SCHEDULE 2 - THE SERVICES
Schedule 2 Part 1
SERVICE SPECIFICATION
Service
Outcome based locally commissioned services
Commissioner Lead
Brighton and Hove CCG
Provider Lead
General Practice via Cluster and City wide arrangements
Period
October 2016 to March 2019
Date of Review
March 2017
1. Population Needs
1.1
Introduction
1.1.1 This specification outlines what Brighton and Hove CCG and Brighton and Hove City Council
(BHCC) want to see implemented in regards to an innovative change to the delivery of General
Practice and the outcomes this will deliver. The delivery of this Locally Commissioned Service
(LCS) provides a significant opportunity to transform the delivery of primary care in Brighton and
Hove, ensuring the patients receive safe and effective care, reducing inequalities and improving
the health and wellbeing of the population. The approach to delivering this LCS will ensure that
all patients registered with a Brighton and Hove GP will have the same access to services they
need regardless of which practice they are registered with.
1.1.2 This specification also demonstrates the commitment to increase investment in General Practice
in recognition of increasing demand and their unique position in delivering health care to our
population. Additional funding and the contractual approach that underpins this LCS will provide
General Practice with the confidence and means to invest in capacity and new ways of working.
1.1.3 The approach, outcomes and guidance that form the basis of this specification has been
developed following a programme of engagement with GPs, other clinicians, patients and other
stakeholders.
1.1.4 Across the population of Brighton and Hove there are a number of key challenges. These
include:
a) Inequalities in health outcomes due to a range of demographic, socioeconomic, cultural and
access issues
b) Significant variation in outcomes
c) Increasing demand on services with growing numbers of patients with long term conditions
and complex co-morbidities.
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1.1.5 Brighton and Hove CCG and Brighton and Hove City Council are introducing an outcome based
approach to locally commissioned services in order to provide better and more equitable care for
the population and support Practices to innovate so as to better manage the significant demand
and challenges they face.
1.1.6 We know that change at this scale takes time and so it is anticipated commissioners will work
jointly with General Practices within clusters to plan a phased implementation of the services
required to deliver the outcomes detailed by this specification.
1.2
National/local context and evidence base
1.2.1 National guidance, research and documentation has set a clear direction of travel for the CCG
and BHCC when developing this specification. This includes:
a)
b)
c)
d)
e)
f)
g)
h)
i)
j)
k)
l)
NHS Five Year Forward View, NHS England 2014
Improving General Practice: A Call to Action, NHS England 2014
Safe, compassionate care for frail older people using an integrated care pathway: NHS
England (2012)
Integrated Care and Support: Our Shared Commitment. NHS England, 2013
Population Health Systems: Going beyond Integrated Care Kings Fund 2013
Securing the future of general practice. New models of primary care. Kings Fund and
Nuffield Trust 2013
Right Care Commissioning for Value: Integrated Care pathways. NHS England 2015
Equity and Excellence: Liberating the NHS. Department of Health (2010)
Integrated Care: what do patient, service users and carers want? National Voices (2012)
Which features of primary care affect unscheduled secondary care use? A systematic
review. Lasserson D, Wye L, et al. BMJ Open 2014
Transforming our health and care system: Ten priorities for commissioners, Kings Fund
(2015)
Managing patients with multimorbidity: systematic review of interventions in primary care
and community settings, BMJ (2012)
1.2.2 Locally, the Joint Strategic Needs Assessment (JSNA) and Preventing Premature Mortality Audit
have particularly highlighted the areas of inequalities and health needs in the City. The CCG and
BHCC’s Better Care Plans and the Joint Health and Wellbeing Strategy all support the vision to
transform services to provide sustainable proactive and responsive care, improve patient
experience, deliver better health outcomes, reduce health inequalities and make better use of
health resources.
1.2.3 Outcome based commissioning is a key strategic initiative and is about developing a shared
common purpose to achieve the best possible outcomes for patients with the investment
available. Developing a shared common purpose will unite patients, general practice and
commissioners in the delivery of sustainable and high quality health care.
1.2.4 All practices are expected to provide essential and those additional services they are contracted
to provide to all their patients through their existing GMS and PMS contracts with NHS England.
