oldham nhs ccg strategic clinical commissioning plan 2014-2019 appendices

1

Oldham NHS CCG

Strategic Clinical Commissioning Plan

2014-2019

Appendices

2

ContentsPage

Appendix 1 - Innovation Approach – Dragons Den 3

Appendix 2 – Clinical Change & Delivery Programme 11

Appendix 3 – The Clinical Programme Approach 47

Appendix 4 – Wider Primary Care at Scale - Backstory, Data & Statistics - Supporting Logic

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3

Appendix 1Innovation Approach - Dragons

Den

4

Oldham CCG Dragons’ DenDecember 2013

5

Dragons’ Den: The feedback

Dr Chris Duffy, GP and Chair of neighbouring Heywood, Middleton & Rochdale CCG: “It was a really fantastic event, and it was evident to me from listening

to some of the pitches, that there is a genuine commitment – from both clinicians and partners across Oldham – to improve health outcomes for people living in the town, not just by doing the same thing but faster, or cheaper, but by creating new and innovative ways of

working, which is really exciting.”

Dr Zahid Chauhan, GP at Medlock Practice in Failsworth: “It was a pleasure to take part in the event, and really very enlightening. There were some fantastic ideas and I’m sure that the ones which made it through to funding will start to deliver some really great results

for patients across Oldham over the coming months and years.”

Jeremy Broadbent, Chief Executive Officer, The Johnson Group: “It was a privilege to be invited onto the panel of dragons, and I hope that the combination of my commercial knowledge and

experience, as well as my input as a local resident who accesses health services in

Oldham, proved useful to the panel.”

Sue Hubbard, patient panellist from Coldhurst: “What a fantastic

morning, I didn’t expect to have such an important part to play in the

panel, voting on these decisions, but have thoroughly enjoyed it and think

it was a great way to get patients involved in the process.”

Dean Craig, Chief Executive Officer, Web Applications and Oldham President of the Greater Manchester Chamber of Commerce: “I thoroughly enjoyed taking part in the Den, what a fantastic way to generate new ideas. In the commercial sector, coming up

with innovative ways of working is part of the day job, and I was really pleased to see the same principles being applied to the way health solutions are being developed in Oldham.

It’s exciting stuff.”

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Dragons’ Den: Process and Expectations

• 48 bids received in total by the early November deadline

• 38 bids shortlisted by MET for invitation to pitch to the Dragons’ Den Panel

• 24 bids put forward for implementation

• CCG worked with successful bidders in early 2014 to implement their projects, identify measureable outcomes, mitigate risks and ensure funding is distributed promptly.

• Majority of initiatives to be launched in March or April 2014.

• Bidders mobilising their own innovation without reliance on internal CCG team

• Bidders produced a short description of their innovation and intended outcomes for publicity material and are liaising with Comms team.

• Costs will not exceed those included within the initial bid.

• Bidders participate in PR and comms opportunities over the next 6-12 months

• Bidders will provide quarterly progress reports and attend CCG meetings when required (usually quarterly)

• Bidders will participate in post evaluation process of the overall innovation bid intervention – post evaluation event

7

Successful Bids: Prevention

Innovation GP sponsor Span Cost CD area GB sponsor

Life coaching Dr Duru Dr Durus practice /ICC

£17.5k Mental Health

Dr Andrew Vance

Hope Citadel – focused care

Dr Patterson

1 practice in Failsworth

£70k All Julie Daines

Preventing childhood obesity – Kids Zone (OCL)

Dr Trewinard

Oldham £40k Children’s Derek Ashford

Mindfulness (Mind)

Dr Jeffery Oldham – 300 patients

£60k Mental Health

Kath Wynne-Jones

Volunteer network (Link)

Dr McMaster

Oldham £60k All Graham Foulkes

Slimmin’ without women (Age UK)

Dr. Jeffery Oldham £11k All Derek Ashford

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Innovation GP sponsor

Span Cost CD area GB sponsor

Primary care pain service

Dr Francis Oldham – 60 people

£30k Elective / MSK Dr Zuber Ahmed

Early connections – dementia

Dr Ahmed Glodwick and St Marys

£30k Mental Health Dr Bilal Butt

Outta Skool – diabetes healthy living programme

Dr Chaudry Oldham – 100 patients

£35k Diabetes Majid Hussain

IHSCT pharmacist support – Celesio partner

Dr Wilkinson

Cluster - to be determined

£38.6k All Dr Ian Wilkinson

Productive GP practice

Dr Watson Saddleworth Medical Practice

£14k All Steve Heaney

Integrated minor ailments service

Dr Duper Pennine Medical Practice

£33k Urgent Care Dr Dave McMaster

Successful Bids: Clinical programme changes

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Successful Bids: Clinical programme changes Innovation GP sponsor Span Cost CD area GB sponsor

PAD service Dr Sharma Oldham £87k Vascular Dr Ian Milnes

DVT service Dr Sharma Oldham £40k Vascular Dr Ian Milnes

Heart failure pilot Dr Sharma 2 clusters - TBC

£59k Vascular Dr Ian Milnes

Cardiovascular diagnostics

Dr Duper Pennine Medical Practice

£11.6k Vascular Denis Gizzi

Arezzo pathways Dr Ahmed 4 practices £30k Elective Dr Anitha Padmaja

Spreading innovation AHSN partner

Dr. Wilkinson Oldham £30k All Dr Ian Wilkinson

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Successful bids: Joint working with the LA Innovation GP

sponsorSpan Cost CD area GB sponsor

A&E assisted discharge service – Red Cross

Dr McMaster

Oldham £83k Urgent care Margaret Williams

Alcohol screening service

Dr Vance Royton cluster

£69k Mental health

Dr Samy

Oldham Street Angels

Dr McMaster

Oldham £40k Urgent Care Kath Wynne-Jones

First aid training Dr McMaster

PSR pilot area

£10k Urgent Care Dave McMaster

BME elders - housing 21

Dr Jeffery Oldham £31.5k Urgent Care Margaret Williams

EOL technology pilot

Dr Watson Practice £7k EOL Denis Gizzi

Appendix 2Clinical Change & Delivery

Programme

11

Prioritisation of Clinical Programme Areas for 2014-15

12

Prioritisation of Resources - RationaleThe CCG has a clear view on its intentions for the outcomes of clinical change programmes, in line with the vision of the Oldham Care Vortex and improving outcomes for the Oldham Family. Previous work undertaken by Clinical Directors, has created a body of knowledge, which has shaped our 5 year plan, taking into account our current landscape from the perspectives of population health, quality and economics, in line with our triple aim objectives.

As we approach the end of quarter 1, it is important that we have a clear capacity plan for our internal resources and those commissioned through the CSU.

The annual work plan for routine assurance is currently being finalised by the internal team to be agreed with CSU account managers.

However in tandem with this, it is important that we have a clear plan of resources required to align with the clinical change programmes, as these will require resources from some CSU support functions

The content of clinical change programmes has been designed by the Clinical Directors based upon:• Intentions of the Health and Wellbeing Board strategy• Current performance• Benchmarking data• Previous content of clinical programme plans• Commissioning for value packs• Public health outcomes framework• Local health profiles• PHE/NNSE a call to action: commissioning for prevention• JSNA• Areas from 2012 CMO report • New national strategies expected in 2014• Feedback from members• Patient and public engagement

It needs to be recognised internally, and by our support partner, that whilst this is our proposed annual plan, this may change dependent upon emerging national and local priorities throughout the year. 13

Prioritisation of Resources - ProcessOver the past 3 months, as the initial part of this process, Clinical Directors have been prioritising their clinical programme plans with the agreed methodology to improve outcomes for clinical programme areas.

The attached diagrams profile the list of current interventions and their assessed priority at the initial assessment undertaken by the programme leads. Through the next 2 weeks, a further stage of assessment needs to be undertaken including:

• Clinical Directors confirming the initial scoring for their areas and the interventions included• Clinical Council considering the initial scoring for the areas and the interventions included, and discussing with the appropriate

Clinical Director• Considering if there needs to be wider scoring using the tool • Determining the cut off score of interventions to be progressed in years 1 and 2

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IMPORTANCE - ASSESSMENT CRITERIA

ASSESSMENT CONSIDERATIONS

'KILL' SCORE LOW SCORE HIGH SCORE

0 1 2 3 4 5

CITIZEN BENEFIT – THE OLDHAM FAMILY

- To what extent would this proposal be addressing an unfilled need - To what degree would shift of service in this area contribute to improving equality of access?- To what degree will a service shift contribute to reducing health inequalities?- To what degree would this proposal be improving quality

n/a

- does not contribute to improving access, experience, quality and/or reducing health inequalities- current offer is perceived to be excellent

- is unlikely to contribute to improving access, experience, quality and/or reducing health inequalities- current offer is perceived to be good

- may contribute to improving access, experience, quality and/or reducing health inequalities- current offer is perceived to be average

- should contribute to improving access, experience , quality and/or reducing health inequalities- current offer is perceived to be fair

- strongly contributes to improving access, experience, quality and/or reducing health inequalities- current offer is perceived to be poor

HEALTH BENEFIT

-Would a shifted service improve clinical quality and health outcomes? (If clinical quality and/or health outcomes will be diminished as a result of shift, score 0) - To what degree is the current provision currently meeting health / clinical quality objectives and would a shift assist? -Evidence base

