Service / Intermediate Care/Ascot House Service Specification–Enhanced Primary Medical Services
Commissioner Lead / J Swift, Head of Primary Care, NHS Trafford CCG
Provider Lead / (GP Provider tbc)
Period / November 2015 to November 2016
Date of Review / Quarterly meetings 2015/16 and 2016/17
1.Population Needs
1.1National/local context and evidence base
Trafford CCG has reviewed its IMC offer to the Trafford population, and has identified a need to modernise and improve its offer to ensure that patients receive the right care, at the right time in the right place. As such a new model will be implemented from October 2015.
The new model will be clinically led by 24/7 nursing and a suite of Health Care Assistants, delivered by Pennine Care NHS Foundation Trust.
We now require further enhancement to the model and as such aim to secure primary care services as outlined in this service specification. As part of this there is a requirement for the enhanced primary care service to work with Pennine Care on the delivery of this service.
The IMC Offer
Ascot Housewill be delivering a new IMC offer that is a CQC registered, 24 hour nurse led Intermediate Care Service, supported by therapists, pharmacy, and a suite of Health Care Assistants, provided by Pennine Care. The service will provide 18 Intermediate Care and 10 Assessment/Respite Review beds, delivering short term careand accommodation for Trafford residents who have been discharged from hospital, or admitted from a primary/community setting, (up to 35 older adults). The centrewill provide rehabilitation with two beds available for regular respite users. The service is designed to enable residents to move on, either back to their own home or to suitable accommodation The primary aim is for residents to return to their own homes. Healthcare is delivered jointly with local health service providers. Ascot House is situated in Sale and is commissioned by Trafford Council (Appendix 1) and Trafford CCG.
This service specification outlines the requirements for proactive management, advanced care planning and primary medical services to be delivered by local primary care provider(s), fully supported by and working closely with the new nurse led workforce at Ascot House
This service has been developed to acknowledge the temporary residentstatus of the transient population, the additional administration/management requirements of this particular cohort of patients, which is viewed as enhanced care, over and above core GMS/PM contract requirements, and to reduce demand on secondary care services.
2.Outcomes
2.1NHS Outcomes Framework Domains & Indicators
Domain 1 / Preventing people from dying prematurely
Domain 2 / Enhancing quality of life for people with long-term conditions / X
Domain 3 / Helping people to recover from episodes of ill-health or following injury / X
Domain 4 / Ensuring people have a positive experience of care / X
Domain 5 / Treating and caring for people in safe environment and protecting them from avoidable harm / X
2.2Local defined outcomes
As a group with complex needs and temporary resident status, this locally commissioned service will ensure all residents have access to the provision of safe and effective, advanced care management and planning primary care medical services, during their period of stay atAscot House to support independent living on discharge, and increase the number of patients that return to usual place of residence.
3.Scope
3.1Aims and objectives of service
This service will be delivered by a General Practitioner, who will provide a range of enhanced primary care medical serves to the resident population of Ascot House. All patients treated under this agreement will be classified as temporary residents unless existing registered patients with the providing organisation. Patients will be registered with the primary care provider for the duration of their stay at Ascot House.
This will be a 7 day service as follows:
- Monday to Friday will be on delivered on site at Ascot House for a period between the hours of 08.00 to 18.30.
- Saturday and Sunday will be delivered remotely through partnership or own arrangement for a period of hours between 08.00 to 18.30
- Outside of these hours demand will be picked up by the separately commissioned out of hours provider
The priority will be ensuring the safeand effective delivery of enhanced primary care medical services and care planning for patients admitted to Ascot House.
1] Between the hours of 08:00 to 18:30 Monday to Friday including bank holidays, the Provider will cover the needs of the patients which include beingonsite to provide daily ward rounds and MDTs. The provider will be available during the rest of the hours to provide support to the wider service. Outside of these core hours,primary medical cover will be provided by the Out of Hours Service
2] Between the hours of 08:00 to 18:30 Saturday and Sunday, the Provider will be available to respond to Ascot House requests for services outside those covered by GMS care. Outside of these core hours,primary medical cover will be provided by the Out of Hours Service
3] The attending GP will be part of the clinical team supporting patients in Ascot House and will be expected to ensure effective communication between Ascot House and the Provider is maintained. The Provider will also lead MDT meetings on site at Ascot House.
4] Every patient being admitted to the service will have been previously assessed as being appropriate and should not require detailed assessment until the next planned attendance by the GP.
5] Patients who are admitted to Ascot House will arrive with a limited period of medication. It is expected that the provider will review that and take over prescribing responsibility within reasonable time and for the period of the admission.
6] The Provider will offer support to the discharge planning and how to achieve the best outcome for individuals.
7] The Provider will ensure continuity of care byproviding consistent clinical support to deliver this service.
