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Local Professional Networks Assembly 17 September 2013.

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Presentation on theme: "Local Professional Networks Assembly 17 September 2013."— Presentation transcript:

1 Local Professional Networks Assembly 17 September 2013

2 NHS | Presentation to [XXXX Company] | [Type Date]2 The Right Honourable Earl Howe Parliamentary Under-Secretary of State for Quality Opening of the LPN Assembly

3 NHS | Presentation to [XXXX Company] | [Type Date]3 Ann Sutton Director of Commissioning (Corporate) NHS England National Ambition for the LPN’s

4 Mission Statement “High quality care for all, now and for future generations.”

5 The Commissioning Landscape 211 - Clinical Commissioning Groups 151 - Local Authorities 27 - NHS England Area Teams Improving outcomes ● Delivering equality ● Improving experience

6 Commissioning together NHS England commissioningRelated commissioning Essential and additional primary medical services through GP contract and nationally commissioned enhanced services Out-of-hours primary medical services (where practices have retained the responsibility for providing OOH services) Out-of-hours primary medical services (where practices have opted out of providing OOH services under the GP contract) Community-based services that go beyond scope of GP contract (akin to current Local Enhanced Services) - CCG Pharmaceutical services provided by community pharmacy services, dispensing doctors and appliance contractors Meeting the costs of prescriptions written by member practices (but not the associated dispensing costs) - CCG Primary ophthalmic services, NHS sight tests and optical vouchersAny other community-based eye care services and secondary ophthalmic services - CCG All dental services, including primary, community and hospital services and including urgent and emergency dental care Dental Public Health – Local Authority Health services (excluding emergency care) and public health services for people in prisons and other custodial settings (adult prisons, young offender institutions, juvenile prisons, secure children’s homes, secure training centres, immigration removal centres, police custody suites) Emergency care, including 111, A&E and ambulance services, for prisoners and detainees present in geographic area Health services for adults and young offenders serving community sentences and those on probation Health services for initial accommodation for asylum seekers - CCG Health services for member of the armed forces and their families (those registered with DMS) Prosthetics services for veterans (Primary care for member of the armed forces will be commissioned by the Ministry of Defence) Health services for veterans or reservists (when not mobilised) for whom normal commissioning responsibilities apply Emergency care including A&E and ambulance services, for serving armed forces & families registered with DMS practice present in geographical area - CCG Public health services for children from pregnancy to age 5 (Healthy Child Programme 0-5), including health visiting, family nurse partnership, responsibility for Child Health Information Systems Healthy Child Programme for school-age children (5-19), including school nursing – Local Authority National Screening & Immunisation programmesSexual Health programmes – Local Authority Public health care for people in prison and other places of detention Sexual Assault Referral ServicesSexual Health programmes – Local Authority

7 A wealth of clinical resources to support commissioning CCGs Clinical Senates Area Team Clinicians Public Health England H&WB Boards Strategic Clinical networks Local Professional Networks Academic Health Science Networks National Clinical Reference Groups National Clinical Directors Clinical Priorities Advisory Group Domain Leads Clinical Directorates Chief Professional Officers Local LPN Assembly Commissioning Assembly

8 NHS | Presentation to [XXXX Company] | [Type Date]8 Dr David Geddes Head of Primary Care Commissioning NHS England National LPN Update

9 The journey so far….

10 You said…we did from last LPN Assembly Essentials you said we must doWhat we’ve done Get the right Chair in placeComprehensive job descriptions Robust recruitment processes Draw up competence framework for Chairs and other LPN leaders Discussion of the training & development toolkit are underway Planned development programme for Chairs & LPN leaders NHSIQ are here today and development work will continue following today’s Assembly Build on existing groups and networksPeople already involved encouraged to remain on the steering groups Newsletter Website Clarity on governance & accountabilitySingle operating model published

11 Recruitment update 81 positions in total for LPN Chairs across England 18 have been confirmed as filled or interim 63 are vacant (some are out to advert)


