Sussex by the sea erica and tom[1]


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Presentation at the Health Libraries Group conference, Glasgow, 12-13 July 2012

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  • In this presentation, Erica and I will show how we support clinical commissioning in West Sussex. Erica and I are unusual, we think. We are both outreach librarians, dedicated to serving particular groups of users and embedded, or moving towards embededness, with those groups. Her job title is Public Health and Commissioning Librarian, while I am Primary Care Librarian. She divides her time between public health, now part of West Sussex County Council, and the Coastal West Sussex Clinical Commissioning Group, whose senior management congregate in the Causeway in Goring-by-Sea, while I work with GP practices and community NHS staff. Today I’m going to give you the dummy’s guide to commissioning and outline the West Sussex health economy, the context and the structures in which we operate. Erica will then give you a more postgraduate view of commissioning and describe some of the ways we have developed to reach this new, politically powerful, knowledge-hungry but sometimes hard-to-reach, constituency.
  • This is the prospectus that Library & Knowledge Services have produced to show how they can support and add value for CCGs. We have some copies if you’re interested.
  • West Sussex Knowledge & Libraries, which we represent, serves everyone across the whole of the local health economy. As well as us, the outreach wing, if you like, there’s a range of staff offering the full range of digital and print-based library services
  • Commissioning has been with us for some time. It’s a little like M. Jourdain’s prose, something that we have been doing unconsciously for all our lives. Seen chronologically, we have at least twenty years of experience of commissioning, from the introduction of GP fundholding in 1991, the total purchasing pilot in 1995, the 1999 abolition of fundholding and establishment of PCGs with the aim of progressing to PCTs, and then the recent history, post-election of the coalition and the Health and Social Care Act 2012.
  • Continuum of commissioning before the election of the current government One could argue that commissioning has been with us since the days of Hippocrates; certainly the act of writing a prescription for a patient is arguably an act of commissioning, and one can discern commissioning activity across a continuum, from direct care for an individual patient, to locality, community regional and national levels. This is how Smith and Mays saw it under the previous government. The chief change under the new act is that the regional level disappears altogether, though the role of the NHSCB area offices is at the moment still unclear and perhaps contested.
  • This is the rather rose-coloured view of the new NHS, with patients at the centre and safe in the embrace on the outermost circle of the SoS, the DoH and parliament. The purple circles represent organisations involved in commissioning care.
  • Erica will say more about this in a while, and the commissioning intelligence model
  • What of Sussex? At the highest level, NHS Sussex covers the whole of the counties of West and East Sussex and the city of Brighton & Hove, containing seven clinical commissioning groups or CCGs. The county of West Sussex contains three of these, Crawley and Mid-Sussex and Horsham and Coastal West Sussex CCG, with which we concern ourselves. Coastal, as we affectionately call it, is the largest, with a population of nearly half a million, served by 58 practices
  • The Coastal CCG area, as we affectionately know it, is further subdivided into five localities, ARCH, in the west of the west, being the largest. The CCG covers nearly 65% of West Sussex; serves a population of 482,100. With a range of local services Including: • 56 GP Practices • 1 acute NHS hospital trust • 6 NHS community hospitals • Over 200 Community Nurses And a wide range of Community teams • Over 50 NHS Dental Surgeries • Around 95 Community Pharmacies
  • 1 acute NHS hospital trust 6 NHS community hospitals Over 200 Community Nurses And a wide range of Community teams Over 50 NHS Dental Surgeries Around 95 Community Pharmacies
  • Among the distinguishing features of the West Sussex health economy as a whole are: a higher than average proportion of elderly people (20% over 65, while the figure for England as a whole is 16%) considerable inequalities in health, both in terms of outcomes and wider determinants of health: poorer life expectancy in deprived areas There are projected to be higher numbers of people with disabilities and living longer with long term conditions. Alcohol remains highest priority in term of lifestyle risk factors - hospital admission rates have continued to increase. Obesity rates remain a concern – of all ages within the population, an issue for both children and adults. Current estimate of 180,000 adults obese in the county and at increased risk of conditions such as diabetes, hypertension, coronary vascular disease, stroke and cancer. Taken from the JSNA and the Health and Wellbeing Strategy
  • CCGs have to manage a complex web of relationships with other organisations. As well as the member practices, these are the key ones for the Coastal CCG