An initiative in this area will result in diminished clinical

quality and/or health outcomes

No evidence base

-will not result in improved clinical quality and/or health outcomes - very limited evidence base

-is unlikely to result in improved clinical quality and/or health outcomes- Limited evidence base

-improved clinical quality or health outcomes - some evidence base

-improved clinical quality and health outcomes-good evidence base

-would result in vastly improved clinical quality and health outcomes-strong evidence base

REFORM / STRATEGIC DIRECTION

-To what degree would this proposal align with the key national priorities and local priorities and objectives? (if there is no alignment, score 0)- Consider for local priorities HT, Primary Care Medical Home, PSR

An initiative in this area is not aligned with any of the

key national or local priorities

- is aligned with very few key national priorities/reform agenda- aligns with very few key local priorities/objectives

- is aligned with some of the national priorities/reform agenda- aligns with some strategic local priorities/objectives

- is aligned with a few national priorities/reform agenda - aligns with a few key local priorities/objectives

- is aligned with most national priorities/reform agenda- aligns with most key local priorities/objectives

- is strongly aligned with national priorities/reform agenda- strongly aligned with key local priorities/objectives

OPERATIONAL IMPERATIVE

- Is this initiative driven by any known/anticipated changes which might impact service demand or provision in this area (e.g. structural changes, workforce changes, political changes, regulatory changes, policy drivers, new providers/market entrants, etc.)?

n/a

- no known changes that might have impact on service demand/provision coming

- changes driving shift in this area exist, but none officially announced

- changes have been announced for some point in the future, which would may impact

- changes are coming which would require change in provision, but the change is medium term

- significant, imminent changes known to be driving shift

FINANCIAL IMPACT

- To what degree might there be a significant financial impact (i.e. cost, savings, net gain, duplicate funding, etc.) on health spend by shifting service in this area

n/a

- significantly negative financial impact expected (very high cost/investment, very low savings)

- negative financial impact expected (high cost/investment, low savings)

- balanced financial impact expected (balanced cost/savings, flat gain)

- positive financial impact expected (low cost/investment, high savings)

- significantly positive financial impact expected (very low cost/investment, very high savings)

Prioritisation Tool

DO-ABILITY - ASSESSMENT CRITERIA

ASSESSMENT CONSIDERATIONS'KILL' SCORE LOW SCORE HIGH SCORE

0 1 2 3 4 5

PATIENT AND PUBLIC ENGAGEMENT

--Evidence that the proposal is in line with what our population are telling us-Will there be a need for need for formal public consultation?- What is the potential likelihood of OSC and other political support?

Does not align with what our population are telling us

- very little alignment with what the population are telling us public consultation will be required- very low probability of OSC support

- limited alignment with what the population are telling us-public consultation is likely to be required- low probability of OSC support

- some alignment with what the population are telling us-public consultation may be required- OSC support possible

- close alignment with what the population are telling us -public consultation is unlikely to be required- good probability of OSC support

- very strong alignment with what the population are telling us- public consultation will not be required- OSC will fully support

STAKEHOLDER ALIGNMENT

- To what degree are the wider range of economy stakeholders aligned with this proposal (i.e. acute, voluntary sector, community provider, primary care, AT, local/national politicians, etc.)

n/a - low stakeholder alignment for this proposal

- some stakeholders are aligned with proposal, but key opinion leaders are not aligned

- some stakeholders are aligned with this proposal including some key opinion leaders

- most stakeholders aligned with this proposal

- full stakeholder alignment

INFRASTRUCTURE

- Does the technology exist to deliver this proposal and if it doesn't currently, will it exist when needed? (if not, score 0)- To what extent would this proposal require new/specialised facilities/equipment?- To what extent would this proposal require significant IT change?- To what degree is there existing estate to deliver this proposal

The technology does not exist to support shift of

service in this area, nor will it be available when needed

- requires very specialist equipment and facilities- significant IT change would be required- there is no available estate

- requires fairly specialist equipment- will require IT changes, and these changes may be difficult to implement- very limited estate available

- some special facilities may be required- some IT changes may be required, but these are not expected to have a large impact- there is some estate available

- specialisation of facilities is either not required or simple to construct- limited need for IT changes- estate exists to support the proposal

- no special facilities are required- no need for IT changes- estate to support this proposal is sufficient

DO-ABILITY - ASSESSMENT CRITERIA

ASSESSMENT CONSIDERATIONS'KILL' SCORE LOW SCORE HIGH SCORE

0 1 2 3 4 5

WORKFORCE

- To what extent could an existing trained workforce be shifted vs. there being a need for a new workforce to be recruited and trained / an existing workforce be re-trained?- Are existing qualified resources sufficient to meet expected demand for this service and are they in the right places- To what extent can qualifications to provide this service be obtained with relative ease?- To what degree would a shift of service, and workforce, in this area impact on Training Staff? Would there be a risk of loss of accreditation in existing facilities?

n/a

- new workforce would need to be recruited and trained, existing workforce is insufficient- qualifications are extremely difficult to obtain- shift of workforce would significantly impact on the Training Staff/accreditation elsewhere

- new workforce will need to be recruited but some existing workforce could be re-trained and shifted- qualifications are difficult to obtain- some impact on Training staff must be addressed

- new workforce may need to be recruited; existing workforce could be retrains, many are in the right places- additional qualifications may be required, but this is not difficult to obtain- very low impact on Training Staff

- no new workforce required, existing workforce could be shifted with minimal retraining- skills base exists in the community- qualification is straightforward to obtain- no impact on Training Staff

- existing workforce could be shifted with no additional training requirements- there is no resource shortage, with significant skills base spread across the community- no additional qualifications required

RISK ASSESSMENT

- Is it possible to change this service within current regulation/legislation? (if not, score 0)- To what extent is there a risk of destabilising other organisations- To what degree is this initiative either dependent on or on the critical path for other interventions- To what degree Is money locked into contracts? Are they long-term? Is there scope to re-negotiate/back-out/etc.?- Is there currently a provider in the market delivering, or capable of delivering, a shifted service in this area?- To what extent has a similar initiative already been implemented on a small scale within the economy (i.e. scale-up)?- Has a similar shift/redesign of this service been implemented elsewhere in the world?- Are there obvious measures for success or best practice?- To what extent is there data (e.g. audit, 3rd party research, service reviews, etc.) to support the proposal

It is not possible to deliver shifted services in this area

within the current legal/regulatory environment

- a significant service change with high risk to destabilise other organisations- highly dependent on and/or a dependency for many other interventions- money is locked into long-term contracts with significant penalties- no market for proposal- provision as per this proposal has no known precedent- no known success measures or best practice exist- no data to support shift in this area

- fairly large-scale service change which may strongly impact other organisations. Destabilisation is unlikely- highly dependent on and/or a dependency for a few other interventions- money is locked into contracts with significant penalties, but may be negotiable- no current market for proposal, but there may be interest from providers- this intervention has been attempted before, but was unsuccessful- some success measures, no known best practice- little data to support shift in this area

-fairly average extent of change which would impact but not destabilise other organisations- interlinked with one or two other interventions being implemented; not dependent or a key dependency- money is locked into contracts but have pathways to exit/redefine- there is interest in building a market- provision of this type of service has been successfully implemented before, but not in the UK- success measures exist, limited best practice- some data to support shift in this area

-not a significant service change with low impact on other organisations- interdependent with other proposals being implemented, but can begin immediately- funds available but will need to exit/renegotiate contracts with little or no penalty- there is a growing market, but not a fully competitive one for provision- provision of this type has been implemented in the UK, but not in the locality- there is some documentation of best practice in this area and sufficient measures for success- sufficient data to support shift of service

- not a significant service change with very low impact on other organisations- not dependent on or a dependency for any other interventions- money available to commission service, no impact on existing contracts- there is a competitive market for provision- provision of this type of service is common throughout the UK and/or would be a 'scale-up' of an existing small-scale initiative in the region- there is significant guidance on best practice and numerous measures for success- substantial data to support shift

Clinical Programme Area Schemes: Maps & Scores

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Clinical Programme Areas: Cancer (1)

RefClinical

Programme area

Co-dependent Clinical

Programme AreaDescription Outcomes Strategic Alignment Clinical lead CCG lead CSU Lead CSU Support Start Date

Completion Date

Prn Imp Score

Prn Do Score

Total Prn Score

Priority / Difficulty

CA14.01 CancerPublic health -

screening programmes

Cancer awareness campaigns to improve screening uptake for national programmes and symptom awareness raising

Early presentation through increased knowledge and awareness in local residents Improved survivorshipReduced mortality Increased quality of lifeReduce life years lost

Improving outcomes: a strategy for cancer Cancer outcomes framework Public health outcomes

Matthias Hohmann

Lesley Hoyle

Apr-13 Mar-15 23 25 48 3B

CA14.02 CancerMaximise use and enhance awareness of community based cancer family history genetic counselling service

Increased early diagnosisImproved personal choices on treatmentsReduced mortality

NHS PlanCancer outcomes framework

Matthias Hohmann

Lesley Hoyle

Apr-13 Mar-15 21 25 46 2B

CA14.03 Cancer SCNBME specific campaign Develop a Cancer awareness and signposting toolkit for social carers of ethnic minority groups

One of a number of regional based research projects being undertaken by SCN. Research now appointed and in post. Working group first meeting May 2014

