ŠĻą”±į>ž’ lnž’’’k’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’ģ„Į'` šæ 'bjbjLULU 4H.?.?«_’’’’’’¤–––––––Ŗņ3ņ3ņ38*4$N4\Ŗ£Vh¶4¶4(Ž4Ž4Ž4Ž4Ž4Ž4"V$V$V$V$V$V$V$ XhsZ|HV–„6Ž4Ž4„6„6HV––Ž4Ž4]V===„6–Ž4–Ž4"V=„6"V==āŠS¤––zUŽ4Ŗ4 šMæQUēĢņ3©9`.T"VsV0£VDT6ļZ ;–ļZ,zUļZ–zUØŽ4vT5T=Ø5Dģ5¹Ž4Ž4Ž4HVHVŸ<dŽ4Ž4Ž4£V„6„6„6„6ŖŖŖ¤"N'¤ ŖŖŖN'ŖŖŖ––––––’’’’ Commissioning Priorities Emergency visits Communication from providers – paperless +?Read codes Communication to patients by providers Improved access to providers Community Nurses Cardiology OASIS redesign COPD Community services OOH Counselling Community matrons Reablement Ambulatory care EQUITABLE SERVICES Use and abuse of referral services Decommissioning services Properly resourcing primary care Jowett ward / data accutacy CAPACITY Individual Groups’ Lists: Address communication failings for already-commissioned services Community Nursing Cardiology? What’s important to you? Aspirations – new services what’s done badly, e.g. COPD not as we hoped, patients don’t like. Can Federation gather feedback, evaluate and decommission? Mental health – EHWB, CAMHS, counselling DNs. Everyone not happy with current service. Can Federation commission a primary care service, i.e. designed by the GPs and nurses. Ideal situation – can we employ our own DNs with the Federation to provide CPD/ training etc? Physio – Wiveliscombe no in-house for > 5 years Mobile services? All measures seem to be trying to reduce secondary care spending. If we commission services that save money for secondary care, how do we see the financial benefit? Would we eventually want to take on the contract with MPH? OOH – influencing service design: nurse triage, response team, understaffed Taunton hospital services Community matron service Reablement team (ISST) Community Nurses (District Nurse) Jowett ward. Emergency Visits Counselling – expand service remit to include urgent assessment Secondary care – patient access to consultant by telephone Paperless comms from secondary to primary care Community nursing Counselling – easier/ quicker/ urgent access MSCIC Outlying practices – overspends Peer pressure Practice support Priorities Community nursing CQC Sharing protocols / plans Management sharing Clinical resource sharing Online blog to share ideas Training / CPD Crisis cover Emergency home visits Equipment IT / website Pool of reserves, e.g. locum / medical secretaries Knowledge Issues Avoiding duplication Conflicts of interest Workload “Bank “ of time spent on federation Employment risk Individual Groups’ Lists Clinical skills sharing (endless) Back office Payroll Emergency Home visits Treat at other local practice rather than hospital , i.e. physio Training events IT sharing – practice level and clinical system capability CPD Nursing Homes Sharing admin / knowledge / equipment Community nursing Locum GPs / Nurses Develop skill register and staff training Education and health promotion collaboration CQC – sharing protocols / plans PMs sharing ideas / supporting each other Sharing management support Individuals with a special interest, e.g. clinical interest, to share with other practices Formal and informal Sharing: education, clinical Resources: admin and IT systems Tasks: CQC forms etc compliance, lead roles, avoid duplication, gunding Bulk (group) purchasing The value lies in sharing ideas, problems and skills Anything to reduce the workload on the individual Help develop staff in the layer below PM A blog / forum that is easily accessible to share problems for the federation to help solve if there are no answers Central repository for resources, e.g. documents and CQC Financial benefits from buing, e.g. 1 electricity contract for all practices; dressings in a central store and bulk buying Managers could share specialist skills Beware: conflict of interest in working together vs maximizing profits for practice Providing Priorities GPED & OOH – Integrated A&E / OOH District Nurses – how would it work with OOH Mobile dermatology van Ear microsuction Patient transport (decrease no. of visits) Ambulatory care Community hospital vs hospital at home Complex care GP Prescribing Emergency visits MTOP Telemedicine Creche Federation-based locum service Exercise programmes Intermediate level care Individual Groups’ Lists What should we do as a Federation? Utilize GP, management and nursing resources Would have to have a “no poaching” agreement What do we really need – how do we find out ? blog, communication. OOH – Deane Doc worked well Take on DN service (with Federation support to practices to employ DNs) Mobile dermatology van Expand the