NEXT STEPS 

November 2015  

Rapid Access Doctor - New service launched

Picture - L to R, Dr Clare Hindley, Rapid Access Doctor and GP,  Joseph McIntyre, Driver, Louise McGraw, Group Station Manager (LAS)

Following successful pilots in Kingston and Sutton earlier in the year, the six south west London Clinical Commissioning Groups have been working together to commission a new, “rapid access doctor” service.

GPs will attend patients with urgent, but non-life threatening, healthcare needs at home following referral from the London Ambulance Service (LAS). These referrals are made either by paramedics on-scene or via a telephone assessment by LAS clinical staff.  The patient will be treated safely at home by the GP and referred on as needed to other health and social care services.  70% of patients seen by the pilot service in Sutton did not need to attend A&E or be admitted to hospital as an emergency.  This is better for patients but also helps free up our local emergency services for those patients who are critically ill.

The service is being rolled out across south west London – it has been launched in Kingston, Merton, Richmond, Sutton and Wandsworth (pictured above) and will be followed by Croydon in the coming weeks.

Dr Chris Elliott, Chief Clinical Officer for NHS Sutton CCG and Senior Responsible Officer for South West London Collaborative Commissioning said:

“I am delighted that our six local CCGs have worked together to commission and launch this innovative new service across south west London.  Not only is it better for patients who will receive safe, high quality care at home, where appropriate, rather than being rushed to hospital, but it will mean that all patients across south west London have access to the same high quality rapid access doctor service that patients in Sutton and Kingston have already benefitted from.”

Lucas Hawkes-Frost, Assistant Director of Operations (South West) for London Ambulance Service said:

'”This is an initiative that the London Ambulance Service is very excited to be involved in, which will allow ambulance crews and other clinicians to care for more patients in the south west without the need for a trip to A&E. This project also stands to improve the links between health professionals across the area; we very much look forward to this partnership.”

Sutton Homes of Care Vanguard Update

Picture: The Sutton CCG team and New Care Models team at Southdown care home

October was an exciting month for Sutton Homes of Care, the new name for Sutton CCG's vanguard project to improve care in care homes in Sutton. We have finally received funding following submission of our value proposition and we launched our nursing home pilot on 26 October.

The pilot involves six nursing homes who have each nominated two members of staff to be their care co-ordinators, who will work as part of a multi-disciplinary team to ensure continuity of care for residents. This means talking to GPs, pharmacists, physiotherapists and other health and social care professionals to ensure that each resident is receiving the best care possible and that care moves seamlessly between everyone involved in an individual’s care.

As part of the programme, the care co-ordinators will receive training from the CCG to increase their skills, allowing them to deliver care that is genuinely centred on each individual resident. Training themes will include care planning, safeguarding, team working and many more areas relevant to care of the elderly. The first training sessions have been held and were a great success.

The pilot will run until March 2016 and if it proves as successful as we hope, we will then be rolling it out to the other nursing homes in Sutton.

We have also had a number of important visitors this month including William Roberts and Lisa Godfrey from the New Care Models team at NHS England, who provide support to vanguard projects; Sir Andrew Dillon, Chief Executive of NICE, who are sponsoring the vanguard initiative in Sutton; and Directors General Jon Rouse and Charlie Massey, and Non-Executive Director Dr Catherine Bell from the Department of Health. After their visit, Jon Rouse tweeted “I have not come across another part of the NHS as committed as Sutton to supporting care homes. Inspiring!”  We are thrilled that Sutton has such a high profile as a leading innovator in the NHS.

As part of our commitment to listen to the views of care home residents and their families, we held a cake, cuppa and chat event at one of our care homes where residents and families shared their views and suggestions for the programme.

This November, we will be launching our Red Bag Scheme, to improve transfers between care homes and St Helier hospital, and we are developing e-learning modules for use within care homes. We are also developing a quality dashboard to support quality and safety across our care homes.

In Step With...

Graham Mackenzie, Chief Officer 
Wandsworth Clinical Commissioning Group 

What role do you play in the SWLCC programme?
Along with my fellow CCG Chief Officers in SWL, I have responsibility for shaping and supporting the design and delivery of the programme. More specifically, I am the SRO for the Transforming Primary Care programme. It’s a busy area at the moment as we work together to enhance primary care in SWL and increasingly look to take on more commissioning responsibilities locally from NHS England. I also represent SWLCC on the London Transformation Group that oversees the delivery of the 13 Healthy London programmes and I am joint SRO for the London Personalisation & Participation Programme. 

If you had a magic wand, what one thing would you change about the NHS?
I’ve worked in Wandsworth for over 8 years and have been a resident of the Borough for much longer than that. I have a real affinity for the place and value being able to contribute to change and improvement in services in my local community.

What are your hopes for the programme?
I started my career in the NHS, many years ago, working in a large long-stay hospital for people with learning disabilities. It was a dispiriting environment. I saw first -hand the negative effects of institutional care, where the requirements of the service overshadowed the needs of individuals.  We’ve made huge strides across health and social care services to improve models and cultures of care, but undoubtedly we can still do more. So my wish would be for faster pace transformation towards enhanced and consistent person-centred, personalised care, treatment and support.