Cancer outcomes frameworkMatthias Hohmann

Lesley Hoyle

Nov-13 Mar-15 20 22 42 2B



Improve Cancer screening uptakes - national screening programmes: breast, cervical and bowel

Early diagnosisIncreased survival rate at 1 yearReduced mortality

Cancer outcomes frameworkMatthias Hohmann

Lesley Hoyle

Continuous Continuous 23 25 48 1A

CA14.05 CancerDeliver GP practice engagement sessions to improve early diagnosis of cancer

Improved early diagnosis and referral Improve 1 year survivorship

Cancer outcomes framework Health and well being strategy - Oldham

Matthias Hohmann

Lesley Hoyle

Apr-14 Mar-15 22 25 47 2B

CA14.06 CancerWork with PAHT to record/share quality assured cancer staging data at diagnosis

Identify pathways for review for access to diagnosticsDevelop local community awareness campaigns based on pathways identified Earlier presentation to GP based on improved knowledge of symptoms

National cancer planCancer outcomes - 1 year survivorshipMorbidity and mortality

Matthias Hohmann

Lesley Hoyle

Feb-14 Mar-15 25 25 50 1B

CA14.07 CancerCapital

development for PAHT

Extend the range and activity of chemotherapy services in Oldham through commissioning of Christies Chemotherapy closer to home service

Chemotherapy services delivered closer to home for Oldham residents

Cancer outcomes framework Health and well being strategy - Oldham

Matthias Hohmann

Lesley Hoyle

Feb-14 Mar-15 20 25 45 1A

CA14.08 Cancer Recruit Consultant Oncologist cover for AOS and all MDT’s at PAHTReduce mortality1 year cancer survivorship

Acute oncology audit (2008) Improving outcomes in cancer

Matthias Hohmann

Lesley Hoyle

Jul-05 Mar-15 20 25 45 1A

Clinical Programme Areas: Cancer (2)

RefClinical

Programme area



Completion Date

Prn Imp Score

Prn Do Score

Total Prn Score


CA14.09 CancerEvaluate Macmillan one-to-one cancer support pilot site: potential to extend and continue based on successful evaluation

Complete holistic cancer care reviews in primary care Complex case management in communityDevelop new follow up pathways for specific cancer pathways in community Support post completion of cancer treatmentReducing social exclusion

The National Cancer Survivorship InitiativeNational Cancer Plan Living with and beyond cancer (Macmillan)

Matthias Hohmann

Lesley Hoyle

Apr-13 Mar-15 20 23 43 1C

CA14.10 Cancer Citizens Advice Bureau support

Improve quality of life Reducing social exclusion Increase in income through benefits claimants Reduce number people in fuel poverty

Living with and beyond cancerSocial Inclusion Anti poverty strategy / action plan

Matthias Hohmann

Lesley Hoyle

Apr-12 May-14 20 22 42 1C



EQALS: Improving screening uptake through sending of reminder letters from GPs to patients who have DNAed screening invitations

Increased screening rates for national programmes Reduce mortality1 year cancer survivorship

Cancer outcomes frameworkcancer strategy

Matthias Hohmann

Lesley Hoyle

Apr-14 Mar-15 25 25 50 2C



EQALS: retrospective significant event audit on a number of consecutive cases of newly diagnosed cancer using the standardised significant event audit template developed by the National Cancer Strategy/RCGP

Improved earlier diagnosis of cancerReduce number of cancers diagnosed through emergency rateIncreased 1year survival ratesreduce cancer mortality rates

National cancer planCancer outcomes frameworkNational Patient Safety Agency/RCGP thematic report on Delayed Diagnosis of Cancer

Matthias Hohmann

Lesley Hoyle

Apr-14 Mar-15 25 25 50 2B

Clinical Programme Areas: Children & Young People’s (inc. Maternity / Women’s) (1)

RefClinical

Programme area



Completion Date

Prn Imp Score

Prn Do Score

Total Prn Score


CYP14.01Children &

Young PeopleLocal authority

Integrated children and young people's team with a single point of entry.

5% reduction in A&E attendances for 0-19 year olds.Speedy and appropriate information sharing to enable better informed decision making, and more appropriate interventions

NHS Outcomes Framework and QP indicator on reducing emergency admissions in under 19sIntegrated Commissioning

Harpal Hunjan

Gill Barnard / Julia Taylor

05.03.13 30.04.14 20 23 43 1A

CYP14.07Children &

Young PeopleProduction and circulation of clinical pathways

Improving children and young people’s experience of healthcareReduction in referrals to paediatric services through effective management of childrens conditions at a primary care levelReduction in attendances at A&E through improved primary care management

NHS Outcomes Framework - Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19sDemand management

Harpal Hunjan


27.12.13 31.09.14 15 20 35 1C

CYP14.08Children &

Young PeopleImplement children and young people’s self care programme for parents/carers. Consideration to Health App

Reduction in attendances at GP surgeries through:Improved communication with healthcare professionalsBetter and regular use of medication to control health conditionBetter self-management skills

NHS Outcomes Framework - Ensuring people feel supported to manage their conditionEmpowering patients to have more control over their care packages, strengthen prevention, self-care and well being (NHS Confederation, 2012)Chief medical offi cers annual report 21012: Our children deserve better: prevention pays.

Harpal Hunjan


10.01.15 31.03.15 15 17 32 2C

CYP14.09Children &

Young PeopleImplementation of GP Educational programme surrounding children and young people

Increased awareness regarding topical issues in the clinical treatment of children and young people in Oldham and about how to prevent admission into hospital where appropriate

Triple AimHarpal Hunjan


01.05.14 11.09.14 19 18 37 2C

CYP14.10Children &

Young PeopleLocal Authority

Continue with Special Education Needs and Disability (SEND) Reform programme, particular emphasis on 'gearing up' universal services

Improved educational outcomes for children with a special educational need or disability.

Health &Social Care Act 2014Harpal Hunjan


03.03.14 30.09.14 22 20 42 1A

CYP14.18Children &

Young PeopleEnd of Life Review of the palliative care support for children

Enhanced quality of life for the child and improved support for families / caregivers

Patient experienceHarpal Hunjan


0 0 0 2B

CYP14.35Children &

Young People

Maternity / Women's

Endocrinology

Integrated diabetes service specific to children & young people and maternity to be rolled out

Reduction in paediatric emergency admissions for diabetesSeamless pathwaysCare managed closer to home

NHS Outcomes Framework and QP indicator on reducing emergency admissions in under 19sAligns with Oldham's Diabetes ServiceCare closer to home NICE Guidance CG15

Harpal Hunjan


22.03.13 01.03.15 0 0 0 2A

CYP14.42Maternity / Women's

Local Authority Raise awareness of consanguinity with parentsReductions in infant mortality and childhood disability

NHS and Public Health Outcomes FrameworkImplementation plan for reducing health inequalities in infant mortality: A good practice guide (DH)

Harpal Hunjan


10.01.14 31.03.15 15 19 34 2A

CYP14.43Children &

Young People

Ambulatory care conditions to be effectively managed and treated in primary and community care. To include:• Mobilisation of CCNT service specification with extended operating hours, 'on call' service provision and redirect resource into hospital (including 'gear up' of critical and immediate referrals)• Improve children and young people's access to GPs. Consider dedicated urgent care slots for the under 5s• Assessment of an acutely ill child with the aid of PEWs. • Distribution of pocket-sized cards to GPs/CCNTs.• Frequent flyers to be managed by GPs/CCNT.

Reduction in inappropriate attendances and repeatattendances at secondary care

NHS Outcomes Framework and QP indicator on reducing emergency admissions in under 19sNICE Guidance CG160

Harpal Hunjan


12.02.14 30.12.14 20 19 39 1A

Clinical Programme Areas: Children & Young People’s (inc. Maternity / Women’s) (2)

RefClinical

Programme area



Completion Date

Prn Imp Score

Prn Do Score

Total Prn Score


CYP14.44Children &

Young People

Local AuthorityMental HealthSafeguarding

Complete new joint strategy to improve emotional wellbeing and mental health for children and young people. To include recommendations from CAMHS joint strategic needs assessment (JSNA) and production of comprehensive action plan. Implement the joint strategy action plan with regard to emotional wellbeing and mental health [to be developed when known. Anticipated to be 3 year plan]

Improvement in the mental health, emotional and psychological wellbeing of all children and young peopleReduction in children, young people and their families reaching crisisReducing the number of readmissions to mental health services and the emergency admissions for self-harmReduction in the prevalence of depression in children and young peopleChildren and young people will wait shorter times to access servicesImproving children and young people’s experience of healthcare and integrated careReduction in the number of children and young people who suffer avoidable harm (and death)More children and young people will be engaged in achieving education, training and employment.

Joint Strategic Needs Assessment (JSNA) Child and Adolescent Mental Health Services (CAMHS) (2012)Oldham Council, Scrutiny Review – Mental Health and Young People (2013) ‘Report of the Youth Councillors and the Overview and Scrutiny Board’NHS Oldham, Health and Wellbeing Strategy (2013-16)Department for Education (2013) ‘Working together to safeguard children’Department of Health (2014) ‘Closing the Gap: Priorities for essential change in mental health’Department of Health (2014) ‘Making mental health services more effective and accessible’

Harpal Hunjan


01.06.13 30.06.16 22 18 40 1A

CYP14.45Children &

Young PeopleRespiratory

Implement recommendations from paediatric asthma needs assessment including: • EQALS scheme to be developed in relation to children and young people's asthma register• Devise clinical model(s) with pathways • Awareness raising to public/clinicians• GP support programme (include as part of GP educational session as above)

Improve health of the population, improve care provided, improve the health experience of individuals, achieve value for money and support local authority’s children and young people’s plan.