  • Well, Good afternoon everybody, & thank you all for coming to our session today to hear about our experiences in supporting primary care & commissioning As Tom has outlined, my name is Erica Rae & I am Public Health & Commissioning Librarian for West Sussex Knowledge & Libraries This is a list of what I hope to cover during the session, & hopefully there should be some time at the end for questions So I’ll explain – A little bit about my role and how I perform it The differences between the two services I support, & changes that are taking place We’ll also take [another] look at the Commissioning Cycle & Commissioning Intelligence Model & how they define the information needs of our users Some sample searches And how Current Awareness is being used as a ‘bridge’ for marketing and developing the service
  • My predecessor was librarian for the PCT in it’s many incarnations for 25 years until her retirement last year With that, and various other organisational changes in the library service at that time, it gave us the chance to bring the role more up to date Around the same time the Public Health team moved from PCT headquarters in Worthing to new offices in Chichester, prior to their integration with West Sussex County Council And we also saw the emergence of the Clinical Commissioning Group (CCG) “Coastal West Sussex Federation” who stayed at Worthing So we morphed the PCT librarian role into my new one, as a ‘roving librarian’ With a remit to provide library services to both the teams on an outreach basis So I now spend my time travelling between the two sites, ‘hot-desking’ with my trusty laptop, based with, and embedded in, the teams rather than in the library
  • It quickly became clear that there are some differences between the teams I work for, both in their attitude & approach Reflecting, I think, the various stresses & pressures on them as they move forward Public Health are preparing to merge with West Sussex County Council (WSCC), when they’ll become Local Government employees, & no longer NHS So they’re feverishly preparing for their transition whilst still trying to deliver ‘business as usual’ – And have been incredibly grateful for my input! Meanwhile the CCG have been grappling with clarifying & developing their role as a support service to GP Commissioners – Whilst getting to grips with the fundamental shifts that will be required in delivering Community Health Services And have found it harder to accept my presence & understand how my input can help
  • There’s also a third strand to my work – Supporting staff of the ‘Joint Commissioning Unit’ (JCU), a collaborative team of commissioners made up of NHS staff from the PCT, and the local authority staff of West Sussex County Council This has demanded what we think is quite a new & novel approach, requiring a fairly fundamental shift in our own thinking, & delivery of services to a more integrated customer base It seemed illogical to be offering library services to only the NHS half of this team so we’ve now started to think of the County Council staff as a potential client base as well, and have done some literature searches for them This has proved to be an interesting and potentially powerful move, as the service has been warmly received And has also required purchase of ASSIA, a new database for searching for Social Care information, a lot of ‘Googling’, & investigating other potential sources of Local Government information
  • So what do we actually do, in terms of evidence and information-finding, and why do we do it? To answer that, I’m going to look in a little more detail at the diagrams we referred to earlier, the Commissioning Cycle, & the Commissioning Intelligence Model
  • Public Health are a very ‘evidence-based’ team, basing a great deal of their work on research findings, with evidence underpinning much of their output and commissioning decisions Whilst evidence review is also very much the case for the CCG, it tends to form a smaller part of the overall whole that is the ‘Commissioning Cycle’ [The NHS Information Centre provide a rather nice little interactive tool to illustrate this at ] And we’ll tend to be involved at the Planning Stage , rather than the active Procurement one, or during Monitoring and Evaluation of their contracts
  • If we now look at the Commissioning Intelligence Model,   [available at The NHS Commissioning Board website ]     ..we can begin to see in more detail where fit in in terms of evidence or information-finding   It’s a rather complicated diagram with lots of detail about the tools & types of services a CCG needs for the commissioning process   Centred around a number of questions that they need to ask And is very ‘data-driven’ – primarily about the numbers   But if we look at some of the questions in close-up we can begin to see how some of them are relevant to us and how we can contribute
  • So, for example – Question 1. How healthy is our population? Where they ask questions such as ‘Who would benefit most from a disease management programme’
  • Question 4. How do we compare? For example ‘do current pathways reflect evidence-based good practice’
  •   And Question 6. How could things be better? Such as ‘Do our patients receive the most appropriate and cost-effective medicines’
  • Some of these types of questions will seem familiar to health librarians and easy to answer with traditional resources   But others are more challenging and require us to ‘think out of the box’ a bit more to find relevant information, as they don’t find their way in to the formal literature Something that they particularly like to see, for example, is ‘How have others done it?’ – existing examples of, for instance, service specifications, service redesigns, case studies, well-being strategies, etc, from other organisations (PCTs, Acute Trusts)
  • Here’s part of a search in HDAS on ‘MSK Hubs’ – a new idea for a centralised Musculoskeletal triage and referral service that’s been successfully implemented elsewhere in the country   It’s a bit faint but hopefully you can see the list of big fat ‘zeros’ in the Results column...
