OCCG Connect Newsletter – May 2015
A Message from the Chief Executive at Oxfordshire Clinical Commissioning Group (OCCG)
You might have read in the local press that we want your views on the sort of health services we’ll commission at Townlands Community Hospital in Henley on Thames. The reason we are consulting the public is because our vision for the hospital has changed: we want to commission services that allow patients to receive high quality health care at home or in the community which we believe is more effective than a traditional bed based hospital approach. It means we have changed our service plans for the hospital and you can find more details of these and how you can share your views with us in the newsletter.
I would urge you to take part in the consultation – which runs until Monday 15 June – to help us gauge your thoughts and views on the best way forward.
Alongside our health and social care partners, we enjoyed a very constructive day last month developing plans for improving the way we deliver health services in Oxfordshire under an initiative called ‘new models of care’. This fits with our new approach at Townlands Hospital and focuses on treating patients at home or in the community. You can read more about the event in the newsletter and we’ll keep you informed of how we are progressing with this work.
Don’t forget you can join us at the next Oxfordshire Clinical Commissioning Group (OCCG) Governing Body meeting at Henley on Thames Town Hall on Thursday 28 May (9.30am to 1pm). You can submit a question beforehand and details on how you can do this are on our website.
Breaking the cycle – Oxfordshire
BTCycleOxfordshire Systems Resilience Group (SRG) is delighted with the commitment and effort shown by NHS and social care staff during a week of action at local hospitals to help improve patient care.
The initiative called ‘Breaking the cycle’ brought together local hospital, ambulance and social care staff who trialled new ways of getting patients who need urgent care seen, treated and, if appropriate, discharged more efficiently.
David Smith, Chief Executive at OCCG and Chair of SRG, said: ‘ The extraordinary efforts of staff working in the hospitals, the community and social care left many inspired and excited by a real belief in our own ability to drive change. The week really showed what we can achieve if we pull together and focus on driving improvement.’
Much was learned from the week and some examples of this included improving access to porters and therapists as well as pooling knowledge on support available in the community. Health and social care partners are looking forward to using the analysis of the week to act as a spring board to achieve more than 95 per cent of patients seen in 4 hours every day in local A&E departments.
Other activities included putting more social care staff on hospital wards, GPs working with paramedics to undertake home visits earlier, carrying out extra patient transport journeys, carrying out scheduled operations earlier and cancelling non urgent meetings to help patients move through hospitals more efficiently.
‘Breaking the cycle’ is an national initiative and has been shown to bring about positive changes in other parts of the country, improving A&E performance, reducing ambulance waiting times as well as reducing delays in transfers of care.
The SRG comprises OCCG and health and social care partners including Oxford University Hospitals NHS Trust, Oxford Health NHS Foundation Trust, South Central Ambulance Service NHS Foundation Trust, Oxfordshire County Council, the voluntary sector and Oxfordshire Local Medical Committee. They help to review the support required for the health and social care services to operate successfully throughout the year.
Transforming Healthcare in Oxfordshire
Managers and GPs from OCCG, local hospitals, local GP Federations, voluntary groups and charities, the county and district councils met to discuss the progress being made to develop new ways of delivering care for local patients.
The event was held last month as partners in Oxfordshire seek to be part of a wider national move to deliver more innovative and cost effective services by introducing ‘new models of care’ across the country.
This is to meet the challenges facing the NHS which include keeping an ageing population healthy with less money to pay for health services; and to move towards treating patients, especially the frail elderly, more effectively at home or in the community where the outcomes for patients are better, rather than use the traditional approach of providing bedded hospital care.
‘New models of care’ will see GPs having a more proactive role, supporting their frailest patients with additional support from other health and social care professionals. It will also include health and social care staff working together to provide effective care packages for patients closer to home.
The event held at the Kassam Stadium in Oxford attracted over a hundred participants. Sir Jonathan Michael, the Chief Executive at Oxford University Hospitals NHS Trust gave the opening address and stressed the importance of transforming health services to better respond to the needs of patients.