NHS Outcomes Framework and QP indicator on reducing emergency admissions in under 19sJoint Strategic Needs Assessment (JSNA) Paediatric asthma (2012)

Harpal Hunjan


01.08.13 31.2.15 23 21 44 1A

CYP14.46Children &

Young PeopleLocal authority

In conjunction with the local authority, implement the Early Help Strategy (0-19) as part of Public Service Reform (PSR) including providing support to:• Review and implement a new health visitor and school nurse service specifications. • Increasing breastfeeding initiation and sustenance. Consideration to health visitor service specification and children's centres.• Implement Family-based Sports and Physical Activity Strategy to increase participation• Implement the teenage pregnancy strategy• Develop and implement a sexual health strategy• Implement the infant feeding strategy• Support NHS England in the introduction of Family Nurse Partnerships to support teenage first time mothers • Troubled Families and Family Focus interventions with local authority• Implement the Healthy Weight Strategy in children and young people (National Child Measurement Programme)• Implement an oral health action plan to improve dental health and reduce tooth decay• Implement key recommendations from the infant mortality strategy

• improving the wider determinants of health• health improvement• health protection• healthcare public health and preventing premature mortality.

Public health outcomes frameworkIntegrated Commissioning

Harpal Hunjan


23.12.12 31.03.15 20 20 40 1A

CYP14.47Children &

Young PeopleMental Health

Support local authority in the production of a joint strategic needs assessment (JSNA) for accident prevention and implement the recommendations (should address children and young people seriously injured in road traffi c accidents, accidents in the home, hospital admissions for drugs & alcohol and self harm)

Reduction in hospital emergency admissions caused by unintentional and deliberate injuries in age 0-24 years

NHS Outcomes FrameworkNICE Guidance (2010) Preventing unintentional injuries among under 15s

Harpal Hunjan


18 18 36 2A

CYP14.48Children &

Young People

Maternal health - Improving maternal and child health through the antenatal period, including:• Opportunities to increase early access to maternity services within primary and community setting• Review of maternity services (across the North East Sector)• Review of Early Pregnancy Assessment Unit (EPAU)• Raise awareness of:maternal obesitysmoking in pregnancyalcoholphysical inactivitymanagement of diabetesmaternal mental health (attachment)

Improved experience of maternity servicesIncreased early access to maternity servicesImproved maternal smoking at delivery ratesIncreased breastfeeding prevelance at 6-8 weeksReducing deaths in babies and young childrenInfant mortalityNeonatal mortality and stillbirths

NHS & PH Outcomes FrameworkHarpal Hunjan


Y 01.11.13 31.03.15 17 17 34 2A

EC14.09Children &

Young PeopleElective Care Gynaecology projects (NES T&F group developing plans)

Improve the health of the population, improve care provided, improve the health experience of individuals and achieve value for money.

NHS Outcomes framework, Triple aimHarpal Hunjan


1.7.14 30.3.15 0 0 0 3B

Clinical Programme Areas: Dementia

RefClinical

Programme area



Completion Date

Prn Imp Score

Prn Do Score

Total Prn Score


DEM14.01 DementiaImplementation of enhanced memory services including voluntary sector

know where to go for help

know what services they can expect

Seek help early for problems with memory

Oldham Dementia patients get high-quality care and an equal quality of care

Are involved in decisions about their care.

Living Well with Dementia

Improving Care for people with DementiaKeith Jeffery

Jacqui Matley /

Lisa Wilkins20 17 37 3C

DEM14.03 Dementia Implement appropriate prescribing of antipsychotics in dementia








Jacqui Matley /

Lisa Wilkins21 22 43

DEM14.04 DementiaEvaluate RAID: Psychiatric inpatient/A&E liaison service for PAHT (PCFT CQUIN 2012/13 -2014/15)

Better outcomes for Dementia patients in Oldham

Improved value for money



Jacqui Matley /

Lisa Wilkins25 18 43 1A

DEM14.07 Dementia Improve diagnosis rates in primary care








Jacqui Matley /


DEM14.08 Dementia Review of respite care optionsBetter outcomes for Dementia patients in Oldham




Jacqui Matley /

Lisa Wilkins6 6 12 1A

DEM14.09 DementiaRollout of Dementia Friendly Communities following pilot in Saddleworth








Jacqui Matley /

Lisa WilkinsMay-14 24 22 46

21 21

Clinical Programme Areas: Dementia (2)

RefClinical

Programme area



Completion Date

Prn Imp Score

Prn Do Score

Total Prn Score


DEM14.09 DementiaRollout of Dementia Friendly Communities following pilot in Saddleworth








Jacqui Matley /

Lisa WilkinsMay-14 24 22 46

DEM14.10 Dementia Training & development for staff, carer and volunteers








Jacqui Matley /


DEM14.11 DementiaCarry out series of events / activities during Dementia Awareness Week








Jacqui Matley /

Lisa WilkinsMay-14 23 23 46 3C

Clinical Programme Areas: Elective Care

RefClinical

Programme area



Completion Date

Prn Imp Score

Prn Do Score

Total Prn Score


EC14.01 Elective Care Complete mobilisation of Oldham community servicesImproved community services, especially responsiveness to urgent demand and care coordination

Responsive community careZuber

AhmedMichael Dearden

David Brownlow

Gary Flanagan

Feb-14 May-14 21 15 36 1B

EC14.02 Elective CareReview interface service referral triage system (ensuring choice and quality improvement)

Robust application of EUR across all pathways - improved effi ciency

System effi ciencyZuber


Apr-14 on hold 13 15 28 3B

EC14.03 Elective Care Interface service onward referral monitoring systemSystematically embed direct listing for surgery where appropriate



Tim BallardGary

FlanaganApr-14 Sep-14 16 16 32 2B

EC14.04 Elective CareImplement consultant-led Referral Gateway Advice and Guidance service, patient non-face to face consultations

Improved primary care quality and reduction in avoidable admissions

Primary care quality improvement & system effi ciency

Zuber Ahmed

Michael Dearden

Feb-14 May-14 18 17 35 1A

EC14.05 Elective Care Review pathology provision and demand management Ensure value for money TBCZuber


not started 0 0 0 3B

EC14.06 Elective CareLiver disease- Implement recommendations from needs assessment

TBC TBCZuber



EC14.07 Elective CareNeurology service redesign (address capacity and demand pressures)

Improved pathway effi ciency and reduced waiting times

Improved access and effi ciencyZuber


Lisa West on hold 0 0 0 2B

EC14.08 Elective Care Complete Dermatology tenderTotal Skin Service to provide Consultant led high quality care in Oldham (reducing inconvenience of current patient travel to Tameside Hospital)

Improving service deliveryZuber


Emma Dearden

Apr-14 Jan-14 19 13 32 1B

EC14.10 Elective Care Arthroplasty FU pathways reform (MSK)Evidence based follow-up protocols to improve detection of maligned joint replacements - improved patient long-term quality of life



Apr-14 Aug-14 18 19 37 2C

EC14.11 Elective Care Fracture clinic pathway reform (MSK)Improve effi ciency and patient convenience by not requiring patients to attend follow-up appointments where appropriate

Improving effi ciencyZuber


Apr-14 Sep-14 19 14 33 2A

EC14.12 Elective Care Direct listing for MSK pathways (MSK)Improved patient experience and pathway effi ciency



Apr-14 Oct-14 20 18 38 2B

EC14.13 Elective Care Pain - implementation of new service modelHolistic pain management service to effectively manage psychological needs alongside physical needs and deliver significant effi ciency savings

Improving service delivery & effi ciencyZuber


Feb-14 Sep-14 24 10 34 1A

EC14.15 Elective Care CancerReview of Gastroenterology services including capacity & demand and implications for Upper GI cancer pathways

TBC TBCZuber



EC14.16 Elective CareMSK IPH : Governance, financial frameworks and contractual mechanisms in place to support the IPH

Kashif?Zuber

AhmedKashif Akram

17 18 35 2B

EC14.17 Elective Care Stocktake of referral templates

Complete and accurate repository of all referral templates used by Oldham practices (accessible via the web) plus the introduction of a gateway approval process for new templates



Feb-14 Aug-14 18 13 31 2B

Clinical Programme Areas: EndocrinologyRef

Clinical Programme area



Completion Date

Prn Imp Score

Prn Do Score

Total Prn Score


END14.03 EndocrinologyInstallation of a cross-sector integrated IT patient management platform

Please remove IT system in place for ODS service Hyder AbbasLesley Hoyle

Mar-13 Mar-15 15 11 26 1B

END14.04 EndocrinologyStructured Patient Education Programme available for all people with diabetes DAPHNE & DESMOND

Improvement in knowledge and self management of diabetes

CVD Strategy Diabetes NSFNICE TA60NHS, Public Health and Adult Social Care Outcomes Frameworks

Hyder AbbasLesley Hoyle

Apr-14 Mar-16 18 25 43 1B

END14.05 EndocrinologyDeveloping partnership working with NHS England to support the screening uptake of Diabetes Retinopathy

Reducing blindness and partial sightednessImproving and maintaining quality of life outcomes for people with diabetes

CVD Strategy Diabetes NSFNICE TA60NHS, Public Health and Adult Social Care Outcomes Frameworks


Apr-12 Mar-15 0 0 0 1B

END14.06 Endocrinology

Children & Young People

LTC Public Health

Supporting public health campaigns on breast feeding, height / weight measurements in school children, diet, obesity and physical activity in all age groups

Reduction in prevalence in Type 2 diabetesreducing number of people with Type 2 diabetes

NICE PH38CVD Strategy NHS and Public Health Outcomes Frameworks


Continuous Continuous 21 25 46 2C

END14.07 EndocrinologyCVD Screening Public Health

Identification of diabetes in targeted ‘at risk’ groups.

