduate Dental Dean
LPN Dental Steering Group• Draft Terms of Reference• Invitations for nominations for membership have been sent• Will play a key role as a conduit between the NDCG and Local Dental Networks• Information needs to flow in both directions to achieve the aspirations of SEICD• Function is to support the LDNs in the development and Implementation of national strategy and policy
Membership of the Dental Steering Group
• Chair: Deputy Chief Dental Officer • Head of Primary Care Commissioning• Assistant Head of Primary Care Commissioning/National
LPN Lead• 4 LDN Chairs (one from each region)• 4 Commissioners (one from each region) • 4 Dental Public Health Consultants (one from each
region) • Regional Consultant in Dental Public Health - NHS
England liaison• Representative from Health Education England
NHS England needs you!
Click icon to add picture
LDN are essential to:• To provide clinical advice to
Area teams• To ensure sufficient local
flexibility in the implementationof national strategies and policies
• Achieving the aspirations of SEICD
• Link across all Area Teams and the centre support structures
Dr David Geddes Head of Primary CareNHS England
Local Eye Health Professional Networks
LEHN – An opportunity for clinical leadership.
Four specific functions for LEHN to consider
• Eye Health Needs Assessment• Redesigning services for quality improvement • Working in Partnership• Improve access for sight tests for seldom heard groups
Health inequalities …
National priorities and LEHN focus
LPN
CCGLA
Health and Wellbeing Board
Facing blindness alone
• Almost half of blind and partially sighted people feel “moderately” or “completely” cut off from people and things around them.
• Older people with sight loss are almost three times more likely to experience depression than people with good vision.
• Approaching one in 10 falls that result in hospital admissions occur in individuals with visual impairment.
Facing blindness alone RNIB 2013
Vision and long term illness.
Rehabilitation
• Rehabilitation is the structured support put in place, over a defined period of time, with the overall aim of maximising a person’s independence and quality of life.
• It is a cost effective approach which aims to help blind and partially sighted people “do things for themselves”, rather than “having things done for them”.
Dementia pathway…
Support for LPNs• Eye Health Steering Group• Getting Started and Building Relationships• Clinical Council for Eye Care Commissioning• National Primary Care Strategy and Area Team
Primary Care Plans
Click icon to add picture
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Dr Robert Varnam PhD RCGPClinical LeadNHS Improving Quality@robertvarnam
Leading purpose & possibility
What do you want to achieve?
Large scale change usually fails
Source: McKinsey Performance Transformation Survey, 3000 respondents to global, multi-industry survey of company executives
70%
25%5%
www.changemodel.nhs.uk
NHS Change Model
Who’s paid them?
What is the performance managemen
t framework?
What’s the plan?
“We have a list of measurable objectives”
versus
“I have a dream”
Compliance and commitment
Compliance CommitmentStates a minimum performance standard that everyone must achieve
States a collective goal that everyone can aspire to
Uses hierarchy, systems and standard procedures for coordination and control
Based on shared goals, values and sense of purpose for co-ordination and control
Threat of penalties/sanctions/shame creates momentum for delivery
Commitment to a common purpose creates energy for delivery
“You can’t impose anything on anyone and expect them to be committed to it”Edgar Schein, Professor Emeritus MIT
Sloan School
“You don’t need an engine when you have wind in your sails”Paul Bate
Using intrinsic motivation
Often, change need not be cajoled or coerced.
Instead, it can be unleashed.
Kelman, S. (2005) Unleashing change.
A study of organizational renewal in government.
Brookings Institution Press; Washington, D.C.
Intrinsicmotivators
build energy and creativity
Intrinsicmotivators connecting to
shared purpose engaging, mobilising and
calling to action motivational leadership
build energy and creativity
Drivers of extrinsic motivation
create focus & momentum for delivery
Intrinsic motivators connecting to
shared purpose engaging, mobilising and
calling to action motivational leadership
build energy and creativity
Drivers of extrinsic motivation
regulation payment & incentive
systems performance
management measurement for
accountability
create focus & momentum for delivery
Intrinsic motivators connecting to
shared purpose engaging, mobilising and
calling to action motivational leadership
build energy and creativity
build energy and creativity
Internal motivators
connecting to shared purpose
engaging, mobilising and calling to action
motivational leadership
Drivers of extrinsicmotivation
System drivers & incentives
Performance management
Measurement for accountability
create & focus momentum for delivery
What do you want to achieve?