This enhanced specification outlines the more specialised services to be provided. The
specification incorporates and extends current locally commissioned services to ensure GPs
have the opportunity to improve outcomes for their population and are funded for care provided
within General Practice that is not included within their core contracts.
1.2.5 The most significant change we want to make is the shift to care that is more planned and
population focused. We want primary care to collaborate with each other and other parts of the
health and care system to provide more joined up services, with greater access when required,
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including 7 day services where relevant, with an emphasis on prevention of ill health, better
management of chronic and long term condition, enhanced self-care and early interventions.
1.2.6 Commissioners wish to see:
a)
b)
c)
d)
e)
f)
Increased focus on prevention by General Practice working in partnership to reduce
morbidity, premature mortality, and health inequalities by treating the cause of illness and
loss of independence.
Better access to primary care, with improved continuity of care and more time available to
spend with patients who need it
Well-coordinated care where patients are proactively identified and reviewed which keeps
people well and out of hospital or residential care where appropriate
Patients enabled to manage their own health and wellbeing with greater confidence and
supported to maintain their independence for as long as possible
Patients empowered and playing an active part of the care planning process and decision
making about the care they require alongside their GP and other professionals
Community services led by GP’s, with a holistic approach that encompasses the entire
patient pathway, with a need to think beyond traditional organisational and professional
boundaries.
1.2.7 Providers will need to come together to design and implement this specification, based on the
detailed evidence in Appendix One. It will also require systematic approaches to patient and
carer involvement in the design and delivery of services.
1.2.8 Strong organisational and workforce development plans will be established by Providers as part
of action planning to ensure the right skill mix is available and new ways of working are adopted.
1.3
Overarching Aims of the Model
1.3.1
We have worked with clinicians, public health, commissioners and the public to agree the
outcomes that are important clinically to our population. These agreed outcomes are detailed in
Outcomes Framework Appendix One.
1.3.2
The aims of this LCS is to invest in General Practice to enable them to deliver services that will
meet these outcomes by providing:
a)
b)
c)
1.3.3
Enhanced access and support to all patients within Brighton and Hove CCG to help them to
stay physically and mentally well, identify and manage patients at high risk of acute and
chronic disease,
Improved management and coordination of care for patients with long term conditions
Maintain and/or enhance the procedures, investigations and interventions carried out in
General Practice to avoid, where appropriate, the need to refer on to other providers
We also wish to support a sustainable model of General Practice for Brighton and Hove
residents. The challenges facing General practice due to increasing demand and workforce
pressures are significant. The CCG and BHCC wishes to invest in General Practice to support
them to address these challenges and develop innovate ways to deliver services. To achieve the
outcomes required for our population alongside these challenges will require practices to
consider delivery at scale. This will require practices to come together in clusters to plan
innovative ways to deliver services, particularly where it makes sense to ensure we make best
use of skills and capacity available within primary care.
2. Scope
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2.1
Service Description
2.1.1 By signing up to this Specification the Provider is required to ensure either through direct
provision in the practice or via cluster arrangements:
a) All patients will have access to all required activities for existing “preventative, proactive,
integrated and extended care” enhanced services as detailed in the evidence and guidance
provided in Appendix Two
b)
All patients will have access to the activity based services for current “Right Care, Right
Place” enhanced services as detailed in the service specifications covering:
1. Phlebotomy
2. Drug monitoring,
3. Ambulatory Blood Pressure,
4. Wound Care / leg ulcer / tissue viability / suture removal,
5. rabies injections,
6. contraceptive needs (LARC and IUCDs),
7. Intermediate care
2.1.2 The Provider is required to work within its Cluster to plan delivery of new activity for up to 3
priority outcomes, based on local population needs as outlined by the baseline data provided.
Suggested new activity is outlined within the evidence and guidance provided in Appendix Two.
Clusters may also put forward alternative activity to meet the outcomes where relevant.
2.1.3 Providers will deliver services in line with the agreed cluster action plans once developed. These
plans must outline their approach to delivering all activities covered by 2.1.1 and 2.1.2, taking into
account the following to design and shape their service offer:
2.2
An Integrated Service
2.2.1 Guidance across the LCS outcomes framework domains recognises that primary, community,
hospital and social care need to be joined up if outcomes are to be improved. This means a
joined up way of working across teams, addressing mental and physical health needs of patients
at an individual level and actively referring patients to reduce social isolation and improve health
such as weight management and smoking cessation.