Close the registered vs prevalence (undiagnosed) gap (estimated nationally to be 25%) Improve disease management Prevent complex comorbidities development (CKD, CVD, PAD) Potential cost savings on treatment of co-morbidities including social care costs

CVD Strategy Diabetes NSFNHS, Public Health and Adult Social Care Outcomes Frameworks


Apr-14 Mar-15 21 25 46 1C

END14.08 EndocrinologyStructured programme of diabetes training and education for General Practice staff

Improved clinical quality of care and management of HbA1c (optimise HbA1c at =<7.5) and cholesterolPrevention of diabetes through improved manageemnt of pre diabetic statesPrevention or slowing of comorbidities and complications associated with diabetesreducing health and scoial care needs Improving life expectancy between those patients with diabetes and the population without diabetes



Apr-14 Mar-15 25 25 50 2C

END14.09 EndocrinologyMedicines

management CCG QP indicator 8 processes of care




Apr-14 Mar-15 25 25 50 1A

END14.10 EndocrinologyMedicines

management Use ICDS specification and QOF management to lever reductions in diabetic morbidity




Apr-13 Mar-15 25 25 50 1A

Clinical Programme Areas: End of Life Care

RefClinical

Programme area



Completion Date

Prn Imp Score

Prn Do Score

Total Prn Score


EoL14.01 End of Life CareMobilisation of Integrated EoL service, including expansion of rapid palliative care discharge programme

TBC TBCMatthias Hohmann

Nadia Baig / Dan Cassell

Apr-14 Mar-15 19 11 30 1A

EoL14.07 End of Life Care Implementation of EPACS system TBC TBCMatthias Hohmann


Jul-14 Dec-14 20 14 34 1B

EoL14.08 End of Life CareEnrol further care homes in GSFCH and Six Steps programmes in 2014 as part of overall EOL education strategy



Apr-14 Mar-15 18 15 33 1C

EoL14.09 End of Life CareEnsure achievment of Quality Premium Indicator through development of end of life services, utilising End of Life Profiles produced by Public Health England.



Apr-14 Mar-15 18 19 37 1B

Clinical Programme Areas: Learning Disabilities

RefClinical

Programme area



Completion Date

Prn Imp Score

Prn Do Score

Total Prn Score


LD14.01Learning

DisabilitiesEstablish a joint commissioning approach for people with learning disabilities, including linking with GM-wide overview (on-going)

To establish a joint commissioning approach to LD services across Oldham


Improving Care for people witth DementiaKeith Jeffery

Jacqui Matley

Jan-14 21 21 42 1B

LD14.02Learning

Disabilities

Undertake a review of the learning disability partnership board objectives including redefine and redevelop links with relevant governance structures including Safeguarding Adults, Health and Wellbeing Board (HWBB) and the Integrated Commissioning Team

Tackle social exclusion and give life changes to people with LD

Ensure value for money in LD services

Promote effective partnership working at all levels to ensure a person-centred approach to

delivering quality services;

Drive up standards by encouraging an evidence-based approach to service provision and practice.

Valuing People Now - National Strategy for LD Keith JefferyJacqui Matley

20 23 43 1B

LD14.04Learning

DisabilitiesMonitor all funded placements via a case manager to ensure quality and safety







20 19 39 1B

LD14.06Learning

DisabilitiesDevelop and formally agree a Joint Strategy for improving the health and wellbeing of people with a learning disability







Jan-14 Nov-14 22 22 44 1B

Clinical Programme Areas: Learning Disabilities (2)

RefClinical

Programme area



Completion Date

Prn Imp Score

Prn Do Score

Total Prn Score


LD14.08Learning

DisabilitiesImplement comprehensive action plan from SAF & implement action plan







22 20 42 1B

LD14.09Learning

DisabilitiesUndertake a training needs assessment for LD in primary care







19 21 40 2B

LD14.16Learning

DisabilitiesExpand the range of respite provision available







19 15 34

Clinical Programme Areas: Medicines Management

RefClinical

Programme area



Completion Date

Prn Imp Score

Prn Do Score

Total Prn Score


MM14.01Medicines

ManagementALL Repeat Medicines Re-engineering TBC TBC Anita Sharma Tariq Sharf

Nigel Dunkerley

Rabana Azim Apr-14 Oct-14 16 18 34 1A

MM14.02Medicines

ManagementEndocrinology Audit of BGTS provision TBC TBC Anita Sharma Tariq Sharf

Nigel Dunkerley

Elise Evans Apr-14 Nov-14 16 19 35 2A

MM14.09Medicines

ManagementUrgent Care

Audits to be undertaken against the primary care prescribing formulary of anti-bacterials

TBC TBC Anita Sharma Tariq SharfNigel

DunkerleyRabana Azim / Elise Evans

Jun-14 Dec-14 16 19 35 1B

MM14.10Medicines

ManagementMental Health

Audit to be undertaken in practices which are high prescribers of antipsychotics in dementia patients


DunkerleyElise Evans Apr-14 Aug-14 18 19 37 1B

MM14.21Medicines

ManagementSupport Pharmaceutical Needs Assessment process TBC TBC Anita Sharma Tariq Sharf

Nigel Dunkerley

Strategic CSU team

Apr-14 Mar-15 19 23 42 1C

MM14.22Medicines

ManagementALL Specials - review of prescribing TBC TBC Anita Sharma Tariq Sharf

Nigel Dunkerley

Hazel Lee Apr-14 Mar-15 14 19 33 2B

MM14.23Medicines

ManagementALL Red and Amber Drugs - review of prescribing TBC TBC Anita Sharma Tariq Sharf

Nigel Dunkerley

Farkhunda Javed

Apr-14 Mar-15 16 18 34 2A

MM14.25Medicines

ManagementRespiratory

Asthma review: prescribing process development and implementation (includes COPD audit of inhaler use)


DunkerleySaddia Parvez

Jun-14 Dec-14 16 19 35 2B

MM14.26Medicines

ManagementMSK

Undertake comprehensive review of analgesic prescribing, including review of high-risk Cox-IIs & NSAIDs patients


DunkerleyElise Evans

Rabana AzimApr-14 Jan-15 16 19 35 1B

MM14.27Medicines

ManagementVascular

Review of Vascular prescribing, including lipid-regulating drugs, ACE, NOAC, heart failure treatment and smoking cessation


DunkerleyRabana Azim / Elise Evans

May-14 Mar-15 19 18 37 1B

MM14.28Medicines

ManagementReview nutrition prescribing, including GM gluten-free policy audit and sip feed provision rationalisation


DunkerleySaddia Parvez

May-14 Mar-15 16 11 27 1A

MM14.29Medicines

ManagementDevelop Genito-urinary medicine criteria and audit prescribing against these


DunkerleyElise Evans Jul-14 Mar-15 16 18 34 2B

MM14.30Medicines

ManagementMobilisation of Continence & Stoma Service TBC TBC Anita Sharma Tariq Sharf

Nigel Dunkerley

Diane Allen Nov-13 Nov-14 19 11 30 1A

Clinical Programme Areas: Mental Health

RefClinical

Programme area



Completion Date

Prn Imp Score

Prn Do Score

Total Prn Score


MH14.01 Mental HealthMH IPH: Governance, financial frameworks and contractual mechanisms in place to support the IPH

Improve Oldham patients experience of MH services

Improve value for money

Keith JefferyJacqui Matley

TBC TBC 25 19 44

MH14.02 Mental Health Review of Birchwood service provision

High-quality MH services with an emphasis on recovery, reflecting local needs


Closing the Gap: priorities for essential change in Mental Health'

'Treating patients and service users with respect, dignity and compassion'

'Protecting patients from avoidable harm'

No Health without Mental Health'


TBC TBC 20 21 41

MH14.03 Mental HealthReview of Community Mental Health Teams (in collaboration with Oldham council)








Mar-14 May-15 18 23 41

MH14.04 Mental Health Review of Psychiatric Intensive Care Unit Provision (PICU)

Improving the quality of life for patients with MH problems







TBC TBC 20 23 43

MH14.05 Mental Health IAPT Service Review and agree KPIs for service with provider








May-14 Mar-15 24 17 41

MH14.06 Mental HealthRAID: Develop business case and determine funding mechanism for future provision, pending outcome of pilot service evaluation








TBC TBC 25 20 45

MH14.07 Mental Health CAMHS Develop Children and Adult Autism Commissioning Strategy TBC TBC Keith JefferyJacqui Matley

