Since their formation in 2012, Clinical Commissioning Groups (CCGs) have already faced formidable challenges, tasked with managing substantial commissioning budgets amid increasing financial pressure. In a further development from 1 April 2015, CCGs will now also be given the option to take up more devolved powers to co-commission primary care services with NHS England. This slide deck presents the third year of results from an annual survey with six CCGs. The survey sheds light on attitudes toward co-commissioning, as well as continuing to track levels of engagement and attitudes towards CCGs’ involvement in primary care development.
As part of our recent report, Understanding pressures in general practice, we conducted a survey of GP trainees. We asked trainees about their intended future working patterns and their views on the pressures facing general practice, the results of which are presented in these slides.
Has clinical commissioning found its voice? GP perspectives on their CCGsNuffield Trust
This slide deck presents the fourth and final year of results from an annual survey of GPs and practice managers in six CCGs across the country. The survey – conducted as part a joint project with The King’s Fund – explores how GP attitudes towards clinical commissioning have evolved since their launch in 2013.
As part of our recent report, Understanding pressures in general practice, we conducted a survey of GP trainees. We asked trainees about their intended future working patterns and their views on the pressures facing general practice, the results of which are presented in these slides.
Has clinical commissioning found its voice? GP perspectives on their CCGsNuffield Trust
This slide deck presents the fourth and final year of results from an annual survey of GPs and practice managers in six CCGs across the country. The survey – conducted as part a joint project with The King’s Fund – explores how GP attitudes towards clinical commissioning have evolved since their launch in 2013.
The perfect health system - Dr Mark BritnellNuffield Trust
At the first keynote for the Nuffield Trust Health Policy Summit 2016, Mark Britnell gives an overview of key characteristics of effective health systems.
Reshaping the healthcare workforce - Candace imisonNuffield Trust
For the Nuffield Trust Health Policy Summit 2016, Candace Imison talks about what steps would be necessary to develop and reshape the health care workforce.
For the Nuffield Trust Health Policy Summit, Stephen Shortt tells the story of a journey from multiple unconnected practices to accountable community based integrated services at scale.
Extended Primary Care Access in Southwark Nuffield Trust
Dr Lauren Parry, Improving Health; Rebecca Dallmeyer, Quay Health Solutions and Hayley Sloan, NHS Southwark CCG present on their Extended Primary Care Access programme.
How is quality faring? Priorities and impact on the frontlineQualityWatch
A presentation given to the QualityWatch 2015 annual conference by Professor Tim Evans, Medical Director and Responsible Officer, Royal Brompton and Harefield NHS Foundation Trust.
Care Quality Commission: Driving improvement in the investigation of deathsCare Quality Commission
A regulators perspective: supporting learning and driving improvement in the investigations of deaths
Presentation by Kim Forrester, Mental Health Act Policy Manager, and Karen Bennet-Wilson, Head of Inspection to the Improving Quality and Learning from Investigation of Deaths in Mental Health & Learning Disability Services event, Wednesday 22 June 2016, Hallam Conference Centre, London.
• Updates on the CQC review into investigations of deaths in NHS Trusts
• Learning from Southern Health
• What should be reported to CQC
• Moving forward...
ACOs and vanguards: Reflections from the USA - Mark LeenayNuffield Trust
Mark Leenay from Optum in the US presents to the Nuffield Trust health policy summit on accountable care organisations and what lessons they may have for vanguards in the UK.
State of Care is our annual overview of health and adult social care in England.
For the first time, we have been able to draw on the findings of our new ratings system across all of the sectors we regulate.
Our analysis shows that, despite increasingly challenging circumstances, many services have managed to either improve or maintain quality.
Andrea Sutcliffe, Chief Inspector of Adult Social Care for the Care Quality Commission (CQC) presented at the National Children and Adult Services Conference (NCAS) on 4 November 2016.
The perfect health system - Dr Mark BritnellNuffield Trust
At the first keynote for the Nuffield Trust Health Policy Summit 2016, Mark Britnell gives an overview of key characteristics of effective health systems.
Reshaping the healthcare workforce - Candace imisonNuffield Trust
For the Nuffield Trust Health Policy Summit 2016, Candace Imison talks about what steps would be necessary to develop and reshape the health care workforce.
For the Nuffield Trust Health Policy Summit, Stephen Shortt tells the story of a journey from multiple unconnected practices to accountable community based integrated services at scale.
Extended Primary Care Access in Southwark Nuffield Trust
Dr Lauren Parry, Improving Health; Rebecca Dallmeyer, Quay Health Solutions and Hayley Sloan, NHS Southwark CCG present on their Extended Primary Care Access programme.
How is quality faring? Priorities and impact on the frontlineQualityWatch
A presentation given to the QualityWatch 2015 annual conference by Professor Tim Evans, Medical Director and Responsible Officer, Royal Brompton and Harefield NHS Foundation Trust.