2.3
Managing patients with multimorbidity
2.3.1 Although the LCS outcomes framework looks at disease specific indicators, the services will need
to be delivered in a joined up way to manage patients with multimorbidity, those with two or more
medical conditions. We recognise that managing several chronic conditions with the current
single disease focus of clinical guidelines, research and the LCS outcomes frameworks is a
challenge. Guidelines rarely deal with comorbidity, in part because they are designed to be based
on evidence from randomised control trial and routinely exclude patients with multiple chronic
conditionsi. Guidelines to cover all combinations of conditions are unlikely and therefore we value,
recognise and support clinical judgement in line with the evidence baseii. At times clinical
judgement may mean an acceptance that in certain circumstances pursuing multiple stringent
disease specific targets is unlikely to be beneficial and may even be harmful. Prioritising the
treatment of one of a patient’s conditions such as depression, which has been shown to impact
the ability of patients to manage their other chronic conditions, may be beneficial.
2.4
Meeting mental and physical health needs
2.4.1 The LCS outcomes framework includes a number of indicators for both mental health and
physical measures of health and a priority for the contract is addressing mental health problems
alongside physical long-term conditions and preventative healthcare. Psychological distress is
common with patients with two or more chronic medical conditions. Priorities as included in the
outcomes framework include:
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a)
b)
c)
d)
2.5
Improving identification of mental health needs among people with long-term conditions
Strengthening data systems to support more systematic coding and better recording of
mental health needs
Including in disease management and rehabilitation, psychological or mental health input
Improving mental health and wellbeing skills within general practice
Patient self-management
2.5.1 Patient self-management is core to improving outcomes across the LCS framework. There are a
number of self-management approaches that aim to empower patients to improve their health
and evidence has shown the importance of ensuring the intervention is tailored to the condition iii.
Specific approaches will be included in the disease specific guidance. Primary care staff and
others will have the skills to enable self-care including techniques such as motivational
interviewing to determine patient priorities and wishes. Patients could be offered the opportunity
to co-create a personalised self-management plan which could include:
a)
b)
c)
d)
e)
f)
g)
h)
i)
2.6
Patient and carer education programmes
Medicines management advice and support
Advice and support about diet and exercise
Use of telecare and telehealth to aid self-monitoring
Psychological interventions (e.g. coaching)
Telephone-based health coaching
Pain management
Patient access to their own records
Referral to the expert patient programme run by SCT
Anticipatory care
2.6.1 Growth in cluster based primary and community care is not about shifting the same care to a new
setting. It is focused on proactive and well-coordinated care which keeps people well enough not
to need secondary care or long term packages. If care is more proactive in its nature and there
are fewer gaps between professionals and organisations there will be a reduction in expensive
reactive care. This is key to both improving health outcomes and managing public sector finances
in a sustainable way. Key areas for anticipatory care are case finding, active management of GP
registers, avoidance of exception reporting and diagnosing conditions earlier. Anticipatory care is
also about ensuring crisis care plans are in place, for example there is an indicator in the LCS
outcomes framework for patients on the palliative care register to have an out of hours form / and
/ or entry on an electronic record regarding their care.
2.7
Preventative care
2.7.1 Primary prevention - more systematic primary prevention is critical in order to reduce the overall
burden of disease and maintain financial sustainability of the NHS. While prevention in childhood
provides the greatest benefits, it is valuable at any point in life. Referrals to health improvement
programmes, delivery of sexual health services are all examples of primary prevention within the
LCS contract.
2.7.2 Secondary prevention– is systematically detecting the early stages of disease and intervening
before full symptoms develop. The LCS outcomes framework has a strong focus on secondary
prevention which largely involves the systematic application of relatively standard, low technology
and low cost interventions. Key actions are:
a)
Ensuring appropriate coverage of key secondary prevention interventions and processes
including managing disease registers, systematically modelling expected versus actual
prevalence and incidence and thereby identifying populations where improvement is needed.
