locality 2 – practice and population overview

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locality 2 – practice and population overview

  1. 1. SPARKBROOK PRACTICE BASED COMMISSIONING PLAN 2008 – 2009
  2. 2. TABLE OF CONTENTS 1. Executive Summary………………………………………………...….page 3 2. Introduction ……… …………………………………………………...page 5 3. Financial Position ……………………………………………………...page 8 4. Commissioning Priorities 2008/9………………………………………page 10 - COPD Screening ………………………...............................page 11 - Primary Care Gynaecology ……………...............................page 13 - Cardiology ………………………………………….. ……..page 15 - Rheumatology …………………………...............................page 18 - Ophthalmology …………………………………………….page 21 - Patient Education ………………………..............................page 23 - Dermatology ……………………………………….............page 25 - Chiropody ………………………………………………….page 27 - Counselling ………………………………………………...page 28 5. Workplan …………………………………............................................page 29 Sapna Sharma, Scott Lamb & Dr Sharad Pandit, September 2008 2
  3. 3. EXECUTIVE SUMMARY The Sparkbrook Commissioning group has identified a set of commissioning priorities for 2008/9, some of which are applicable to the larger commissioning group and other which are priority areas for only 1/2 of the 3 sub commissioning groups within Sparkbrook. The following briefly summarises the proposed initiatives and their relevance to the strategic objectives of the PCT. • COPD Screening: Enhanced COPD screening provision through Spirometry to ensure proper identification of at risk patients. Aimed to meet the strategic objective of improving services and outcomes for chronic disease patients. • Gynaecology: Establishing a Gynaecology service within a community setting to manage a set number of conditions suitable for primary care diagnosis and treatment. Aimed to meet the strategic objective of improving the range and quality of primary care services and shifting services out of hospital. • Cardiology: Establishing a Cardiology service within primary care to manage a set number of conditions suitable for primary care diagnosis and treatment, including access to echocardiography. Aimed to meet the strategic objective of improving the range and quality of primary care services and shifting services out of hospital as well as improving services and outcomes for chronic disease patients. • Rheumatology: Establishing a Rheumatology service within primary care to manage a set number of conditions suitable for primary care, focusing on follow up management of patients with long term conditions. Aimed to meet the strategic objective of improving the range and quality of primary care services and shifting services out of hospital as well as improving services and outcomes for chronic disease patients. Sapna Sharma, Scott Lamb & Dr Sharad Pandit, September 2008 3
  4. 4. • Ophthalmology: Establishing a service to see the large volume of follow ups within ophthalmology that require basic annual checks. Aimed to meet the strategic objective of improving the range and quality of primary care services and shifting services out of hospital. • Patient Education: Addressing the general themes of enhanced patient education, focusing on patient self care, chronic disease management and appropriate utilisation of NHS services. Aimed at improving the health and well-being of patients • Mental Health Counselling: Providing in-practice support for patients who require counselling, but for whom current services are not suitable. Aimed at the strategic objective of improving the range and quality of primary care services and improving the health and well-being of patients Sapna Sharma, Scott Lamb & Dr Sharad Pandit, September 2008 4
