Presentation on theme: "Briony Ladbury Safeguarding Children Lead NHS London Dr Ruth Hallergan - GP December 2012."— Presentation transcript:
Briony Ladbury Safeguarding Children Lead NHS London Dr Ruth Hallergan - GP December 2012
Funding Accountability Local Health Watch Local Authorities HWB Boards JSNAs Public Health Parliament Department of Health Commissioning Board professional senates Clinical Commissioning Groups & Clinical Networks Patients and Public – (adults and children) Monitor Economic Regulator Integration Patients interests Competition safeguards Care Quality Commission (Any Willing/Qualified) Provider NHS Reforms Accountability for results licencing contract Local partnership Public Health England LSCB CSS NTDA
1 NHS NATIONAL COMMISSIONING BOARD (NHS NCB) NHS budget distributed from here Public Health England PH budget distributed from here North South Mid East NCB Regional Offices replace current clustered SHA areas Regional 4 NCB Offices Single national operating framework Department of Health Public Health Budget NHS Budget Local Area Offices (LAT) NCB Local Area Team (LAT) Correspond to current PCT Clusters Clinical Commissioning Groups (212) May group into federations for commissioning health services across a population CCGs to demonstrate local authority alignment CCGs do not commission GP services done by NCB Local Public Health Directorate (Director of Public Health) Located in Local Authority In 2006 – 152 PCTs in England NHS Reforms Commissioning/Accountability Structure London Commissioning Support Units
1 NHS NATIONAL COMMISSIONING BOARD (NHS NCB) NHS budget distributed from here Department of Health London Clinical Commissioning Groups (CCGs) May group into federations for commissioning health services across a population CCGs to demonstrate local authority alignment Access Commissioning Support LONDON PH Public Health Directorate (Directors of Public Health in each LA) NHS – London Structure Sept 2012 Leadership for Safeguarding Chief Nurse Leadership for Safeguarding London Region Chief Nurse & Deputy Chief Nurse Safeguarding Children Lead & Safeguarding Children Doctor Leadership for Safeguarding A CCG accountable officer (?GP) Safeguarding Children Expertise Designated Nurse & Doctor for Safeguarding Children PROVIDER TRUSTS PRIMARY CARE Leadership for Safeguarding Safeguarding Trust Board Lead Named Nurse and Named Dr for Safeguarding Children / Named Midwife LONDON NHS CB OFFICE Regional & Local Area Team Responsibilities Also NTDA Leadership for Safeguarding Named GP 1 per LA?
Responsibilities London NHS CB London Office Regional & Local Responsibilities Improve quality and outcomes Reduce health inequalities Empower patients Promote innovation Policy lead for safeguarding Annual assurance and peer review of primary care and directly commissioned services Specialist advice and support to NHS Work with CQC and Monitor on a joint information sharing protocol / MoU for areas of concern Authorisation and oversight of CCGs (and on-going development) Safeguarding responsibilities in directly commissioned services (primary care, specialised services – prison health (health visiting & family nurse partnership until 2015) Developing and sustaining effective partnerships (networks/ London SCB)
Responsibilities for CCGs Commission services for registered and unregistered patients – but NOT primary care services Support quality improvement in primary care Must meet safeguarding responsibilities as per authorisation guidance Safeguarding Training for staff Clear lines of accountability in CCG governance arrangements Co-operate with Local Authorities Participate with and support the operation of LSCBs Secure the expertise of a designated doctor and nurse for safeguarding children – clinical experts that must be embedded in the clinical decision making processes given authority to influence and work across the whole health economy Sit in CCGs (doctors in provider with SLA) NOT in CSU Retain Local Authority alignment Secure the expertise of a designated doctor and nurse for LAC Secure the expertise of a designated paediatrician for CDOP
London CCGs 4.1 Clinical Commissioning Groups (CCGs) CCGs will need to demonstrate as part of authorisation that they have appropriate systems in place for discharging their responsibilities in respect of safeguarding (see the Draft Guide for Applicants for CCG Authorisation, 4.2.3 and 5.3), Where the designated professionals are currently employed within PCTs, it is expected that their employment will transfer to a CCG. Where the designated professionals (most likely the designated doctor) are employed within a provider organisation, the CCG will need to have an SLA with the provider organisation that sets out the practitioners responsibilities and the support they should expect in fulfilling their designated role. The CCG will need to ensure that its designated clinical experts are embedded in the clinical decision making of the organisation with the authority to work within local health economies to influence local thinking and practice. Where there is more than one CCG per LA/LSCB area, CCG can develop a lead/hosting arrangement for their designated team. 4.1.1 Commissioning support Whilst Commissioning Support Units or other commissioning support services will have a number of important roles to play in helping CCGs to commission effective services and assure themselves of the safety of those services, they are not considered as an appropriate vehicle for the hosting of designated professionals
