[Dr Helen Hibbs, Wolverhampton Clinical Commissioning Group to update the Board]
Minutes:
Steven Marshall, Wolverhampton CCG stated that the Wolverhampton CCG Operational Plan was a standing agenda item. The NHS had amended the annual cycle and it had now become a two-year plan. As the Operational Plan was still live, it was considered appropriate to give an overview of the key priorities and main activities of the last year.
Steven Marshall gave the following Operating Plan update:
Local Place Based Models of Care/Primary Care:
· Primary care groupings established, joint working underway with hub working together to deliver increased access in primary care on weekends and bank holidays. Discussions underway to identify services that could be delivered at scale across primary care, for example wound care and joint injections.
· Development of Local Quality and Outcomes Framework (QOF) scheme underway.
· Performance dashboards developed for each care model to help determine patient outcomes, demand and variation.
· Working with key stakeholders across the health economy to develop an Accountable Care Alliance model, aiming towards shadow form by 1 April 2018.
· Implemented risk stratification, social prescribing and enhanced rapid response service provision which will help strengthen partnership/multidisciplinary (MDT) working with Health and Social Care as well as delivering admission avoidance and care closer to home.
· Two-way text messaging currently being piloted with a view to being rolled out to all practices by the end of the financial year.
· First phase of Care Navigation being rolled out in primary care (Minor Eye Conditions, Minor Ailments Scheme, etc.)
· Primary Workforce Strategy drafted and in the process of being finalised.
· Clinical Pharmacists working in practice groups.
· Practices undertaken Practice Resilience training.
Urgent and Emergency Care/Improving Flow and Admission Avoidance:
· Discharge to Assess Pathways implemented across all wards, regional recognition for D2A work and Direct Transfers of Care (DTOCs) reduced on track to hit NHS England trajectory.
· Frail elderly pathways being developed and falls service being redesigned in partnership with trust to have a much greater focus on prevention.
· Step up beds commissioned.
· Developed Integrated Emergency Care Passport jointly with Social Care, West Midlands Ambulance Service and RWT.
· Rapid response service provision has been enhanced to include seven days a week provision (over six months 3,375 patients were seen, 3,155 were successfully treated in the community, representing an 85% admission avoidance rate).
· Enhanced risk stratification and MDT approach with primary and community and social care services.
· Launch of red bag scheme.
· A&E Delivery Board is continuing to support schemes that will help improve patient flow and reduce impact on A&E during the winter period.
Elective Care:
· Musculosketal (MSK) service is embedded, community eye care services have been recently re-procured and work is ongoing with the Trust to redesign ophthalmology pathways and shift services into the community closer to home where possible.
· Currently scoping out opportunities to implement clinical assessment services in other specialities.
· The CCG is also currently in the process of reviewing and redesigning other pathways such as wound care pathway, End of Life, neuro rehab and heart failure.
· Continuing to support practices with offering choice to patients at point of referral.
· Working with providers to ensure patients are not waiting more than 18 weeks from referral to treatment and ensuring remedial action plans are put in place where required to deliver improvements.
Cancer:
· Strategic Cancer Group set up, responsible for ensuring oversight and implementation of Achieving World Outcomes Strategy.
· Recovery and Health Wellbeing sessions being delivered by RWT for breast cancer patients and looking to roll out to further specialities.
· Working with Cancer Research UK and GP practices to improve knowledge and information.
· Working with Cancer Research, RWT, GP practices and other key stakeholder to improve uptake of bowel screening.
Mental Health:
· Implementation of Primary Care Counselling Service.
· Improved access and waiting times, early intervention in psychosis and eating disorders with additional investment and remodelling of the pathways.
· Pump priming investment in peri-natal mental health (including multi-agency training) running this programme for our Sustainability and Transformation Plan (STP).
· Recommissioned autism and Attention Deficit Hyperactivity Disorder (ADHD) diagnostic are on a pathway for adults.
· Reducing out of area placements (acute overspill and specialist).
· Better Care Fund – focus on urgent mental health care pathway, further alignment of all age 24/7 crisis care as part of crisis concordant with a focus to move to mental health liaison core 24.
· CAHMS Transformation Plan developed with focus on (Children and Young People (CYP), IAPY, CAHMS crisis services, tier 3 and improved access to tier 4, increasing access prevalent population).
In answer to a question regarding End of Life care, Steven Marshall confirmed that those were better for cancer patients due to the additional resources and focus. There was also a difference depending on where you lived in the city and it was hoped to standardise that. As there were no additional resources, any investment in one area would mean a loss in another and it was a question of prioritisation.
The Chair advised that hospices provided services for cancer patients; however, it was much more difficult to decide the type of End of Life care required for people suffering from other, longer term conditions.
In answer to a question regarding the priorities for improving primary care, Steven Marshall confirmed that quality and coverage where the key elements, with GPs working collaboratively using a multi-disciplined model. That included GP practices merging to provide better quality services in the community.
Helen Child, Third Sector Partnership stated that better care in the community was welcomed and she referred to the importance of supporting people with mental health issues, as many where left without support if they did not meet specific criteria.
Steven Marshall advised that previously under urgent care pathways some people had not meet the criteria and had been left without support. However, with primary care counselling and a more considered approach it was hoped to avoid that in the future.
The Chair advised that if the Operational Plan was updated before next year then a report would be submitted to the Board, if not the Board would receive the update report in 2019.
Resolved:
That the verbal update be noted.