North Derbyshire Clinical Commissioning Group - Commissioning Intentions 2015

Chatsworth Road Medical Centre PPG - Comments

Introduction

These comments are from members of Chatsworth Road Medical Centre and are an amalgam of comments received from specific members.

While it is difficult for us as a PPG to assess the overall CCG position, the commissioning intentions seem to be thoroughly researched and in line with requirements.

The comments are shown in sequential order based on the contents of the Commissioning Intentions Report

The responses to the comments are provided by the relevant officers and managers in the ND Clinical Commissioning Group

Comments

2.1 - Strategic Context

The CCG has a large budget cut to implement while undertaking a range of service improvement programmes. Has there been an overall risk assessment as to which improvement programmes are most at risk from the budget cuts? For instance if 'expensive GP's' retire and there is a lack of new entrants into general practice is there an overall risk of poorer quality services. If so what risk management plans are in place within the Programme Management Office for each of the transformation programmes within the report and also for general service provision?

RESPONSE: Sam Robinson (Governance Officer): CCG Governing Body abides by the CCG Risk Management Strategy for managing principal risks. The strategy outlines the CCG’s and Governing Body’s approach to risk and the manner in which the CCG identifies, evaluates and controls all risks.

The risk management process recognises:-

  • The context within which the risk is managed and properly identified and understood
  • Identifies and prioritises the risk to the achievement of the CCGs objectives, values, policies and aims
  • The evaluation of the likelihood, probability and potential consequence and severity of impact of the risk being realised.
  • The risks being managed and controlled efficiently, effectively and economically
  • Communication and consultation with relevant stakeholders to ensure they are involved in managing the risks which impact on them

RESPONSE: Brian Nevin(Planning Manager):Under the 21st Century programme, each programme has been risk assessed and a process has been agreed and is being used to score those risks in terms of consequence and likelihood. The risks are reviewed regularly to ensure that adequate controls are in place and appropriate action is being taken.

Could the Integration Transformation Fund help this situation, when will the CCG be able to incorporate this into the planning?

RESPONSE: Beverley Smith (Chief Transformational Officer):The CCG has robust financial planning and reports as such in accordance with its governance.

Overall Position of Primary Care

The care provided by GP's and nurses in medical centres is a key part of CCG commissioning and obviously the effect of primary care appears in many sections in the report. Chesterfield has seen a very difficult case of the failure of the Holywell Group to provide an adequate service. Our own practice has limited its growth to make sure that high quality patient care is top of the list of objectives. It appears that practice mergers are not effective and in fact are fraught with risk to patient care. Is there any overall strategic view on the way to provide primary care through a reasonably sized medical centre / practice?

RESPONSE: Marie Scouse (Head of Clinical Quality Primary Care, DHU, 111):Within the CCGs five year plan Strategic Aim 1 relates to Primary Care “Having high quality primary care that works seamlessly with all aspects of the system is central to the CCGs vision The CCG will continue to support practices to maintain and improve quality of Primary Care Provision and to have a broad range of primary care and community care services provided at GP practice level” The CCG is involved in many work streams that are considering how General practice can be supported and developed in North Derbyshire These include Education and Recruitment, Workforce development and alternate models for Primary Care Provision throughout the 24 hour period. These pieces of work are in the early stage of development and to date there have been no recommendations regarding the size of practices that will deliver Primary Care in the future. Consultation with the general public will be undertaken prior to any change to service provision being made

3.2.1 - Integrated Care

The Chatsworth Road PPG believes that the Integrated Care Programme is one of the most important elements in the CCG's plans both to improve care and reduce wasted time and treatment. However our GP's consider that there is a risk to this programme as it will require more initial funding than is being allotted. The PPG has raised this separately and Jackie Pendleton is planning to visit the PPG. We do however wish to register the concern as part of the response to this Commissioning Intentions document.

3.2.6 - Voluntary Sector

With reference to the use of the voluntary sector how will the CCG assess contract capability when this sector has to fund raise in an uncertain environment to ensure that they can provide any service, for instance the current target of raising an extra £1 million pounds to keep the beds operational in Ashgate Hospice. Beds were recently decommissioned due to lack of funds in what is a well known and supported facility.

Additionally when considering a service for which the voluntary sector would be ideal e.g. the recently announced ‘befriending’ service for the elderly and frail, dementia sufferers, mental health sufferers and those with learning disabilities, how does the CCG reconcile the fact that different charities ‘compete’ for the contracts to provide such services and risk duplicating (wasting resources) on parallel recruitment, training and management costs.

RESPONSE: Nicola Longson (Head of Integration): There is work underway to start working across organisations to better co-ordinate commissioning from the Voluntary Sector. Not just health and social care but also to include local authorities and police. We plan also to work on understanding service availability in our geographical communities so this will enable us to see in all sectors what services are available in each area and any overlap.

3.3.2 – One stop Dermatology provision.

What is the difference between a ‘one stop’ provision and a pre-existing clinic or department? Is there a danger here of increasing bureaucracy and management costs in implementing so called ‘one stop’ shops in order to ‘streamline’?

RESPONSE: Lisa Wain (Commissioning Manager): One Stop provision combines a first outpatient appointment with treatment/biopsy in one attendance. The purpose of having this is to increase efficiency for appropriate patients and also beneficial for service efficiencies.

The CCG has a proof of concept scheme commencing soon, which shall see dermatology provision within each locality (except High Peak as 3VH have a Dermatology Service) by means of a GP with a Special Interest. Patients can be referred from their own practice into one of the primary care based services for diagnosis/treatment/management or onward referral to secondary care if required (exceptions around urgent and suspected cancer). This will eliminate the need for many patients having to go into secondary care, enabling the more appropriate cases to be treated there.

CRH have been involved and are going to be mentoring the GPs via monthly sessions held at CRH. The scheme shall operate for 18 months; the final 6 months of which will allow for evaluation of the service and for the CCG to consider future options/viability of the service (the scheme was approved initially at CRG and has been to Primary Care Development Group on a number of occasions for discussion prior to approval).

3.3.6 – What are the manpower consequences when creating centres of excellence for various specialities, as above there is a danger of fragmentation and duplication of provision and staff shortages.

RESPONSE: Beverley Smith (Chief Transformational Officer):This is not necessarily about increasing staffing members but streamlining services to ensure more appropriate and responsive care, enabling the workforce to work more effectively in meeting the needs of our patients.

3.4 – In looking to General Practices and their patients for innovation the problem is the client group that engages in this exercise (see typical PPG membership). This group does not necessarily welcome change and does not subscribe to the idea that, in order to meet the demands of the future, the service has to change. This client group will largely wish to commission based on maintaining the status quo

3.6.1 – Regarding maternity services and a 4 session multi agency provision. Recent studies have highlighted the essential need for a continuing 1:1 care pattern that enables a trusting relationship to be created between a named healthcare professional and the expectant female; this ensures that early problems can be easily spotted and rapid action taken e.g. as in the case of perinatal mental health issues.

Chatsworth Road Medical Centre – Patient Participation Group –

CCG Commissioning Intentions Comments02/12/14Page | 1