current diabetes intermediate service with GPs with advanced skills/ knowledge Ear microsuction OOH + nursing (community) Ambulatory care Identify services needed and can provide Joint injections Community nursing Medication SYNC Community Nurses / COPD Counsellors GP Specialists Health Visitors?? Clinical Excellence Complex care GP / prescribing Community Hospitals Hospital at Home Locum service – GPs, nurses, sec Creche /after school club /holidays Emergency visits!!! :-) integrated to OOHs, IT, SCR and GPED. Communication Priorities Tool to report problems / issues. Need to feed back. Simple solution. E-mail. “Drip drip” approach Website Communicating within the practice Concise Practice leads Individual groups’ lists Concise and simple communication (1 side A4, no links, once per month, by e-mail) Federation website with patient links to message + GP forum password protected Continued Federation meetings with Practice lead. Blog/ website E-mail Encourage colleagues Problem /issue reporting tool (forum) “I have had this problem with …” Feedback of Federations issues in practices Bulletin when appropriate not newsletter Engaging with patients Priorities Target groups of patients according to topic Role of PPG /PRG Collaboration of PPGs around Federation Virtual PPGs Education of patients TDBC / other groups Formal Federation PPG Individual groups’ lists PPGs Via Taunton Deane/Somerset CC public health Virtual suggestion box Federation send out survey to all PPG chairs Other groups – disability + minorities (ethnic) – approach representatives Use of PPGs’ shared events across federation practices Surveys re proposed service changes Help with hard to reach groups Patient Reference groups Annual focus groups Links to other agencies PPGs – targeted patient involvement, e.g. new COPD service Patient participation groups Virtual patient participation groups Promotion Advertising ?PP involvement at Federation Level Use PPG to canvass patient opinions / views on services Federation-based patient education events Moving forwards Priorities Rotating days for meetings to enable engagement Admissions – case by case review with protected time /funding Development of the Federation with a clear split between commissioning and providing. Decision re Taunton Health. Resource analysis Capacity Individual groups’ lists Clear split between commissioning /providing Re-establish Taunton Health Resource analysis – what is available/ CME/CPD – link to SPGT Communication. Blog/ frum /website – needs to be easy to use. Ensure robust systems in place Need to ensure Federation has strong foundation /engagement of members to maintain “bottom-up” rather than top-down management. Staff involvement PPG Rotating days of Fed Meeting and Venue Maximum representation Website to communicate Protected time and funding Expand 3 groups – commissioning / providing/ practice support. Use skills and interested of various arties Engaging other partners Review admissions on case by case basis, in practice & A+E. Form a communication link from Fed ( CCG Message boards and Fed meetings for communication How can the Fedration best influence the CCG Prioritise areas of concern and be realistic re achievability Influencing the ongoing changes with the district nurses Ensure the COPD service is reviewed to meet patient needs Support the reablement team and their development iv treatment at home Communication from the CCG Dementia service – some need for improvement - ?GPs OOH Smoking in pregnancy     Taunton Federation Awayday 26th January 2012 Page  PAGE 1 of  NUMPAGES 6  */`s‡‘ # $ ¹ ŗ Ō j Š R q  1-,23œµot»ĒóēŪóŠÅŠÅŠÅŠŗŠŗÆŪŗ§ŗÅŗÅŗœ‘‰}ri}r}rarahƒLĆCJaJh–"<5CJaJhę)hę)CJaJhę)hę)5CJaJhźMCJaJhę)h'BCJaJhę)h¦6ęCJaJhĪ[ CJaJhę)h²u÷CJaJhę)hĻjCJaJhę)hd/ĻCJaJhę)hŹ}^CJaJhę)h/l5CJaJhę)hHw†5CJaJhę)hŹ}^5CJaJ$*`‡¤µĄĻēė÷  $ 7 Z s ” ° ¹ ŗ Ō  ' 3 ÷ņźźźźźźźźźźźźźźźźźźźņåņņņgd/l & FgdYs gd²u÷$a$gd/l«& 'žž3 4 M i č  ÷ ' 8 Ž   f € ™ ° Ņ ß ą ń 1lœÆÜāśśśņķķķķķķķķķķķķķķķķķķķķķķķgdĻj & FgdĻjgd²u÷"-?C]pŠ„“Į×įī!+,3H^g‹›œµ×śņķåååååååååååååķķķķķķķķķķ & Fgdę)gdę)$a$gdƒLĆgdĻj×äģCS“”¢ČŚķDEeŖ7WŸ·øķHśśśśśśśśśśśśśśśśśśśśśśśśśśśśśgdę)ĒČėģöœ³ŁŚékl…”³GTĀĆŪūY‚RdÕך€‡™²>BPQõźßÓĒÓ¼±¼¦¼±¦¼Ē߱߱ߛ߱ߐߐ±ź„źxź„źxźmhę)hł^CJaJhę)hę)>*CJaJhę)hę)5CJaJhę)h“5œCJaJhę)hĻjCJaJhę)hšD‚CJaJhę)hd/ĻCJaJhę)h/lCJaJhę)h/l5CJaJhę)h^zT5CJaJhę)h^zTCJaJhę)hę)CJaJhę)hƒLĆCJaJ'H¼õp—ėö#Pgx£³Śźö  ?Skl…Öśśśśśņķååååååååååååååååķķķ & FgdYs gdĻj$a$gdę)gdę)ÖGc«ĀĆ.HXY‚“„µ¶ĪŚéū-ARs—˜ÖśśśśśśśśśśśśśśśśśśśśśśśśśśśśgdĻjÖåšAV^€ˆ—˜™²S…†”›°±ų$NOPh÷ņźźźźźźņņņņņņņņņņņņņņņņā$a$gdŽe’ & Fgdę)gdę)$a$gdę)Qghrs±Å'@CklŽ®8;! 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