13 Ambitions for today’s LPN Assembly

14 Launch of the LPN Website

15 NHS | Presentation to [XXXX Company] | [Type Date]15 Local Ambition for LPN’s Pharmacy Dental Eye Health

16 Dr Jill Loader Regional Pharmacist NHS England South Pharmacy LPNs

17 HWB/Local Authorities Clinical Commissioning Groups Strategy, policy, contract, procedure and assurance of achievement of outcomes Implementation and development plans to reflect local circumstances Local intelligence, clinical expertise, innovation and development of integrated care pathways Peer support, peer review and benchmarking Maximising performance LPN Assembly NHS England regional/ central Area Teams Local professional networks Informing needs, demand, supply in primary, community and secondary care Aggregation of need and assurance of performance HEE/LETBs LPNs working as an integral part of NHS England Area Teams, developing close local working relationships

18 Pre April 2013 PCT Medicines optimisation Consultation with LPC Pharmaceutical Needs Assessment Complaints Accountable officer for Controlled Drugs and LIN Public Health Waste medicines Patient engagement Clinical leadership and engagement Pharmaceutical Applications Medicines strategy Medicines QIPP Accreditation Fraud Poor performers Contract monitoring Commissioning essential, advances and enhanced Pharmaceutical services Medicines safety Transfers of care Care Homes Access to medicines out of hours

19 Post April 2013 NHS England Medicines optimisation Consultation with LPC Pharmaceutical Needs Assessment (H&W Boards) Complaints Accountable officer for Controlled Drugs Public Health Waste medicines Patient engagement Clinical leadership and engagement Pharmaceutical Applications Medicines strategy Medicines QIPP Accreditation Fraud Poor performers Contract monitoring Commissioning essential, advanced and enhanced Pharmaceutical services Medicines safety Transfers of care Care Homes Access to medicines out of hours Quality improvement CCGs Direct commissioning of public health services from pharmacy Contract monitoring LAs Commissioning services direct from pharmacy e.g. minor ailments, palliative care medicines Safe use of controlled drugs Patient pathways Networks Primary care prescribing

20 Local Professional Networks for Pharmacy Clinically-led commissioning ensuring a coherent offer for public from multiple commissioners of services from community pharmacy informed by patient and public engagement Quality improvement support continuous improvement in quality of pharmaceutical services provision locally. Pharmaceutical Needs Assessment advise H&W Boards in producing a robust local PNA Outcomes Framework contribute to every domain through effective joined up work on medicines optimisation and support for healthy living through community pharmacy – CCGs, NHS England, Local Authorities, Public Health England, Health Education England

21 Communication

22 Medicines Optimisation Principles

23 Chair: Clare Howard S upporting the development of Local Professional Networks and sharing best practice Supporting the development and implementation of national strategy and policy Working with key stakeholders on the development and delivery of national priorities Providing clinical leadership Pharmacy LPN Steering Group Ensure contribution of LPNs in each AT is maximised to improve outcomes and reduce inequalities

24 Getting Medicines Right at Discharge Integrated care around the patient Cross sector working - NMS, tMURs Improve safety, reduce readmissions Effective communication On-going monitoring Understanding which medicines have been stopped and started and why. Support for medicines-taking Joint decision making – plan when to take, when to stop, when monitoring needed, when to review, outcomes, side effects

25 Effective Patient Involvement Clearly define remit of each member of group What is needed and why and what they will get out of it Make sure patient reps are properly prepared appropriate background to LPNs, a good pre-brief (include roles, jargon, expectations, behaviours) opportunity to ask questions in a non threatening environment Ensure support available from both an NHS buddy and another patient rep Be clear about training provided, claiming expenses etc. Keep engaged and give regular feedback re the difference their contribution is making

26 Support for Chairs of Pharmacy LPNs

27 Serbjit Kaur Deputy Chief Dental Officer NHS England LPN (Dental) Steering Group Chair Dental LPNs

28 Key Aims and Objectives for Dentistry Implementation of SEICD To improve oral health and reduce inequalities To improve access to high quality dental services To Improve the outcomes for patients To provide seamless delivery of care across all dental specialties To integrate dental services within wider NHS To develop meaningful quality metrics Getting value for money without compromising clinical quality.