  5. 5. INTRODUCTION Practice based commissioning (PBC) is one of the main initiatives driving change within the NHS. Over the years, the Heart of Birmingham tPCT has introduced a number of initiatives through PBC which have been designed to bring care closer to the patient, improve the quality of health care, and reduce existing health inequalities. One of the many challenges of PBC includes the effective use of PBC resources to address both national and local priorities. These priorities include; improving health outcomes for babies and children, improving health and social services for the elderly, improving the management of patients with a chronic disease, reducing health inequalities, and improving access and reducing waiting times for health services. Other relevant priorities, both regional and local include, improving women’s health services, especially around sexual health and maternity, improving mental health services, reducing avoidable hospital admissions, and improving the patient experience. The GPs involved with PBC recognise the need to work with other PCT initiatives, particularly the Towards 2010 programme. In developing these priority areas the consortium has taken into consideration these PCT developments, both national commissioning priorities and local priorities for the Heart of Birmingham tPCT and actively sought feedback from patients and the public. Sapna Sharma, Scott Lamb & Dr Sharad Pandit, September 2008 5
  6. 6. The tables below provide a practice and population overview by consortium. LOCALITY 1 – PRACTICE AND POPULATION OVERVIEW SPARKHILL The Sparkhill Commissioning Group comprises 28,113 patients in 6 practices within Heart of Birmingham Teaching Primary Care Trust, as listed below: GP Practice Address List Size Hall MG, Jassel GS, Mavi BS 578 Stratford Road, Sparkhill, Birmingham. B11 7,212 4AN Karzoun FK, Gill SK 26 Oakwood Road, Sparkhill, Birmingham, B11 4,986 4HA Shah SY, Mann AB, Poltock Fernley Medical Centre, 560 Stratford Road, 6,211 TL Sparkhill, Birmingham, B11 4AN Ramachandram RS Moor Green Lane Medical Centre, 339 Moor Green 3,352 Lane, Moseley, Birmingham, B13 8QS Rajput VK, Rajput S Springfield Medical Practice, 739-741 Stratford 3,408 Road, Springfield, Birmingham, B11 4DG Melchior AM, Fleming GC 183A Woodlands Road, Sparkhill, Birmingham 2,944 B11 4ER SMALL HEATH The Small Heath commissioning group comprises 29,759 patients in 6 practices within Heart of Birmingham Teaching Primary Care Trust as follows; GP Practice Address List Size Dadheech VK, Dadheech HH The Limes Medical Centre, Cooksey Road, Small 6,766 Heath, Birmingham, B10 0BS Thomas MK, Thomas V Birmingham Heartlands Surgery, Gray Street, 3,509 Bordesley Village, Birmingham B9 4LS Khattak SH, Khattak SS 58 Benton Road, Sparkbrook, Birmingham, B11 3,481 1TX Verma SK, Zafar SA, Zafar A 192 Charles Road, Small Heath, Birmingham B10 4,380 9AB Ahmad Y, Ahmad N, Ahmad Coventry Road Medical Centre, 448 Coventry 7,873 S, A Ahmad Road, Small Heath, B10 0UG Shah VM, Shah MJ Bordesley Green Surgery, 143-145 Bordesley 3,750 Green, Birmingham B9 5EG Sapna Sharma, Scott Lamb & Dr Sharad Pandit, September 2008 6
  7. 7. LOCALITY 2 – PRACTICE AND POPULATION OVERVIEW BALSALL HEATH Locality 2 comprises 53,671 patients in 14 practices within Heart of Birmingham Teaching Primary Care Trust. Details are listed below: GP Practice Address List Size Abdel-Malek GT Farm Road Health Centre, 32 Farm Road, 5,504 Sparkbrook, Birmingham, B11 1LS Pandit SS 1 Brinklow Tower, Upper Highgate Street, 3,677 Highgate, Birmingham B12 0XT Ramarao MV Sparkbrook Health Centre, Farm Road, 3,173 Sparkbrook, Birmingham, B11 1LS Walji MTI Balsall Heath Health Centre, 43 Edward Road, 4,902 Balsall Heath, Birmingham, B12 9LP Sinha AK Balsall Heath Health Centre, 43 Edward Road, 2,710 Balsall Heath, Birmingham, B12 9LP Ahmed B 1 Newport Road, Balsall Heath, Birmingham, B12 6,719 8QE Chunduri DR The Balaji Surgery, 2 Blackford Road, Sparkhill, 3,092 Birmingham, B11 3SH El-Sheikh OAA Strensham Road Surgery, 4 Strensham Road, 3,107 Balsall Heath, Birmingham B12 9RR Agarwal MD Warwick Road Medical Practice, 220-222 Warwick 4,124 Road, Sparkhill, Birmingham, B11 2NB Hafeez A, Hafeez F 158 College Road, Moseley, Birmingham B13 9LH 3,811 Kulshrestha RP Aberdeen Street Medical Centre 1,641 Firstcare Mobarak Health Centre, 8-10 Cannon Hill Road, 6,225 Balsall Heath, Birmingham, B12 9NN Mayor V 52 Chesterton Road, Sparkbrook, Birmingham, B12 2,115 8HE Cheema MN 35 Warwick Road, Sparkhill, Birmingham, B11 2,871 4RA Sapna Sharma, Scott Lamb & Dr Sharad Pandit, September 2008 7