TBC TBC 6 6 12

MH14.08 Mental HealthMedicines

ManagementReview of prescribing for mental health TBC TBC Keith Jeffery

Jacqui Matley

TBC TBC 6 6 12

MH14.09 Mental HealthMedicines

ManagementImplementation of shared care guidelines with primary care TBC TBC Keith Jeffery

Jacqui Matley

TBC TBC 6 6 12

MH14.10 Mental HealthUndertake joint strategic needs assessment (JSNA) re life expectancy gap in people with severe mental illness (SMI)

TBC TBC Keith JefferyJacqui Matley

TBC TBC 6 6 12

Clinical Programme Areas: Respiratory

RefClinical

Programme area



Completion Date

Prn Imp Score

Prn Do Score

Total Prn Score


RS14.02 Respiratoryother LTC's and

social care Develop assistive technology strategy for Telehealth and Telecare

Aims and objectives identified for developing assistive technology across Oldham which supports the 3 million lives campaign. Action plan for moving forward assistive technology within Oldham to prevent admissions to and facilitate discharges from acute care Support people to maintain their health and independent living within their own homes. Reduced moves into care / residential homes

Our health, our care, our say (2006)3 million lives campaignHealth and social care act 2012A Vision for Adult Social Care: Capable Communities and Active Citizens (Nov 2010) NHS Operating Framework 2012-13

Nas Gill / Kathryn Taylor

Lesley Hoyle

Feb-14 Sep-14 17 15 32 2A

RS14.03 Respiratory Pilot - Development of COPD Care Bundles for Primary CareThis work is to be based on COPD case finding project currently under way in Failsworth cluster.


Lesley Hoyle

Sep-13 Dec-14 22 21 43 2A

RS14.04 RespiratoryMedicines

ManagementDevelopment of data extraction tool for the identification of Asthma patients - GSK partner

This is a Pharma supported project Nas Gill / Kathryn Taylor

Lesley Hoyle

Sep-13 Dec-14 0 0 0 3B

RS14.05 Respiratory

Public Health England and

Public Health (Oldham)

Support national and local awareness campaigns – BreathlessIncrease in case finding at earlier stage of diseaseReduced mortality rate from respiratory illness

Public health outcomes framework Nas Gill / Kathryn Taylor

Lesley Hoyle

Feb-14 Mar-14 20 21 41

RS14.11 RespiratoryMobilization of Integrated Respiratory services from April 2014including provision of Pulmonary Rehab

Reduction in acute care admissionFacilitation of earlier dischargeReduction in diagnosed vs undiagnosed COPD

Everyone Counts: Planning for Patients 2014/15 to 2018/19‘An outcomes strategy for COPD and Asthma NHS outcomes framework


Lesley Hoyle

Apr-14 Mar-15 20 25 45 1A

Clinical Programme Areas: Urgent Care

RefClinical

Programme area



Completion Date

Prn Imp Score

Prn Do Score

Total Prn Score


UC14.01 Urgent Care / LTCGovernance, financial frameworks and contractual mechanisms in place to support the Alliance

Clear governance process for Urgent Care Alliance YesDavid

McMaster


/Anne Richardson

Apr-14 Aug-14 17 16 33 1A

UC14.03 Urgent Care / LTC IM&T plan to support the Urgent Care Partnership improved IT links across urgent care services YesDavid

McMaster


/Anne Richardson

Aug-14 Mar-15 15 18 33 2A

UC14.05 Urgent Care / LTC

Development of Community services around the Primary Care Home. Including development of integrated Health and Social Care Core Assessment teams and model for care delivery which includes IAPT support and pharmacy input

Reduce non-elective admissions by 20% for adults (18 years and over) with more than one long term

condition Reduce length of stay by 25% for adults (18 years

and over) with more than one long term condition Improve Patient experience and decision making

in the choice of their care.

YesDavid

McMaster


/Anne Richardson

01.04.14

need to confirm with Ian

Wilkinson

22 17 39 2B

UC14.07 Urgent Care / LTCLong Term Conditions Platform - to include Shared Care Decision Making Programme and motivational interviewing

to support patient engagement, improve patient experience, self management and motivation .

Enable staff to better support patients in making decisions about their care

YesDavid

McMaster


/Anne Richardson

04.09.13 31.03.14 21 21 42 2B

UC14.10 Urgent Care / LTC Review of out of hours admissions ATT (GTD)

Reductions in emergency ambulance activityReductions in A&E attendances

Reductions in hospital admissions Improved response times

Greater patient satisfactionReductions in clinical risks to the patient

associated with hospital admissionDelivery of safe care closer to home

YesDavid

McMaster


/Anne Richardson

01.10.13to be

included in community

spec

Aug-14 16 20 36 1B

UC14.11 Urgent Care / LTC Integrated Discharge Model Reduction in delayed transfers of care YesDavid

McMaster


/Anne Richardson

01.04.14 Mar-15 22 20 42 1A

UC14.12 Urgent Care / LTC Response services review - implement recommendationsintegration of intermediate care and reablement,

links to integrated discharge modelYes

David McMaster


/Anne Richardson

Apr-14 Dec-14 21 16 37 1A

UC14.13 Urgent Care / LTC Care Homes Pilot (EQALS 2a)

The overall aim of this component of EQALS is to improve the health and well-being of GP patients

who are resident in care homes• Establishing registers of care homes patients

• comprehensive medical reviews of care home patients

• reduce A&E attendances and NEL admissions• provide training to GPs and care home staff

YesDavid

McMasterNadia Baig / Dan Cassell

01.04.14 31.03.14 22 20 42 1A

UC14.17 Urgent Care / LTCRespecification of EQALS phase 1 to include national requirements for £ per patient over 75

Improved care for patients with long term conditions

YesDavid

McMaster


/Anne Richardson

May-14 Jun-14 17 16 33 1C

Clinical Programme Areas: Vascular

RefClinical

Programme area



Completion Date

Prn Imp Score

Prn Do Score

Total Prn Score


VS14.03 Vascular To introduce a DVT pathway (Manchester pilot) · Reductions in clinical risks to the patient

associated with hospital admissionYes Anita Sharma

Anne Richardson

Anne Richardson

Apr-14 Sep-14 19 21 40 2C

VS14.07 VascularEstablish an Integrated Cardiology Service by December 2014 - not including respiratory breathlessness clinics

Delivery of safe care closer to home Yes Anita SharmaAnne

RichardsonRichard Roberts

Apr-14 Jan-15 24 15 39 1A

VS14.08 Vascular

Support the use of Guidance on Risk Assessment and Stroke Prevention (GRASP) software in GP practices to advise, support and assist clinicians with treatment of Atrial Fibrillation (AF) and commencement of anti-coagulation therapy. Incentivise AF case finding and anti-coagulation reviews

TBC Yes Anita SharmaAnne

RichardsonAnne

Richardson18 21 39 2B

VS14.13 VascularDevelop post discharge follow up guides, leaflets and care plans re. heart failure

to support patient self care and reduce appointments in primary, community and

secondary care servicesNo Anita Sharma

Anne Richardson

Anne Richardson

May-14 Apr-15 17 23 40 2C

VS14.14 VascularImprove training/monitoring systems (e.g. service utilisation, GP education and feedback)


secondary care servicesYes Anita Sharma

Anne Richardson

Anne Richardson

Apr-14 Mar-15 17 22 39 2B

VS14.16 VascularMaximise referrals to Cardiac Rehabilitation services-include as contractual KPI


secondary care servicesYes Anita Sharma

Anne Richardson

Anne Richardson

Jan-15 Mar-15 18 22 40 2C

VS14.20 Vascular Evaluation of Dragons Den Innovation pilotsto ensure future services are commissioned which

met the cardiovascular needs of the population No Anita Sharma

Anne Richardson

Anne Richardson

May-14 Mar-15 0 0 0 2C

4747

Appendix 3The Clinical Programme Approach

The clinical leadership model

Managing the ‘Whole’ over Time

The Oldham Chocolate Orange

CCG will control the whole health care system and therefore the whole programme budgets in line with

Government policy.

In order to hold control and deliver efficiencies and enhanced quality of the whole ‘real’ budget, segments will be extracted and delegated authority allocated to

clinical teams / clusters / firms to take clinical and management control over a specific clinical budget area.

Each segment (or Programme Budget area) will be set a framework within which to operate led by a Clinical

Director, which is outlined within this section.

The CCG Governing Body will retain macro accountability.Managing The ‘Segments’ over Time

The segments represent individual programme budget areas linked to specific clinical domains such as MSK, Respiratory, CVD etc.

The idea is based on the concept of local ‘clinical firm’ leadership of segment areas using a common method.

This will provide flexibility for all clinicians to engage. 48

The following diagrams represent how potential opportunities within a programme budget have been determined and will be executed. The commissioning support infrastructure put in place for the CCG in the future, will need to be able to execute this method of working on behalf of Clinical Directors.

