Month: June 2021

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Digital referrals help hard-to-reach patients

We strongly believe that improving patient experience is at the heart of all that we do. In creating the Weight Management Referral Hub, we have embraced a person-centred approach and designed a tool that allows patients to choose the weight management product which they feel they can connect with most successfully, and which then provides a flexible and tailored service to match their individual needs.

Background

Managing weight and reducing obesity have become major health issues in recent years and the realisation that a patient’s weight can have a major impact upon their experience of – and recovery from – COVID-19 has only made the issue more pressing over the last year.

This web-based Referral Hub has been developed to give eligible patients access to tier 2 weight management services delivered digitally as part of the NHS Digital Weight Management Programme, following automated e-referral from general practice.

Action

A triage algorithm process identifies the appropriate level of intervention the patient will need based on their likelihood of completing the programme and offers a choice of WMS providers to deliver the service. The patient selects the provider of choice and the system links to the chosen WMS and passes across key information to enable the patient to register and get started.

The NHS Digital Weight Management Programme (DWMP) is targeted towards people with a diagnosis of diabetes or hypertension who are living with obesity (BMI 30+ adjusted appropriately for ethnicity), where we know we can have a significant impact on improving their health, reducing health inequalities and costs.

It is also designed to offer effective weight management services to people with obesity and co-morbidities (diabetes and/or hypertension).

The programme features interventions of varying intensities, delivered by commercial providers, offering tailored approaches which target people from Black, Asian and minority ethnic groups, men, younger people, and those from deprived communities – and make a real difference to their health and wellbeing.

The Hub provides a single point of access for health professionals to manage patient referrals and allocate patients to appropriate DWMP providers and acts as a single point of contact for all potential patients, offering them a choice of provider appropriate to their level of intervention, and sending the chosen provider details of the person’s eligibility assessment.

Impact

Following extensive testing of the Hub, we have signed up 218 practices to take part. Staff have reported saving significant amounts of time in processing referrals as the Hub makes the relevant templates electronically available to all GP practices.

Referrals are then automatically generated into the Hub via an application programming interface which then leads to swift contact with patients. Each user can then access the Hub via their smartphone or computer, and by following a series of simple steps they can select their chosen provider and begin their programme.

The savings produced in terms of time and resources and the improved completions of the programme by patients using the Hub have demonstrated the value of this approach and the potential for major efficiency gains, as well as a large reduction in the amount of money spent on treatment for patients with weight management issues.

By cutting back on applications paperwork and making referrals through the Hub, and by making the transfer of patient details automatic, the Hub leaves NHS staff free to concentrate on other tasks.

Feedback from early testers:

“Very simplistic process and easy to follow. From what I remember it was only about 6/7 steps so very user friendly.”

“It was simple to use and and quick to use. Very easy to understand.”

“It looks great on the phone and really easy to use !!”

“All went smoothly. Received a text message, clicked the link, answered all questions through to choosing the provider, shut it down and clicked back on the link in the message. Previous answers were pre-filled, chose the provider and it said everything completed. No issues.”

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Rapid recruitment for COVID-19 vaccine drive

Our work supported the recruitment of the bank and volunteer staff working at vaccination centres, at a time of high pressure in the NHS when work volumes were already extremely high, capacity was already strained, and staff were having to navigate difficult home lives because of COVID.

Background

Between January and June 2021, our project provided large-scale recruitment services to five NHS organisations which were supporting ICS/PCNs with the mass vaccination roll out. We supported the completion of around 2,500 pre-employment checks for volunteers and bank workers.

Action

We quickly recruited and trained 40+ recruiters to support an original small team of seven; we set up IT systems, provided a corporate induction, took project scope calls with area leads to determine support requirements and put in place processes that met data sharing regulations so that we could quickly source staff for vaccination centres.

We collated volunteer forms and converted them into applications and conducted remote ID verification calls and pre-employment checks, and processed checks for the Bring Back Staff Scheme. The team organised an alternative occupational health provider to support with fit-to-work and immunisation checks to relieve pressures on the existing occupational health team. We also pre-arranged immunisation sessions at a local GP practice for applicants.

The team supported Cheshire CCG while Mid Cheshire Hospitals NHS Foundation Trust hosted the bank, using volunteers and bank staff deployed to Cheshire PCNs and to the Cheshire Racecourse and Alder Hey vaccination centres.