  8. 8. FINANCIAL POSITION In addition to national and local objectives the commissioning priorities have also been developed within the context of existing freed up resources (FURs) available to practices. Sparkbrook has a large amount of FUR’s available for PBC projects. Currently, Locality 1 (Small Heath and Sparkhill) have just over £2 million available and have committed around £1.5 million on PBC schemes. Locality 2 (Balsall Heath) have just over £465,000 available having spent over £440,000 on PBC schemes. The table below details the financial position of each practice in Sparkbrook. In August 2008, a decision was taken to write-off overspends from 2005/6 (just over £300,000). For some practices this led to additional available FUR’s whilst others were unaffected by the decision. The total value of FUR’s will be available to each practice until April 2009. Once we enter the 09/10 financial year all FUR’s that have not been committed from previous years i.e. 05/06, 06/07 and 07/08 will be managed by the Clinical Director of Commissioning. The CDC will dedicate these funds for collaborative schemes in an effort to distribute the resources equally. Practices will still have the option to submit business cases for practice level initiatives but they must be approved by the CDC. Sapna Sharma, Scott Lamb & Dr Sharad Pandit, September 2008 8
  9. 9. The CDC will retain responsibility of these FUR’s for twelve months, until April 2010, after which all remaining FUR’s will be transferred back to the PCT. Although FUR’s from the previous years will be managed by the CDC, practices will retain responsibility for committing any newly freed-up resources from 08/09 Sapna Sharma, Scott Lamb & Dr Sharad Pandit, September 2008 9
  10. 10. COMMISSIONING PRIORITIES 2008/9 This part of the document sets out the practice based commissioning priorities for the Sparkbrook commissioning group for 2008/9. The Sparkbrook commissioning group is split into 3 smaller commissioning groups known as the Balsall Heath, Sparkhill and Small Heath commissioning groups. The 3 groups have been holding regular meetings to develop their commissioning priorities. These priorities are in response to a wide range of information available to practice based commissioners including, local and national priorities, secondary care activity, public health data, financial activity, GP’s own experiences of delivering care to their patients as well as feedback from patients and the public. Upon approval of this plan the commissioning groups will proceed to develop the proposed ideas into business cases in conjunction with their local PBC team. The table below provides details for the Sparkbrook PBC team: Name Position Email Dr Sharad Pandit Clinical Director of Commissioning sharad.pandit@hobtpct.nhs.uk Sapna Sharma PBC Manager sapna.sharma@hobtpct.nhs.uk Scott Lamb PBC Data Analyst scott.lamb@hobtpct.nhs.uk The following sections of this document outline the proposed commissioning priorities for Sparkbrook, some of which are applicable to the larger commissioning group and other which are priority areas for only 1/2 of the 3 sub commissioning groups within Sparkbrook. Sapna Sharma, Scott Lamb & Dr Sharad Pandit, September 2008 10
  11. 11. COPD SCREENING (Sparkhill, Balsall Heath and Small Heath) Proposal: The Sparkbrook Commissioning group propose to commission a COPD screening programme. This will involve a Spirometry testing and interpretation service for all patients at risk of developing COPD. The service aims to identify patients with COPD as early on during their illness as possible and also improve the long-term management of these patients. Outcomes: • Increase in recorded prevalence of COPD • Reduction in emergency admissions and ACS spend for COPD related conditions Linkage to PCT priorities: • Long-term Conditions Evidence of Need: The Heart of Birmingham tPCT has the lowest recorded prevalence of COPD in the West Midlands (0.69%). The average prevalence of COPD within Sparkbrook (0.59%) is significantly lower than the HOB average prevalence and is less than half of the National average of 1.48% (see example 1). In 2007-2008 there were almost 300 COPD related emergency hospital admissions with a cost of around £321,000 to Sparkbrook practices. It is thought that the majority of these admissions could have been avoided with earlier diagnosis and better management of the condition within Primary Care. Sapna Sharma, Scott Lamb & Dr Sharad Pandit, September 2008 11