29 The big issues To reduce oral health inequalities with respect to access to services and outcomes for patients To develop patient pathways to ensure patients can access appropriate care, dependent on need, regardless of the setting within which this care is developed To develop a service with a greater focus on prevention To develop a service that meets patients expectations

30 Directly Commissioned Services Committee Primary Care Oversight Group National Dental Commissioning Group National LDN Steering group Oral and maxillofacial surgery Vulnerable people Advisory Report to National Dental Commissioning Group Relationships Clinical Priority Advisory Group Report to

31 National Dental Commissioning Group Aims: To ensure a holistic approach to commissioning To work with all key stakeholders to lead the transformation of dental services required to deliver SEICD Key Objectives: To develop a comprehensive dental commissioning strategy To oversee the delivery of a single operating model To encourage innovation and creativity and identify best practice To encourage active dialogue on issues and challenges relating to dental services

32 National Dental Commissioning Group Chief Dental Officer Head of Primary Care Commissioning, NHS England Assistant Head of Primary Care Commissioning, NHS England Head of Primary Care and Commissioning Outcomes, NHS England Dental Policy DH Deputy Chief Dental Officer Dental Commissioning lead for Public Health England 2 Dental Commissioners for each region nominated by the regional lead Health Education England - Post Graduate Dental Dean

33 LPN Dental Steering Group Draft Terms of Reference Invitations for nominations for membership have been sent Will play a key role as a conduit between the NDCG and Local Dental Networks Information needs to flow in both directions to achieve the aspirations of SEICD Function is to support the LDNs in the development and Implementation of national strategy and policy

34 Membership of the Dental Steering Group Chair: Deputy Chief Dental Officer Head of Primary Care Commissioning Assistant Head of Primary Care Commissioning/National LPN Lead 4 LDN Chairs (one from each region) 4 Commissioners (one from each region) 4 Dental Public Health Consultants (one from each region) Regional Consultant in Dental Public Health - NHS England liaison Representative from Health Education England

35 NHS England needs you! LDN are essential to: To provide clinical advice to Area teams To ensure sufficient local flexibility in the implementation of national strategies and policies Achieving the aspirations of SEICD Link across all Area Teams and the centre support structures

36 Dr David Geddes Head of Primary Care NHS England Local Eye Health Professional Networks

37 LEHN – An opportunity for clinical leadership. Four specific functions for LEHN to consider Eye Health Needs Assessment Redesigning services for quality improvement Working in Partnership Improve access for sight tests for seldom heard groups

38 Health inequalities …

39 National priorities and LEHN focus LPN CCGLA Health and Wellbeing Board

40 Facing blindness alone Almost half of blind and partially sighted people feel “moderately” or “completely” cut off from people and things around them. Older people with sight loss are almost three times more likely to experience depression than people with good vision. Approaching one in 10 falls that result in hospital admissions occur in individuals with visual impairment. Facing blindness alone RNIB 2013

41 Vision and long term illness.

42 Rehabilitation Rehabilitation is the structured support put in place, over a defined period of time, with the overall aim of maximising a person’s independence and quality of life. It is a cost effective approach which aims to help blind and partially sighted people “do things for themselves”, rather than “having things done for them”.

43 Dementia pathway…



46 Support for LPNs Eye Health Steering Group Getting Started and Building Relationships Clinical Council for Eye Care Commissioning National Primary Care Strategy and Area Team Primary Care Plans

47 NHS | Presentation to [XXXX Company] | [Type Date]47 Dr Robert Varnam PhD RCGP Clinical Lead NHS Improving Quality @robertvarnam Leading purpose & possibility

48 What do you want to achieve?


50 Large scale change usually fails Source: McKinsey Performance Transformation Survey, 3000 respondents to global, multi-industry survey of company executives

51 NHS Change Model


53 Who’s paid them? What is the performance management framework? What’s the plan?

54 “We have a list of measurable objectives” versus “I have a dream”

55 Compliance and commitment ComplianceCommitment States a minimum performance standard that everyone must achieve States a collective goal that everyone can aspire to Uses hierarchy, systems and standard procedures for coordination and control Based on shared goals, values and sense of purpose for co- ordination and control Threat of penalties/sanctions/shame creates momentum for delivery Commitment to a common purpose creates energy for delivery

56 “You can’t impose anything on anyone and expect them to be committed to it” Edgar Schein, Professor Emeritus MIT Sloan School

57 “You don’t need an engine when you have wind in your sails” Paul Bate

58 Using intrinsic motivation Often, change need not be cajoled or coerced. Instead, it can be unleashed. Kelman, S. (2005) Unleashing change. A study of organizational renewal in government. Brookings Institution Press; Washington, D.C.

