GOSPORT PRACTICE BASED COMMISSIONING LOCALITY BUSINESS PLAN
The Gosport Locality
Brune Medical Centre
10 Rowner Road
Gosport PO13 0EW
Telephone: 02392 794169
Fax: 02392 504060
Dr Stuart Morgan, PBC District & Clinical Lead
Email:
Brenda Woon, PBC Locality Manager
Email:
Table of Contents
- Table of Contents……………………………………………
- Purpose…………………………………………………….. .
- Executive Summary………………………………………….
- Description of Gosport Locality……………………………..
i. Background
ii. Local hospital services
iii. Transport
iv. Health needs
- Management and Organisation………………………………
i. The Gosport Cluster
ii. The Executive Board
- Operating Plan………………………………………………
i. Outline
ii. Purpose
iii. Structure
iv. Membership
v. Meetings
vi. Roles and responsibilities
vii. Remuneration
- Review of Community Services………………………………
i. Existing services
ii. Planned services
- Patient Choice…………………………………………………
- Marketing and Communications Proposal……………………
i. Outline
ii. Proposal
- Cost Savings Proposal
i. Changing financial climate
ii. Management allowance
iii. Proposal
- Conclusion
- Appendix:
1. Work Plan ( See Separate Link)
2. Purpose
The purpose of this Operational Review is to inform stakeholders of the geographical position of the Gosport Locality, its structure, the health needs of its patients and future plans in a financial climate where 2010 – 2011 will be the last year of any real growth in NHS funding for at least a three year period. This means that changes have now become urgent.
3. Executive Summary
The Gosport Practice Based Commissioning (PBC) Cluster was formed to commission local services which are easier and quicker to access in an environment closer to the patients home. The Gosport peninsula makes travelling to and from the acute hospital setting, lengthy and tedious for local patients.
With an ever increasing demand for services and due to the fact that Gosport has a high area of deprivation, deaths from cancer and smoking related diseases are higher than the national average. Other priority areas include child obesity, teenage pregnancy and hospital admissions for alcohol related harm.
The Gosport Cluster comprises a group consisting of a GP and Practice Manager from each of the 11 Practices in Gosport, a Locality Manager and Administrator and other local stakeholders We work together to address issues relating to primary and secondary care and social care services. The Cluster Group meets every two months and shares good practice regarding the provision of primary care services, and achieving national and local targets.
The Gosport Practices have signed-up to the Practice Based Commissioning (PBC) Local Incentive Scheme (LES).
The Executive Board meets monthly and has been established to execute decision making on behalf of the Gosport Locality. Membership is made up of Chair and Vice-Chair, 5 GPs, 4 Practice Managers, Locality Manager and Administrator. It approves and oversees the allocation and administration of the Locality Management Allowance budget, establishes and prioritises clinical pathways and develops service specifications agreed as priorities ensuring patients views are heard and considered.
Each Clinical Lead on the Group has responsibilities in the areas of:
· Clinical governance
· In-patient non-elective admissions
· In-patient elective admissions and Tier 2 Services (clinically-led services based in the Gosport Locality)
· Prescribing
· Patient and Public Involvement
The clinically-led existing community services in the Gosport Locality are:
· Community ENT service
· Community Gynaecology service
· Community Cardiology service
The clinically-led planned services for the financial year 2010/2011 are:
· A 24-hour Community Virtual Ward Service run by community nurses covering 365 days per year for patients in Nursing/Residential care and in their own homes.
· A Community Rapid Assessment Service for the elderly. This is for elderly patients who would otherwise have been referred to hospital, but via this service may be able to be managed and supported in the community.
· A Community based Pulmonary Rehabilitation Service for patients with a diagnosis of Chronic Obstructive Pulmonary Disease (COPD) who have breathlessness which interferes with activities of daily living.
· An Improving Access to Psychological Therapies (IAPT) service. The proposal is to have psychological therapies embedded as a core part of mental illness with interventions delivered in the community and links with employment services.
In line with the Government’s health strategy the Gosport Locality wish to give patients more choice about how, when and where they receive their NHS treatment. It hopes to achieve this by offering more locally based services, which are quicker and easier to access.
