Conclusiones y Recomendaciones
NIÑOS DE PRIMARIA
West Kent CCG includes both the member GP practices (GPs and their practice staff) and the CCG staff (Governing Body, Commissioners, Finance and Administration staff).
GP Practices
New Primary Care will be difficult to achieve efficiently unless the services that wrap around the federated GP practices can work easily and in the same way with all of their practices. Equally, federated GP practices will be less efficient if they are unable to work easily with each other. Service providers will also find it difficult to deliver services cost effectively if GP practices are working in many different ways.
It is recognised that some IT within GP practices has scope to move to more standard approaches but other areas such as the main clinical systems are heavily embedded in the way the practices work. It is also recognised that GPs will need to see benefits from any proposed changes to IM&T systems before they will be embraced. The strategy is to:
Ensure that GP practices are using GP Systems of Choice (GPSoC), chosen from the list of centrally funded systems produced the Health and Social Care Information Centre (HSCIC). This includes:
o Principal Clinical Systems, including consultation and records management, prescribing, patient registration, core appointment, document management, and national services such as Choose and Book, GP2GP and Electronic
Prescription Service
o Subsidiary Clinical systems, including patient transactional services, patient clinician communication, patient record access, workflow and task
management, document management, appointments, and future services such as mobile clinical applications, decision support, telehealth, and data entry forms
As this list is continually being expanded, West Kent CCG will support GP practices in moving to any new recommended systems
Standardise basic IM&T infrastructure in practices. This covers: o PCs and laptop types and their basic set-up
o Core software, such as the Microsoft office suite and minimum version levels o Messaging systems, to move to unified messaging across the CCG as a whole o Remote access
Leave the GPSoC used in each practice as-is but support any practices that want to change systems as part of standardising systems within a federated group of practices
Move to standardising other IM&T systems used by the practices such as external information systems
Standardise management of IM&T Move to ‘digital primary care’, including:
o Removal of all non-electronic communication between health and social care practitioners
o Electronic communication with patients if they choose this as a primary means of communication
o Electronic interconnection of systems with other health and social care providers - part of the work described in section 3. Leading and Driving IM&T Integration and Ensuring Stakeholder Coordination & Collaboration.
o Move away from paper records
o Implementing appropriate safeguards such as preventing loss of data and non-response to communications
Support care.data
Provide access to GP records for patients - part of the work described in section 3. Leading and Driving IM&T Integration and Ensuring Stakeholder Coordination & Collaboration
Provide access to the information and tools described in section 4. Super-intelligent Commissioning - Evidence-based and Predictive
Provide faster N3 connections, retaining ‘industrial strength’ robustness and
availability. This will be required to support the integration of systems and the trend of increasing data volumes moving between users
Move away from servers and data held on GP practice sites to provide better system protection, remove the effort of having to manage data backups locally, facilitate easier and more cost-effective support, and provide 24x7 access to data required to support integration
Support GP practices with innovation that relies on IM&T
Conform to Information Governance requirements and patient consent at all times CCG Staff
The requirements for the Commissioning teams and related strategy are covered in section
The remainder of the CCG staff primarily use systems for normal office support functions including Finance. Information is usually accessed from external information resources or from the CCG file storage system.
However, the CCG is still looking to maximise efficiency across all activities and has recently developed a set of standards, procedures and templates - the West Kent Way - to make it easier for staff to work effectively.