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b)
c)
2.8
Actively supporting patients to attend cancer screening, and deliver NHS Health Checks,
smoking cessation, alcohol brief interventions in line with the evidence base and target
groups. This will involve working with others such as BSUH breast screening centre,
pharmacies delivering smoking cessation services and voluntary sector organisations and
community groups commissioned to support increasing uptake of screening and NHS Health
Checks.
Ensuring systematic control of hypertension, cholesterol and diabetes among practice /
cluster populations
Strengthening Referrals
2.8.1 Many of the activities undertaken within this LCS will provide Primary Care staff with opportunities
to refer patients to other professionals and services to improve the outcomes for individual
patients. There are a number of indicators within the LCS outcomes framework that will support
cluster to consider where other services can support delivery of these outcomes and provide a
way of measuring progress towards addressing risk factors or functional difficulties of patients.
This includes:
a) Medicines Management: regular medicine use reviews for patients with multiple comorbidities or a single long-term condition via referrals to Better care pharmacist or GP for
medicines review or to community pharmacies for Medicine Use Reviews
b) Health improvement: referrals for weight management and physical activity
c) Social Isolation: referrals to voluntary sector to improve social connections
d) Falls prevention: reduction in injuries due to falls by screening of people over the age of 65
and referrals to the falls prevention service for those who have fallen
2.9
Innovation
2.9.1 There is scope within the contract for innovation, for clusters of practices to develop new ways of
working together; to change the way services are currently being delivered if that doesn’t work
and an opportunity to rethink how patients access and relate to services, use of new technology,
different services for different groups e.g. young people, people with long-term conditions.
Innovation needs to be supported by evaluation as part of a learning approach and a structured
means of sharing learning both positive and negative will be put in place between clusters
2.10
IT and digital approaches to care
2.10.1 The risk stratification tool can be used for proactively identifying patients for services delivered
through core GMS, admission avoidance DES and this LCS outcomes framework and there are
opportunities for strengthening clusters and practices use of IT and data systems to improve
patient care. Digital approaches are likely to be an increasing role in enabling people to find out
about their condition, to monitor and treat themselves and to exchange information with others.
2.11
Patient and public involvement
2.11.1 Providers are expected to involve patients and the public in reviewing current service delivery and
activity and with the development of their cluster action plans in response to this specification.
For more information see Appendix Three patient and public engagement paper.
2.12
Strong local governance
2.12.1 General Practices will, by working at cluster and city wide level, provide collaborative leadership
for the implementation of this specification and the guidance in Appendix Two. This will require
general practice to agree how they will work together at scale, with appropriate arrangements in
place to oversee delivery of their action plans. General Practice will work in the collaborative
manner outlined in their cluster development plans.
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3. Service Delivery
3.1
Cluster working
3.1.1 Although the LCS contract will be held with individual practices, it is a requirement for practices
to work as part of cluster to hold an LCS contract. This provides an opportunity for joining up
services, maximising use of resources and ensuring equity of access across the city. Delivery of
this specification will provide more opportunities for practices and clusters to collaborate with
each other and with others particularly primary and community care providers e.g. community
pharmacy, voluntary and community sector, community health services, mental health and social
care workers to deliver improved outcomes.
3.2
Baseline data
3.2.1 Baseline data has been collected as far as is currently available for all indicators within the
outcomes framework and will be made available to GP Practices to guide decisions as to how to
prioritise and redesign services. It is planned that the remaining baseline data for indicators will
be collected through use of the risk stratification tool, once the tool covers citywide data in 2016.
3.3
Action plans
3.3.1 Clusters of GP Practices are required to work together to put together action plans to provide the
detail of how they will deliver the services covered in the LCS outcomes framework and the
evidence and guidance papers.
3.3.2 Clusters will provide action plans that will cover how the cluster will work in the following areas:
3.4
Leadership and support - this is about how the services and improvements in the services will
be delivered within the cluster. It is about who will provide leadership for the cluster for the action
plan and details of the workforce regarding who will support getting patients into the right part of
the system and how, particularly patients who are not actively engaged. Clarity on who is
responsible for doing what and how they do it must be clear.
3.4.1 For example
- will there be a lead for the cluster who is accountable for delivery?
- what clinical, managerial and administrative support is required?