The Locality intends to market its services to the patients and public of Gosport by using local press bulletins, newsletters, web sites and in-surgery advertising via patient groups and the Locality Patient and Public Stakeholder Group.
The Practices within the Locality will be focussing on the financial pressures imposed on the health service over the next few years and will work towards reducing the high overspend which is now facing NHS Hampshire.
4. Description of Gosport Locality
i. Background
Gosport lies on a peninsula in South East Hampshire south of Fareham; to the east is the town of Portchester and to the north is the M27 motorway.
Gosport PBC Locality has a patient list size of just under 82,000. There are 11 GP practices servicing the patients of Gosport with a total of 50 GPs.
The practices are as follows:
Bridgemary Medical Centre
Brockhurst Medical Centre
Brune Medical Centre
Bury Road Surgery
Forton Medical Centre
Gosport Medical Centre
The Lee-on-the-Solent Medical Practice
Manor Way Surgery
Rowner Health Centre
Stoke Road Medical Practice
Waterside Medical Centre
ii. Local Hospital Services
Gosport has a Community Hospital (Gosport War Memorial Hospital) which provides a range of outpatient clinics for the local population. Acute services are run by Portsmouth Hospitals Trust (Queen Alexandra Hospital and St Marys Hospital), both based in Portsmouth.
iii. Transport
Transport for patients to and from the hospitals in Portsmouth remains a problem, particularly for those patients who rely on public transport as there is only one main very busy road (A32) providing access.
iv. Health needs
The health of the people in Gosport is generally similar to the England average. However, the rate of violent crime, early deaths from cancer and teenage pregnancy appear worse than the England averages. The levels of deprivation and child poverty are low. Overall life expectancy for men and women is similar to the England average. However, within Gosport life expectancy for men from the most deprived areas is nearly 8 years lower than for those from the least deprived areas.
Over the last ten years, the death rate from all causes combined and the early death rate from heart disease and stroke have both fallen and are similar to the England average. The rate of early death from cancer has fallen slowly over the same period but remains higher than the England average.
An estimated 27% of adults are smokers and the smoking related death rate is worse than the England average. Smoking is estimated to account for more than 140 deaths each year. The Hampshire Local Area Agreement has prioritised tackling all age all cause mortality rates, child obesity, teenage pregnancy and hospital admissions for alcohol related harm over the next three years.
5. Management and Organisation
i. The Gosport Cluster
The Gosport Cluster Practice Based Commissioning Group has been formed to promote the Primary Care service delivery within the locality to best serve and improve quality of care to the local population.
The Cluster Group will provide a forum for discussion, to ensure that all Stakeholders in the General Practice are actively engaged in key issues and developments of Practice Based Commissioning (PBC) and to work closely with NHS Hampshire (NHSH) in working to achieve local aims and objectives.
The Cluster Group will provide a forum for gaining a consensus view from Gosport Practices regarding key developments which meet the overall health service national/local targets and reform.
The Cluster Group will provide the Gosport Locality with the opportunity to highlight developments, service issues relating to primary, secondary or social care services. Where necessary, highlighting these issues to the PBC District Lead for further action.
The Cluster Group will ensure that the Gosport Locality is kept informed of:
· Local issues and key work areas of the PCT (e.g. GMS, prescribing, clinical governance, commissioning and health improvement) including any decisions taken by the Area Professional Advisory Committee (APAC).
· National legislation and its implications at a local level
The Cluster Group will share good practice, in particular regarding the provision of primary care services, prescribing and achieving the national primary care access targets and PCT national and local targets.
The Cluster Group will monitor and review effectiveness of PBC developments in the Cluster.
The membership of the Group shall consist of a nominated GP representative who has voting rights and a Practice Manager from each General Practice within the Gosport Locality. The Group shall nominate a Clinical Chair and a Vice-Chair who will both be members of the Cluster. Membership of the Group, including the appointment of a Chair, shall be reviewed on an annual basis in April of each year.
Operation of the Group:
Meetings shall be held every two months and members shall miss no more than 80% unless there are extenuating circumstances.
The agenda for each meeting shall be prepared by the Locality Manager or Commissioning representative in collaboration with the Chair.