59 Intrinsic motivators build energy and creativity

60 Intrinsic motivators connecting to shared purpose engaging, mobilising and calling to action motivational leadership build energy and creativity

61 Drivers of extrinsic motivation create focus & momentum for delivery Intrinsic motivators connecting to shared purpose engaging, mobilising and calling to action motivational leadership build energy and creativity

62 Drivers of extrinsic motivation  regulation  payment & incentive systems  performance management  measurement for accountability create focus & momentum for delivery Intrinsic motivators connecting to shared purpose engaging, mobilising and calling to action motivational leadership build energy and creativity

63 Internal motivators connecting to shared purpose engaging, mobilising and calling to action motivational leadership Drivers of extrinsic motivation  System drivers & incentives  Performance management  Measurement for accountability create & focus momentum for delivery

64 What do you want to achieve?

65 Five tips for leading a network

66 Invest more in people than plans Create massively distributed leadership Lead through the sense of purpose and possibility you create Talk fearlessly about values Invest in your first followers

67 NHS | Presentation to [XXXX Company] | [Type Date]67 Case Studies

68 Stephen Gough Lancashire LPN Lead NHS England Lancashire Local Professional Networks

69 Objective To describe the governance structures and framework by which the Lancashire Area Team will ensure the integration of LPNs within the health system, specifically the primary care strategy and clinical strategy, and hold LPNs to account for the delivery of their work plans.

70 LPN Executive Commissioning Director & Medical Director LPN ChairLEHN ChairLDN ChairLPN Manager Head of Primary Care Assistant Director Clinical Strategy

71 Framework The supporting framework consists of a suite of locally developed documents, using NHS England templates, applied across all 3 LPNs and include: > LPN Matrix of stakeholders > LPN TOR > LPN Structures > Summary Work Plan > Detailed Work Plan with milestones and outcomes > Conflict of Interest > Policy Commercial Sponsorship Policy


73 73

74 Lancashire Pharmacy Network


76 Electronic referral for post-discharge pharmaceutical care Including community pharmacy based : Targeted MURs (discharge medication review) New Medicine Service

77 Alistair Gray East Lancashire Hospitals NHS Trust (ELHT) GP Hospital Pharmacy Community pharmacy

78 Patient Voice

79 Elaine Hawthorn GM LPN (Dentistry) Chair Baby Teeth Do Matter The first project of the GM LPN for dentistry

80 NHS | Presentation to [XXXX Company] | [Type Date]80 Baby Teeth DO Matter The first project of the GM LPN for dentistry Quality and Access

81 In this case study you will hear about: The first problem we tackled as a LPN I will share the outline of what we did and why what we produced and achieved Later in the workshop you will be considering whether our formula could be useful in your LPN If any of you have addressed other issues and started projects our LPN would be pleased to receive your learning

82 NHS | Presentation to [XXXX Company] | [Type Date]82 GM LPN Early days….. Establishing the network

83 Steering Group formed in Jan 2012 Core group - 3 X Dentists (from the outset) 2 X Commissioners, 1 X Dental Public Health We considered how the LPN could function across 10 PCT localities with helpful advice (CCG Chair and Director of Public Health) Following consideration on structure - rather than sit around talking about ToRs etc and the dentists losing the will to live - we decided to take action and do something positive The first task would test whether this collaborative approach, led by dentists, could work

84 NHS | Presentation to [XXXX Company] | [Type Date]84 Baby Teeth DO Matter The task

85 What did we do and why? One problem in GM is high decay levels in the very young – it starts before age 3 Leading to far too many children having pain, dentists struggling to treat them and too frequent GAs for extractions 5 year old decay rates had not changed despite all our (separate) best efforts for many years We learned from PH that the best way to influence behavioural change is a quality 1 to 1 contact with a health care professional

86 Getting the message out there Dental decay is largely preventable with a healthy diet and use of fluoride Task: to encourage attendance of all under 5s in GM especially those who had not seen a dentist ever or in last two years – find the missing thousands and when they got there - make the contact count with simple achievable message (bedtime routine), fluoride varnish application and given free TB & TP Dentists wanted something lasting not a quick access fix to year end – more on that later ….