3.4.2 Training and professional development needs to be built into workforce planning, including the
staff time to be released and the cost. The system for quality assurance for the action plan
should follow the quality standards document in the appendices of the guidance. Quality
assurance of staff skills and competencies needs to be referenced in the plan.
3.4
A standard approach across the cluster – Clusters of GP Practices will need to review how
LCSs and services are currently being delivered by practices and how they will align approaches
for this new LCS contract. This provides an opportunity for learning and joining up services.
Clusters will need to agree a standard approach for all LCS services across the cluster.
3.5
Delivery and skill mix for delivery of services - clinical or other staffing capacity will be
determined by the volume of work involved. The cluster of GP Practices and practice leads
developing the Cluster LCS Action Plan will need to look at the baseline and budget allocations,
estimate activity levels involved and design a workforce which can deliver that activity.
3.5.1 Clusters will need to consider the clinical workforce best able to provide the service to the
standard required. Using the evidence and guidance provided, consideration will include the level
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of skill required, the level of risk being managed and how to make best use of the wider primary
health care team for delivery where quality can be assured and efficiency maintained.
3.5.2 Practices will avoid potential false economies where staff skill standards are reduced but lead to
higher cost elsewhere in the system (for example increased referrals to other services, higher
supervisory costs or other inefficiencies)
3.6
Sharing resources across the cluster – clusters of GP Practices will agree how resources will
be shared across the cluster. This includes not just payment for services delivered by practices
but workforce resource to address health needs as identified by the baseline data. Resources
may be required to standardise the approach used across the cluster. Improvements in quality
and efficiencies to be made will be considered.
3.7
Patient and public engagement – each action plan will include details of how clusters involve
local patients and the public in their work. The cluster is required to demonstrate from the
beginning of the action planning process they are working inclusively and transparently.
3.7.1 Two action plans will be developed per cluster described below. Clusters will detail their phased
approach for implementation.
3.8
Action Plan 1: Preventative, proactive, integrated and extended primary care
3.8.1 This covers domains 1 – 6 of the LCS outcomes framework.
3.8.2 The new main areas of the action plan will be:
A: Delivery of all existing enhanced services to all patients
3.8.3 Currently there is significant variation in the delivery of enhanced services across the city. This
new contract aims to address this. Clusters will need to agree how all patients within the cluster
will have access to existing enhanced services; which practices will deliver what services and
how referral mechanisms will happen within the cluster.
B: Innovative/ enhanced / suggested activities:
3.8.4 These are activities that are not part of the existing enhanced services, but are part of delivering
on the outcomes framework and flow from and complement existing enhanced service activities.
Practices will look at the baseline data to decide on up to 3 priority areas of need for their
population and to agree a cluster working approach for these priority areas. Taking comorbidities into account throughout, we expect that new structures and ways of working and
activities would also complement other areas of patient care covered in the outcomes framework
in addition to the 3 priority areas focused on.
3.9
Action Plan 2: Right place, right time
3.9.1 This covers services that remain activity focused and include: phlebotomy, wound closure,
intermediate care, leg ulcers, suture removal, ambulatory blood pressure monitoring, drug
monitoring, rabies, contraceptive implants and Intrauterine Contraceptive Devices (IUCDs.) The
focus for the Right Care, Right Place action plan will be about improving efficiencies for delivery,
use of skill mix of staff, sharing resources across the cluster and ensuring all registered patients
have access to the services.
3.9.2 This action plan cover indicators in domain 7 of the outcomes framework and the activity will
continue to be paid as currently on an activity basis.
3.9.3 The action plan will need to include expected levels of activity and equity of service across the
cluster.
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3.10
Coherent City model
3.10.1 It is important that clusters tailor their response to this specification (i.e. action plans) to the
needs of their communities in line with baseline needs and that innovation is promoted at the
front line. However, there needs to be clear city level working to enable clusters to work
effectively together when needed. Other hospital, community, mental health and social care
services will need to be able to create a common interface with the clustering arrangement.
3.11
Staffing
3.11.1 Primary care working at a practice, cluster and at a city wide level will be responsible for
ensuring adequate skilled staffing to fulfil the activities and interventions within their action plans.