Step 1: Identify the priorities and establish the clinical leadership and commissioning support arrangements

Clinical programme management

49

Step 2: Identify allocative, technical and market efficiencies

ALLOCATIVE

Examine VariationAnalysis of OpportunitiesInsights into changes

Benchmarking standardsSpecific clinical changesRegulation & ControlsEvery Decision CountsThresholds

Doing the right things right

TECHNICAL

Clinical Pathway AnalysisService Efficiency ReviewsRe-engineering using toolsCapacity & Utilisation Analysis

Integrating Delivery Cost V Benefit AnalysisUsing PROMS for changeThresholds

Optimising Service & System

MARKET

Assessing ServicesAssessing MarketsRegulating SuppliersNegotiating valueOpportunity for CompetitionRedesigning supply relationshipsNHS ConstitutionThresholds

Driving Value through HMA

Adding Value & Balance through Clinical Leadership

How to drive enhanced patient, service and economic benefit from

Clinically led Programme Management

1. Diagnose status of PB (inc coding validation)2. Define strengths and weakness & Op/Gen3. Undertake health market analysis (HMA)4. Follow improvement process (use tools)5. Segment QIPP into 3 domains (CIP)6. Prepare clinical efficiency plan7. Prepare clinical engagement plan 8. Mandated Innovation (e.g. NICE) 9. Prepare Programme Documentation (POP &

COF / QOF KPIs) & reporting system10. Prepare balanced scorecard (link to CAF)11. Organise public/patient participation12. Total decision & contribution pathways13. Determine LA Integration Opportunities14. Prescribing (PB) standards & regulation15. Quality premium / incentives / Performance16. Apply Generic LTC Platforms17. Peer support & education system18. Commissioning support & business needs19. Patient defined Shared Decision Making (YOCP)20. PC Quality improvement Objectives

What parts of this complex system do Clinical Directors add value to?

CAF: Commissioning outcome frameworkPOP: Plans on a PageCIP: Cost improvement programmeYOCP: year of care plans OpGen: Opportunity Generator

Clinically Led Programme Management – The Model for Improvement

50

Step 3: Provider analysis e.g. MSK

Programme Budget: Leadership, Control, Regulation & Benefit Dividend

1st Phase areas of efficiency focus

• Quantify the changes required• Quantify the proposed transfers in activities• Quantify the cost of those activities• Apply an efficiency requirement (transfer of activity requires efficiency %)• Calculate the dividend to effected suppliers

Step 4: Sub-pathway analysis51

Step 5: Define the technical documents for the programme area

Strategic and Tactical Approach to EfficiencyAlignment of QIPP with Clinically led Programme Budget Management

Strategic and Tactical Approach to EfficiencyAlignment of QIPP with Clinically led Programme Budget Management

PIDS: Project Initiation DocumentsProgramme Plans / Programme Budget PlanInsightsInitiativesDriver DiagramsEfficiency / Economic PlanEngagement / Stakeholder PlanBalanced Scorecards

PIDS: Project Initiation DocumentsProgramme Plans / Programme Budget PlanInsightsInitiativesDriver DiagramsEfficiency / Economic PlanEngagement / Stakeholder PlanBalanced Scorecards

Allocative Efficiency

Optimal grip on decision quality and threshold controls for funded activities

Allocative Efficiency

Optimal grip on decision quality and threshold controls for funded activities

Technical Efficiency

Continual review of delivery systems to ensure optimal care delivery at optimal cost

Technical Efficiency

Continual review of delivery systems to ensure optimal care delivery at optimal cost

Market Efficiency

Establishing optimal service & supply chain cohesion. Driving quality & value via patient

choice and clinical integration

Market Efficiency

Establishing optimal service & supply chain cohesion. Driving quality & value via patient

choice and clinical integration

Short term Impact & Saturation (0-12)Economic Impact (High)

Social Impact (High)

Short term Impact & Saturation (0-12)Economic Impact (High)

Social Impact (High)

Med/long term Impact & Saturation (12-24)Economic Impact (Med)

Social Impact (Med)

Med/long term Impact & Saturation (12-24)Economic Impact (Med)

Social Impact (Med)

Medium term Impact & Saturation (12-18)Economic Impact (Med)

Social Impact (Low)

Medium term Impact & Saturation (12-18)Economic Impact (Med)

Social Impact (Low)

Core Principles

•The 3 efficiency domains have to be considered and analysed

•The 3 core domains have to be balanced

•Allocative efficiency (on its own) has a saturation limit i.e. the ‘big hit’ is largely achieved once. In order to retain efficiency created, 2&3 will need to enable and support longer term gains.

Core Principles

•The 3 efficiency domains have to be considered and analysed

•The 3 core domains have to be balanced

•Allocative efficiency (on its own) has a saturation limit i.e. the ‘big hit’ is largely achieved once. In order to retain efficiency created, 2&3 will need to enable and support longer term gains.

Initially, when adopting the programme budget approach, only the clinical elements of the programme budget spend which are directly attributable to the category, and can be performance managed (primarily tariff based activity) will be included. 52

Commissioning intentions approach

PROGRAMME PHASE 1

Opportunity Identification & Prioritisation

Identify Initiatives• Overarching objectives driven by:

• strategic vision, commissioning intentions, needs assessments, national policies/priorities, etc.

• Supported by additional data sources including:

• 'Data Cube', other health intelligence/indicators, etc.

• Further informed by local initiatives• CCG plans, 'grassroots' initiatives)

• 'Long-list' of initiatives must be:• specific actions, not vague

Prioritise Projects

• Assess and score initiatives against Importance and Do-Ability dimensions

• Discuss/define importance and do-ability thresholds

Agree Implementation Plan• Further consideration of

interdependencies, themes, capabilities and capacity to plan

Theme AProj AProj BProj C

Theme BProj AProj BProj C

Theme CProj AProj BProj C

Theme DProj AProj BProj C

M: Decision M: Implement

TP: Analysis TP: Implement


M: Decision M: Implement

QW: Implement


QW: Implement


QW: Implement


QW: Implement

Year 1 Year 2

QW: Implement

AVOID ALTOGETHER

IMPLEMENT IMMEDIATELY

ASSESS IMPACT AND ACT

DELIVER IF DESIRED

AVOID ALTOGETHER



DELIVER IF DESIRED

Prioritising actions

The Prioritisation Tool, (co developed with the NHS Institute in 2009) is a key component of this phase of activity

54

The Prioritisation Tool : Importance & Do-ability (+ ability to flex weighting due to macro forces)

DO-ABILITY: 5 dimensions are assessedPatient & Public Engagement - PATIENTHealth Economy Stakeholder Alignment- LOCALTechnology - LOCALWorkforce -LOCALService delivery – BEST VALUE

IMPORTANCE:5 dimensions are assessedPatient Benefit - PATIENTClinical Benefit - POPULATIONReform/Strategic Direction –PATIENT /POPULATIONOperational Imperative – LOCALFinancial Impact – BEST VALUE

Economic impact & do-abilityFlex weighting

depending on financial scenarios

AVOID ALTOGETHER



DELIVER IF DESIRED

55

56

Each of the Clinical Directors have developed a suite of documents for their clinical programme area,, which includes:

The approach to developing the clinical programme plans

Document Purpose

The case for change Describes why this programme has been chosen as an area of focus

Plan on a page Defines the vision and strategic direction for the programme

Driver diagram Defines what tactics are going to adopted to deliver the outcomes

Programme implementation plan Details economic, activity, performance and workforce impacts expected, and what key actions will be taken over the next 12 months

Risk register Defines what are the key risks to the programme.

Balanced scorecard Defines the measurement framework for assessing programme outcomes. The CCG assurance measures (of which all of the operating framework indicators are included) have been divided up into clinical programme areas, to ensure that there is a clinical leader accountable for each of the measures.

. The majority of these plans have been developed following dialogue with providers along the continuum of care. There is an expectation that as the clinical programmes mature they will take into consideration the long term strategy of providers involved in the

clinical pathways and the needs of individual groups of the patient population. 56

5757

Appendix 4Wider Primary Care at Scale

A: Backstory, Data & Statistics B: Supporting Logic

5858

A: Wider Primary Care at ScaleBackstory, Data & Statistics

Description 2009/10£m

2010/11£m

2011/12£m

2012/13£m

2013/14£m

Total in 5 Years

£mPrimary Healthcare 98 109 110 108 51 477Secondary Healthcare 294 307 304 304 245 1,453Capital Grants 1 2 5 8Commissioned by New Organisations 120 120Total Healthcare Spend in Oldham 393 416 416 416 416 2,058

Description 2009/10 2010/11 2011/12 2012/13 2013/14Oldham Population (Actual) 238,023 239,584 241,059 241,412 242,970

Total healthcare spend in Oldham 2009-2014

Oldham Population 2009-2014

Key Facts•£2b+ cumulative healthcare spend in Oldham over previous 5 years.•Equating to £9k (£1,700+ per annum) per head of population.•Population growth has been relatively steady.•Changes in healthcare commissioning landscape resulting in £120m of Oldham healthcare now procured via new commissioning organisations.

An overview of Healthcare Spend in Oldham – 2009 - 2014

An overview of Overall Healthcare Spend in Oldham – 2009 - 2014

Description2009/10

%2010/11

%2011/12

%2012/13

%2013/14

%Primary Healthcare 25.0% 26.2% 26.5% 25.9% 12.3%Secondary Healthcare 74.8% 73.8% 72.9% 72.9% 58.8%Capital Grants 0.2% 0.0% 0.5% 1.1% 0.0%New Commissioners 28.8%

An overview of Overall Healthcare Spend in Oldham – 2009 - 2014

• Healthcare spend ratio in Oldham over the past 5 years has been 75% Acute VS 25% Primary Care.

• 29% of the CCGs budget transferred over to the new commissioning organisations in 2013/14.

