LOCAL PROFESSIONAL NETWORKS

SINGLE OPERATING FRAMEWORK

3 March13

CONTENTS

Foreword

  1. Introduction
  1. Broader NHS context for managed clinical networks, including LPNs.

2.1 Outcomes

2.2Features of Networks

2.3Network Governing Body

2.4Types of managed clinical networks

2.5The NHS Change Model

2.6 Benefits of networks

  1. Local Professional Networks- functions

3.1 Core Functions

3.2 Dental LPN specific functions

3.3 Pharmacy LPN specific functions

3.4Eye Health LPN specific functions

  1. The LPN assembly
  1. Support from other national bodies
  1. Geography of LPNs
  1. Membership and Governance of LPNs
  1. Annual Work Plan
  1. Hosting and support
  1. Alignment with the new system
  1. Next steps

Foreword

Clinical networks are an NHS success story. Combining the experience of clinicians, the input of patients and the organisational vision of NHS staff they have supported and improved the way we deliver care to patients in distinct areas, delivering true integration across primary, secondary and often tertiary care.

During 2012 we published documents on Strategic Clinical Networks, Operational Delivery Networks and Senates and this, on Local Professional Networks, is the final one.

Local Professional Networks will be established in each area covering pharmacy, dentistry and eye health communities. They will ensure that the contribution of these professional groups is maximised in the improvement of outcomes and reduction in inequalities. LPNs will need to work closely with Strategic Clinical Networks, Academic Health Science Networks, Senates as well as commissioners, providers and patients.

During 2012 we tested the idea in a number of areas and found that such networks brought benefits for patents and professionals alike. We have held a number of stakeholder events to explore how this model should develop and comments from these events have fed into this document. We now set out the steps that need to be taken to establish comprehensive coverage across England to improve care for patients.

The next stage is for the NHS CB area primary care commissioning teams to establish the three local networks and to support clinical leaders to come together to develop a prioritised plan for the improvement of local services.

This is a great opportunity to improve outcomes for patients across the country and make best use of skilled professionals who meet many patients every day in communities across England.

Professor Sir Bruce KeoghKeith RidgeBarry Cockcroft

NHS Medical Director Chief PharmaceuticalChief Dental Officer

Officer

1. Introduction

‘Securing Excellence in Primary Care’ (NHS Commissioning Board (NHS CB) June 2012) committed to the development of Local Professional Networks (LPNs) for dentistry, pharmacy and eye health.

Local Professional Networks will:

  • Support the implementation of national strategy and policy at local level
  • Work with other key stakeholdersonthe development and delivery of local priorities, some of which go beyond the scope of primary care commissioning
  • Provide local clinical leadership.

Local Professional Networks are one part of a family of managed clinical networks supported by the NHS CB as recommended by the NHS Future Forum, led by Prof Steven Field in 2011.

Managed clinical networks support local clinicians to deliver the NHS Outcomes Framework in local health systems. They are a key part of the clinical leadership structure for the NHS; The NHS CB is committed to strengthening clinical leadership in its new arrangements.

Local Professional Networks will work across the boundaries of commissioning and provision, as engines for change in the modernised NHS. They sit alongside other managed clinical networks such as Strategic Clinical Networks, Operational Delivery Networks, Academic Health Science Networks and also Clinical Senates.

Local Professional Networks will be hosted and supported by the Area Teams of the NHS CB.There will typically be three LPNs, one each for eye health, pharmacy and dentistry in each area geography. All LPNs will come together in a national LPN Assembly to influence wider policy change and improvement. The Area Team Medical Director will be responsible for ensuring that local networks are effective. Local testing during 2012 has shown that clinicians and managers find LPNs beneficial.

LPNs now need to be established and developed effectivelyacross the NHS, in accordance with the values and principles of the NHS CB. This document outlines a single operating framework to guide LPN establishment, development and functioning. This framework promotes consistency of approach but also allows flexibility for health communities to develop their own LPNstructures in line with local need and circumstances.

It is expected that the LPN Assembly will support work to shape this framework further, agreeing a common national approach to LPN operation where beneficial. In doing this it will be important to draw on the learning of other networks, particularly other managed clinical networks in the NHS, to ensure alignment and with engagement from a wide range of stakeholders, both inside and outside the NHS.

2Broader NHS context for managed clinical networks, including LPNs.

2.1 The Outcomes Framework

The NHS Outcomes framework is the overall uniting framework for the NHS CB. These outcomes are relevant to all clinicians across all of their work.By aligning local work plans of different NHS bodies to a single set of outcome measures, different programmes of work can be more easily aligned. Networks support local clinicians to deliver the outcomes framework in local systems.

