1. Commissioning Intentions - Planned Care Workstream
2019/2020
Continuing Healthcare
Joining up and pooling the funding of Health and Social Care needs for people needing continuing healthcare
Working together more effectively to commission services for social care, nursing care and continuing care placements – managing the opportunities together
Assess the health and social care needs of people together, share decision making and reviewing needs more regularly; increasing the offer of personal health budgets so people can make more decisions on the care they need
Cancer
Commission a stable prostate monitoring shared care service with GPs via the Confederation
Aim for patients with suspected cancer to be seen by a specialist within 7 days
Meet or improve upon the national targets from referral to treatment started (62 days) by increasing access to early diagnostic tests and improving the response times
Recognise living with cancer as a long term condition and provide more ongoing support to patients and families.

2. Outpatient Transformation:
Continue working with the Homerton to transform our model of outpatient care locally by:
Preventing unwarranted first attendance/referral- improved advice and guidance, MDT/GP discussion and feedback, triage to community/primary care/other pathways, GP Education/Training, Patient Self- Management
Reducing unnecessary face-to-face follow ups- patient centred tools, enable self-management, virtual/telephone/primary care follow up
Optimising what should be done in secondary care and by whom- links across specialties to avoid/reduce internal consultant to consultant referrals; e-consultation in patient home/GP premises; group consultations where similar patients are consulted in a group; extended scope practitioners/advanced nurse practitioners/specialist nurse for targeted follow up allowing consultants to focus on complex/surgical work
Diabetes:
Consider the output and recommendations from the Diabetes Needs Assessment and review / revise the current service accordingly
Community Services:
Msk – work with the Homerton Locomotor service to introduce patient self-referral for basic physiotherapy
Commission an Optometrist referral review service to sort and allocate most GOS18 referrals away from GPs to appropriate services such as MECs or MEH
Expand the gynaecology community offer so more patients can be seen and treated away from secondary care.

3. Health checks for Learning Disabilities (LD)
Aim to join up and increase the funding for Health and Social Care needs for people with LDs
Improve Health Checks for people with LDs to ensure they are done annually as a minimum and needs are assessed for both Health and Social Care needs
Teledermatology – continue to implement
The Homerton have recently proposed an integrated model of teledermatology that we are looking to implement later this year.
The proposal offers a service integrated with both the community dermatology service and HUH secondary care with the clinical photography subcontracted to GP practices via the GP Confederation.
Referrals via e-RS with Advice and Guidance available through the same model.
Diagnostics/Pathology
Working with HUH to improve TQuest, reduce unnecessary testing by educating and introducing pop ups to advise on other options or signpost to latest advice and guidance.
Obesity Pathway:
Working with Prevention Workstream on new obesity pathway including surgical options

4. Mental Health IAPT Service
Roll out of LTC IAPT service
Extension of voluntary sector IAPT service
Mental Health Accommodation Pathways
Monitor Housing First pilot (pending approval) mental health impact
Work with LBH Mental Health team on a joint supported accommodation pathway strategy
Explore Shared Lives option as a way to increase mental health support in the community
Mental Health – Support to the Continuing Care Team
ELFT Rehabilitation team reviewing CHC contract
Review of Look Ahead operational specification  - Rehabilitation team  to work alongside CHC
contract
Dementia Alliance to review nursing home and care home provision e.g. working with Care Homes, ASC, LBH and CoL to develop training packages on dementia and delirium for all home/agency carers

5. Medicines and Prescribing
Main Focus for the year – Polypharmacy & supporting Adherence
Increased reviews of patients’ medication
Improved patients awareness about medication reviews
Discharge to Pharmacy project for patients being discharged from hospital
Improve healthcare professionals’ knowledge and skills on correct administration of eye drops to improve patients use of eye drops – hence improving outcomes and reducing waste
Improving prescribing of insulin
General practice audits to identify patients on high doses of opioids
?Audit of prescribing for depression in line with NICE CG90
General Practices undertaking e-learning modules on anticoagulation and opioid aware
Maintain/ improve practices response to Medicines and Healthcare products Regulatory Agency (MHRA) drug safety alerts and prescribing error reporting via NRLS