  12. 12. Example 1 Sparkbrook COPD Prevalence Rates vs National Average 1.60 1.40 1.20 Prevalence % 1.00 0.80 0.60 0.40 0.20 0.00 Spirometry is the test most commonly used to diagnose COPD. The test is also used to assess the progression and severity of COPD and help guide treatment and monitor if treatment is working or of it needs to be modified. Thus, spirometry testing plays an integral part in both the early stages of capturing patients with the risk factors associated with COPD and also the long-term management of the condition. Although the majority of practices offer this procedure to their patients there are, however, some concerns associated with this e.g. the amount of time required to carry out the procedure, the complexity of spirometry interpretation and the difficulties associated with maintaining the level of skill required to carry out spirometry effectively. On the basis of the above observations as well as the low prevalence and high number/cost of emergency COPD admissions, commissioning a spirometry testing and interpretation service would tackle the first crucial step towards the effective management of patients with COPD. Service Delivery: The service will be delivered by establishing a COPD screening programme. This will be by either a locally enhanced service (LES) where practices have the appropriate level of competency to screen patients for COPD or alternatively by commissioning a specialist team to deliver an in-practice COPD screening service. Sapna Sharma, Scott Lamb & Dr Sharad Pandit, September 2008 12
  13. 13. PRIMARY CARE GYNAECOLOGY (Sparkhill, Balsall Heath and Small Heath) Proposal: The Sparkbrook commissioning group propose to develop a Primary Care based gynaecology service for a range of gynaecology conditions that are suitable for treatment within the Primary Care setting. The service will be aimed at reducing the number of gynaecology outpatient attendances in secondary and will be provided either by GP’s with a special interest (GPwSI) in gynaecology or an equivalent provider. Outcomes: • Bringing services closer to home • Reductions in secondary care referrals Linkage to PCT priorities: • Planned Care • Acute Care Evidence of need: In 2007/8, spending on gynaecology outpatient attendances represented the 4th highest speciality within the Heart of Birmingham tPCT (6% of all outpatient attendances) costing over £600,000. Example 2 provides a breakdown of this cost into new, follow-up and consultant-consultant referrals for Sparkbrook. Example 2 Locality 1 Locality 2 Activity Cost Activity Cost Follow Up 1599 £134,063 Follow Up 1695 £143,712 New - New - Cons2Cons 148 £21,417 Cons2Cons 80 £11,206 New - GP 891 £129,322 New - GP 1039 £149,874 New - Other 118 £16,367 New - Other 171 £23,673 Total 2756 £301,169 Total 2985 £328,465 Sapna Sharma, Scott Lamb & Dr Sharad Pandit, September 2008 13
  14. 14. Furthermore, it is thought that the following conditions (which represent approximately 70% of all secondary care gynaecology activity) can be managed within Primary Care: •Initial assessment of infertility •Initial assessment of pelvic pain •Initial screening for sterilisation •Menopause management •Management of difficult smears •Menstrual bleeding •Post menstrual bleeding Service Delivery: A Primary Care based Gynaecology service should ideally be delivered as a combination of provision within General Practice as well as within a community clinic e.g. low-level conditions (that do not require GPwSI accreditation) can be treated within general practice whilst high-level conditions unsuitable for treatment within general practice would be treated within a community gynaecology service. This service could also be used to “fill in the gaps” where GP practices do not have the capacity/meet the requirements to provide a gynaecology service for low- level conditions. Possible providers for the community gynaecology service would be GPwSI’s or secondary care gynaecologists. Sapna Sharma, Scott Lamb & Dr Sharad Pandit, September 2008 14