The National Domain Leads will identify priority programmes of work through the planning process. Medical Directors at NHS CB regional and area team level will ensure that network plans are aligned both to national priorities and local needs. NHS Improving Quality (IQ) will provide a range of support including training, tools and techniques. Networks will need to focus both on improving outcomes and reducing inequalities between outcomes for different population groups. Networks will operate in line with the NHSConstitution. All networks will describe their priorities in line with the outcomes framework so that every clinician knows what a given improvement means for them and for patients they treat.

Networks enable clinicians to work with others to lead improvement of outcomes for patients; they are part of the clinical leadership arrangements which the NHS CB is strengthening within its new architecture.

2.2Features of Managed Clinical Networks in the New System

All managed clinical networks have certain features:

  • They have agreed a set of work priorities aimed at improving specific indicators within the Outcomes Framework.
  • At their heart is a set of clinical relationships with a defined clinical focus e.g.dentistry and geography.
  • Networks deliver improved outcomes for patients through aligning statutory bodies’ and others’ improvement effort.
  • Networks work through an influence model. They make extensive use of influencing skills and techniques and work with intrinsic motivators such as connecting to shared purpose, engaging mobilising and calling to action and building energy and creativity. They ensure these align to extrinsic motivators such as system drivers and incentives, payment by results, performance management and measurement for accountability, to ensure an overall focus for momentum and delivery. They may support the design of other bodies’ formal, statutory levers such as pricing or contracting arrangements.
  • Networks have strong patient and public involvement mechanisms to ensure that patient outcomes are kept at the centre of improvement activities.
  • Networks have formal leadership and governance arrangements to ensure that effort is directed and effective. They may have a mandate for improvement from commissioners and providers(i.e. within a contract specification), but they are not statutory bodies and do not seek to duplicate these powers or responsibilities.
  • All local NHS bodies will be expected to be part of relevant networks and can expect to be challenged about the nature of their engagementthrough statutory accountability arrangements.

2.3Network Governing Body

Managed clinical networks, such as LPNs, need to have a credible governing body, although they are non- statutory bodies. All Network governing bodies are different.Some are called steering or oversight groups instead of boards. All governing bodies meet regularly to determine priorities, review process and strengthen alignment.

The governing body comprises a range of interests: clinical and manager, commissioners and providers, patients, third sector and local authority leads, as relevant, and cover the clinical interests and geographical areas.However, members typically do not represent their host organisation on the governing body; they have been appointed for their credibility, skills and experience. A formal governance agreement with relevant NHS providers and commissioners gives the network governing body a mandate to act.

The ‘network’ comprises 4 different elements:

  • the network governing body or formal leaders;
  • the formal network members (such as NHS commissioners and providers and those that sit on formal network groups);
  • the network support teams (typically improvement, information, communications and administrative specialists)
  • wider stakeholders (all those touched by the activities of the network in a given geographical and/or clinical area).

When these individuals and bodies come together, they are very powerful; Building these relationships through on- the- ground delivery of improvement is a key focus of the governing body.

2.4‘Types’ of managed clinical network

From 1 April 2013, with the formal introduction of the Health and Social CareAct 2012 changes, there will be various and new types of managed clinical networks in the NHS. What unites networks is much greater than what differentiates them.

Networks are differentiated by their focus and their governance arrangements. It is the role of the network host to ensure that the network itself is effective in meeting members’ needs and its focus and governance is locally appropriate.

Some, such as Strategic Clinical Networks, focus on broader strategic issues, whereas Local Professional Networks and Operational Delivery Networks have more of an operational focus. However, strategic networks will at times consider operational issues a priority and sometimes an ODN or LPN will have the right members to address a particular strategic issue.

Some are hosted and funded by commissioners and some by providers, but all sit ‘between’ commissioners and providers in their way of functioning, as described earlier. Some are nationally mandated, such as LPNs; some only exist in some parts of the country in line with local needi.e. local respiratory networks hosted by CCGs in some parts of England. Some networks, such as Academic Health Science Networks and research networks focus on the innovation ‘end’ of the improvement spectrum as opposed to the dissemination and spread of acknowledged best practice.

2.5The NHS Change Model

The NHS CB has adopted a single change model, based on an extensive evidence review of what makes large scale transformation effective.Networks, such as LPNs will use this as their framework for improvement. The likelihood of success is increased if all elements of the model are deployed simultaneously. An initial focus of networks is to build shared purpose through practical improvement projects which can then be a spring board for further change.

All NHS CB employees (and others) will be trained in use of the NHS Change Model by the NHS Improving Quality (IQ), the NHS CB new improvement body. The evidence relating to use of a change model is that effectiveness is improved, if a consistent, systematic and evidence based approach to large scale change is used.

More information about the change model and how to use it can be found at Networks ensure that those involved in improvement have the right skills to support change, and may provide specially trained improvement managers to support change. Networks identify and promote examples of good practice, showing that ambitious change is achievable locally.