  • So here’s what we did on the internet to try & find examples of other redesign projects & service specifications – Examples straight away of some Case Studies...
  • And some service specifications   Using the search string msk hub "service specification" in Google And if we add in the advanced search method restricting the domain to we start to find a lot more! (Find more! using msk hub "service specification" )
  • Similar searches for Public Health, & the JCU, have involved Googling for other PCT’s health and wellbeing strategies –   "alcohol strategy" pct or primary care trust   Information on the Government’s recently announced "Troubled Families Initiative"   "troubled families initiative"   And we’ve also recently invested in ASSIA, a new database, (Applied Social Sciences Index & Abstracts) to add to our arsenal of tools for searching for Social Care information   As well as investigating other resources such as the Local Government Association website & National Centre for Social Research
  • There are also some really useful ‘ready-made’ resources other enterprising libraries have created   The Commissioning Handbook provides a wealth of information & advice on ‘how to do it’
  • Anne Gray’s Milton Keynes based website is an excellent source for identifying Hot Topics & subscribing to updating bulletins
  • And finally...   To market & promote the service, we’ve found that –   Taking the service out to the teams rather than waiting for them to come to you is essential   They won’t necessarily equate traditional ‘clinical-based’ information with what we can do, so it helps to ‘learn their language’   I have no compunction in pushing current awareness at them instead of them asking for it   It’s a good marketing tool & gets you known – I’ve had people come back to me after receiving something unsolicited
  • Creating bespoke services that show you understand their world are useful   For example PubComm is a Netvibes site I created as a ‘one-stop shop’ – a dedicated current awareness portal for Public Health & Commissioning information at   (just Google ‘netvibes pubcomm’)
  • And last but not least, some useful websites –   Commissioning Handbook for Librarians   Local Government Association   National Centre for Social Research   NH'S Commissioning Board Special Health Authority   NHS Information Centre for Health and Social Care NHS Networks Commissioning Zone   NHS Primary Care Commissioning   Quality:MK
  • Sussex by the sea erica and tom[1]

    1. 1. Sussex by the sea: supporting primary care commissioning Erica Rae and Tom Roper West Sussex Knowledge & Libraries
    2. 2. West Sussex Knowledge & Libraries• Two physical sites, at Chichester and Worthing• Support all NHS staff, whether acute, primary, mental health, local authority, hospice… – Head of Library and Knowledge Services – Deputy Head of Library and Knowledge Services – Public Health & Commissioning Librarian and Primary Care Librarian – Clinical Librarian and Knowledge Systems Librarians – Library managers and library assistants
    3. 3. A brief history of commissioning• 1991: purchaser-provider split, GP fundholding, GP & locality commissioning• 1995: total commissioning• 1997: Labour elected, committed to end fundholding• 1999: fundholding abolished, PCGs (later PCTs) established• 2010: coalition elected• 2011: CCGs• 2012: Health and Social Care Act passed
    4. 4. Continuum of commissioning before the election of the current government7 Smith J A , Mays N BMJ 2012;344:bmj.e980©2012 by British Medical Journal Publishing Group
    5. 5. The commissioning cycle Attribution: Bdailey86 from Wikimedia Commons
    6. 6. Sussex