  15. 15. CARDIOLOGY (Sparkhill, Balsall Heath and Small Heath) Proposal: The Sparkbrook commissioning group recognise the need for the development of a diagnostic pathway for Primary Care Cardiology and specialist teams to improve the management of patients with cardiac conditions. In particular, the commissioning group supports the development of community based ECG, echocardiography, 24 hr BP monitoring and 24 hr ECG testing. Outcomes: • Bringing services closer to home • Reductions in secondary care referrals Linkage to PCT priorities: • Planned Care • Acute Care Evidence of Need: The number of outpatient attendances for cardiology in Heart of Birmingham PCT were significantly higher than both the West Midlands and National average in 2007/8 (see example 3). Consequently, cardiology is currently the 8th highest costing outpatient speciality in Sparkbrook; the total cost for new and out- patient follow-ups in 2007/8 was £292,189. Sapna Sharma, Scott Lamb & Dr Sharad Pandit, September 2008 15
  16. 16. Example 3 Sparkbrook Cardiology Outpatient Attendances Per 1000 Patients 2007/8 25 20 Standardised Rate 15 10 5 0 M 75 M 66 M 79 M 99 M 16 M 33 M 78 M 74 M 56 M 83 M 85 M 53 6 M 46 M 28 M 81 M 27 85 3 M 64 M 93 85 5 85 4 85 4 85 4 M 35 M 51 68 71 01 77 79 02 1 0 7 6 6 1 7 1 0 0 1 7 7 0 7 1 0 1 7 1 85 85 85 85 85 85 85 85 85 85 85 85 85 85 85 85 85 85 85 85 85 M M M M M M Furthermore, congestive heart failure was identified as the highest costing Ambulatory Care Sensitive (ACS) condition within Sparkbrook in 2007/8 (see example 4). Hence, the available evidence points to both better diagnostic assessment for cardiac conditions as well as improved management. Example 4 Highest cost ACS Conditions for Sparkbrook 2007/8 £229,710 £332,033 Congestive heart failure COPD Dehydration & gastroenteritis ENT infections £257,057 Asthma £309,315 £276,602 Sapna Sharma, Scott Lamb & Dr Sharad Pandit, September 2008 16
  17. 17. Service Delivery: The Sparkbrook commissioning group support the development of a community based outpatient and diagnostic service provided by either an accredited GP with a special interest in cardiology or a secondary care cardiology specialist. The Balsall Heath commissioning group have also expressed an interest in investing in those elements of the service that are suitable for provision within general practice i.e. 24 hr BP monitoring by purchasing the relevant medical equipment for use within the practice. In-practice provision will save on the costs associated with secondary care referral for this service. Sapna Sharma, Scott Lamb & Dr Sharad Pandit, September 2008 17
  18. 18. RHEUMATOLOGY (Sparkhill and Balsall Heath) Proposal: The Sparkhill and Balsall commissioning groups have identified Rheumatology as a commissioning priority as this is an outpatient speciality which has a high follow up ratio (7.45 in 2007/8). The commissioning groups propose to transfer (where appropriate) a proportion of this activity into Primary Care. Outcomes: • Bringing services closer to home • Reductions in secondary care referrals Linkage to PCT priorities: • Acute Care • Long-term Conditions Evidence of Need: In 2007/8, 88% of all Rheumatology activity was for follow-up attendances (Example 5) with a total cost of £170,359 in Sparkbrook (Example 6). The high number of patients on methotrexate (a drug prescribed for rheumatoid arthritis) accounts for a high proportion of this activity as these patients attend secondary care for regular monitoring; these patients could easily be monitored within primary care, thus, saving the cost of outpatient follow up appointments. Sapna Sharma, Scott Lamb & Dr Sharad Pandit, September 2008 18