87 The missing thousands Total number Seen by dentist Not seen by dentist in past 24 months Children under three years of age 108,78044,60064,180 Children aged three and four years of age 75,52051,35424,166 TOTAL88,346

88 How did we pay for it? £200,000 allocated from the collective PCT dental underspend CsDPH had to fight hard for this - less than 1% This was to pay for TB & TP, literature and to secure the time of 10 clinical champions - one for each PCT locality to encourage practices to participate The dentists had to be prepared to use their currently contracted UDAs to prioritise this group and actively seek them out UDA allocation SLA agreed (with difficulty) across 10 PCTs The incentive (3 UDAs subtracted from annual total) was allowed if the child returned 3/12

89 Materials

90 Launched in November 2012 400+ practices in GM, almost half signed up This is credited to the leadership of the clinical champions within the localities – one rang every single practice to encourage participation! They involved the media running stories in local press and used radio to let parents know that dentists were keen to see their children even though they “only” had baby teeth In the finite time we had almost 4000 very young children some of whom had never been before attended the dentist and the majority returned within three months for further advice & FV

91 Using the media

92 The add on for the long term….. Dentists seeing these young children wanted support in best practice treatment and decision making And for BTDM to continue So…. We established a sub group to take this forward It included specialists, GDPs, public health and commissioning leads and was Chaired by one of the clinical champions Clinical pathways booklet and training produced to assist dentists and their teams provide better quality care and reduce the GAs

93 The launch of the BTDM pathway booklet


95 Things we struggled with… Commissioners adapting from previous PCT approach, to really listen and act upon what the dentists were saying – some found relinquishing power to the clinicians difficult Looking back the SLA was too complicated and the specialists found it hard to be pragmatic – they had not always taken on board the “keep it simple” message and the pace needed Involving the champions and engaging practices was variable across GM Getting funding

96 What worked well…. Dentists were very enthusiastic and LDCs gave positive input and support In a very short time we achieved far more working collaboratively on the same goal than we had working separately 4000 in and quality pathways Meeting the CCG Chair and other leaders outside of dentistry was inspiring for the dentists and it made sure that they knew about us and what we were trying to achieve Almost 500 dentists from across GM attended the launch of the pathway booklet and the Area Team Director of Commissioning looked at the audience and said “ I can’t ignore this” he was impressed they had given up an evening of their free time

97 NHS | Presentation to [XXXX Company] | [Type Date]97 Baby Teeth DO Matter Best of all….. 4000 young children and their families have been given the opportunity to have a future free of decay

98 Debbie Graham Interim LEHN Chair of Birmingham, Black Country and Solihull The Solihull and Birmingham LEHN story so far

99 Commercial break Follow National Eye Health Week on twitter @myvisionmatters @myvisionmatters

100 LEHN membership Optometrists Ophthalmologist [2e care] Patient representative LOC CCG clinical leads Clinical advisor Community paediatric care [orthoptist] Low vision service providers Health & Well Being Board Vision 2020 [regional] Public Health Local Authority Aston University optometry Primary care commissioner Admin. Support

101 The first meeting… Wide stakeholder input Invitation of workplan ideas and opportunities Organisational development Core lead group Task and finish groups Communications Building on existing workstreams …..

102 Systems & processes Constituting the network: Workplan agreement: -core group identified -terms of reference agreed -accountability agreement -conflict of interest addressed -prioritisation criteria -sign-off by BSol cluster

103 Measures of Success for the LEPN Secure Public Health engagement (at Health and Well Being Board level) in the eyecare needs assessment Secure Public Health attendance/membership at the LEPN meetings Communicate to Clinical Commissioning Groups and Primary Care Optometrists, the evidence base in relation to handling referrals between primary and secondary care Provide a report on the outcomes of the intra-ocular pressures local enhanced service to aid future commissioning decisions Develop and recommend a complete, evidence-based age-related macular degeneration pathway Develop and recommend a complete cataract pathway in line with the Map of Medicine evidence-based approach Produce and implement an effective Communications Strategy and Plan to ensure the LEPN’s accessibility to stakeholders and vice versa Too Ambitious?

104 Next steps Event to establish single LPNs including LEHN across AT Appointment of chairs Steering group to prioritise workplan suggestions Commissioner and medical director sign-off Quick second LEHN meeting Task and finish group approach Single LEHN across Birmingham Solihull and Black Country

105 10-10-13 Follow World Sight Day on twitter @iapb1

106 NHS | Presentation to [XXXX Company] | [Type Date]106 Workshops

107 NHS | Presentation to [XXXX Company] | [Type Date]107 Thank you for attending

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