Local Professional Networks Towards an LPN Operating Framework Draft Denise McLellan January 2013

NHS | Presentation to [XXXX Company] | [Type Date]2 “Clinical networks are an NHS success story. Combining the experience of clinicians, the input of patients and the organisational vision of NHS staff, they have supported and improved the way we deliver care to patients in distinct areas, delivering true integration across primary, secondary and often tertiary care.” Sir Bruce Keogh, NHS Medical Director and Jane Cummings, Chief Nursing Officer

Context Securing Excellence in Commissioning Primary Care ( para 3.36 NHS CB June 12) committed to the development of local professional networks LPNS will facilitate clinical input and leadership in service improvement and commissioning at local level Cover pharmacy, dentistry and eye health Aligns to broader emphasis on clinical networks

Clinical networks in the new system Strategic Clinical Networks hosted by the NHS CB where major cross sector organisational change is needed in cancer, CVD, maternity and children and mental health/ dementia and neurological conditions Operational Delivery Networks, hosted by providers, where the main focus is management of patients across organisational boundaries ie burns, trauma, neonatal, adult critical care Local Professional networks, hosted by the NHS CB for pharmacy, eye health and dental, focussed in providing clinic advice to commissioning and developing local momentum for change Local Networks- variable, but as agreed between commissioners and providers to meet local needs and priorities

Networks- common themes Based around patient pathways System wide: providers, commissioners, third sector Clinical relationships and leadership at the core Strong patient engagement Support improvement in outcomes Need facilitation, robust governance and clear leadership

Commissioning functions and fit of the LPN Strategic planning- identifying needs LPN to review JSNA and suggest additional sources/ comment

Commissioning functions and fit of the LPN Reviewing service provision LPN to advise on priorities and contribute expertise to reviews

Commissioning functions and fit of the LPN Deciding priorities and innovations LPN to advise commissioners on priorites and help select innovations worth pursuing

Commissioning functions and fit of the LPN Setting standards and specifications /advising and consulting LPNs to ensure local applicability of national standards and help publicise. LPNs agree local protocols in alignment with national ones

Commissioning functions and fit of the LPN Designing the shape and structure of provision LPNS to contribute to and review overall shape and structure of provision, identifying priorities for change

Commissioning functions and fit of the LPN Planning capacity and managing demand LPN to advise on development of local demand and capacity model parameters and assumptions LPNs to support implementation of arrgts to flex capacity LPNs to make a leadership contribution in management of deamnd peaks

Commissioning functions and fit of the LPN Monitoring and evaluation LPNS to advise on measures to be used and approaches to data collection and quality assurance

Operational Role- Clinical Flow Implement pathways of care by clinical collaboration What and how Example ?

Operational - Safe and Effective Care- monitor standards Ensure safe and effective services across pathways Identify gaps and understand measures What and how ?

Operational - Develop provider guidance and standards Develop usable provider guidance which enables high standards and compliance Push national and regional standard setting – identify gaps

Operational - Compare and improve Enable benchmarking and sharing of data on quality and effectiveness

Operational - Identify future needs Horizon scan on new innovations and technologies Identify capacity and demand gaps and opportunities to reduce inequalities

Guiding principles Underpinned by NHS constitution Outcome Framework driven Operate System wide Clinically led Evidence based approach to improvement_ Use of NHS change model Robust governance

Network Benefits- the system Provide credible clinical advice to commissioners and providers Support focussed and prioritised improvement activities Support clinical handover between providers Improve consistency of care across system and regardless of entry point Support learning, dissemination and spread of improvement Route for patient engagement Improve system working/ reduce fragmentation Improve system resilience Facilitate measurement and benchmarking Entry point for other bodies- ie HWBs, PHE, LETb, HEE etc

How Networks support commissioners Needs assessment Service Review Prioritisation Setting standards, and service models Planning capacity and predicting demand Monitoring and evaluation NOT: Performance management or contract sanctions or termination

How Networks support providers Specific programmes to improve outcomes, particularly where there is system dependency Mechanism to share resources and risk Data sharing, benchmarking, standard setting Different perspectives and view will improve local services Commissioners may require Career and professional development

Purpose of LPNs ( para 3.37) Support implementation of national strategy and policy at local level Work with key stakeholders on local priorities, some of which go beyond the scope of primary care commissioning Provide local clinical leadership, with professional line of accountability to NHS CB Chief Professional Officers, through Area Teams

Characteristics of LPNs ( para 3.39) Small clinically- led commissioning team at the core Opportunities for more clinicians to be involved in service improvement Engagement with the wider community of practitioners, practice owners and others involved in providing services

LPN functions- all professions (3.41) Support NHS CB in commissioning primary care with robust clinical input Drive improvement in outcomes, in line with local and national priorities Provide clinical leadership and facilitate wider engagement Mechanism for patient engagement Support other commissioners, ie CCGs, PH, LETB Advise and work with local Health and Wellbeing Boards Feed into other clinical networks Engage with local representative committees ( of contractors) Additional Profession specific responsibilities

Functions: Dental- specific LPNs Cover the whole dental pathway, including secondary care and out of hours Key role in agreeing quality measures for dental secondary care, including CQUIN payments Will need to work closely with local authorities and Public Health England to deliver and develop cohesive Oral Health Strategies and associated commissioning plans

Functions: Pharmacy- specific LPNs Support local authorities who lead on the development of the Pharmaceutical Needs Assessment which the NHS CB will use in commissioning pharmaceutical services A particular role is to support programmes of work around self care and long term conditions management in community pharmacy to achieve Outcome 2 Work with CCGs and others with regards to medicines optimisation ‘Hold the ring’ on enhanced services ( PH/ CCG commissioned)

