City & Hackney Clinical Commissioning Forum

1. City & Hackney Clinical Commissioning Forum Thursday 8th January 2015 St Joseph’s Hospice 13:00-15:00

2. EPS Release 2 City & Hackney Clinical Commissioning Forum 8th January 2015 Ashik Rai

3. Electronic Prescription Service It makes the prescribing and dispensing process easier and more convenient. @EPSnhs EPS enables prescriptions to be sent electronically from the GP to the dispenser of the patient’s choice.

4. EPS overview Nomination Electronic Signatures Electronic cancellation Electronic claims Electronic repeat dispensing

5. GP practice key process changes • Approach to capturing nominations • Preparing a repeat prescription • Signing electronic prescriptions • Electronic repeat dispensing • Split prescriptions. • Electronic Cancellation • Business continuity (when things don’t quite work as expected …)

6. Pharmacy key process changes • Approach to capturing nominations • Dispensing and downloading electronic prescriptions • Dispensing tokens • Electronic cancellation • Electronic endorsement and patient declarations • Electronic claims • End of month processes • Business continuity (when things don’t quite work as expected …)

7. New prescription tracker https://nww.spine2.ncrs.nhs.uk/prescriptionsadmin/ - available from August 24th 2014 The old tracker URL will re-direct to the new URL above.

8. Future of EPS – in progress • Controlled Drugs in EPS • EPS “Phase 4” • Dispensing System supplier relationships • Spine 2 • New prescription tracker • Claim amendment • Message Acknowledgement • EPS Release 3 …

9. Future of EPS – EPS Release 3 An example of the options being considered: • Enhancement of repeat dispensing functionality • More comprehensive dm+d drug mapping / adherence • Eliminate the need for paper dispensing tokens • Multiple nominations for patients • Self-service access for patients, to allow them to view, adds, change or remove their nomination • Instalment prescribing/dispensing • Ability for patients to manage their own medication via a mobile device (e.g. electronic tokens, prescription re-ordering, booking of appointments) • Sharing of prescribing /dispensing information with SCR. • Improvements to the management of larger prescriptions (more than four items) • ‘Push’ delivery of prescriptions • EPS in other health care settings

10. EPS London Deployment Map

11. EPS London Update • Total 1,443 Practices • 1065 Live (74%) • 122 Planned (8%) • 256 No Plan (18%) • Total 1,874 Pharmacies • 1818 Live (97%) • 8 Planned (0.5%) • 48 No Plan (2.5%)

12. EPS Deployment in City & Hackney

13. EPS Training & go-live planned

14. EPS go-live to be booked • Abney House Medical Centre • Brooke Road Surgery • Cranwich Road Surgery • Dalston Practice • De Beavoir Surgery • Lower Clapton Health Centre • SomerfordGrove Health Centre • SorsbyHealth Centre • Statham Grove Surgery • Tollgate Lodge Healthcare Centre

15. EPS Utilisation in City & Hackney How much is it used? At the end of December 2014: • 28 practices were using EPS Release 2 • 22 practices are using EPS for over 25% of prescriptions • of which 12 practices are using EPS for over 40% of prescriptions and 6 over 50%. • National Average Usage = 35% • Target for March 2015 = 40% EPSr2 Data taken from NHS BSA cliams for August and compared the total prescriptions in May 2014

16. Contact details Annette Breslin GP IT Project Officer (NEL CSU) Annette.Breslin@nelcsu.nhs.uk 07961 077038 Charlette Appleton Emis seconded Trainer (EMIS) Charlette.Appleton@e-mis.com 07436 273588

17. Questions?

18. EPS Social Contact Details Ashik Rai Senior Implementation Manager Email: ashik.rai@hscic.gov.uk Web: http://systems.hscic.gov.uk/eps

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20. PRIMARY CARE TAKING ON COMMISSIONING FROM APRIL 2015

21. WHAT ARE WE GOING FOR

22. MONEY • Still work in progress…. • Sufficient money to carry on with contracts √ • Central budgets – TBC • Review again end of January

23. OUR STRATEGY REMAINS

24. OUR PLANS • Access • Early years • LTC and cancer • Mental Health • Social prescribing, prevention and support • Care plans/PBIC • Equity of provision via the Confederation • Understand outcomes and ££s

25. NEXT YEAR • PBs to look at turning DESs in local contracts? - LD, Access, Minor Surgery • PBs to consider more enhancements to “core” and QOF • Other than early years no new things – revise specs for 15/16 • Keep on with additional investment to recognise work in primary care • Keep on working with Confederation to turn into additional manpower and support • Understand and share current spend and outcomes by practice • How do we assess • How do we level up • How can we streamline core and additional • Strategy only works if we remain “productive” – i.e. minimising hospital spend – CCLES behaviours are critical.