Dr Joe McManners, Clinical Chair at OCCG, said: ‘The traditional way of doctors, hospitals and community services working more or less separately is increasingly struggling to deliver effective patient care for the different populations we serve. The only way to deliver better care for patients is for all professionals involved in a patient’s care to work together and be involved in the planning of the changes. This includes GPs, hospital and community clinicians, social care staff, charities and the voluntary sector.’
Joe added: ‘There has been an increased demand on NHS and social care services with less money to spend on them. If we want to improve care with these challenges we need to find different ways of working. This particularly applies to patient groups with complex needs, but also applies to groups of patients for whom the traditional 20th century structures don’t work. The new approaches presented at this event should be able to support more responsive patient care in the community.’
Participants discussed the new ways of working already being developed by the NHS and partners in Oxfordshire through five on-going projects. These include:
- Better access to GP services helped by a successful funding award from the Prime Minister’s Challenge Fund:
For full details please see the story ‘Funding to Improve GP services In Oxfordshire’ in this newsletter or click here
- The Mental Health Partnership
This brings together six mental health organisations from the NHS and charity sector in the county who have signed up to work more closely together, to make it easier for people with mental health problems to get the best possible support when they need it. This partnership exists to deliver the mental health outcome based contract introduced by OCCG, to focus on improving patient outcomes (such as housing and employment) as well as providing usual services.
The partnership has developed three initiatives to offer local service users the best possible care, including:
- A triangle of care – a therapeutic alliance between service users, professionals and carers that promotes safety, supports recovery and sustains wellbeing.
- The Mental Health Recovery Star – a tried and tested model for supporting and measuring change for adults of working age experiencing mental health problems. It is designed to be completed collaboratively between service users and staff, to discuss issues and assess where they are now and where they are going.
- The Recovery College – an educational approach to recovery which focuses on people’s strengths, supporting them to understand their own challenges and how they can manage them to achieve their aspirations.
- Oxfordshire Integrated Care Alliance Programme
- In response to OCCG’s work on outcomes based contracting, Oxford Universities Hospital NHS Trust and Oxford Health NHS Foundation Trust are working together, to transform urgent healthcare services for older people and adults who have complex health problems. Underpinned by an alliance agreement to deliver an outcome based contract, the two trusts are committed to change that is patient-centred, transformational and sustainable and delivered at scale and pace. They highlighted that structural process and change throughout the system is essential.
Their proposed model of care is based on supporting a hierarchy of need they have identified for this patient group, which ranges from general elderly patient care at the one end, to the acutely unwell patient at the other. In order to develop services to support this model, they will be focussing on the following key principles:
- a Unified Care Network – providing a seamless network of complex care for patients who are frail, comorbid and vulnerable involving, for example, community care hubs and effective use of telemedicine
- Ambulatory Care by Default – providing the best care, closer to home using infrastructure and teams adapted to outreaching care, managing frail patients proactively with a focus on enablement.
- Specialist Generalist Care – Model of Care – providing Geriatricians, Generalists and Psychological Medicine in both acute and community hospitals and hubs. Outreach support to primary care will be delivered from community hubs and relationships built with clinical colleagues in acute hospitals.
- Universal Best Practice – to deliver cost effective health care based on outcomes that patients told us they want. Key elements of this are; promoting self-care, enabling care, tailored multi-disciplinary care, zero delays, enhanced recovery approach, capable care 24-7 in care environments that are universally, frail and dementia-appropriate.
- Working with Others – the Alliance will work with all organisations across the Oxfordshire health and social care system including those in the voluntary sector.
4. Community Integrated Locality Teams
- The vision for community integrated locality teams is around support for an individual person, so whatever intervention they are receiving, from any number of organisations and professionals, there is just one plan and approach to meet their needs.
- For the individual this means: ‘I can plan my care with people who work together to understand me and my carer(s), and allows me control and brings together services to achieve the outcomes important to me.’
- To do this, there will be one county model, delivered from locality bases to manage patients efficiently, by neighbourhood teams, supporting between 4 and 6 GP practices.
- The teams will be made up of staff and teams from: community health including occupational therapists and physiotherapists, end of life care, community nurses, older people’s mental health, home care support service, falls prevention; social care: including social workers, occupational therapy co-ordinators and Health and Wellbeing Centres; and voluntary organisations:including: community networks, Circles of Support, and Carers Oxfordshire.