This will include but is not limited to:
 General Practitioners
 Practice nurses
 Health Care assistants
 Reception and administrative staff
3.12
Exclusion criteria:
3.12.1 Patients not registered with a Brighton & Hove GP
3.13
Interdependence with other services/providers
3.13.1 It is expected that General Practice will develop close working relationships with each other and
other providers to attain optimum outcomes. General Practice will co-operate with an indicative
but not exhaustive list of agencies (below) to ensure that the outputs and outcomes outlined in
this specification are attained:
 All general practices within Brighton & Hove CCG
 Community Rapid Response Service and other Short Term Services
 Integrated Primary Care Teams
 Integrated Diabetes Service (Diabetes Care for you)
 Integrated Respiratory Service
 Other specialist nursing and therapy teams
 Specialist Palliative Care Team including Macmillan nurses
 Drugs and Alcohol Teams
 Community pharmacists
 Adult Social Care
 Mental Health Services
 Nursing and care home sector providers
 Consultant medical staff and ward staff at Brighton & Sussex Hospitals (BSUH) Trust and
other hospitals as required
 Third sector (Voluntary and Charity organisations)
 Public and Patient Engagement
 Brighton & Hove CCG
 Brighton and Hove City Council
4. Referral, Access & Acceptance Criteria
4.1
Geographic coverage/boundaries/location of service delivery
4.1.1 The service will cover the registered population of GP practices within Brighton & Hove. Care
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delivery will take place in the patient’s home, at GP practices or other community settings as
appropriate.
4.1.2 A key aim of the LCS specification is to achieve universal coverage of all existing (2015/16) LCS
commissioned services. Clusters’ focus must be on the population they serve as defined by the
practices’ registers. Coverage for specific services will be detailed within specific topic area
evidence and guidance papers.
4.1.3 It is important that general practice come together in clusters in a coherent manner that supports
delivery of care within general practice but also supports partnership working with the local
community and with community health and social care.
4.2
Days/Hours of operation
4.2.1 Practices, working together as a Cluster must tailor their response to this specification (i.e. action
plans) to ensure there is an enhanced level of access to in hours GP services, including a
smooth transition between in and out of hours GP services.
4.3
Referral criteria & sources:
4.3.1 All specific pathways for individual outcomes/services/interventions are detailed where
necessary in the individual service specifications and protocols.
5. Discharge Criteria & Planning
5.1
Patient Discharge
5.1.1 All specific pathways for individual outcomes/services/interventions are detailed where
necessary in the individual service specifications and protocols.
6. Service Standards
6.1 Service Standards
General Practice and Clusters will be required to provide services that should be centred around
the quality standards in Appendix Four.
6.2
Information Governance
6.2.1
Each practice and cluster will comply with all relevant national information governance
requirements.
6.2.2
Each Cluster will identify an information governance lead, who will be responsible for ensuring
the administration of the LCS contract in line with all relevant national information governance
requirements; e.g. anonymisation of papers/agendas where patient level data is not required.
6.2.3
Each practice will need to undertake appropriate checks and risk assessments in order to satisfy
themselves as data controllers that they are able to share data for the purposes of delivering
primary care services. This may include appropriate data sharing agreements being put in place,
approval of systems in use etc.
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6.3
Patient satisfaction and complaint
6.3.1
Practices will co-design any new models of care with patients. Practices will implement patient
reported outcome measures and patient and carer satisfaction and experience measures.
Shared decision-making on an individual patient level is core element of the contract. For more
information see Appendix Four patient and public engagement paper.
7. Performance Management & Outcomes
7.1
7.1.1
Management Information Systems
Providers will work with commissioners to agree and set up a data and reporting system. It is
anticipated this will be through the use of the reporting function of the risk stratification tool
(SOLLIS). The details of this will be finalised
7.1.2 The commissioners will work with providers to develop and implement adequate information
systems to meet the reporting requirements of this specification.
7.2
Service Monitoring and Review
7.2.1 Reporting intervals: The Provider will supply the commissioners with reports on a quarterly basis,
based on the approach as outlined in 7.1.1 and 7.1.2.
7.2.2 Reporting responsibility: It is expected General Practice will work at a cluster and at a city wide
level for reporting requirements. The contract agreement will detail the position holder
responsible within the provider arrangement’s for provision of the reports and will also detail the
position holder within the CCG who are to receive the information.