  19. 19. Example 5 Rheumatology activity in Sparkbrook for 2007/8 236, 12% New Follow-up 1714, 88% Example 6 The cost of secondary care Rheumatology activity for Sparkbrook in 2007/8 £52,884, 24% New Follow-up £170,359, 76% Service Delivery: The Sparkhill and Balsall Heath commissioning groups propose to develop a locally enhanced service (LES) aimed at reducing the number of Rheumatology follow-up appointments within secondary care by delivering an in- practice follow-up service for patients who are suitable to be treated within the Primary Care setting. Sapna Sharma, Scott Lamb & Dr Sharad Pandit, September 2008 19
  20. 20. Although a Nationally Enhanced Service (Near Patient Testing) has previously been introduced to encourage GP’s to monitor some of these patients within Primary Care, this initiative has received poor uptake from GP’s within the Heart of Birmingham tPCT. In addition, there is little evidence of follow-up reductions within the practices that have taken part in this enhanced service. Thus, there is a clear need to introduce an alternative service which not only addresses these issues but also ensures that the outcomes are achievable. Sapna Sharma, Scott Lamb & Dr Sharad Pandit, September 2008 20
  21. 21. OPHTHALMOLOGY (Sparkhill and Balsall Heath) Proposal: The Sparkhill and Balsall Heath commissioning groups recognise that there is currently a large volume of follow-up patients in Ophthalmology who attend secondary care for basic annual checks. The group are in support of establishing a community ophthalmology service to screen and monitor selected patients and thus transfer some of this activity from secondary to primary care. Outcomes: • Bringing services closer to home • Reductions in ophthalmology follow-ups Linkage to PCT priorities: • Planned Care • Acute Care Evidence of need: In 2007/8, the average number of follow-up appointments for every new outpatient appointment was 6.8. Example 7 illustrates the proportion of new and follow-up activity for this speciality with 87% of the total being accountable to follow-up’s. Further, ophthalmology has been identified as the 6th highest costing outpatient speciality within Sparkbrook with a total cost of £361,309 in 2007/8. Finally, the number of ophthalmology out-patient attendances over the last year has been considerably higher than both the West Midlands and National average (see example 8). Sapna Sharma, Scott Lamb & Dr Sharad Pandit, September 2008 21
  22. 22. Example 7 Ophthalmology activity in Sparkbrook for 2007/8 956, 13% new follow-up 6521, 87% Example 8 Sparkbrook Ophthalmology Outpatient Attendances Per 1000 Patients 2007/8 35 30 Standardised Rate 25 20 15 10 5 0 M 46 M 75 M 16 M 78 M 93 M 74 M 15 M 56 M 74 M 83 M 94 M 85 M 24 M 35 M 53 M 51 6 M 28 M 66 M 81 M 79 M 27 M 99 M 13 85 3 M 64 68 73 1 0 0 1 0 7 7 1 0 1 7 7 6 1 6 7 1 7 7 0 0 7 1 0 85 85 85 85 85 85 85 85 85 85 85 85 85 85 85 85 85 85 85 85 85 85 85 85 85 M M Service Delivery: The commissioning group supports the development of a community based ophthalmology service provided by either an accredited GP Sapna Sharma, Scott Lamb & Dr Sharad Pandit, September 2008 22
  23. 23. with a special interest in ophthalmology or a secondary care specialist. PATIENT EDUCATION (Small Heath and Balsall Heath) Proposal: The Small Heath and Balsall Heath commissioning groups have identified patient education as a priority in order to reduce the number of inappropriate self referrals to both general practice and secondary care. There are a number of ways in which patient education can be addressed, some of which will be explored in more detail. Outcomes: • Improving self-care • Reductions in unnecessary attendances Linkage to PCT priorities: • Long-term conditions • Staying healthy Evidence of Need: There is general consensus amongst clinicians that a high proportion of patients lack sufficient knowledge about their condition and consequently turn to these services for advice on problems which could easily be self treated and thus avoid unnecessary attendances to GP services and secondary care. Furthermore, research on patient education consistently highlights those patients with low health literacy as:  Being at greater risk of hospitalisation and having longer hospital visits  Having higher rates of admission to emergency services  Being less likely to adhere to prescribed treatments and self-care plans  Having less knowledge of disease management and health-promoting behaviours  Having decreased ability to communicate with healthcare professionals and sharing in decision-making Sapna Sharma, Scott Lamb & Dr Sharad Pandit, September 2008 23