Care Quality Commission: Driving improvement in the investigation of deathsCare Quality Commission
A regulators perspective: supporting learning and driving improvement in the investigations of deaths
Presentation by Kim Forrester, Mental Health Act Policy Manager, and Karen Bennet-Wilson, Head of Inspection to the Improving Quality and Learning from Investigation of Deaths in Mental Health & Learning Disability Services event, Wednesday 22 June 2016, Hallam Conference Centre, London.
• Updates on the CQC review into investigations of deaths in NHS Trusts
• Learning from Southern Health
• What should be reported to CQC
• Moving forward...
ACOs and vanguards: Reflections from the USA - Mark LeenayNuffield Trust
Mark Leenay from Optum in the US presents to the Nuffield Trust health policy summit on accountable care organisations and what lessons they may have for vanguards in the UK.
State of Care is our annual overview of health and adult social care in England.
For the first time, we have been able to draw on the findings of our new ratings system across all of the sectors we regulate.
Our analysis shows that, despite increasingly challenging circumstances, many services have managed to either improve or maintain quality.
Andrea Sutcliffe, Chief Inspector of Adult Social Care for the Care Quality Commission (CQC) presented at the National Children and Adult Services Conference (NCAS) on 4 November 2016.
Infographic showing the results of our member survey of over 500 healthcare leaders.
Our 2015 Challenge brings into focus the scale and nature of change needed to ensure a sustainable healthcare system for the future. Here are the views of healthcare leaders from our national survey.
Transforming end of life care in acute hospitals: Critical success factors report
Feedback from a focus group of pilot site representatives looking at factors that have influenced progress during the first phase
13 December 2012 - National End of Life Care Programme
Over 50% of people die in acute hospitals in England, despite statistics and surveys consistently showing that most people would prefer to die in their normal place of residence.
The Transform Programme was set up to provide practical support for hospital Trusts delivering end of life care. Twenty-five acute Trusts (43 hospitals) signed up to take part in the first phase pilots during 2011/2, supported by a route to success 'how to' guide which included five key enablers and key metrics to implement best practice.
Each of the pilot sites provided regular returns on progress against implementation of the five key enablers and a focus group was also held to discuss some of the practical issues that had helped and sometimes hindered progress. This short report reflects the views expressed by those participating in the focus group.
Publication by the National End of Life Programme which became part of NHS Improving Quality in May 2013
Specialist and Associate Specialist (SAS) doctors are highly experienced and highly skilled doctors working in the UK NHS. Now SAS doctors can register with their employer to be recognised as 'Autonomous Practitioners'. The GMC has published guidance on becoming a recognised Autonomous Practitioner and doctors are encouraged to develop evidence of their skills in leadership, management and research. These slides provide a clear rationale for an SAS Leadership Fellow programme to support SAS doctors in their medical careers.
Presentation on issues in effective commissioning of drug and alcohol recovery services given. Presentation on behalf of the Association of Directors of Public Health (UK)
Uncover Hidden Population Using Predictive Modeling Tool VitreosHealth
Using Predictive Modeling Tool to Identify at Risk Patients who has a chance of becoming users of High-Cost Healthcare service and subsequently Reducing PMPM (Per Member Per Month) Costs While Increasing Member Satisfaction
This report looks at findings from web survey and depth interviews about use of the site amongst people looking for a new GP. It identifies what factors are important to people and provides feedback on some proposed new indicators.
Evaluation of the Integrated Care and Support Pioneers ProgrammeNuffield Trust
Nick Mays of the Policy Innovation Research Unit presents some conclusions from the early evaluation of the Integrated Care and Support Pioneers Programme.
Effectiveness of the current dominant approach to integrated care in the NHSNuffield Trust
Jonathan Stokes of the Greater Manchester Primary Care Patient Safety Translational Research Centre presents a systematic review of case management in integrated care.
Providing actionable healthcare analytics at scale: Understanding improvement...Nuffield Trust
Thomas Woodcock, Improvement Science Fellow at Imperial College London, talks about the various measurement approaches and processes when working at large scale to assess care quality improvements.
Ramani Moonesinghe, Associate National Clinical Director for Elective Care at NHS England, discusses the use of data for monitoring care quality at various levels within the system.
Paul Aylin, Co-Director of the Dr Foster Unit at Imperial College London, gives concrete examples of using a specific statistical model for monitoring care quality, cumulative sum (CUSUM).
Martin Utley, Director of the Clinical Operational Research Unit at University College London, reflects upon his involvement in the launch of specific tools to monitor care quality for paediatric cardiac surgery.
Evaluating new models of care: Improvement Analytics UnitNuffield Trust
Martin Caunt, Improvement Analytics Unit Project Director and NHS England and Adam Steventon, Director of Data Analytics at The Health Foundation share insights into how they have approached evaluating new models of care.
