Consolidated Funding Framework (CFF)

2018-2019 Support Pack

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Contents

This support pack is intended to be printed as a whole on both sides, so some pages have been left intentionally blank. Individual copies of each item are available on the CCG website and can be found at the following link

Item / Item Details / Page
A1 / Foreword / 5-6
A2 / CFF Sign-up Sheet 18-19 / 7-8
Financial Balance
B1 / Financial Balance – Guidance / 9
Engagement
C1 / Engagement Guidance: Clinical Representation , PPG Engagement and Patient Communication, Collaborative working and Workforce and skills data. / 11-12
C2 / PPG Engagement Plan Template / 13
C3 / PPG Engagement Progress Report Template / 14
C4 / Collaborative Working Project Plan Template / 15
C5 / Collaborative Working Progress Report Template / 16
C6 / Collaborative Working Project Evaluation Template / 17
Frailty and Care Management
D1 / Care Planning Guidance / 19-22
D2 / Catheter Register Guidelines / 23-26
D3 / GSF/MDT Guidelines / 28-31
D4 / GSF/MDT Meeting Template / 32
D5 / Post Death Audit Guidance / 34-36
D6 / Post Death Audit Report Tool / 38-39
D7 / Post Death Audit Report access and guidance / 40
D8 / Mental Health Dementia Care Planning Guidance / 42-44
D9 / Mental Health Physical Health Check for Serious Mental Health (SMI) Patients / 46-50
D10 / Diabetes and Diabetes Prevention Guidance and Improvement Plan Template / 52-57
Cancer
E1 / Cancer Guidance / 59-60
E2 / Cancer Campaign Timetable / 61
E3 / Practice Cancer Plan Template / 63-64
E4 / Locality Cancer Plan Template / 65
E5 / Cancer Quarterly Return Template / 67-68
E6 / Breast Screening Letter Template / 69
Planned Care
F1 / CCG Pathway and Thresholds Assessment Guidance / 71
F2 / Medicines Optimisation Guidance / 73-77

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East and North Herts CCG:

Consolidated Funding Framework (CFF) 2018-19

Foreword:

Aim and Purpose – This is the second year of the CFF, which is an investment of nearly £6m into primary care and general practice by the CCG Governing Body. The main aim of CFF funding is to give extra capacity to primary care operating in an integrated and collaborative way in order to help address the ever increasing demand and workload on primary care.

CFF 2017-18 – This has been reviewed with practices and key changes made to the 2018-19 CFF include, simplification – from 17 clinical sections to 12, simplified reporting and monitoring to reduce practice workload and limited changes/new items. Some areas have been dropped completely such as Children’s A+E frequent attendees.

CFF 2018-19 – has been jointly developed during January and February with practice representatives’ patient groups and LMC input. There are limited new elements such as PPG and Locality controlled collaborative working funds. We have tried to build on the successful elements of the 2017-18 CFF and amended funding and monitoring especially where it was not clear what metrics were being used to trigger payments.

The CFF has 5 sections: 2 non Clinical (25%) and 3 Clinical (75%) TOTAL £10.10 per patient.

Non Clinical
Financial Balance
£1.50 / Engagement
£1.0 (4 elements)
  • LCC per practice
  • PPG engagement
  • Workforce returns
  • Locality Collaboration Funds
/ Clinical
Frailty/Care Planning
£4.75 (6 elements)
  • CARE Plans
New and review
  • Mental health
Dementia
SMI Health Checks
  • Diabetes
NDPP
8 Care Processes
  • MDT/GSF Support
  • Catheter Register
  • Post Death Audits
/ Cancer
£1.75 (3 elements)
  • Awareness Training
  • Screening Improvement
  • Breast
  • Cervical
  • Bowel
  • Case Review and Pathway/patient experience improvement
/ Planned Care
£1.10 (3 elements)
  • Practice pathway compliance
  • Practice threshold and referral compliance
  • Medicines Management

Mandatory Elements – The 2 mandatory elements remain the same as in 2017/18 namely.

  • Pseudonymised data extraction to improve risk stratification and system data integration
  • Record sharing by consent. Practices to ask patients for consent to share as part of care planning process and record number of patients who decline to allow sharing.