Functions: Eye health specific Local needs assessment NHS sight tests and domiciliary services are predominantly demand-led, hence more emphasis on quality assurance Focus on improving services in line with 5 national eye health pathways: ocular hypertension monitoring service; glaucoma; referral refinement; low vision service for adults; People with a Learning Disability (adults) Future work to reduce avoidable visual impairment

Link to ‘national’ NHS CB arrangements Single national Performers’ list with standard polices and procedures across all primary care contractors, managed at area team level National contracts and supporting policies National commissioning priorities annually National policy committee for each contractor group National Assembly of LPNs with links to CCG assembly Access to new Improvement Body and leadership academy for tools and support Plus PHE and HEE to determine national public health and educational priorities National professional leads ie Keith Ridge, Barry Cockcroft

LPN Geography Assumption is that LPN geography will be aligned to that of the area team to facilitate commissioning advice Local option for Area Team to vary LPN geography based on clinical relationships, clinical flows and issues prioritised LPNs may wish to work together for given issues All LPNs should be aligned to a named senate and it should be exceptional that senate and LPN boundaries do not align

Membership Clinical Chair ( sessional appointment made by Area Team medical director with multi-professional input) Patient representative (s) Local clinicians as agreed to form clinical majority Other specialists such as public health as agreed Senior Commissioning Manager from Area Team who is also responsible for ensuring adequate administrative input Membership is not representative; Appointed for the quality of leadership, credibility and knowledge

Governance National standard terms of reference and accountability agreement with some opportunity for local modification Clear policy on managing conflict of interest, based on national CCG models Annual accountability agreement and workplan need to be agreed with LPN members and Area Team Chair is accountable to Area Team Medical Director ( as the local clinical leader), with national ( profession specific) professional input if required Access to Chair of local clinical senate to request issues raised or a response ie system wide impact of change

Annual Workplan Implications of national clinical commissioning priorities and policies Local priorities for improvement based on local outcomes Review of effectiveness of network itself and priorities for improvement Year one: Each LPN to have a clinical leadership development strategy Description of core resources and links to other parts of the system Description of PPE support arrangements National template will be made available Complete by February for the following year

Hosting and support, including finance Hosted by primary commissioning team of Area Team of NHS CB Access to all NHS CB matrix support arrangements ie intelligence, financial expertise etc £120k pa identified within core Area team funding to resource local clinical and administrative resource for network, though may be supplemented from other sources Area Team to determine best local fit arrangements; local structures will not all be the same

Illustrative use of AT funds 1 day per week 1 day per week 3£ 4300 Non pay£10000 LPN Chair LPN Chair 1 LPN Chair £ clinical days across 3 per day£47400 Total pa£120000

Alignment with the new system Will need to work with CCGs, PHE, LAs, health watch, Health and Wellbeing boards, Health Education England and regulators ( Monitor and CQC) Will need links to local clinical networks and senates and academic health science networks Will need to work with improvement body and leadership academy and Local education and training boards Will need to work with local PPE arrangements Workplans will need to describe how these relationships operate locally

HR issues Assumed that core managerial and admin team will be employed within the NHS CB primary care commissioning team Assumed that clinical staff will be employed on a sessional basis, not by NHS CB Careful attention will need to be paid to previous PCT clinical advisors to make best use of knowledge and expertise All appointments overseen by NHS CB HR

Communications and engagement National distribution of slide set for comment and local area presentations- January 13 Slides will be developed into national operating framework for NHS CB exec team approval and then NHS CB website Feb 13 National development conference for LPNs with improvement body and leadership body input Feb 13

Review of LPN testing General positive feedback about the benefits of working in networks Concern over resources, though recognised that much can be done with relatively small amount of resource Need for national direction and clear system of prioritisation recognised to ensure effectiveness and reduce variability

Next steps for Area Teams Meet members of any local networks that exist and review testing-asap Agree local arrangements for LPNs - Jan 13 Appoint chairs and core team-Jan 13 Appoint other members- Feb 13 Agree outline work plan- Feb 13 Agree local relationships- March 13 LPNs operational- April 13 Ongoing development and refinement 13/14

Next steps- National work Draft accountability agreement, terms of ref, workplan template, Patient engagement model and conflict of interest policy- end of Jan 13 LPN Operating Framework final draft – Jan 13 Agreement of Operating Framework NHS CB exec team- Feb 13 Agreement of input from national bodies such as improvement body, leadership academy, national information centre, etc March 13 Set up LPN Assembly March 13 Agree scope of and set up clinical policy groups Feb 13 Communication and engagement plan- Jan 13

FAQs Q:Much less resource than expected? A:Testing has shown that much can be achieved on a relatively small amount with the right leadership and prioritisation Q:Does this cover investigation of poorly performing practitioners? A:No, separately funded Q:Does this cover specialist pharmaceutical advice to area teams- inc C/Drugs? A:No, separate proposal Q: The time scale looks tight? A: Agreed, but it is possible and the alternative, for commissioning not to be clinically informed is not attractive Q: Professional advice for contract conflict resolution?: may need to be more independent and separately resourced

Further questions? Local Area Team Director of commissioning, Medical Directors or head of primary care commissioning David Geddes- NHS CB Head of primary care commissioning Denise McLellan- Transitional lead for networks and senates, NHS CB Operations Directorate