- Systems Leadership
- This is a way of working, sharing ambitions and leadership to achieve results across organisations. This goes beyond joint working and is about leading together, rethinking services to put the user at the centre, tackling the underlying causes of complex social and clinical problems, and integrating services to improve quality and value for money.
- Locally we are working to the Local Vision Initiative. This programme brings together local and national government, the NHS, social care, public health, the voluntary sector, user-led groups, the private sector and leadership specialists. Everyone involved in the programme has one shared purpose: to improve services by removing barriers between sectors and organisations.
- Each Local Vision programme is supported by an experienced ‘enabler’ to support leaders in each project to come together and deliver successful outcomes. Our enablers will be meeting with key system leaders in May and will then facilitate a workshop in June. This work will run alongside current system working, to improve how we behave as a system.
Over the coming months’ progress will continue with the focus on testing these new models of care in certain areas of the county.
A Focus on OCCG
Introducing Dr Barbara Batty
In this edition of the newsletter we focus on Dr Barbara Batty who has been a lead GP commissioner at OCCG for the past couple of years. Barbara brings a wealth of experience to this role having worked in general practice in South Oxfordshire for the past 25 years; she is currently a senior GP Partner at the Woodlands Medical Centre in Didcot.
Barbara has been at the heart of GP commissioning going back to her involvement with the former Oxfordshire Primary Care Trust and before that the Primary Care Groups. Her interest in working with frail elderly patients led her to play an active role in the development of the Emergency Multi-Disciplinary Unit at Abingdon’s Community Hospital which has a particular focus on the rehabilitation of older people.
The unit’s innovative approach to providing health care was recognised when it scooped a national award from the Guardian newspaper in 2013. Barbara said: ‘This way of providing healthcare involving a specialist team of clinicians, consultants, GPs, and nurses, enables frail and vulnerable people to receive care closer to their home and in the community, reducing the need for them to stay in hospital.’
Barbara has been actively involved in commissioning health services at OCCG through her role as the South West Locality Deputy Clinical Director until 2014. More recently, she has been working as a GP lead improving urgent care services and developing outcomes based contracting for older people. This new way of delivering services will mean that the success of healthcare will be measured by results or outcomes that matter to elderly patients.
Away from work, Barbara – who is married with three children – enjoys long distance running, having completed this year’s Reading half marathon in just over two hours. Her ambition is to run the Oxford half marathon in under two hours in October.
Funding to Help Improve GPs’ Services in Oxfordshire
The funding will help trial different ways of offering better access to GP services for thousands of patients. These include more urgent same day visits, email consultations and better use of websites to provide health advice.
Across the county, GPs have been working in partnership via ‘federations’ to develop these various initiatives, with the aim of improving healthcare and delivering more care in the community.
The funding – which forms part of the successful Prime Minister’s Challenge Fund bid – means that four pilot projects in Oxfordshire can be tested over the coming year. OCCG supported each bid as part of its priority to play a bigger role in developing local GP services.
At the end of the year, the pilot projects will be evaluated and opportunities analysed by GPs and commissioners before decisions are taken on whether to continue the services and potentially expand them so that they are available county-wide.
The pilot projects include:
- Neighbourhood Access Hubs.
- Home Visiting Teams.
- Care Navigators.
- Online project offering Email Consultations and a Local Health Website.
Neighbourhood Access Hubs
Patients who need a same day urgent appointment with a GP or nurse, but are unable to get one at their GP practice, will be offered one at a local healthcare facility with a local GP or nurse who will also have access to their medical records. This will enable practices to offer more twenty minute appointments to patients with more complex conditions.
This pilot will run initially in Banbury, Bicester, Witney and Wantage and their surrounding villages before being expanded to other areas around the county.
In the north of the county, there are also plans to create Skype-type links to care and nursing homes and even to patients’ homes.
Home Visiting Support Teams
These teams will respond to requests for urgent same day home visits from older patients, or patients with more severe conditions or their carers. Patients will be seen by emergency care practitioners promptly to identify early support for patients. This pilot will be run in Banbury, Bicester, Faringdon, Witney and Oxford.