Proper safe record sharing is key to enabling safe integrated working for the benefits of complex comorbidity patients. We are trying to move to a single system care record for the patient and the CFF is attempting to support this major system wide objective.

New Localities Structure – The CCG Governing Body and the STP are moving towards an integrated care system (ICS) and the Governing Body has re-organised GP leadership roles to enable primary care to lead on this and achieving a more sustainable primary care, as well as integrated place based care linked to the primary care home model.

There will be a two tier meeting system from April 2018 for Localities to support the delivery of CCG and system objectives as set out in the CCG Operating Plan for 2018-19. The CFF is supporting practice engagement in each Locality Commissioning Committee which is accountable to the Governing Body for improving the health of their population and ensuring Integrate Care Delivery Boards (ICDB) deliver local service transformation and service performance targetsas part of the NHS Constitution and Mandate.

Locality Commissioning Committees (LCC) – are formally committees of the Governing Body and will have their own Local Commissioning Plan and priorities for which the local Integrated Care Delivery Board (ICDB) will be the vehicle for delivery. The CFF is intended to empower the LCC and the LCC will be where practices can make a case for exceptionality or special circumstances where CFF payments are concerned. Each LCC will have an oversight role on the CFF and where there are any obvious conflicts of interest issues then the problem will be escalated to the CCG and the Primary Care Committee (PCC) which will act on behalf of the Governing Body on GMS delegation and Locally Enhanced Services including the CFF. It is expected that all practices will be part of their local LCC and attend at least 6 of the 7 planned meetings over the year.

Integrated Care Delivery Boards (ICDB) and other GP/Clinical support – The expectation is that Locality practices will agree locally who will represent practices/general practice on the ICDB. The expectation is that between 2 and 4 members will be representing their Locality practices as all practices are not needed at ICDB meetings as well as LCC meetings. A Federation for example may be selected to represent all practices in one ICDB, or practices could chose to attend by town or rural representation. The ICDB is linked to the STP Place Based Care Delivery Board system as well as the CCG – LCC accountability line.

CFF 2018-19 – Aligns the incentives for practices with developments in primary care and the GPFV especially the extended access agenda and we hope further innovation and change across the health and social care system will benefit patients such as more MDT working and moving to 30-40 minute appointments for complex frail patients.

Monitoring and Reporting – will be done through new Locality Information Packs at each LCC and there will be CCG – wide commissioning workshops to share best practice as well as address problems and issues raised during implementation.

Quarterly Submission Dates – Practices to report back to the CCG on a quarterly basis. The submission dates are as follows:

  • Q1 – Monday 16th July 2018
  • Q2 – Monday 15th October 2018
  • Q3 – Monday 14th January 2019
  • Q4 – Monday 15th April 2019

Consolidated Funding Framework (CFF) 2017-19

Year 2 – 2018-2019

Practice sign up form

Practice Name
Practice Number
Locality

Practice Declarations

As part of the CFF, practices are asked to identify a Lead for the below areas: Please provide the appropriate information, and if during the CFF these positions change within the practices, practices will need to alert the CCG Commissioning team on nd advise of the same information for the new lead.

Lead role: GSF Co-ordinator
Lead Name
Position in Practice
Contact email
Contact Telephone number
Lead role: Diabetes Lead
Lead Name
Position in Practice
Contact email
Contact Telephone number
Lead role: Cancer Champion
Lead Name
Position in Practice
Contact email
Contact Telephone number
I confirm that the practice named overleaf signs up to the Consolidated Funding Framework for 2018/19, and will comply with the core requirements set put in the CFF metrics for 2018/19. The authorised signatory will be the dedicated CFF lead for the practice.
I confirm that the practice representatives identified overleaf will comply with the positions and roles assigned to them on behalf of the practice.
This declaration confirms that the practice will promote early presentation activities for the Cancer element of the CFF as per the guidance provided. The practice will work with the CCG to promote national and regional cancer campaigns, including Be Clear on cancer,will take part in the cancer case analysis, case reviews and 6 months reviews and education and training throughout the year.
The practice will engage with the PPG to help promote and support the campaigns and have a program of activity
This declaration confirms that the practice will comply with the CCG Pathways and Implement Thresholds Assessment elements of the Planned Care Section of the CFF Metrics and guidance documentation.
Any elements of the CFF the practice will not be signing up to are declared in the table below:
Element / Reason for abstaining
Authorised Signatory
Name (print)
Signature
Date
Contact number
Email

Note: No upfront payment will be provided to practices until they have confirmed their sign up to the CFF including the compulsory element of the metrics

***Please return to the CCG on by 30th April 2018***

As stated in the 2018 – 2019 CFF Metrics, the remuneration for the financial balance section is £1.50 (per registered patient). At the end of the financial year, the overall locality spending is to be no greater than its agreed budget measured at the end of year when the Accounts are approved in June 2019.