8] The Provider will work with other generalist e.g. Advanced Practitioners and specialists e.g. secondary care clinicians, to provide optimal patient care, meeting on a weekly basis. Where medical input is supplied by clinicians other than the GP, the Provider will maintain overall clinical responsibility while the patient is resident at Ascot House, as GP lead within the multidisciplinary team.
The service detail, and any changes to the above, will be determined through negotiation between commissioner and the Provider through quarterly contract monitoring meetings.
3.2Service description/care pathway
The scope of the service relates specifically to advanced care planning, primary care medical services, to patients at Ascot House.
3.3Population covered
The service is available to the resident population of Ascot House.
3.4Any acceptance and exclusion criteria and thresholds
This service specification relates only to the resident population of Ascot House.
3.4.1 Acceptance criteria for Ascot House Service
- Patient must be medically stable and not require the continuous medical supervision of a medical practitioner over a 24-hour period.
- Patient must be registered with a Trafford GP.
- Planned admissions take place 08.00 – 19.00.
- Unplanned admissions and hospital transfers can take place up to 20.00 on a daily basis.
The Provider will maintain links with other relevant health and social care professionals, as outlined, where appropriate.
3.6 Patient Registration
Patients who are admitted to Ascot house will be temporarily registered with the provider of the enhanced primary medical service at Ascot House (however patient choice will continue to apply).
3.7 Patient Records
The provider will be responsible for ensuring that an appropriate clinical record is maintained for these patients and that the correct level of information is available within the local record at Ascot House and the ongoing GP record. We will work with the provider to deliver adequate IT support for this. This will not require IT investment on behalf of the provider.
4.Applicable Service Standards
4.1 Applicable national standards (e.g. NICE)
4.2Applicable standards set out in Guidance and/or issued by a competent body (e.g. Royal Colleges)
4.3 Applicable local standards
The Provider will be required to work with IMC clinicians and Commissioners to develop MDT protocols and standards and following which demonstrate, and evidence compliance.
4.4Risk Management
The Provider will operate in accordance with all Acts of Parliament, statutory regulations or other such laws, recommendations, validated or approved guidance or practices as may affect the provision for services specified under the Agreement
Any litigation resulting from an accident or negligence on behalf of the service provider is the responsibility of the service provider who will meet the costs and any claims for compensation, at no cost to the commissioner
The provider must ensure that their professional indemnity insurance provider has confirmed that this activity will be included in their policy
4.5 Patient confidentiality and consent
The Commissioner and any provided services are bound by the NHS Code of Confidentiality, and the provider should ensure they are aware of this guidance. Where possible, a clinician must be satisfied that a patient understands and consents to a proposed treatment or investigation, in line with local policies
4.6 Variation in provision
The Provider will give NHS Trafford CCG 30 days’ notice for any reason they are unable to provide a service for a short time (i.e. holiday/illness)
4.7Breach of Contract
Breach of the conditions of this contract may result in a reduction or withdrawal of payment and cancellation of this contract
Those matters which would be regarded as breach of contract are as follows:
- Failure to comply with any of the terms of the agreement without reasonable cause
- Inability to provide any of the agreed monitoring information without reasonable cause
- Whether payments under the scheme should be suspended, and if so for what period
- Whether any payments should be recovered, or
- Whether payment should cease altogether and the scheme is terminated
4.8 Ascot House Service Monitoring
The Intermediate Care Unit is managed by the Ascot House general manager, who will work with the Pennine Care providerto coordinate the multidisciplinary team (which will include the provider of enhanced primary medical service) to ensure all patients progress in a timely manner through a maximum 42 day rehabilitation programme.
The provider will work with full team at Ascot House to monitor the following:
- Length of Stay
- The coordination of discharge planning
- Patient follow-up on discharge
- Standardised referral procedure (step up and step down)
- Standardised assessment process using single assessment documentation
- Multidisciplinary goal setting
- Patient experience and complaints
5.Applicable quality requirements and CQUIN goals
5.1Applicable Quality Requirements (See Schedule 4 Parts [A-D])
In respect of patient experience including complaints, applicable quality requirements will be supported by local collaborative work with the provider, please see section 7.4 Patient Experience (including complaints).
5.2Applicable CQUIN goals (See Schedule 4 Part [E])
6.Location of Provider Premises
The Provider’s Premises are located at:Local to Trafford
7.Performance & payment
7.1 Payment
The 2015-16 is;
Activity / Carried Out By / Time per Week (Hours) / Cost per Hour / Cost per Week / Cost Per Annum
£ / £ / £
Weekday ward round / GP / 15 / 100 / 1,500 / 78,000
Weekend support availability / GP / 4 / 120 / 480 / 24,960
Weekly MDT meeting / GP / 2 / 100 / 200 / 10,400
Total Cost / 2,180 / 113,360
The Provider will be required to process claims for payment on a quarterly basis.