The Group shall have a quorum of two-thirds of all representatives. Voting will normally be by a show of hands. Members of the Group will be invited to submit items at any time but no later than 1 week before the next meeting. The agenda and all related papers will be distributed electronically to members to allow the opportunity to read prior to the meeting.
Minutes of the meeting shall be taken by the Locality Manager or Commissioning representative and distributed within two weeks of the meeting being held. When the agenda is disseminated the minutes of the previous meeting will also be attached for reference.
ii. The Executive Board
The Executive Board (EB) has been formed to establish clinical pathways which have been agreed as priorities in the Gosport Locality. The Board aims to encourage the development of care pathways for patients as a means of continually improving services in the Locality. The EB will also be responsible for monitoring the overall use of NHS Resources in Gosport.
Each member of the PBC EB will comprise of:
Chair (PBC District Lead)
Vice-Chair (PBC Deputy Lead)
4 x GP Members
3 x Practice Managers
Locality Manager (non-voting)
Each member will have a particular role and responsibility in the areas outlined in NHS Hampshire’s Operating Plan to bring activity down to planned levels agreed with the Acute Trust contracts for 2010/1011 and beyond.
The roles and responsibilities will be in the areas of:
· Clinical Governance
· In-patient non-elective admissions
· In-patient elective admissions and Tier 2 Services (clinically-led services based in the Locality)
· Prescribing
· Patient and Public Involvement
The main functions of the PBC EB are:
· To exercise executive decision making on routine business matters of the Gosport PBC Locality
· To approve and oversee the allocation and administration of the Locality Management Allowance Budget
· To establish and prioritise the clinical pathways which the Locality wishes to develop in order to inform commissioning intentions
· To oversee the development of service specifications in those clinical pathways agreed as priorities, ensuring that patient views are heard and considered during the process.
· To determine the support required, from the totality of the collective notional budget and the management resource available, to enable and encourage the development of care pathways as a means of continually improving services in the Locality.
· Meetings will be held monthly
6. Operating Plan
i. Outline
Below are the outline details of an operating framework for the PBC Cluster Executive Board which operates in the Gosport Locality. The Gosport PBC Cluster comprises the following practices:
Bridgemary Medical Centre
Brockhurst Medical Centre
Brune Medical Centre
Bury Road Surgery
Forton Medical Centre
Gosport Medical Centre
The Lee-on-the-Solent Medical Practice
Manor Way Surgery
Rowner Health Centre
Stoke Road Medical Practice
Waterside Medical Centre
ii. Purpose
The purpose of the Executive Board (EB) will be to act in an executive capacity, on behalf of the Cluster, to facilitate timely and effective decision making regarding the Cluster’s PBC business matters.* On behalf of the Locality it will oversee the development and procurement of health care services delivered in the primary care sector, by primary care practitioners supported by secondary care specialists and other, independent, providers of health care services
iii. Structure
The EB will be made up of:
PBC District Lead (Chair) – PCT appointed GP
PBC Deputy Lead (Vice-Chair) GP
Clinical Governance Lead GP
Prescribing Lead GP
Elective Care Lead GP
Non-elective Care Lead GP
Patient & Public Involvement Lead GP
Budgetary Development Lead PM
Prescribing Lead PM
PPI Lead PM
PBC Locality Manager Non-voting
iv. Membership
Membership of the EB will be determined by an electoral process involving nomination and ballot. The process will be administered by the PBC Locality Manager. Membership of the EB will be reviewed annually by the whole Cluster membership.
v. Meetings
The EB will meet monthly. It may meet more frequently if the business at hand requires. A quorum will require the attendance of 4 voting members. EB decisions will be made on the basis of a majority vote. In the event of a tie, the Chair shall have the casting vote, or he/she may elect to refer the matter for Whole Cluster decision if appropriate.
*Reference Appendix 1: Work Plan
vi. Roles and Responsibilities
Roles and responsibilities of EB members are as follows:
a. Chair: District Lead. To lead on strategic engagement with the SHA and PCT and the dissemination of policy
b. Clinical Governance Lead: To provide a focus for the governance of commissioning and clinical activity.
c. Prescribing Lead: To be the Chair of the Prescribing Group and
liaise with the Gosport Prescribing Group and NHS Hampshire Medicines Management Team. To advise the EB on cost effective prescribing within the Locality.