Aspiring to Clinical Excellence: Our Journey so far

What is ACE? ACE is a programme of improvement aimed at reducing the level of variation in general practice by bringing all practices up to the same standards and delivering improved health outcomes for patients

What did we prioritise for 2013/14?

What difference have we made so far? Early data on this year’s scheme has demonstrated that: We have a high level of engagement in commissioning activities from our member practices Although the CCG has seen a 1.5% increase in outpatient referrals for those specialties where the CAS service was in place, nationally GP referrals have increased by 5.5% across outpatient specialties The CCG saw a 26% reduction in average monthly costs for ‘specials’ prescribing compared to the national trend of a 10% reduction. The actual cost reduction compared to the national trend is equivalent to £33,429 per month. Spending on high cost drugs has reduced by an average of £34,304 per quarter, compared to last year. On average, practices are identifying an additional 14% of patients appropriate for placement on a disease register therefore ensuring patients with chronic diseases receive early identification and management of their chronic disease. Our practice appraisals programme will be used to verify achievement at the end of the year

Practice Appraisals PPG DES Patient Survey Patient Choice Engagement & Involvement CAS Prevalence Searches Medicines Management Safeguarding ACE Winter Implementation of ACE Foundation 14/15 Prevalence Screening/ Vaccinations/ Immunisations QOF Achievement List size Population Primary Care Capacity Enhanced Service Delivery Practice Details Clinical Effectiveness Patient Experience ACE

Our priorities for next year

What have our stakeholders told us?

Our discussions with PPG Chairs

What’s new ComponentDetail Engagement & Involvement1.Local Commissioning Networks (LCN) meetings 2.Open Forums and AGM 3.Educational Events 4.Service Improvement/Redesign/surveys 5.Annual Practice Appraisal 6.Practice Manager Forums Medicines Management1.Therapeutic audit e.g. Respiratory/Diabetes 2.Safety audits e.g. Post MI therapy/antimicrobial prescribing 3.Participation in CCG waste campaign Quality & Safety1.Primary Care review of C Difficile cases to support achievement of CCG target 2.Significant Events learning to be shared with LCNs Multidisciplinary Working1.Further development of the IMPACT model (previously a part of the ‘Risk Stratification DES’) 2.Implementation of local protocol for improved communication between GPs and Health Visitors (building on Children’s Safeguarding) 3.Regular meetings between GPs and HVs Support for Carers1.Identification of carers and establishment/maintenance of carers register 2.Offer of signposting support for carers 3.Development of innovative approaches to supporting carers and sharing learning with LCN and during practice appraisal Excellence in Commissioning1.Improving the quality of GP referrals using Advice & Guidance, Choose & Book and E-referrals (replaces CAS component) 2.Use of the GP Feedback Tool to improve the quality of CCG commissioned services

ACE Excellence Level ACE Excellence will operate as a single, universal offer that: Describes a package of ‘excellent’ enhanced primary care provision across all GP practices Is delivered through General practice Stretches the existing boundaries of primary care provision Describes packages of care that can be delivered by – Practices themselves and/or – Practices sourcing the expertise/capacity required by working in collaboration with local practices and/or providers

Objectives Support delivery of a model of primary care that ensures universal coverage across the CCG population Provide practices with an overarching framework that allows the freedom to identify creative solutions for how patients receive their care whilst ensuring accountability for care remains with practices Support delivery of a patient-centred and integrated approach to improving primary care management of long-term conditions Up-skill the primary care workforce to deliver services that may have previously been provided by secondary/community providers Achieve a genuine shift of capacity and resources from secondary care to primary care Bring to life the CCG’s value of “working smarter, not harder” by providing practices with a framework that frees professionals from ticking boxes and, instead, requires them to focus on delivering improved health outcomes for patients. Support the development of a primary care model that is fit for the future and therefore resilient to future challenges

Current State The future

Questions 1.Thoughts on the objectives of the ACE Programme? 2.Additional ideas/proposals we could explore together? 3.How do we continue the conversation with the Patient Council?