The strategy is to:
Implement internal changes to ways of working in line with the West Kent Way. This includes changes to IM&T
Develop more efficient ways of communicating such as unified messaging
Ensure the CCG has the right tools for the job; appropriately specified equipment and communications
Standardise basic IM&T infrastructure. This covers: o PCs and laptop types and their basic set-up
o Core software, such as the Microsoft office suite and minimum version levels o Remote access
o Networking and WiFi
Develop the use of mobile tools to allow CCG users to work from any appropriate location
Develop document management so there is a single repository of CCG information Develop staff to make the best use of the IM&T facilities
Maintain outsourced IM&T to gain economies of scale from external providers; performance of providers to be tightly managed
Ensure conformance to Information Governance requirements and patient consent at all times
Follow the principles outlined in the Guiding Principles for IM&Tsection later in this document
Guiding Principles for IM&T
West Kent CCG will adopt a number of overriding principles in regard to IM&T. We will consider these throughout all IM&T projects and continuing operations:
IM&T will be driven by business or clinical needs, not the other way round. New technologies may still stimulate business or clinical changes
All IM&T must work hard for its users. Systems should be exploited to help users do their jobs rather than users being slaves to the IM&T systems
Systems should be intuitive, easy to learn, simple to understand, and present information in a way that can be easily assimilated by the user
Where possible, the CCG will be the Data Controller
We will not build up our own IT facilities; the CCG does not have the expertise or facilities to do this, nor is this the provision of an IT service ourselves part of the CCGs core business. Any IM&T systems will be commissioned as services from suppliers
We will avoid huge projects with long delivery timescales; IM&T projects will be broken down into smaller, more manageable activities where deliverables and return of benefits can be easily measured
We will copy the best, learn from others, and piggy-back or collaborate to ensure we shorten delivery times, get a quicker start to the return of benefits, reduce project risks and share costs
Choice of systems will include requirements for agility and adaptability to easily accommodate the rapidly evolving nature of healthcare. Choice of systems will also include interoperability according to the needs defined in the 3. Leading and Driving IM&T Integration and Ensuring Stakeholder Coordination & Collaborationsection We will avoid highly customised systems that are difficult to change and expensive to
support
Choice of providers will include understanding their own development plans to ensure they are innovative, proactive and in line with the direction of West Kent CCG Providers must conform to Information Governance requirements and patient
consent at all times
Decisions about proceeding with changes to IM&T systems will be set against the requirements from Mapping the Future and meeting the agenda for radical change within the NHS, rather than just pure financial benefits. For example, providing access to systems for patients will incur new costs but meets the requirements for patients to have more control over their own care
We will adopt a rapid implementation approach to get systems in place and benefits being returned at the earliest time; we will avoid procrastination
We will avoid being locked into suppliers to make it easier to move services should the need arise
IM&T Forward Plan April 2014 to March 2019
and Indicative Costs
Appendix 2: IM&T Forward Plan April 2014 to March 2019
provides an overview of the required activities and timescales to deliver this IM&T strategy. There is a considerable level of effort required with a mix of activities, ranging from extending the use of existing systems through to CCG-wide systems or service implementation. The plan is front-loaded to return benefits at the earliest opportunity. More work will be required as each activity is undertaken to plan the work in detail - following the West Kent Way - including:
Deciding whether the activity needs to follow a formal project management approach or can be managed through normal operations.
Defining the outcomes from the activity in terms of one or more of: o Improving outcomes for patients
o Improved operating efficiency o Meeting legal obligations o Meeting NHS England directives
o Meeting other drivers for care system change o Saving money
o The IM&T changes to facilitate the above outcomes Defining the scope of the activity
Defining the work to deliver the activity Defining the resources required
Defining the timescales
Defining the revenue and capital costs
Until this work is done, it will not be possible to give precise costs for delivering the strategy. However, as a guide, Tables 1 and 2 below show the budgetary figures that have been submitted to NHS England.
Table 1 - Budgeted Capital Spend
Financial Year (£K)
Activity 2014/15 2015/16 2016/17 2017/18 2018/19
TOTALS 1,840 795 500 500 500
Table 2 - Budgeted Revenue Spend
Financial Year (£K) Activity 2014/15 2015/16 2016/17 2017/18 2018/19 Maintenance: 221 316 376 436 496 Depreciation 222 668 873 863 691 TOTALS 443 984 1,249 1,299 1,187 Note that:
We will aim to make as much use of centralised funding as possible. This includes areas such as funding for GP IT and once-off project funding such as the Better Care Fund
We will look for other funding sources such as grants from the European Union We will share IM&T activity with other CCGs and providers - where it makes sense to
do so - to be as cost efficient as possible
The budgetary figures assume that for most activities, we will capitalise the majority of any project costs, including manpower to deliver the activities
The budgetary figures include allowances for ongoing maintenance and support Capital and revenue spend to support CQUIN schemes is not included in the figures
above. It is assumed that these would be covered by the providers as part of the CQUIN payments they receive, or the CCG would have to budget separately for any non-provider costs. These will be determined on a scheme-by-scheme basis The cost of the additional permanent headcount described in this strategy is not
included in the figures above - recruitment costs, salary and overheads for the IT Commissioner/Head of IT and Senior Business Intelligence Analyst
Next Steps
Following approval of this strategy by West Kent CCG, the immediate next steps will be to: Move forward quickly with the delivery of the activities in the Forward Plan so that
the strategy will be realised. This will need to align with, and be driven by, the programme of work within the CCG commissioning teams.