Five tipsfor leading a network
• Invest more in people than plans• Create massively distributed leadership• Lead through the sense of purpose and possibility you
create• Talk fearlessly about values• Invest in your first followers
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Case Studies
Stephen GoughLancashire LPN LeadNHS England
Lancashire Local Professional Networks
Objective
To describe the governance structures and framework by which the Lancashire Area Team will ensure the integration of LPNs within the health system, specifically the primary care strategy and clinical strategy, and hold LPNs to account for the delivery of their work plans.
LPN Executive
Commissioning Director &
Medical Director
LPN Chair LEHN Chair LDN Chair LPN Manager
Head of Primary Care
Assistant Director Clinical
Strategy
FrameworkThe supporting framework consists of a suite of locally developed documents, using NHS England templates, applied across all 3 LPNs and include:• > LPN Matrix of stakeholders• > LPN TOR• > LPN Structures• > Summary Work Plan• > Detailed Work Plan with milestones and outcomes• > Conflict of Interest • > Policy Commercial Sponsorship Policy
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Lancashire Pharmacy Network
Electronic referral for post-discharge
pharmaceutical care
Including community pharmacy based :
• Targeted MURs (discharge medication review)
• New Medicine Service
Alistair GrayEast Lancashire Hospitals NHS Trust (ELHT)
GP
HospitalPharmacy
Community pharmacy
Patient Voice
Elaine HawthornGM LPN (Dentistry) Chair
Baby Teeth Do MatterThe first project of the GM
LPN for dentistry
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Baby Teeth DO MatterThe first project of the GM LPN for dentistry
Quality and Access
In this case study you will hear about:• The first problem we tackled as a LPN• I will share the outline of what we did and why• what we produced and achieved Later in the workshop you will be considering whether our formula could be useful in your LPN • If any of you have addressed other issues and started
projects our LPN would be pleased to receive your learning
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GM LPNEarly days…..
Establishing the network
Steering Group formed in Jan 2012• Core group - 3 X Dentists (from the outset) 2 X
Commissioners, 1 X Dental Public Health• We considered how the LPN could function across 10 PCT
localities with helpful advice (CCG Chair and Director of Public Health)
• Following consideration on structure - rather than sit around talking about ToRs etc and the dentists losing the will to live - we decided to take action and do something positive
• The first task would test whether this collaborative approach, led by dentists, could work
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Baby Teeth DO Matter
The task
What did we do and why?• One problem in GM is high decay levels in the very young –
it starts before age 3 • Leading to far too many children having pain, dentists
struggling to treat them and too frequent GAs for extractions
• 5 year old decay rates had not changed despite all our (separate) best efforts for many years
• We learned from PH that the best way to influence behavioural change is a quality 1 to 1 contact with a health care professional
Getting the message out there• Dental decay is largely preventable with a healthy diet and
use of fluorideTask: • to encourage attendance of all under 5s in GM especially
those who had not seen a dentist ever or in last two years – find the missing thousands
• and when they got there - make the contact count • with simple achievable message (bedtime routine), fluoride
varnish application and given free TB & TP • Dentists wanted something lasting not a quick access fix to
year end – more on that later ….
The missing thousands
Total number
Seen by dentist
Not seen by dentist in past 24 months
Children under three years of age
108,780 44,600 64,180
Children aged three and four years of age
75,520 51,354 24,166
TOTAL 88,346
How did we pay for it?• £200,000 allocated from the collective PCT dental
underspend CsDPH had to fight hard for this - less than 1%
• This was to pay for TB & TP, literature and to secure the time of 10 clinical champions - one for each PCT locality to encourage practices to participate
• The dentists had to be prepared to use their currently contracted UDAs to prioritise this group and actively seek them out UDA allocation
• SLA agreed (with difficulty) across 10 PCTs• The incentive (3 UDAs subtracted from annual total) was
allowed if the child returned 3/12
Materials
Launched in November 2012 • 400+ practices in GM, almost half signed up• This is credited to the leadership of the clinical champions
within the localities – one rang every single practice to encourage participation!