Lisa Annaly, Head of Provider Analytics at the Care Quality Commission, discusses lessons learned from the CQC as they have worked to monitor care quality over time.
Kate Silvester, a healthcare systems engineer, discusses the challenges of working with data and statistical techniques for real-time monitoring of care quality.
Monitoring quality of care: making the most of dataNuffield Trust
Chris Sherlaw-Johnson, Senior Research Analyst at the Nuffield Trust, introduced the Monitoring quality of care conference and gives an overview of some of the approaches that we've been using at the Trust to identify where care quality has been improving, especially for frail and older people.
Providing actionable healthcare analytics at scale: Insights from the Nationa...Nuffield Trust
Christopher Boulton, Falls and Fragility Fracture Audit Programme Manager at the Royal College of Physicians and Rob Wakeman, Clinical Lead for Orthopaedic Surgery at the National Hip Fracture Database talk about what they have learned by analysing the national hip fracture database.
Providing actionable healthcare analytics at scale: A perspective from stroke...Nuffield Trust
Benjamin Bray, Research Director and the Sentinel Stroke National Audit Programme, presents at the Monitoring quality of care conference about stroke care analytics.
New Models of General Practice: Practical and policy lessonsNuffield Trust
Nuffield Trust policy researchers Rebecca Rosen and Stephanie Kumpunen present findings from our upcoming report on large scale general practice models.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Antimicrobial stewardship to prevent antimicrobial resistanceGovindRankawat1
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India is one of the largest consumers of antibiotics worldwide.
India carries one of the largest burdens of drug‑resistant pathogens worldwide.
Highest burden of multidrug‑resistant tuberculosis,
Alarmingly high resistance among Gram‑negative and Gram‑positive bacteria even to newer antimicrobials such as carbapenems.
NDM‑1 ( New Delhi Metallo Beta lactamase 1, an enzyme which inactivates majority of Beta lactam antibiotics including carbapenems) was reported in 2008
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Thyroid Gland- Gross Anatomy by Dr. Rabia Inam Gandapore.pptx
Primary care co-commissioning: a survey of members’ views of their CCG and its role in primary care
1. Primary care co-commissioning: a survey
of members’ views of their CCG and its
role in primary care
Ruth Robertson
Holly Holder
Laura Bennett
Natasha Curry
Shilpa Ross
Chris Naylor
2. Introduction
• This slide pack presents results of an online survey of GPs and practice managers in
six clinical commissioning groups (CCGs), selected to broadly represent CCGs across
England.
• The survey was undertaken in February/March 2013, January/February 2014 and
January/February 2015.
• In 2015 we received 312 responses. These covered approximately 23% of GPs and
45% of practice managers in our case study sites.
• The slides that follow mostly show responses from GPs only – where appropriate we
have also shown responses from practice managers. Slides that show all respondents
include a small number of other practice staff who completed the survey (see notes
under each slide for clarification).
4. Key findings
1. CCG members have mixed views on primary care co-commissioning
• On 1 April 2015, the majority of CCGs took on fully delegated or joint responsibility for
commissioning primary care with NHS England. New responsibilities include designing incentive
payments and performance-managing GP practice contracts.
• Although most governing body members felt positive about co-commissioning (81%), a majority of
GPs and practice managers without a formal CCG role felt ‘negative’ (26%) or ‘neutral’ (43%).
Many may be waiting to see how the policy is implemented before forming a view.
2. Most GPs do not support performance management by CCGs
• The majority of GPs accepted that their CCG has a role in supporting primary care development,
particularly in influencing GPs’ prescribing patterns (which 83% support) and encouraging
collaboration with neighbouring GPs and others (77%).
• However, few GPs supported their CCG’s use of performance management tools such as targets
(25%) and sanctions (13%) to achieve these ends.
5. 3. Clinical engagement in CCGs is declining, but, is higher than under PBC
• 2013 – 2015: the proportion of GPs highly engaged with their CCG declined from 19% to 11%; those
who felt they could influence their CCG’s work declined from 47% to 34%.
• However, overall GP engagement remains higher than estimates under Practice-based
Commissioning (PBC).*
• The survey identified a number of possible reasons for declining engagement: the majority of CCG
leaders felt they lacked the time or training to fulfil their role; CCG managers were seen to be more
influential in commissioning decisions than GPs on the governing body; referral and prescribing
patterns had reportedly changed since the establishment of the CCG, but only 21% of GPs felt the
quality of care had improved.
4. There are some positive signs for the future
• The majority of CCG leaders planned to continue in their role for the foreseeable future, and a fifth of
GPs and practice managers not currently in leadership positions were interested in getting involved.