Recruit the permanent resources - IT Commissioner/Head of IT and the Senior Business Intelligence Analyst - along with resources to drive the delivery of the IM&T activities
Build IM&T requirements into all contracts being set up or renewed
Start to establish the effective working relationships between the IM&T teams in the providers, Kent County Council, the Commissioning Support Unit and the CCG
Further activities will come out of the detailed planning around the activities in the Forward Plan.
Conclusion
This is an ambitious IM&T strategy, driven by the need for rapid and radical change within the healthcare environment and integration with social care. As Mapping the Future states, “Doing more of the same better, faster will not be enough” so we have set high
expectations. It will be challenging to deliver but the drive from Government, NHS England and the CCG provide the critical buy-in to make this doable.
The strategy will almost certainly evolve in future years as more knowledge of the operating environment is gained and the momentum for change builds across all stakeholders.
However, the focus is on doing as much as possible, as soon as possible, so we can get benefits at the earliest opportunity.
Appendix 1: List of CQUIN Schemes - 2014/15 to
2016/17
Occurs in Year
No Schemes 2014/15 2015/16 2016/17
1. 70/30 Schemes - Stroke ESD 2. 70/30 Schemes - TADS 3. Adoption - post adoption work and implementing
requirements of Ofsted inspection
4. Autism
5. CAF Business Model
6. Cardiac Rehab
7. Cardiology
8. Care of the Elderly
9. CDU SSEM tariff
10. Challenging Behaviour - Children 11. Children's Community Childrens Nursing 12. Children's Mental Health
13. Community geriatrician and care homes
14. Con to Con
15. CT Angiography
16. CVD redesign
17. Dementia
18. Diabetes
19. Direct access endoscopies
20. EDS
21. Electronic sharing information solution
22. End of Life Care
23. Endobronchial Ultrasound (EBUS)
24. Enhanced Rapid Response Services
25. Epilepsy nurses
26. Faecal Calprotectin testing
27. Full implementation of the Responsible
Commissioner Guidance 28. Glaucoma Monitoring
29. GP in EOC
30. Gynaecology - transforming OPD
31. Impact of on-going Falls
Occurs in Year
No Schemes 2014/15 2015/16 2016/17
33. Implementation of dermatology virtual clinics/ advice
and guidance
34. Integrated Respiratory service
35. Medication Review - Care Homes
36. Medicines Optimisation Scheme (MOS) 37. MO - Control of Growth 38. MO - Dose Optimisation
39. MO - Eclipse Live and analytics
40. MO - Formulation Changes
41. MO - Individual Practice QIPP
42. MO - Joint formulary
43. MO - Prescribing for Review
44. New / FU ratios
45. Neurology
46. Obs and Gynae
47. Ophthalmology Follow Ups 48. Ophthalmology High Cost Drugs
49. Orthopaedics - Transforming OPD
50. Orthotics
51. Paed Assessment
52. Parkinson Nurse
53. Pathology / Radiology
54. Paula Carr Surveillance Clinics
55. Peer Supports
56. Physical Impairment - Children
57. Placements
58. Primary Care Mental Health Workers
59. Reablement
60. Reduction in A&E high tariff charges for minor
injuries and illnesses 61. Risk Stratification & Integrated care
62. Romney
63. Romney project
64. Roving GP
65. SAU SSEM tariff
66. SLCN. Multi-agency commissioning framework for children and young people with speech, language and communication needs
Occurs in Year
No Schemes 2014/15 2015/16 2016/17
clusters
68. UMAU SSEM tariff
69. Urgent and Ambulatory Care
70. Urgent Care for Children and Young People
71. Urgent Care/Psychiatric Liaison
72. Winter money - Preventing NEL Admissions