• They involved the media running stories in local press and used radio to let parents know that dentists were keen to see their children even though they “only” had baby teeth
• In the finite time we had almost 4000 very young children some of whom had never been before attended the dentist and the majority returned within three months for further advice & FV
Using the media
The add on for the long term…..• Dentists seeing these young children wanted support in
best practice treatment and decision making • And for BTDM to continue So….• We established a sub group to take this forward• It included specialists, GDPs, public health and
commissioning leads and was Chaired by one of the clinical champions
• Clinical pathways booklet and training produced to assist dentists and their teams provide better quality care and reduce the GAs
The launch of the BTDM pathway booklet
Things we struggled with…• Commissioners adapting from previous PCT approach, to
really listen and act upon what the dentists were saying – some found relinquishing power to the clinicians difficult
• Looking back the SLA was too complicated and the specialists found it hard to be pragmatic – they had not always taken on board the “keep it simple” message and the pace needed
• Involving the champions and engaging practices was variable across GM
• Getting funding
What worked well…. • Dentists were very enthusiastic and LDCs gave positive
input and support • In a very short time we achieved far more working
collaboratively on the same goal than we had working separately 4000 in and quality pathways
• Meeting the CCG Chair and other leaders outside of dentistry was inspiring for the dentists and it made sure that they knew about us and what we were trying to achieve
• Almost 500 dentists from across GM attended the launch of the pathway booklet and the Area Team Director of Commissioning looked at the audience and said “ I can’t ignore this” he was impressed they had given up an evening of their free time
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Baby Teeth DO MatterBest of all…..
4000 young children and their families have been given the opportunity to have a future free of decay
Debbie GrahamInterim LEHN Chair of Birmingham, Black Country and Solihull
The Solihull and Birmingham LEHN
story so far
Commercial break• www.visionmatters.org.uk• Follow National Eye Health Week on twitter @
myvisionmatters
LEHN membership• Optometrists
• Ophthalmologist [2e care] • Patient representative• LOC • CCG clinical leads• Clinical advisor• Community paediatric care
[orthoptist]• Low vision service providers
• Health & Well Being Board• Vision 2020 [regional]• Public Health• Local Authority• Aston University optometry• Primary care
commissioner • Admin. Support
The first meeting…
• Wide stakeholder input• Invitation of workplan ideas and opportunities• Organisational development
• Core lead group• Task and finish groups• Communications
• Building on existing workstreams
…..
Systems & processes
• Constituting the network:
• Workplan agreement:
- core group identified- terms of reference agreed- accountability agreement- conflict of interest addressed
- prioritisation criteria- sign-off by BSol cluster
Measures of Success for the LEPN
• Secure Public Health engagement (at Health and Well Being Board level) in the eyecare needs assessment
• Secure Public Health attendance/membership at the LEPN meetings• Communicate to Clinical Commissioning Groups and Primary Care Optometrists, the
evidence base in relation to handling referrals between primary and secondary care• Provide a report on the outcomes of the intra-ocular pressures local enhanced service to
aid future commissioning decisions• Develop and recommend a complete, evidence-based age-related macular degeneration
pathway • Develop and recommend a complete cataract pathway in line with the Map of Medicine
evidence-based approach• Produce and implement an effective Communications Strategy and Plan to ensure the
LEPN’s accessibility to stakeholders and vice versa
Too Ambitious?
Next steps
• Event to establish single LPNs including LEHN across AT• Appointment of chairs• Steering group to prioritise workplan suggestions• Commissioner and medical director sign-off• Quick second LEHN meeting• Task and finish group approach
• Single LEHN across Birmingham Solihull and Black Country
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Workshops
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Thank you for attending