London CCGs 4.1.2 Funding CCGs should plan on the basis that running costs will be defined in the same way as PCT administration costs, which excludes any payments for the provision of healthcare or healthcare related services. CCGs, supported during the transition by PCT cluster finance staff, will need to exercise judgement in deciding what are healthcare related services. Current rules allow administration costs to exclude specific clinical advice where it relates to the care given to individual patients. Current advice indicates that designated professionals should fall within this definition. There are likely to be other costs associated with the safeguarding system, eg the local contribution to the operation of the LSCB, which will have to be met from within a CCGs running cost allowance. HEALTH WARNING - LACK OF DETAIL Capacity, Seniority – competencies in new system? Clarity re Named GP role – responsibilities & authority? Effects of localism? Will it change - is only interim guidance? What will appear in Working Together ? CCG Leads, Designated & Named Professionals & GP must be assertive & adept at horizon scanning to anticipate issues, assess & articulate risk Munro Review 2011
Named GP for City & Hackney Although not mandatory, registration with a GP is universally available to all children and is seen as an essential requirement to ensure effective delivery of health care and as a means of monitoring and supporting vulnerable children
Clinical Work Patients under 15 are seen in approximately 25% of GP consultations Children under 5 visit their GP on average 6 times per year Daily communication with a wide range of health care professionals Monthly link meetings with health visitor and midwife
Local Safeguarding Childrens Board Present the GP viewpoint to other agencies Executive Board Child Death Panel Serious Case Reviews; Ill spend time in the GP surgery creating a chronology of events relating to the child and their family
Training With the Designated Nurse and a social worker we deliver Level 3 Safeguarding Updates to practices in City & Hackney (45). Attended by frontline staff including GPs, Practice Nurses, reception and administrative staff We present clinical scenarios and encourage lively discussion
GP Networks GP Forum attended by 57 GPs with a focus on Looked After Children Monthly Safeguarding bulletin to all Practice Leads GP booklet giving local guidance Regionally, new Pan London Named GP group Nationally, Primary Care Forum with biannual conferences and email discussions on pertinent issues
Supervision Monthly meetings at the Tavistock Clinic Attended by acute and community paediatricians, adult and child psychiatrists and GPs Work across from Royal London Hospital to Chelsea & Westminster Hospital Unique opportunity to learn from Primary to Secondary to Tertiary Care
Miscellaneous Childrens Social Care, work together to streamline and improve communication between our agencies. Education, recent meetings with head teachers and GPs to share good practice. Email queries.
New challenges ahead The Named GPs roles & responsibilities were omitted from the first version of 2012 Working Together Experienced & trusted Named GPs may decide not to continue with their role post March 2013 20% of posts for Designated Doctors remain unfilled nationally
New challenges ahead The named GP is aligned to the National Commissioning Board for directly commissioned services (including primary care) Designated Professionals will be employed by (or have SLA with) a Clinical Commissioning Group. The Clinical Commissioning Group Accountable Officer is likely to be a local GP who will have responsibilities for overseeing safeguarding quality in local GP practices. Will this be appealing?
My View Really good safeguarding works when all the pieces of the jigsaw that encompass a childs experience are skilfully and compassionately matched together by every agency that knows the child and their family. I believe that our greatest challenge is to continue to champion communication, trust and effective safeguarding whilst working in new and unfamiliar structures.
Questions for discussion What would help to clarify and support the role and responsibilities of Named GPs locally? What could Named GPs do, to better safeguard children and young people in the new NHS Landscape? As members of the wider multi-agency safeguarding community how can you engage and support your named GP?