Sharing your Information for Better Care Central Care Record (CCR)

1. Sharing yourInformation for Better CareCentral Care Record (CCR) Dr Masood Nazir

3. Birmingham CrossCity CCG – current configuration Population: 730,000 patients Number of practices: 117 practices across 125 sites Budget: over £900 million Formed from 3 PCTs across the city and Six former groups: Equity, UBC, SBIC, Sparkfield, BICC, NEB Made up of ten area based clinical networks

4. Local Commissioning Networks Small enough to care, big enough to make a difference

5. A complex 2nd city 8 provider organisations: • University Hospital Birmingham FT – QE Hospital Birmingham • Heart of England FT – Good Hope, Heartlands & Solihull hospitals • Sandwell West Birmingham FT – City Hospital • Birmingham Children’s Hospital • Birmingham Women’s Hospital • Royal Orthopaedic Hospital • Birmingham Community Health NHS Trust • Birmingham and Solihull Mental Health Trust Largest Local Authority in Europe

6. How would CCR help me & my patients?

7. Business Portal Patient Portal Clinical Portal Access to Information • Business Portal for Commissioning decisions • Clinical Portal ( clinicians need this to provide informed & joined up care) • Patient Portal ( Patients will be wanting to access this data)

8. Silos

9. Options Do nothing - Discounted on the basis it would not deliver against the objectives set. Bring together all GP’s to one common clinical system and agree standardisation with all Providers - This option was discounted on the basis of cost, timeframes to deploy and lack of willingness from GP practices to move to one common system. Develop a data repository which will provide Care professionals with a single portal for information.

10. Understanding the record The clinical encounter record Detailed Care Record (local) Central (Detailed) Care Record (Shared) Including Local Pathways of Care Summary Care Record

12. This clinical portal has enabled the capture of a central electronic patient record. The introduction of this system has supported care pathways and clinicians now have access to up-to-date clinical information in all care settings, regardless of discipline or location. Patients with long term conditions particularly benefit from the clinical portal.

13. Benefits • Single Healthcare record • Real-time information • Shared web-based portal • Click through to records from systems – single sign-on • Improved and safer working • Better support of LTC and End of Life • Better management of admissions and discharges • A&E and Out of Hours • Reduction in diagnostics costs • Better collaboration and reduced treatment times • Safer transfer of Patients between health and social care settings • Strategic planning, risk stratification & service redesign. • Improved standards and best practice

14. Improvement in health and social care outcomes • Reducing the incidence of medication errors causing serious harm • Improving the experience of healthcare for people with mental illness • Improving the experience of care for people at the end of their lives • Increase in patient self care and care ownership • Improve Management of risks • Improved multi-agency safeguarding as a result of alerts • Saving and Efficiency • Reduction in medical tests carried out • Avoidance of emergency admissions where possible • Avoided costs of data extraction • Quicker discharge from hospital where appropriate The CCR would benefit both care quality and enable efficiencies

15. User Requirements :Clinicians and Social Care staff

16. Minimum CCR – information held • Do Minimum • Data items to be delivered based on primary care dataset only • Demographic details • Medication history • Allergies • End of Life care plan • Medical tests and results (ones recorded in GP patient record only) • Alerts present in GP patient record

17. Acute provider summary GP summary Community Health summary Medical tests and results Medical tests and results Medical tests and results Medication clashes and reasons for change Medication clashes and reasons for change Alerts - domestic violence Medication clashes and reason for changes A&E / IP / OP attendances MH / Social services / Community Healthcare care plans Alerts - domestic violence / child protection Soc serv / Com Health care plans Ambulance activity Referral details Referral details Social Services care plan Ambulance trust MH / Social services / Community Healthcare care and visit plans Child protection alerts Ambulance activity GP visits Mental Health MH/Soc serv/Com Health care plan Medical tests and results • Core summary • Demographic details • Agencies involved (contact) • Carer / NOK details • Medication history • Allergies • Alerts • A&E / IP / OP attendances • End of Life care plan • Medical discharge summary Medical tests and results MH/Soc serv/Com Health care plan Alerts – domestic violence / child protection / high volume user Medication clashes and reasons for change Medication clashes Alerts – domestic violence / child protection Advanced decision Adult Social Services (ASS) GP visits Referral details MH/Soc serv/Com Health care plan GP visits Children’s Social Services Referral details ASS (hospital based) GP visits Alerts – dom viol / adult protection MH / Soc serv/Com Health care plan Family social care history Best interest decisions

18. So Can we do it?

19. Supporting communications and engagement activity • Public • Dedicated Website • Briefing to MPs and Councilors • Media plan - including pro-active approach for print, online and broadcast media and reactive lines to take • Practices / CCG • Briefing for CCG GP practice facilitators, including FAQs • Communications Pack for practices, including: • - Posters • - Extra booklets • - Example letter • - FAQs • - Digital messages for Well TV screens (where available) • Media handling protocol • Opt-outs • Data Quality framework

20. Data Processing Agreements • Data processing agreements between the CCGs and SWB CCG, to enable SWB CCG as the data processor to hold patient data on the GPs behalf. • Need for agreements before any extractions are initiated, on the understanding that with the patients consent a clinician involved in their care can view their data: • Option 1 – Agreement with CCG • This is in compliance with ‘The principles of data sharing guidance’ - BMA • Effective engagement with their GPs and advise of the activity undertaken • The processing agreements will need to be worded appropriately • Process for Practices to opt-out • Awareness session with LMC – letter of endorsement • Option 2 – Agreements with Practices • Process will be cumbersome and extend project timeframes • Will require resources from the CCG and project team • Communications to practices from CCG

21. Roles and responsibilities • CCR project team • Engagement and training to Practices • Management of Comms and PALs • Regular progress reporting to each CCG • Practice extractions • Opt-out rate • CCG • Senior contact for each CCG • Provide support and guidance to Project team • Support with resolution of issues • Sending key messages to practices • List of CCG Commissioning Managers / Facilitators

23. Example impacts: Fewer home visits reduces costs or increases capacity Increased patient flow in capacity constrained acute settings Increase elective care capacity Non-Cash Releasing Benefits • Improved patient assessment and treatment in urgent care settings • Fewer OOH home visits • Fewer referrals to Emergency Depts, Minor Injury Units and Walk in Centres • Fewer hospital emergency admissions • Improved prioritisation and capacity in Ambulance service • Reduced administration • To establish and record patient data in urgent care settings • In GP practices entering hospital discharge data • Savings associated with fewer unnecessary prescriptions, tests and procedures

24. IG Considerations Legal • Compliance with Data Protection Act, Common Law Duty of Confidentiality & NHS Codes Consent • Consent to upload (process information)- Informed implied consent • Consent to view- explicit consent Audit • Audit trails • Privacy alerts

26. Reducing costs through COLLABORATION

27. “Know where to find the information and how to use it – That’s the secret of success” “An individual without information can’t take responsibility. An individual with information can’t help but take responsibility” Jan Carlzon, business leader (QuoteDaddy)

28. Give me a kick when it’s all sorted Masood Nazir: masood.nazir@nhs.net