MLCSU also supported with the recruitment drive for the Shropshire, Telford and Wrekin region. We quickly established a process to use the existing systems at St Helens and Knowsley Teaching Hospitals NHS Trust, East Lancashire Hospitals NHS Trust and Midlands Partnership NHS Foundation Trust to process applications on their behalf.

Impact

Over the last two years, MLCSU have built the capability to flex staffing requirements to meet NHS demands by developing a temporary staffing team who specialise in generating flexible workforce solutions such as bank and associate pools. This innovative private sector/agency-type model was a massive advantage when it came to deploying 40+ bank staff to work on this project at short notice.

Its streamlined processes and integrated systems allowed the team to provide services with little front-end set up, and by drawing on skill sets from the wider people services department, the model produced effective training and onboarding solutions for new staff.

Due to their speed and efficiency, the team have supported with the overall success of the vaccination rollout locally and nationally, processing approximately 2,500 applicants.

Phil Meakin, Programme Lead for COVID-19, Cheshire CCG, said:

“This has been an amazing system effort from the people of Cheshire, Trust staff, ICPs, CCG, Liaison Workforce, and MLCSU.

“The team from MLCSU provided us with daily updates of applicants’ process status and held weekly meetings to make sure our processes were working effectively. This helped us to understand the timings of when we would have enough resource to support Vaccination Centres.

“We are very grateful for their accurate and effective work of MLCSU in supporting people through a challenging process. Without all partners working together, it would have taken far longer to vaccinate the people of Cheshire.”

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Blog: My time helping vaccination centres

In this blog, we hear how Kelly Bishop, a senior nurse within the Midlands and Lancashire Commissioning Support Unit’s Urgent Care Team, has been supporting Lancashire and South Cumbria in delivering their COVID-19 mass vaccination programme.

Since December 2020, I have been supporting the Healthier Lancashire and South Cumbria (HLSC) integrated care system, as one of three clinical leads over their seven mass vaccination sites. Carrying the title ‘Senior Nurse, Mass Vaccination Programme’ has been the most privileged yet responsible time of my career and one I will look back on with great pride.

Finding the right space and people

So, what does providing MLCSU’s vaccination support services mean for a nurse in the Urgent Care Team?

The initial task was to assess potential sites and floor plans for clinical suitability, alongside estate management colleagues from HLSC. We looked at empty shops, sport centres, town halls and cathedrals across the region, eventually deciding on seven sites. An amazing team of joiners, electricians and plumbers got to work.

Duties of a senior nurse

As the work on the sites progressed, my focus moved to training and onboarding over 500 new members of staff made up of the most amazing and diverse people. The programme has seen the coming together of existing NHS staff, retired nurses returning to practice, new recruits offering to be vaccinators, the fire service and armed forces, alongside our own army of volunteer marshals. Inductions and training commenced, uniforms were issued, and finally rosters formed.

Other days were spent: writing the clinical protocols and policies within which the sites would operate; unpacking and checking all the equipment onto the sites; building relationships with provider trusts as Care Quality Commission registration was confirmed. Ensuring no detail was missed, such as installing plug sockets in squash courts in time for the vaccine fridges, pulled in the full use of my clinical and programme management skillset!

Opening day and beyond

Finally, the opening of the seven sites in quick successions within seven days came! I can only describe opening a mass vaccination site like trying to roll a large boulder downhill, it takes every bit of your being, energy, and strength to get it moving; but once it goes, it goes.

Now the vaccination programme is well on its way, my daily life involves the operational running of the sites and ensuring high clinical standards are maintained, assurance is given to HLSC and lead provider trusts and, most importantly, that our population receive a timely vaccination and a good experience.

I am only one of many in MLCSU that have supported the mass vaccination programme, and we should be proud. Thank you to the Urgent Care Team for affording me this great opportunity.

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5000+ delayed CHC assessments cleared

The NHS Continuing Healthcare Framework was suspended from March to August 2020 due to COVID-19. All care that facilitated hospital discharge or prevented admission to hospital during that period was automatically paid for directly by the NHS without assessment. Once the framework was reinstated, there were over 5,000 patients due a ‘deferred assessment’ which needed completing as soon as possible. Clinical commissioning groups (CCGs) would receive funding in November 2020 to support individuals eligible for NHS CHC funding.​

To establish an efficient process, health and social care systems employed a ‘Trusted Assessor’ model, designed to reduce delays when people are ready for discharge. It is based on providers adopting assessments carried out by suitably qualified ‘Trusted Assessors’ working under a formal, written agreement.​
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Action