If a Locality achieves financial balance in 2018/19 (based on assessment by the CCG finance team following submission of end of year accounts), the Locality will be awarded £1.50 per registered patient.

If a locality fails to achieve financial balance in 2018/19, the Locality can be awarded up to 50p per registered patient if it is overspend is less than that recorded in 2017/18.

The funding distribution by Practice will be decided and agreed by the Locality Commissioning Committee.

Financial balance will be monitored and measured by the CCG and reported on following approval of the CCG’s Accounts in June 2019. The locality finance reports will provide an indication throughout the year on how localities are performing.

END

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This guidance is designed to be read in tandem with the detail provided in the Metrics. The aim of the engagement section of the CFF is summarised in the metrics. Meeting attendance per se is an inexact measure for assessing engagement, and so while attendance at meetings is important, it is important that other measures of engagements are also covered in this section.

Meeting Attendance

The CCG Localities workshops are new meetings, and will be an opportunity to tackle areas which are of relevance to the entire CCG. The topic areas may cover areas such as diabetes, GDPR, extended access or others, with an aim of sharing best practice either locally or nationally, and enabling learning across the CCG.

Localities may choose to arrange Task and Finish groups to undertake specific agreed pieces of work, for which locality management funds may be used to appropriately reimburse clinical time, as approved by the relevant Locality Commissioning Committee. The Locality Commissioning Committee may choose to approve the funding of locality management funds for agreed Task and Finish Groups through a virtual meeting process (held via conference call facilities with formal recording of the funding request and the decision and approval) should approval be required within a more rapid time frame.

Metrics and other guidance is provided in the Metrics section. All meeting attendance will be monitored via meeting minutes and/or records of attendance.

C1a Task and Finish Group Guidance

PPG Engagement and Patient Communication

Practices to improve PPG engagement and encourage use of the ‘building better participation’ toolkit developed by NAPP (the national association for patient participation) which can be found at the below link.

Practices are to use the range of resources available including planning sheets and self-assessments. Building better participation is designed for use by a PPG working alongside its GP practice.

You are not expected to work through all four Areas and all their Goals.

This tool is designed for you to pick and mix from the Goals, as is appropriate to your PPG and your practice. You may decide to focus on several Goals within some Areas, while not looking at others.

If the PPG wants to make use of the four Areas of Building better participation we recommend that, initially, you review them with some PPG members and your practice together. We suggest you concentrate at first on the Goals that are most relevant to your PPG.

Things you might discuss with your PPG and practice:

• Which Goals are relevant to you to work on?

• How you might show you are meeting each Goal?

• How you would use the Goals to help set action plans for the year ahead?

Practices are to complete the PPG engagement plan template based on locality and practice clinical priority areas and submit a copy of the plan at the end of Q1 2018. Practices will then provide evidence of progress in implementing at least 2 key actions at the end of Q4.

An engagement plan template and progress report template will be provided by the CCG.

Collaborative Working

This is not to be used for a service that is already funded from another source. The localities may choose to combine the resources from this section of the CFF with other funding sources if appropriate to enable the delivery of the project.

A written project proposal (Item C4) will be submitted to and formally approved by the Locality Commissioning Committee by the end of Q1. Localities may choose to use another template should they prefer, or to submit additional information, but all key areas contained within the template plan must be addressed in the project plan. Planning and implementation will comply with the CCG policy on remuneration (if relevant to the locality plan).

The project needs to be duration of a minimum of six months and a maximum of 12 months.

A further template is provided (Item C5) for monitoring progress, which localities may use should they find this helpful. An evaluation template (Item C6) is provided which must be used and submitted to the Locality Commissioning Committee at the completion of the project.