Primary Care Finances - 5 Years Overview

The reduction in 2013/14 expenditure is due to transition of core Primary Care services to the Area Team.

The CCG is still responsible for the overall Prescribing budget in addition to the CCGs investment in Local Enhanced Services (LES) and EQALS (Enhancing Quality & Local Access) schemes.


The balance of Core Primary Care spend transferred to the Area Team in 2013/14.

Description 2009/10 2010/11 2011/12 2012/13 2013/14Global Sum plus APMS & PCTMS Essential, Additional and Other Services 10,858 12,221 13,656 11,644 5,928MPIG Correction Factor 768 576 559 556Total Global Sum and MPIG 11,626 12,797 14,215 12,200 5,928Quality Aspiration Payments 3,194 3,050 3,215 3,416Quality Achievement Payments 752 1,679 1,606 1,754 202009/10 PE 7&8 QOF Easements 203 (188)Total Quality 4,269 4,689 4,987 5,525 20Directed Enhanced Services (Section A below) 2,184 2,140 2,085 1,951National Enhanced Services 93 61 59 83Local Enhanced Services 1,497 1,278 999 457 389EQALS - Enhancing Quality & Local Access Supplies 823of which separately reported:NHS Health Checks for 40-70 year olds 0 110 60 76Care Plans for people with Long-Term Medical Conditions 457End of Life 45Dementia 57Repeat Prescribing 244Total Enhanced Services 4,151 4,059 3,454 2,577 1,192PCO Administered (Section B GMS details below) 692 603 577 834Premises 2,813 1,853 2,071 2,112IM & T monies spent by PCTs on GP practice systems as per Modernising IM & T in General practice guidance

307 185 144 213

Out of Hours Services 1,761 1,708 1,730 1,731 1,719Balance of PMS expenditure (including baseline and Non Dispensing Doctors but excluding Enhanced services element)

9,335 9,973 10,725 11,935

NON DES ITEM - Pneumococcal vaccine, childhood immunisation -Main programme

46 45 24 38

Total GMS+PMS+APMS 35,000 35,912 37,927 37,165 8,859


Oldham CCG Primary Care QualityRefresh of Oldham performance with regard to 10 indicators reported in the National Primary Medical Services Assurance Framework. Indicators chosen because reliable national benchmarking data is available

Seven indicators from Quality Outcomes Framework (QOF) 2012-13.

• ASTHMA8:Asthma Diagnosis• CHD8: CHD cholesterol monitoring• COPD15: COPD Diagnosis• DM17: Diabetes Cholesterol monitoring• DM27: Diabetes HbA1C monitoring• DM31: Diabetes BP monitoring• MH10: Health checks for mental illness

Three indicators from GP Patient Survey (GPPS) aggregated data - Q4 2012/13 and Q2 2013/14.

• Ease of getting through to someone at GP surgery on the phone• Overall experience of making an appointment• Overall experience of GP surgery

Oldham performance benchmarked against 210 CCGs with Oldham GP practice detail

Overall Performance (10 indicators) - Oldham CCG Vs 210 CCGS

Oldham ranked 129th of 211 CCGs

0.0

200.0

400.0

600.0

800.0

1,000.0

1,200.0

1,400.0

1,600.0

1,800.0

2,000.0Aggregate ranking score - all 10 indicators (lower is better)

Quartile 1 Quartile 2 Quartile 3 Quartile 4 Oldham CCG

ASTHMA8: Asthma Diagnosis - Oldham CCG Vs 210 CCGS

65.0%

70.0%

75.0%

80.0%

85.0%

90.0%

95.0%

100.0%ASTHMA 8: The percentage of patients aged eight and over diagnosed as having asthma from 1 April 2006

with measures of variability or reversibility

Quartile 1 Quartile 2 Quartile 3 Quartile 4 Oldham CCG National Average


ASTHMA8: Asthma Diagnosis - Oldham CCG Practices

52.2% of Oldham practices in top 50%45.7% of Oldham practices in top 25%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

110.0%ASTHMA 8: The percentage of patients aged eight and over diagnosed as having asthma from 1 April 2006

with measures of variability or reversibility

Practice National Average Oldham Average Lower National Quartile 1 Lower National Quartile 2 Lower National Quartile 3

CHD8: CHD cholesterol monitoring - Oldham CCG Vs 210 CCGS

65.0%

70.0%

75.0%

80.0%

85.0%

90.0%CHD 8: The percentage of patients with coronary heart disease whose last measured total cholesterol

(measured in the previous 15 months) is 5mmol/l or less


Oldham ranked 73rd of 211 CCGs

CHD8: CHD cholesterol monitoring - Oldham CCG Practices


60.0%

65.0%

70.0%

75.0%

80.0%

85.0%

90.0%

95.0%

100.0%

105.0%CHD 8: The percentage of patients with coronary heart disease whose last measured total cholesterol

(measured in the previous 15 months) is 5mmol/l or less


COPD15: COPD Diagnosis - Oldham CCG Vs 210 CCGS

75.0%

80.0%

85.0%

90.0%

95.0%

100.0%COPD 15: The percentage of all patients with COPD diagnosed after 1st April 2012 in whom the diagnosis

has been confirmed by post bronchodilator spirometry



COPD15: COPD Diagnosis - Oldham CCG Practices


60.0%

65.0%

70.0%

75.0%

80.0%

85.0%

90.0%

95.0%

100.0%

105.0%COPD 15: The percentage of all patients with COPD diagnosed after 1st April 2012 in whom the diagnosis

has been confirmed by post bronchodilator spirometry


DM17: Diabetes Cholesterol monitoring - Oldham CCG Vs 210 CCGS

65.0%

70.0%

75.0%

80.0%

85.0%

90.0%DM 17: The percentage of patients with diabetes whose last measured total cholesterol within the previous

15 months is 5mmol/l or less



DM17: Diabetes Cholesterol monitoring - Oldham CCG Practices


70.0%

75.0%

80.0%

85.0%

90.0%

95.0%

100.0%DM 17: The percentage of patients with diabetes whose last measured total cholesterol within the previous

15 months is 5mmol/l or less


DM27: Diabetes HbA1C monitoring - Oldham CCG Vs 210 CCGS

65.0%

67.0%

69.0%

71.0%

73.0%

75.0%

77.0%

79.0%

81.0%

83.0%

85.0%DM27: The percentage of patients with diabetes in whom the last IFCC-HbA1c is 64 mmol/mol (equivalent

to HbA1c of 8% in DCCT values) or less (or equivalent test/reference range depending on local laboratory) in the preceding 15 months



DM27: Diabetes HbA1C monitoring - Oldham CCG Practices


45.0%

50.0%

55.0%

60.0%

65.0%

70.0%

75.0%

80.0%

85.0%

90.0%DM27: The percentage of patients with diabetes in whom the last IFCC-HbA1c is 64 mmol/mol (equivalent

to HbA1c of 8% in DCCT values) or less (or equivalent test/reference range depending on local laboratory) in the preceding 15 months


DM31: Diabetes BP monitoring - Oldham CCG Vs 210 CCGS

65.0%

67.0%

69.0%

71.0%

73.0%

75.0%

77.0%

79.0%

81.0%

83.0%DM 31: The percentage of patients with diabetes in whom the last blood pressure is 140/80 or less



DM31: Diabetes BP monitoring - Oldham CCG Practices


40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%DM 31: The percentage of patients with diabetes in whom the last blood pressure is 140/80 or less


MH10: Health checks for mental illness - Oldham CCG Vs 210 CCGS

75.0%

80.0%

85.0%

90.0%

95.0%

100.0%MH 10: The percentage of patients on the register who have a comprehensive care plan documented in the

records agreed between individuals, their family and/or careers as appropriate


Oldham ranked 132nd of 211 CCGs

MH10: Health checks for mental illness - Oldham CCG Practices


60.0%

65.0%

70.0%

75.0%

80.0%

85.0%

90.0%

95.0%

100.0%

105.0%MH 10: The percentage of patients on the register who have a comprehensive care plan documented in the

records agreed between individuals, their family and/or careers as appropriate


Getting through to GP surgery on the phone - Oldham CCG Vs 210 CCGS

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%GPPS: Ease of getting through to someone at GP surgery on the phone



Getting through to GP surgery on the phone - Oldham CCG Practices

67.4% of Oldham practices in top 50%50.0 % of Oldham practices in top 25%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

110.0%GPPS: Ease of getting through to someone at GP surgery on the phone


Experience of making a GP appointment - Oldham CCG Vs 210 CCGS

40.0%

45.0%

50.0%

55.0%

60.0%

65.0%

70.0%

75.0%

80.0%

85.0%

90.0%GPPS: Overall experience of making an appointment



Experience of making a GP appointment - Oldham CCG Practices


30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%GPPS: Overall experience of making an appointment


Overall experience of GP surgery - Oldham CCG Vs 210 CCGS

65.0%

70.0%

75.0%

80.0%

85.0%

90.0%

95.0%GPPS: Overall experience of GP surgery



Overall experience of GP surgery - Oldham CCG Practices


50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

110.0%GPPS: Overall experience of GP surgery


oldham nhs ccg strategic clinical commissioning plan 2014-2019 appendices

Documents

panel of dragons

dragons den panel

oldham president

implementation ccg

ccg meetings

internal ccg team bidders

months bidders

fantastic way