26. Primary Care Quality Board CCG Primary Care Clinically led Boards bringing together commissioners and providers to develop clinical plans Oversight of core contract ££s and outcomes - contracts would remain with individual practices HOW WE PLAN TO DO IT CCG Programme Boards CCG Contracts Primary Care Committee Chaired by Mark Rickets LMC; Consortia; Confederation; Public Health; NHSE Chaired by Jamie Bishop (lay member) Board Consultant and Nurse; Healthwatch x 2, Two Lay members, CO & CFO  Supported by Independent GP Adviser, DPH, HWBBs in attendance Define what we want to commission from practices to deliver our service models (and align delivery across providers) Coordination of Programme Board plans Delegated responsibility from CCG Board for primary care contracts All plans subject to member and LMC consultation Scrutinises and approves all contract proposals for practices/the Confederation/ OOH provider Scrutinises all payments to Confederation/ practices/ OOH provider Additional services/local “DES”/local CCG contracts – via the Confederation if list based Proposals to deliver equity

27. OTHER STUFF • New conflicts of interest guidance • Refresh CCG policy • Declarations, openness • Fine balance….. • Constitution changes • Reflecting responsibility for primary care • New conflicts policy • Meeting in public • Lay member roles

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29. Planned Care Programme Update Dr Nikhil Katiyar 8th January 2015

30. GP first referred activity • GP first referred Outpatient activity: is increasing. Based on our referrals year to date, we will have increased our referrals as much as 18% by the end of this financial year. It could equate to almost £2m and this is before the possible impact on elective admissions and day cases. • We are concerned because this can affect our financial stability, our ability to invest in primary care and other new services. • The analysis shows an overall increase across all practices • The Top five specialities across all practices are: gynae, general surgery, T&O, dermatology and ENT. • Acute Paediatric referrals also feature highly in the practices which are 2STD above the CCG average

32. Evidence from the King’s Fund • Firstly – what not to do. • In the current financial climate there is a danger of becoming preoccupied with reducing the volume of referrals. An unsophisticated approach to this, for example setting target referral rates, could do more harm than good. • Commissioners should not introduce financial incentives to drive blanket reductions in referral numbers. • Several areas have established referral management centres which check all GP referral letters before directing them to the most appropriate destination, or rejecting them as unnecessary. These centres may have had some benefits but do not appear to be cost-effective and in some cases undermine referral quality. • Instead, an approach based on peer review and audit of referral patterns among groups of GPs, coupled with a system for harnessing feedback from hospital consultants, holds the greatest promise for improving the quality of referrals while also controlling costs. • Decision-making around referral is a complicated process, balancing several competing concerns and sources of information. There are many different reasons why a GP might make a referral, including the patient's need for reassurance or simply to 'do something’. • There is wide variation in referral rates between practices. At least some of the variation is accounted for by non-clinical factors such as GPs' willingness to tolerate risk and uncertainty, sensitivity towards patient pressure, or fear of accusations of malpractice. • A whole systems strategy will be required to manage demand, with active collaboration between primary, secondary and community care services.

33. Your support • We recognise the pressure we are all under but we need to understand this and gather insight • Things we would like to consider with you: • How do we work more collaboratively with secondary care to ensure our referrals are appropriate? • The higher referring practices would provide the richest source of insights and examples of comparison with other practices • Gary Marlowe, Planned Care Lead would like to meet with the top 7 referring practices with their consortia lead to explore the referrals in more depth during the next month. We will provide support to these practices in case finding. • Consider providing an C&H induction programme on our pathways and culture for new and salaried GPs • We want to think about new ways of supporting practices as well as through the CCLES – prioritising specialities in our education events, more consultant outreach to practices/consortia

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35. City and Hackney CCG Clinical Commissioning Forum 8th January 2015 Children’s Programme Board Consultation with GPs on a strategy for Early Years (0-5 year olds)

36. What currently exists • NHS England • Pre-conception advice (GMS) • Post natal 6- 8 week checks (GMS) • Health Visitors, including developmental checks • Specialised services • CCG • Perinatal mental health • Ante and post natal CCG Contract • Community Services • Vulnerable Children’s Contract • Acute Services • LA Public Health • Children’s Centres • Health Visitors (from October 2015) • School Nursing • Family Nurse Partnership • Local Authority • Social Services • Public Health England • Immunisations • Screening Voluntary sector: Innovation Fund Bonding with Baby Programme So there are many contracts with multiple commissioners and providers

37. How can we improve on this • We want to see an integrated offer from pre- birth to 5 years, with onward links to School Nursing. • The outcomes we would want to contract for are: • An integrated pathway from pre-conception to 5 years • Accessible and strengthened multidisciplinary Child Health Clinics • Improved communication and joint action, agreed and monitored, across health and social care when vulnerability is identified • Improved immunisation rates • A key question is • Do we want GPs to continue to offer Child Health Clinics from practices • or • Do we focus on developing Child Health Clinics in Children’s Centres?

38. Child Health Clinics • If we contract for practice based clinics • What would good look like? • If we contract for Children’s Centres • How do we enable professionals to work together, share information and support children and their families at the right time and place?

39. What do you think about … • How and to whom should we best deliver pre-conception advice? • Should we / how can we incentivise increased rates of immunisations? • How can we work with non-engaging families? • Should we / could we develop the red book so it is a hand held record of all needs and interventions? • Would a Children’s Service Directory, with referral forms, be useful on GP systems? • What else have we not considered?

40. Next steps • Consultation with CCF, review of GP questionnaire responses • Development of draft strategy • Consultation with Children’s Programme Board and LBH Early Years working group • Consultation with public and patient engagement including the Children’s Disability Forum, Maternity Services Liaison Committee and PPI Committee • Consultation with CEC and initiate application for non recurrent funding • Please get involved - • we need interested GPs to help us achieve great things for children in City and Hackney