2.6Benefits of networks

Networks such as LPNs supportcommissioners across the commissioning cycle, in line with their work plans. They develop a high level of clinical focus and expertise and create momentum for large scale change. Networks have a role in performance measurement, but will not have a formal part in performance management.

Networks support providers to improve outcomes, particularly where there is dependency on other parts of the health and social care system. They bring together clinicians with different perspectives to bring innovation to health care delivery. They may support data sharing and benchmarking and support the sharing of risk or resources. Networks offer clinicians an opportunity to develop leadership and improvement skills and have influence outside of their employing organisation.

There is a wide range of ways that patients, carers and third sector bodies can influence NHS delivery. Patients, carers and third sector bodies have found clinical networks a useful means to support improving care at a local level and networks cannot function without comprehensive patient and public involvement. The particular benefits of involvement in networks for patients include opportunities to:

  • cover the whole patient pathway
  • focus on improvement
  • work with all types of health care professionals
  • cover a defined local geography
  • access good support for involvement from the network support team
  • not be aligned to any one part of the system
  • focus on different parts of the pathway over time

For the system as a whole, networks, such as LPNs, generate a range of benefits:

  • Commissioners and providers receive credible and consistent clinical advice
  • Prioritised and aligned improvement activities are supported
  • There is safe and efficient clinical handover of patient between providers
  • Care across the systems is consistent and improving, regardless of the patient’s entry point
  • Learning and improvement is spread and disseminated between peers
  • Patients have a structured route for engagement in service improvement
  • The system works as a whole, not in a fragmented way
  • The resilience of the system to unexpected surges and changes is improved
  • System wide benchmarking and measurement is facilitated
  • Networks support relationships across the systems i.e. withHealth & Wellbeing Boards (HWBs),Public Health England (PHE), Clinical Commissioning Group (CCGs), Health Education England (HEE) etc.

3Local Professional Networks- functions

3.1 Core Functions

The core functions of a Local Professional Network are as follows:

  • Support NHS CB in commissioning primary care with robust clinical input
  • Drive improvement in outcomes, in line with local and national priorities
  • Provide clinical leadership and facilitate wider clinical engagement
  • Support patient involvement
  • Support other commissioners i.e. CCGs, PHE, LET (B)
  • Advise and work with local Health and Wellbeing Boards
  • Feed into with other local networks and the local senate
  • Contribute to the national LPN Assembly
  • Engage with local representative committees (of primary care contractors)
  • Undertake additional profession- specific responsibilities
  • To take action to reduce inequality in outcomes within the overall context of improving outcomes, with particular reference to those with learning disabilities, dementia, from ethnic minorities and other vulnerable groups.
  • Commissioners may wish to request LPNs to coordinate pathway redesign and may provide funds for improvement managers possibly through CQUIN moneys.(Contracting for quality and innovation within the national NHS contract).

3.2 Dental LPN specific functions

  • Cover the whole dental pathway, including secondary care and out of hours
  • Key role in supporting the development of quality measures for dental secondary care, including CQUIN payments
  • Will need to work closely with local authorities and Public Health England to deliver and develop cohesive Oral Health Strategies and associated commissioning plans

3.3Pharmacy LPN specific functions

  • Support local authorities who lead on the development of the Pharmaceutical Needs Assessment which the NHS CB will use in commissioning pharmaceutical services
  • Consider new programmes of work around self care and long term conditions management in community pharmacy to achieve Outcome 2
  • Work with CCGs and others with regards to medicines optimisation
  • ‘Hold the ring’ on enhanced services ( PH/ CCG commissioned) highlighting inappropriate gaps or overlaps

3.4Eye Health LPN specific functions

  • NHS sight tests and domiciliary services are predominantly demand-led, hence more emphasis on quality assurance
  • Focus on improving services in line with 5 national eye health pathways: ocular hypertension monitoring service; glaucoma; referral refinement; low vision service for adults; Eye services for adults with a learning disability.
  • Future work to reduce avoidable visual impairment

4The LPN assembly

All LPNs, regardless of clinical area, will come together nationally through the Local Professional Network Assembly. The LPN Assembly will facilitate communication, influence and development between the LPNs and with the rest of the system at national level. In particular it will be the means by which LPNs can influence national commissioning policy. Through the assembly, LPNs can ensure that there is effective development and support for LPNs. It will be possible for members to establish working groups to address topics of mutual interest and concern. The LPN Assembly will be supported to meet face to face several times a year as well as via digital platforms.

5Support from other national bodies

Through the Area Team Support Manager, LPNs will have access to the full matrix of NHS CB support i.e. in business intelligence, communications and engagement etc. LPNs will have access to NHS Improving Quality (IQ) resources such as training, tools and techniques and examples of best practice. LPNs will also have access to the NHS Leadership Academy, with its particular role in supporting the development of clinical leadership. PHE, through health observatories and working with local authorities, will provide access to public health data.