1. NHS West Kent Clinical Commissioning Group Care Plan Management 3 rd June 2015 Andrew Brownless Chief Information Officer

2. NHS West Kent Clinical Commissioning Group Overview NHS West Kent CCG’s five year care strategy “Mapping the Future” identified the need for electronic shared care plan. –Digital sharing of information between health/social care professionals at the point of care –Digitised shared care planning, particularly in the most complex cases where a lack of planning results in unexpected, unconstrained and sometimes unnecessary demands on the care system Approach signed up to by CEO of all participating organisations Connect Integrate Share

3. NHS West Kent Clinical Commissioning Group What is the problem we are trying to solve Current Scenario Mr. Jones is a COPD patient who relies on oxygen kept at home to help with breathing. Mr. Jones has a tendency to panic when his breathing difficulties get acute and he often calls 999 for help. The ambulance service attends but, without knowledge of his history or any planned alternative approaches, has no choice but to transfer Mr. Jones to hospital

4. NHS West Kent Clinical Commissioning Group With an electronic shared care plan accessible to care professionals: the ambulance service would be able to see that Mr. Jones has a tendency to panic and can be calmed down without the need to go to the hospital. The ambulance service can also see that he has support from his son who can be contacted to take over from the ambulance service The GP and MDT can see that Mr. Jones was attended by the ambulance service and what was done. The care plan system shows a history of events to inform reviews of Mr. Jones’s care plan and to enable changes to the plan which will avoid similar incidents in the future. The outcome is better care for the patient and more effective use of NHS resources.

5. NHS West Kent Clinical Commissioning Group Current State Procurement process completed Phase 1 - due to go live in June 2015 –Care professional led design process –Information Governance approach agreed and implemented –Unplanned admission DES patients from 11 GP practices, –Care Plan Management application accessible to care professionals from all participant organisations Planning for phase two –Data feeds from acute, community, mental health, social care, ambulance and West Kent Hospices –Roll out to remaining practices, extend to additional patient pathways

6. NHS West Kent Clinical Commissioning Group CPMS – Future potential Will provide: An information-rich single care record for all patients, not just those with a care plan Patient access to health records System-wide sight of care to significantly aid commissioning Using the platform for other applications such as smartphone- based self-care Digitising patient records Need to demonstrate effectiveness Need to consider complexity of IG arrangements