  24. 24.  Being less able to make appropriate health decisions  Making less use of preventive services  Incurring substantially higher health costs Thus, the group feel it is fundamental to invest in education programmes for these patients not only to improve their general health and well-being but to also encourage the appropriate use of NHS resources. Service Delivery Chronic Disease Educators/Health Trainers: The Birmingham Health Exchange offer a choice of patient education services ranging from on-line resources, public access points at community locations and more recently, Chronic Disease Educators and Health Trainers. The Small Heath and Balsall Heath commissioning groups have expressed an interest in commissioning the latter 2 services. The health trainer service offers one-to-one support for patients on changing a range of health behaviours such as smoking cessation, healthy eating and exercise. On the other hand, the chronic disease educator service provides groups of patients suffering from CHD, CKD or Diabetes with more specific education including: • Improved symptom management • Improved quality of life through knowledge of condition and health behaviours • How to slow disease progression • Improving medical management of the condition • Helping patients and their carers to manage the emotional impact of their condition Information Leaflets on how to cope with specific illnesses: The Balsall Heath commissioning group are keen to develop a set of local patient education materials which are sensitive to the individual practice population. Some potential themes Sapna Sharma, Scott Lamb & Dr Sharad Pandit, September 2008 24
  25. 25. around this material include education around specific illnesses, general lifestyle advice as well as information used for signposting patients to local services. DERMATOLOGY (Small Heath) Proposal: The group have expressed an interest in establishing a local dermatology service for the treatment of skin conditions that are suitable for treatment within a community setting. Outcomes: • Bringing services closer to home • Reductions in secondary care referrals Linkage to PCT priorities: • Acute Care Evidence of need: Dermatology has been identified as the 5th highest costing outpatient speciality within Sparkbrook with a total cost of £361,869 in 2007/8. Furthermore, the number of dermatology out-patient attendances over the last year has been considerably higher than both the West Midlands and National average . Example 9 Sparkbrook Dermatology Outpatient Attendances Per 1000 Patients 2007/8 35 30 Standardised Rate 25 20 15 10 5 0 M 75 M 66 M 79 M 99 M 33 M 78 M 74 M 56 M 83 M 24 M 53 6 M 46 85 8 85 1 85 7 M 13 M 16 85 4 85 3 85 5 85 4 85 4 M 85 M 35 85 1 68 12 78 12 16 09 01 77 79 05 1 0 7 6 6 1 7 0 1 7 7 0 0 7 1 7 85 85 85 85 85 85 85 85 85 85 85 85 85 85 85 85 85 M M M M M M M M M M Sapna Sharma, Scott Lamb & Dr Sharad Pandit, September 2008 25
  26. 26. Service Delivery: The Small Heath commissioning group recognise that there is now a community based dermatology service (Greet Health Centre, Sparkbrook). However, the group are concerned about the travelling distance for patients attending from Small Heath practices. Consequently, the group wish to explore ways in which to establish a dermatology service which is closer to home for their patients. This could involve identifying an alternative provider with a special interest in dermatology or negotiating more local delivery of the current service. Sapna Sharma, Scott Lamb & Dr Sharad Pandit, September 2008 26