Key findings
*Practice-based Commissioning (PBC) was introduced in 2005 in order to increase clinician involvement in primary care trust
(PCT) commissioning. For an estimate of GP engagement in PBC, see Curry and Wood (2009)
6. Implications
• Maintain positive clinician-to-clinician relationships: in implementing co-
commissioning, CCGs must make full use of their links with members to influence
practices and avoid alienating members when performance-managing GP practice
contracts – a CCG role that few respondents support.
• Avoid a perception of CCGs as manager-led organisations: clinical engagement is
declining and CCG managers are already seen as more influential than GPs. To be
successful in co-commissioning, CCGs must forge strong partnerships between
members and managers that maximise the clinical voice, while ensuring they manage
the conflicts of interest that arise as GPs commission primary care.
• Focus on improving quality in primary care: few GPs feel CCGs have improved the
quality of care locally. However, co-commissioning gives CCGs an opportunity to make
positive changes that are visible to GPs in their day-to-day practice. This will be vital to
maintaining GP engagement and driving much-needed change in primary care.
7. Implications
• Sustain clinical leadership: as CCGs implement the Five Year Forward View, they will
have to compete with emerging provider organisations for GP leaders’ time. Some GPs
were keen to get more involved in CCG work and this enthusiasm needs to be
harnessed. Practice managers appear to be an under-utilised resource, with the
potential to play a more defined role in supporting the work of CCGs, as well as in the
development of new delivery models.
8. What do GPs think about co-commissioning and
their CCG’s role in primary care?
9. Most GPs and practice managers were aware of primary
care co-commissioning
10. Governing body members felt positive about the new developments,
whereas most members without a formal CCG role were neutral
12. However, the majority of GPs agreed that the CCG has a
role to play in developing primary care
• The majority of GPs agreed that the CCG has a legitimate role in
influencing their work, particularly in:
o influencing prescribing patterns – 83% agree
o working as part of multi-disciplinary teams – 77% agree
o influencing their relationship with other GP practices – 75% agree.
• To do this, the majority supported CCGs facilitating training (75%),
encouraging peer review of data (63%) and providing financial
incentives (53%) – these mechanisms were also seen to have the
greatest impact.
• Only a quarter supported the use of targets and only 13% supported
the use of sanctions.
14. Between 2013 and 2015, the proportion of GPs highly engaged
with their CCG declined from 19% to 11%
15. Close to half of GPs without a formal CCG role, and almost a quarter of
CCG practice representatives, felt completely or moderately disengaged
16. Only one in three GPs felt they could influence their CCG
in 2015, compared to nearly half in 2013
17. Why? Governing body members and CCG practice representatives
continued to struggle to find the time or training needed to fulfil their role
18. CCG managers are seen to be more influential over CCG
decisions than GPs on the CCG governing body
19. Only one in four viewed patients as being ‘very’ or ‘quite’
influential over CCG decisions
20. When asked about what difference the CCG has made,
it was a mixed picture
• GPs viewed their CCG as having had a limited impact in primary care
so far:
o The majority reported that the CCG had changed their adherence to referral pathways
(68%) and their prescribing patterns (63%).
o But far fewer felt that the CCG has had a positive impact on the overall quality of care
they provide (21%) and patient experience of GP services (12%), with the majority
feeling that the CCG has made no impact in these areas to date.
• By far the most negative feelings were about administrative burden:
71% of GPs reported that being part of the CCG has had a negative
impact on the amount of paper work and extra meeting commitments
they have.
22. The majority of governing body and CCG practice representatives
planned to continue in their role for the foreseeable future
23. There are also encouraging signs from other members, who said they would
be interested in getting more involved with the CCG in the future
24. Practice managers continued to report high levels of engagement – their
role could be developed to better support the clinical leadership
25. About this research
• This survey is part of an ongoing study by the Nuffield Trust and The King’s Fund,
which has followed six CCGs since 2012.
• The CCGs were selected to vary in size, location, level of deprivation and urban/rural
locations.
• Findings from earlier stages of the research, which included interviews and
observations in each CCG, were published in July 2013 and January 2015.
• The study focused on two key research questions:
o How involved are CCG members in the activities of the CCG, and what relationships are being
built between them and CCG leaders?
o How are CCGs discharging, or planning to discharge, their responsibility to support quality
improvement in general practice?
If you have any questions about the research, please contact Holly Holder
(holly.holder@nuffieldtrust.org.uk) or Ruth Robertson (r.robertson@kingsfund.org.uk).
26. www.nuffieldtrust.org.uk
www.kingsfund.org.uk
Follow us on Twitter:
http://twitter.com/NuffieldTrust
http://twitter.com/TheKingsFund
1 April 2015
For more information on the project, see:
www.kingsfund.org.uk/projects/evolution-clinical-
commissioning-learning-local-experience
www.nuffieldtrust.org.uk/our-work/projects/evolution-clinical-
commissioning-learning-local-experience