The Provider will send the contract monitoring form electronically (see 7.3) to the CCG, and the associated invoice to SBS (at the same time) each month or quarter.The CCG will undertake a post payment verification audit during 2015-16.
7.2 Data Quality
The Provider will contribute to the systematic documentation of the patient’s medical history and care planning and provide assurance through the contract monitoring and quarterly review meetings.
7.3 Contract monitoring
Ascot House Primary Medical Services
Name of Provider:
Period of claim (Qtr1 Apr-June, Qtr 2 July-Sept, Qtr 3 Oct-Dec, Qtr 4 Jan-Mar)
Number of new patients / Number of new patients assessed within 24 hrs / Number of new patients with care plan in place / Number of new patients assessed at MDT review / Number of new patients readmitted to hospital / Number of complaints / Patient experience*
Report – content to be agreed and covering requirements set out in section 7.4 below
Key Performance Indicators are as below and it is expected that these will be integrated with the totality of the Ascot House IMC delivery model.
The Provider, will therefore be expected to integrate and contribute to the IMC service using the metrix below an indicator of those aspects that will be embedded in the IMC reporting structure.
Ref / Indicator / Measure
Comp C1 / % of complaints responded to within timescale agreed at the outset upon receipt of the complaint with the complainant (“the response period” SI 309, 2009 paragraph 13 (7)) where appropriate / 95% of eligible complaints (for local negotiation)
Comp C2 / % of complaints acknowledged in 3 working days of day following receipt of complaint / 90% of eligible complaints (for local negotiation)
Comp C8 / % of complaints where, following investigation, an action plan has been put in place, acted upon, completed within in agreed timescales and reported back to the complainant / Greater than 90% of cases
The provider complaints report will set out:
- *number of complaints received;
- *type of complaints received (e.g. verbal, written, email, personal caller);
- *subject matter of those complaints;
- *staff group(s)/staff discipline(s) complained about (with provision, if necessary, to request specific data e.g. at consultant level if necessary)
- *Progress including outcome of each complaint;
- * Whether the complaints were well-founded, partially well founded or not upheld;
- *Remedial actions and learning from complaints;
- *Details of referrals of complaints to the Parliamentary and Health Service Ombudsman (including the outcome) and nil return if there were no referrals
- Evidence that any action plans developed have been implemented within the timescales as set out in the report and communicated to the complainant;
- Evidence that the provider has mechanisms to identify themes/trends and takes action to address these e.g. reduction in repetitive themes/trends
7.4Patient Experience (including complaints)
Complaints
The provider will be expected to have in place appropriate capacity and capability to manage complaints in accordance with current complaints legislation and be able to respond to patient enquiries regarding its service. Complaints legislation makes provision for a provider to authorise another organsation to act on its behalf in the management of complaint. The CCG would be open, in respect of this service, to the provider making such an arrangement.
Patient experience
A comprehensive and robust programme of work to gather, analyse, understand and measure patient experience should be instilled in services.
CCG involvement such as in the form of receipt of scheduled reports, subsequent analysis and review will occur to ensure that the requirements for the service relating to complaints (including PALS) and patient experience are met. Any work a provider carries out should tie in with anticipated outcomes and benefits of a service(s) so that this can be measured from the complaints and patient experience perspective
Patient experience is a key placeholder in determining if a service is effective. Patient Experience programmes of work are inherent in every new/re designed service. This is consistent with the CCGs expectations of existing providers for Trafford people.To contribute towards the patient experience programme (to be developed) of the wider intermediate care provision, the provider is expected to co-operate with any patient experience undertaken by the intermediate care (including the services set out in this specification) provider, and to ensure any feedback received in respect of intermediate care will be shared accordingly to allow for that intelligence to be analysed and utilized to ensure changes are made to improve services where necessary.
8.Key contacts
Jason Swift, Head of Primary Care(Commissioning Lead)
Primary Care Interface Team
NHS Trafford CCG
Marion Ross, Head of Unscheduled Care(for further details)
Unscheduled Care Team
NHS Trafford CCG
07785977203
Linda Newton, PCIT Development Coordinator (Contract Monitoring)
Primary Care Interface Team
NHS Trafford CCG
Jasmine Clarke
Head of Customer Care & Experience(Patient Experience & Complaints)
NHS Trafford CCG
NHS Shared Business Service (Invoice processing)
NHS Trafford CCG 020A Payables L155
Phoenix House
Topcliffe Lane
Tingley, Wakefield
WF3 1WE
Tel: 0303 123 1177
Appendix 1
Statement of Purpose
ASCOT HOUSE
Respite, Assessment & Intermediate Care Centre for Adults
Ascot Ave
Sale
M33 4GT
July 2015
Registered Provider and Registered Manager
Registered provider
Trafford Borough Council
Trafford Town Hall
Talbot Road
Stretford
M32 OTH
Registered Manager
Sue Burrell
Ascot House
Ascot Ave