GP practices in Oxford will work with staff in community health services and social care to offer better, joined up care for the two per cent of patients registered with city practices with the most complex conditions. Care Navigators will co-ordinate support for these patients and liaise with their GPs, families and carers, either in practices or in patients’ homes to ensure care is proactive. This pilot will run in all GP practices in Oxford. There will be a similar care navigator pilot running in Banbury, Bicester, Witney and Wantage.
- Email Consultations
GPs in two practices in Abingdon: The Abingdon and Malthouse Surgeries, will offer patients urgent appointments by email outside of practice opening hours, including: early morning, early evening and Saturday mornings. Alongside the new urgent service outside of opening hours, they will introduce a routine in hours email consultation service.
The email consultation pilot has the potential to be expanded to other practices.
- Local Health Website
The Abingdon and Malthouse surgeries will develop a website with health advice to enable people to gain a greater understanding of how they can look after themselves with healthy life-style choices, or manage their care if they have a complex condition. The website will be a localised site and will include self-help guides for managing chronic conditions, a symptom checker and a comprehensive directory signposting people to local support groups and services.
Extra support will be offered by a care navigator who will be available in each Abingdon practice to develop patients’ understanding of their health condition and steer them to support services available locally in the community.
Once the website has been tested it will be made available across the county.
The pilot projects target populations in the county that need greater health care support, to respond to demand for more out of hospital urgent care and to offer further options for patients to get health care advice and take greater responsibility for managing their care.
Dr Joe McManners, Clinical Chair at OCCG, said; ‘We welcome this national recognition of our ambition in Oxfordshire to be at the forefront of developing health services for the benefit of our patients. The funding also provides some much needed extra resource for primary care. We are committed to working with and supporting clinicians and partners locally to help patients get early access to health advice. These initiatives will offer local patients greater flexibility and easier access to health care advice and appointments. We will be working with GPs locally to monitor the success of these projects and to investigate opportunities to develop and share the best across the county.’
The Prime Minister’s Challenge Fund has been running since 2013 to help improve access to general practice and stimulate innovative ways of providing primary care services nationally.
Have Your Say on a New Model of Care for Townlands Hospital
OCCG has been discussing developments and the need to change the original service offer for the new Townlands Community Hospital in Henley on Thames with local providers, local GPs and the Townlands Steering Group.
As part of this work OCCG wants to understand the public point of view about the proposed changes to services in the hospital.
At the heart of the changes are proposals for the delivery of good quality care close to home which may include diagnosis, observation, treatment and rehabilitation. This type of care is referred to as ‘Ambulatory care’ as it is not provided in the traditional bed based environment.
Dr Andrew Burnett, South East Locality Clinical Director at OOCG, said: ‘This approach has been endorsed by many clinical groups such as the Royal College of Physicians (RCP) Acute Medicine Task Force, the College of Emergency Medicine as well as The Kings Fund and others. Delivering ‘ambulatory care’ is not easy. This way of working will require clinicians and their patients to work together in ways that we haven’t done up until now, but this will be an opportunity to bring together the people who can provide the support and care people need and want in one place, bringing services for children and adults, for both mental and physical health and wellbeing, together’.
Within Oxfordshire the shift towards ambulatory care has been made with the introduction of the Emergency Multidisciplinary Units in Abingdon and Witney. These are supported by GPs, community services and acute hospital specialist teams combining resources to best meet the needs of the patient population in or close to their home, wherever possible.
Our desire to make ambulatory care available across Oxfordshire is central to the proposal outlined for the new Townlands Hospital model of care.
In view of the change in the way healthcare will be shaped in the future, we launched a consultation with the public earlier this month, which will run until Monday 15 June. Please share your views with us on our plans for the hospital.
Or, request a copy of the consultation by calling 01865 334638.
Join Us at the Next Governing Body Meeting
The next OCCG Governing Body meeting will take place on Thursday, 28 May 2015 from 9.30am to 1pm at Henley Town Hall, Market Place, Henley on Thames RG9 2AQ.
You can submit a question beforehand to: firstname.lastname@example.org or write to OCCG Business Manager, Jubilee House, 5510 John Smith Drive, Oxford Business Park, Oxford, OX4 2LH.
For more details about our Governing Body meetings please visit the OCCG Governing Body pages here