The Midlands and Lancashire Commissioning Support Unit (MLCSU) set up projects supporting the CHC activity based on the Trusted Assessment model in five integrated care systems (ICSs). Together with CHC expertise, we also employed clinical and business resource to address the issue.​

Working in collaboration with CCGs, NHS trusts, local authorities, community providers and others was key to completing the retrospective assessments This was achieved through excellent partnerships, the development of key systems and exceptional working practices to ensure deadlines were met.​
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Impact

All care packages across the five ICSs, which were funded automatically by the NHS during the first phase of the pandemic, have now been assessed against the core NHS CHC Framework. This ensures that the packages:​

* Provide the most appropriate care according to individuals’ needs​
* Are realigned to the correct funding stream
* Eligible patients are now funded by core CCG CHC budgets. For remaining patients, the payment of their care costs has transferred from the COVID-19 budget to local authority responsibility, which has determined a variety of different pathways to support their care costs

The successful completion of assessments also earned the team a nomination for ‘Best working across CCGs and local authorities’ at a national awards ceremony by the CHC Strategic Improvement Programme (SIP) Collaborative.

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Finance team celebrate leadership accreditation

We are delighted to announce that following a recommendation by the Future-Focused Finance (FFF) assessors, the Midlands and Lancashire Commissioning Support Unit’s Finance team have been awarded Level 3 Towards Excellence Accreditation.

The Future-Focused Finance Towards Excellence Accreditation, awarded by the NHS Finance Leadership Council, recognises organisations with excellent finance skills development culture and practices in place. There are three levels, each designed to reflect the continuous development of the finance function and recognising the highest standards of financial competence and commitment to skills development.

For our clients, the accreditation provides further assurance that our staff working on their behalf have the very best finance skills and are benefitting from the highest levels of investment in their development.  This is reflected in the quality of our services for which we regularly receive very positive comments, including this recent feedback: “A professional, proactive, efficient, friendly and knowledgeable financial services team!”

Tony Matthews, Director of Finance and Commerce at MLCSU, said: “This is fantastic news. This level of accreditation is very significant as it shows that we have achieved the highest level of finance skills, development culture and practices. I would like to thank all our staff for their efforts and contribution in arriving at this fabulous outcome.”

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National award nomination for CHC

The Staffordshire and Stoke-on-Trent Continuing Healthcare team has been recognised at a national award ceremony for their work to complete all deferred patient assessments following the COVID-19 suspension of the NHS national framework for continuing healthcare funding. 

NHS continuing healthcare (CHC) supports adults with long-term complex health needs with free social care arranged and funded solely by the NHS. Following a patient assessment, the care can be provided in a variety of settings outside hospital, such as in a person’s own home or in a care home. The NHS CHC framework setting out the assessment process was temporarily suspended between March and August 2020 to protect the NHS when the COVID-19 pandemic hit. All care that facilitated hospital discharge or prevented admission to hospital during that period would be automatically paid for by the NHS, leaving a large gap in patient assessments.

The Midlands and Lancashire Commissioning Support Unit provides CHC services across the Midlands, Staffordshire, Derbyshire, Leicestershire, Lancashire and Cheshire and Merseyside. The Staffordshire team worked in partnership with Stoke-on-Trent City Council to successfully complete retrospective assessments of individuals supported via COVID-19 funding arrangements during the suspension of the framework. This was achieved through excellent partnerships, the development of key systems and exceptional working practices to ensure deadlines were met.

The team was nominated in the ‘Best working across CCGs and LAs (local authorities)’ category by a senior social care worker from Stoke-on-Trent City Council.

Receiving recognition in this category is particularly meaningful given that better collaboration between health and social care is one of the most significant areas of development for the NHS currently. Being nominated by the local authority highlights the effectiveness of employing a multi-agency partnership approach and is a testament to the relationships we have created for the benefit of improving patient and family experience.

The awards were organised by NHS England and Improvement to reflect and celebrate the success of the CHC Strategic Improvement Programme (SIP) Collaborative, which supports local healthcare leaders and CHC experts to work together to help improve services for the population. SIP was key in encouraging multi-agency participation in improving outcomes for individuals in need of care.

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Our year – through COVID and beyond

The past year year has been a challenging and turbulent one. In our annual report 2020/21, we focus on what being a responsive system partner supporting the NHS through COVID has truly meant. We also summarise how we’re helping systems in delivering the goals of the Long Term Plan, and we highlight key areas where we made a difference across all our services.