7.2.3 Frequency of contract review meetings: The commissioners will meet with the clusters to support
implementation and outcomes during the roll out of the cluster action plan. Contract performance
management meetings frequency will also be agreed with commissioners again to support
development and delivery of the action plans and cluster outcomes.
7.3 Activity monitoring and Key Performance Indicators
7.3.1 City wide targets have been set using a selection of the indicators from the LCS outcomes
framework in Appendix One and progress in relation to these targets will be monitored quarterly
for each cluster. Clusters will set their own targets as part of completing the action plans with
support from the CCG and public health. Monitoring progress against targets is to ensure there is
a focus on improvement and learning rather being punitive. However there is an overriding
principle behind this contract; the need to grow primary and community based care can only be
affordable on the basis of making the health improvements as set out in the outcomes
framework.
7.3.2 As the service model and approach to delivery is developmental specific metrics and key
performance indicators will be set by commissioners with providers each year as part of the
annual contracting process.
7.3.3 It is important that the service offer and outcomes citizens receive are equitable as far as
possible. The new LCS outcomes approach cannot close the outcome equity gap by itself and
closing existing gaps in equity will take many years. However, clusters should understand and
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take positive actions to close those gaps when outlining service delivery within action plans. The
characteristics by which we would seek to ensure equity of offer and outcome are:
7.3.4 Protected characteristics for Equality, Diversity and Human Rights and priority groups
a) Age
b) Disability
c) Gender reassignment
d) Marriage and civil partnership
e) Pregnancy and maternity
f) Race
g) Religion and belief
h) Sex (gender)
i) Sexual orientation
j) Armed forces personnel
k) Carers
l) Homeless
7.3.5 The LCS contract will enable clusters of practices to work differently with the aim of reducing
health inequalities, investing proportionally more in populations with poor outcomes. Although
deprivation is not a defined protected characteristic it is a significant factor regarding inequity in
service delivery. In order to improve inequity in the city as well as achieve overarching outcomes
of this LCS practices are required to start collecting data for the above protected characteristics.
This should be recorded when registering new patients or when patient details are updated.
7.3.6 Key performance indicators and measures will be set following agreement of Cluster action plans
to enable performance to be monitored to support review, on-going development and ensure
effective patient outcomes.
8. Costing and Payment
8.1
Commissioners wish to see cluster based health and social care grow in terms of its offer to the
public and for this to be matched by an increase in resources. This resource can only be directed
to clusters and the community by a shift from other services.
8.2
Costing against cluster action plans will be developed jointly with commissioners and will include
details on expected activity and the cost for delivery of services. Growth in the cluster offer
should be through growing capacity and skills within the teams in an integrated way rather than
adding new discrete services.
8.1
As with 2015/16 BHCC public health LCSs, these will continue to be funded through payment by
activity quarterly. As described above under action plan 2 this will also be the same for the CCG
commissioned services listed.
9. Future Service Developments
9.1
Investments in primary care are part of the transformation of general practice and growth in
community based health and social care. For general practice the development of the LCS
outcomes framework signals an increased focus on proactive and preventative care. If care is
more preventative and interventions are more joined up there are less gaps between
professionals and organisation, resulting in a reduction in more expensive reactive hospital care
or care home admissions. It is expected an increased focus on primary prevention to stop people
developing diseases in the first place and secondary prevention identify and treat or slow
progression. Resource for this growth can only be directed in a recurrent manner by this shift of
B&HLCS outcomes framework
Service Specification final September 2016
12
demand for more intensive services. Therefore the service model and requirements set out
within this specification will be reviewed initially at six months from start of implementation and
then annually with providers to ensure alignment to wider system change.
Appendices
Appendix One:
Appendix Two:
Appendix Three:
Appendix Four:
Outcomes Framework
Evidence and Guidance papers
Patient and Public Engagement
Quality Standards
i
Wallace E etc Al “Clinical Review: Managing patients with multimorbidity in primary care” BMJ 2015;350:h176
Roland M, Paddison C Better management of patients with multimorbidity. BMJ 2013;346:f2510
iii
De Silva D, Helping people help themselves, the Health Foundation 2011
ii
B&HLCS outcomes framework
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