    7. 7. Coastal West Sussex: Locality areas and practices• Adur – 9 GP surgeries in Lancing, Shoreham-by-Sea, Sompting and Southwick• ARCH – 22 GP surgeries in Arundel, Bognor Regis, Chichester, East Wittering, Loxwood, Midhurst, Petworth, Pulborough, Selsey, Southbourne, Tangmere and Yapton,• Arun – 6 GP surgeries in East Preston, Littlehampton and Rustington• Cissbury – 13 GP surgeries in Ferring, Goring-by-Sea and Worthing• Chanctonbury – 5 practices in Billingshurst, Henfield, Steyning & Storrington
    8. 8. Coastal West Sussex• GP Practices• One acute NHS hospital trust, two main sites• Six NHS community hospitals• Over two hundred community nurses• A wide range of community teams• Over fifty NHS dental surgeries• Around ninety-five community pharmacies
    9. 9. Some salient features• Higher than average proportion of elderly people (20% over 65, England 16%)• Considerable health inequalities• Poorer life expectancy in deprived areas• Rising numbers of people with disabilities• Rising numbers of people living longer with long term conditions.• Alcohol-related hospital admission rates have continued to increase.• Obesity affects all ages within the population• c.180,000 adults obese, at increased risk of – Diabetes – Hypertension – Coronary vascular disease – Stroke – Cancer
    10. 10. Key relationships for the CCG• NHS Commissioning Board• NHS Sussex and NHS South of England• Providers – Western Sussex Hospitals NHS Trust – Sussex Community NHS Trust• West Sussex County Council – Joint Commissioning Unit – Health and Wellbeing Board• Patients and public
    11. 11. Public Health & Commissioning Librarian• Role of the PHCL Librarian• Public Health and Commissioning – What’s the difference?• Service changes• Commissioning Cycle/Intelligence Model• Example searches• Current Awareness
    12. 12. • The PCT – we’ve always been there!• A change of service• A change of customer base• A new role for me• The remit• The practicalities
    13. 13. • Different teams, different approaches• Major changes!• Public Health will merge with Local Government• CCG developing their role
    14. 14. • Joined up services• A culture shift• Branching out into Local Government• A new client base?• Requiring new tools and methods
    15. 15. • So what do we do?• And why do we do it?• A couple of illustrations…
    16. 16. The Commissioning CycleCopyright © 2011, Re-used with the permission of The Health and Social Care Information Centre. All rights reserved
    17. 17. • Traditional resources – – NHS Evidence – HDAS – Cochrane• Who’s already done it?• Thinking ‘out of the box’
    18. 18. • No Results?
    19. 19. Find more! using msk hub "service specification"
    20. 20. • Google – For Public Health – examples of other PCT’s health and wellbeing strategies "alcohol strategy" pct or primary care trust For the JCU – information on the "Troubled Families Initiative” "troubled families initiative"• New databases – For Social Care information Applied Social Sciences Index & Abstracts (ASSIA )• Other resources – Local Government Association website National Centre for Social Research
    21. 21. • Help is at hand! The Commissioning Handbook
    22. 22.
    23. 23. • And finally...• Marketing and Promotion – Don’t wait for them to come to you Current Awareness helps Keep up to date yourself Learn to speak their language
    24. 24. Netvibes/PubComm
    25. 25. Useful websites•Commissioning Handbook for Librarians•Local Government Association•National Centre for Social Research•NHS Commissioning Board Special Health Authority•NHS Information Centre for Health and Social Care•NHS Networks Commissioning Zone•NHS Primary Care Commissioning•Quality:MK