Workforce and Skills Data

Practices are to complete the workforce data template, and workforce skills/training needs template as sent out by the Primary Care workforce and Education team directly. These will be sent to practices each quarter, with no fixed template as they will be standardising workforce and skills data collection across the STP so the template may change during the year.

END

Item C2 – PPG Engagement Plan

Item C3 – PPG Engagement process ReportItem C4 – Collaborative Working Project Plan

Item C5 – Collaborative working – Progress Report

Item C6 – Collaborative working – Evaluation Report

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Care Planning in Primary Care - CFF 18/19

Background

Care and support planning with people with long term conditions (LTC’s) is about better conversations - emphasising the importance of the care and support planning process itself in achieving outcomes, rather than the written care plan that may emerge at the end.

This guidance provides details on which care plan should be used and where to find it. The documents in this guidance are all patient held documents and there is an expectation that these will be given to the patient. In addition, the professional care plan requirements will be met by the use of templates, sharing of information and details of both are provided below.

What do I need to do?

1) Identify your cohort of patients

1.1 Identify the total number of patients that are in need of a care plan as per the list below:

Patients who are or are at risk of:

  • Frequent attendance at A and E or Ambulatory Care
  • Pneumonia / LRTI (Lower Respiratory Tract Infections) or regular COPD exacerbation
  • End stage Long Term Conditions:
  • CHF (Congestive Heart Failure) NYHA (New York Heart Association) Stage 3/4 or
  • COPD MRC(Medical Research Council) stage 4/5 or O2 therapy or
  • CKD (Chronic Kidney Disease) Stage 4/5 or rapidly declining neurological conditions)
  • Those that exacerbate frequently
  • Frequent admissions (greater than or equal to 2 admissions per annum)
  • End of Life (within the last 12 months of life) or graded as moderately or severely frail
  • Carers who support very vulnerable patients

Some patients may fall into more than one category - please only count them once.

1.2 From that list of patients confirm how many already have a care plan

Total number of patients / Number with a care plan / Number without a care plan
X / Y / Z

This will provide your baseline figures

Target numbers are

  1. New care plans = 70%
  2. Review of care plans = 30%

Total number of patients / Number with a care plan / Number without a care plan
100 / 20 / 80

Example

  1. New care plans = 70% (of 80) = 56 care plans
  2. Review of care plans = 30% (of 20)= 6 care plans

2) Completing Care Plans

2.1 Which Care Plan?

SystmOne - Ardens Users / SystmOne - Non Ardens Users / EMIS Web
Use the relevant condition specific templates to capture key information.
Use the LTC review template to help you identify which condition specific plans the patient needs.
-Click on future care planning
-Click on Generic Care Plan (This is the foundation document) - make sure you select the code from the drop down box
-Click on Specific Care plan - this will take you to the self-management plans for specific conditions
Signpost patients (where appropriate) to self-management support on the Health in Herts webpages
For end of life patients: Ask for consent to add information to the summary care record. Use the EPaCCS leaflet
Further step by step guidance can be on the CCG website / Continue to use the same Personal Care Plan that you used for 17/18 and have used in previous years as part of the avoiding unplanned admissions DES.
Ensure patients are correctly coded with a GSF stage / Frailty code, where appropriate.
Signpost patients (where appropriate) to self-management support on the Health in Herts webpages.
For end of life patients: Ask for consent to add information to the summary care record. Use the EPaCCS leaflet to explain how this works / Continue to use the same Personal Care Plan that you used for 17/18 and have used in previous years as part of the avoiding unplanned admissions DES.
Ensure patients are correctly coded with a GSF stage / Frailty code, where appropriate.
Signpost patients (where appropriate) to self-management support on the Health in Herts webpages.
For end of life patients: Ask for consent to add information to the summary care record. Use the EPaCCS leaflet
Read Codes / CTV3 (e.g. SystmOne) / EMIS
Personal Care Plan offered / XaRB3 / 9NS5.
Offer of Personal Care Plan accepted or Personal Care Plan completed / XaRB2 / 8CMF.
Personal Care Plan declined / XaRB0 / 8IAe
Review of Personal Care Plan / XaRB1 / 8CMC

3) Next Steps