End Of Life @healthyLDN CMC In-Context Launch 38% 1930 3/5 Healthy London Partnership Digital Transformation Team CMC In-Context Launch Following the review of CMC, it was recognised utilisation of the EOL record through CMC in 111/IUC providers was low. 111/IUC Clinicians found the process of accessing the record quickly and in real-time difficult to navigate and highlighted the challenge as a priority. One of the 15 recommendations of the CMC review was to address and support easier access to the care plan for IUC/111 clinical users. This is initiated by a flagging mechanism for 111 Health Advisers to pass callers with an CMC (EOL) flag to a clinician or GP so they may access the plan for clinical and personalised advice. This is now supported by “3-click access” to the CMC care plan through to an in-context link to Adastra to drive greater utilisation without leaving Adastra. How it works Scope of impact 38% Overall Increase in usage since first site live in December 3/5 (LCW NCL, LAS SEL, LAS NEL) STP’s now live with In- Context Launch into CMC 1930 Since Dec ‘18 patients successfully flagged with a CMC record Benefits Next Steps Complete roll out of In-Context launch capabilities across London’s IUC network Continue to progress remaining 111/IUC providers access to CMC in context Launch (Vocare - SWL and CareUK - NWL) Launch CMC In-Context with all GPOOH providers to support remaining GPOOH providers in adopting CMC in context launch. Work with all IUC providers to secure 100% uptake of viewing flagged records to ensure the plan is viewed. Develop Adastra Tough book solution for GPs, providing access to viewing care plans whilst visiting patients at home. Benefits to patients Patients and will be confident their care plan is accessible and followed to be able to experience dignity and respect at the end of their lives. Patients with a death recorded on CMC and a preferred place of death (16,570) since August 2010, 75% of deaths occurred in patients’ first or second preferred place of death. Benefits to staff Clinicians can easily access the CMC plans and are are informed and able to make appropriate decisions following patients own preferences and avoiding hospital admissions when this is chosen – this includes ambulance crews, NHS 111 clinicians and GPs Out of Hours System-wide benefits The only source of electronic care plans accessed by London Ambulance Service (LAS) crews en- route or on the scene with patients CMC provides a technology platform which enables healthcare professionals to develop care plans to share with a wide variety of services. e.g. high intensity user plans; MH crisis and LTC treatment escalation plans To find out more, please contact: Contact Eileen Sutton @ eileensutton@nhs.net @healthyLDN

15 Concise & measurable recommendations CMC Review Healthy London Partnership Digital Transformation Team CMC context Coordinate My Care (CMC) is the only care planning tool used across all 5 STP footprints. It was established in August 2010 to address the need for patients to have high quality shared care plans to enable clinical content within an integrated end of life pathway. CMC care plans have been used across London to record preferred place of death (PPD). Over 58,330 CMC care plans have been created since August 2010, 16,947 of which have been created in the past 12 months. CMC review: In order to support London CCG Accountable Officers assess the impact, anticipated benefits and value of continued funding, a review was initiated by all 5 STP UEC Accountable Officers and was broken down into four key components, led by Dr Phil Koczan, Dr Jonty Heaversedge and supported by HLP. The review has involved stakeholder engagement and workshops with clinicians and commissioners across the system, robust analysis of current governance processes and a feasibility assessment of digital initiatives planned. From this, a fair and balanced package of 15 recommendations was presented. These recommendations are now being tracked formally by the London U&EC Transformation Board. What we did SCOPE APPROACH OUTPUT COMMISSIONING ARRANGEMENTS In depth interviews with key stakeholders from the London Office of CCGs, STP reps, Royal Marsden and CMC to understand which organisation formally commissions CMC to hold delivery to account and support mitigation of blockers Define prioritised backlog of commissioner requirements Assess potential options for formal commissioning role GOVERNANCE & STRATEGY Baseline current governance and oversight arrangements in place, including CMC Steering Group, CMC Clinical Governance and U&EC Board Identify gaps in governance and strategy decision-making, horizon scanning and design to-be governance model to support future oversight arrangements 15 Concise & measurable recommendations UTILISATION BARRIERS Identify and prioritise (based on severity and impact) all current barriers to creating and accessing high quality CMC end of life digital care plans Capture clinical feedback through interviews with providers (e.g. LAS999) and NHSE Clinical Network EOLC review event DIGITAL INTEROPERABILITY Categorise digital interoperability initiatives by quick wins for winter 18/19 (e.g. in context links with Adastra and Cerner) and longer term strategic interoperability (e.g. role within the LHCRE programme) Confirm anticipated cost & benefits of technical workstreams Recommendations now in place: 1. Funding In order to optimise investment to date, it was recommended that London CCGs continue funding for 19/20 4. New Commissioning refreshed commissioning arrangement for continued development and delivery of the CMC product 7. Access credentials Including extending password management and troubleshooting for existing services. 10. CMC data reports To report on utilisation and impact of CMC digital EoL records across NHS services 13. In-Context Launch to integrate CMC with Adastra via the London Patient Relationship Manager (PRM) 2. Solution relaunch with refreshed communication material and training to re-engage clinical leads, and commissioners 5. Contract management London CCGs to identify sufficient resource to support robust contract management 8. CCG care planning Led by CCG’s to share care plans across with the patient and other members of the MDT care team 11. Refreshed IG to reflect evolving commissioning and digital interoperability approaches 14. One London alignment To prioritise the development and deployment of an integrated in context link 3. Integration with RESPECT process in collaboration with other NHS organisations; align with relevant national End of Life care planning initiatives 6. Improve training offer and provide appropriate technical support and training to reduce barriers to adoption 9. CMC Strategic Board should be revised to incorporate wider participation from commissioners and LHCRE 12. Follow up review to review the implementation of the recommendations which started in April 2019 15. Development roadmap. To include the synchronisation of data from multiple IT systems to prevent reduce double entry 15 @healthyLDN