Describe yourself in three words?
Reliable. Measured. Honest.

Roundup from the Party Conferences..

This year’s conference season recently came to an end. The NHS Confederation has written an engaging summary of what each party had to say...

Ensuring key challenges are heard

NHS Confederation attended the three biggest parties’ conferences to make sure the key challenges facing the NHS were heard. Contributing to sessions on ensuring people-centred care, end-of-life care and the future shape of the NHS, the Confederation outlined the wide range of ways that our members are working with partners to transform care and ensure the long-term sustainability of the health and care system. 

With that consistent thread, each party set out how it will address the health and care agenda. (Summary below provided by the NHS Confederation).

Conservatives 

For the Conservatives, Jeremy Hunt stated: “Some people say we don't have enough money in the NHS to deliver the high standards of care we all want. But it isn’t a choice between standards or money. If someone catches MRSA in hospital, they stay in hospital for longer costing the NHS more money. Safer care costs less, not more."

Other key points from Jeremy Hunt:

• Mr Hunt argues that safe care isn’t just about weekend services – there needs to be a focus on avoidable deaths. Central to this is the ability for staff in the NHS to be open and transparent.  
• On GPs, Mr Hunt highlighted the £750m scheme announced to improve primary care premises and technology to allow surgeries to expand and modernise their services. 

Labour

The conference gave Labour's new spokesperson, Heidi Alexander, an opportunity to start setting out her views on health and care. During her speech, Heidi Alexander said: "We need to create a health and care service centred on people and their families, with mental health at the centre, not the fringes.

"We need big changes in the way the NHS handles complaints and responds to whistleblowers. Big changes if we are to break the vicious, vicious cycle linking poverty and poor health. And big changes too in the way we care for older people and support the carers who care for them.”

• Mrs Alexander cited figures claiming that almost 90,000 patients waited longer than two months to start cancer treatment, over 300,000 patients have had their operation cancelled at the last minute and 4.8 million waited longer than four hours in A & E.
• Many doctors and nurses face real-terms pay cuts over next four years.
• On the junior doctors’ contracts, Mrs Alexander said the contract risks ‘returning to the bad old days of overworked doctors, too exhausted to provide safe patient care.’ She added that this government is ‘punishing staff for their own financial mismanagement of the health service.

Liberal Democrats

For the Liberal Democrats, Norman Lamb, who remains in place as Lib Dem health spokesperson, stated: “Health and care is so important. We must not let party politics get in the way of what is the right thing to do. I argued for the same approach on care before the 2010 election. I will keep making this case. I will not give up until this case is won.”

Other key points from Norman Lamb:

• Mr Lamb advocated an effort to use new technology more effectively in the health service, including an upfront fund that could link GP practices with hospitals, ambulance services and patients, allowing the latter to ‘control their medical records.’ 
• Mr Lamb called for a fundamental shift from a sickness service to a health service arguing that the NHS should focus on prevention and the effective management of existing conditions.

• He vowed to lobby for a non-partisan commission to come up with a new settlement for the NHS and care. 

With thanks to The NHS Confederation for providing this summary. More detailed information can be found here on their website.

OPINION 

Good practice from around the world...

Alexandra Norrish, Acute Provider Collaborative  Programme Director describes how data can be used to transform healthcare*

Diversicare, Nashville, Tennessee

At first glance Diversicare is not an obvious parallel for the NHS. A for-profit organisation, with 6,000 employees and an annual revenue of around US $94m, Diversicare’s online profile certainly suggests that it sees itself as a business first and foremost. The company has chosen to specialise exclusively in what its chief executive describes as “low cost” care – a mix of social care and health care, covering skilled nursing, rehabilitation, day care, and residential care. 

What Diversicare does outstandingly well is to use data. The chief executive comes from a background in health IT, and the business model focuses around data mining as the way to drive down cost and increase quality.

The entire business – stretching across several states – is run from one room in Nashville, which is lined with computers. At these computers, a team of about 20 analysts track data in real time. Every time a nurse in one of the Diversicare facilities administers a drug, or records an incident, or sends a patient to hospital, the information – anonymised – is uploaded in real time to the computers in Nashville.

There, a series of calculations are run every night to track what is going on across the organisation. The computers pick up on any variation in performance: if one care home has unusually high prescription of drugs, or higher than average hospital admissions, the evening report will flag this. When I visited, the chief executive showed me an incident from the previous month: the computers had picked up on a sudden increase in problems associated with the shift patterns of one particular member of staff. Staff at the facility had not noticed, but the computers had picked up on a pattern of poor care as soon as it started.

Using data to understand care outcomes in this way is not altogether unusual in the US, but it is light years away from what most NHS organisations envisage. The basic principle is not complicated; could this be the next step after an Electronic Medical Record?

* This is an opinion piece and the views in this article are that of the author.