  27. 27. CHIROPODY (Small Heath) Proposal: The Small Heath commissioning group have identified the need to extend the current service provision of chiropody services for their patients. The current service provides priority to diabetic patients; however, the commissioning group believe that this service should be more widely available to other patient groups and in particular elderly patients. Outcomes: • Bringing services closer to home Linkage to PCT priorities: • Long-term conditions • Acute care Evidence of need: Good foot health is paramount in maintaining older people's independence, mobility and social contact. Lack of even the most basic foot care puts the elderly at risk of complications that can lead to dangerous falls, severe restrictions on mobility and social isolation. It is generally acknowledged that healthy feet have a huge impact on the quality of life for most people. Service Delivery: The Small Heath commissioning group are keen to invest in an in- practice chiropody service open to referrals for a selected range of foot conditions. The service could be based in either all practices within the commissioning group or a selected number of practices open to referrals from neighbouring GP’s. Sapna Sharma, Scott Lamb & Dr Sharad Pandit, September 2008 27
  28. 28. COUNSELLING (Sparkhill) Proposal: The commissioning group have expressed a need to provide support to patients who present with minor/borderline mental health conditions such as stress and anxiety, mild depression, bereavement, low self-esteem and sleep disorders. Outcomes: • Improving the general well-being of patients Linkage to PCT priorities: • Mental Health Evidence of need: The commissioning group have identified a number of patients that present to the practice with sometimes very complex issues that are not always appropriate to be referred to the mental health team. Many of these patients simply need someone to talk to and so GP’s are left in a position where they tend to see these patients on a regular basis which is, in effect, a counselling service. This inevitably has a knock-on effect for other patients who need to access GP services. Service Delivery: The Sparkhill commissioning group propose to establish an in- practice counselling service which will work in conjunction with the current mental health service provision. The service will be open only to minor mental health conditions (as outlined above) and could be delivered either from a range or all practices within the commissioning group. Sapna Sharma, Scott Lamb & Dr Sharad Pandit, September 2008 28
  29. 29. WORKPLAN The commissioning priorities set out in this document will be developed into business plans throughout the coming 12-18 months. Where there is overlap between Sparkbrook priorities and those of other commissioning groups in HoB, the 3 PBC managers have agreed to share these priority areas and develop them as HoB wide initiatives. The following table summarises the responsible PBC Managers, clinical leads and timescales for each Sparkbrook commissioning priority: Sparkbrook Commissioning Priorities Business Case 24/08/2009 16/11/2009 18/08/2008 01/09/2008 15/09/2008 29/09/2008 13/10/2008 27/10/2008 10/11/2008 24/11/2008 08/12/2008 22/12/2008 05/01/2009 19/01/2009 02/02/2009 16/02/2009 02/03/2009 16/03/2009 30/03/2009 13/04/2009 27/04/2009 11/05/2009 25/05/2009 08/06/2009 22/06/2009 29/06/2009 06/07/2009 13/07/2009 20/07/2009 27/07/2009 03/08/2009 10/08/2009 17/08/2009 31/08/2009 07/09/2009 14/09/2009 21/09/2009 28/09/2009 05/10/2009 12/10/2009 19/10/2009 26/10/2009 02/11/2009 09/11/2009 23/11/2009 30/11/2009 07/12/2009 14/12/2009 21/12/2009 28/12/2009 Commissioning Priority PBC Manager Clinical Lead Completion COPD Screening Sapna Sharma Dr Ramachandram October 2008 Gynaecology Jon Lear Dr Gill December 2008 Cardiology Nuala Woodman Dr Pandit December 2008 Chiropody Sapna Sharma Dr Verma December 2008 Rheumatology Sapna Sharma Dr Abdel-Malek/Dr Hall/Dr Rajput February 2009 Dermatology Sapna Sharma Dr Y Ahmad April 2009 Ophthalmology Jon Lear Dr Kulshrestha/Dr Gill April 2009 Counselling Sapna Sharma Dr Melchior July 2009 Patient Education Sapna Sharma Dr V Shah & Rashda Shahnaz September 2009 Balsall Heath Small Heath Sparkhill Implementation Period

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