In the past year, we, along with colleagues from across the NHS and wider health and care sector, have adapted to shifting priorities and made many changes to our way of working. Our vision has remained to be pivotal in fully supporting the delivery of major improvements in health and wellbeing. Our philosophy is to face every new challenge and opportunity together with systems as partners.

Midlands and Lancashire Commissioning Support Unit team members have been and continue to be deployed in the national Supply Cell, working on procuring ventilators and hard-to-source items, and have provided reporting and programme support to NHS England and Improvement’s national effort. We have reallocated a range of service teams and funding to response, recovery and restoration programmes. As a system-wide service, we provided advice and support to our partners, including the sharing of intelligence, best practice and volunteers to support COVID-19 operations and Winter Rooms.

Beyond COVID, we’ve developed an unparalleled experience across a wide range of areas. In addition to our established transactional support services, we continue to contribute with significant strategic  and programme management expertise, providing tailored transformational support to 10 health systems. Examples, among many others include advancing the application of machine learning and AI in addressing population health management challenges; driving forward work on population profiling and risk stratification; using automation and chatbot technology to facilitate more efficient care delivery; reducing waiting times and hospital length of stay rates; solving flexible capacity issues for GP practices, saving them time and money.

We bring added value and we work with customers as partners, whatever the need. In the future, we know commissioning will become far more about the strategic management of the health of the population. We have the dedication of our expert staff and the flexibility in our delivery models to collaborate with you, developing and delivering services within a single system plan.

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PrimaryPoint: a digital portal for primary care

PrimaryPoint is a website, designed to provide primary care organisations with fast and easy 24/7 access to the latest policies, procedures, toolkits, and other services. Developed exclusively for primary care, the online portal helps our customers be compliant with current legislation and best practice. The site has templates, ready to be personalised with the customer’s information and logo, helping to cut down on day-to-day administration. Currently, services accessed through the site include information governance (IG), human resources (HR) and finance.

A bit of history…

Our very successful IG portal was already serving more than 600 GPs, providing them with essential documents and guidance. This made us think whether other services across the CSU could be provided in a similar way.

Our in-house app development team, the Digital Improvement Unit (DIU), was drafted in to build a site that would extend the IG service and offer other services to primary care. There is a useful homepage which explains what the portal is and shows all the services MLCSU offers to primary care. The IG portal was migrated across to PrimaryPoint, and our HR and finance departments got to work producing a library of policies, procedures, and standard letters.

In October 2020, we successfully launched PrimaryPoint. Since then, the IG service has gone from strength to strength, with now more than 900 GPs accessing the portal. The IG service on PrimaryPoint is comprehensive, covering contracts and agreements, IG policies and processes, DSP Toolkit guidance and help (for the annual return GPs must send to NHSE), as well as policies and templates and a monthly newsletter. In addition to the online service, our IG experts can also train GP staff and answer any questions primary care organisations have in relation to IG.

Our services

HR is well suited to an online service too, offering tailored policies, procedures and standard letters. Based on best practice, the HR section of Primary Point provides support with absence management, annual leave, flexible working, disciplinary procedures, grievances and performance management, among others. The online service can be used independently, or it can be supported with additional HR advice, guidance, and training.

Our finance service on PrimaryPoint is at its best when used together with additional finance expertise supporting GPs and PCNs to manage their accounts. The online service includes help with financial governance documents, an accountable officer template, a standard finance report template, as well as a guide to coding transactions. There is also a comprehensive guide to the Xero accounting package (which MLCSU uses with its primary care customers), although other systems can be used.

Later in 2021, we will be adding business continuity services to PrimaryPoint, with more areas to follow later this year, such as procurement, communications, and medicines optimisation.

What our customers say

“I have found the resources available from MLCSU most useful in completing the IG annual return.  It was useful to have documents populated with our information which we have been able download and save for staff to access.  Once set up, the portal easy to use and self-explanatory with correlating GDPR reference numbers.”

Katrina Dipple, Business Manager at Darwin Medical Practice

“I have accessed the IG section of the portal frequently since its launch in January 2020. The quality and detail of the policies available appear to be of a high standard and where possible we are using these to replace our current policies/processes. We are also grateful to MLCSU for taking requests for policies that we feel would be a useful addition to the portal, such as a National Data Opt Out Policy.”

Stephen Fitchett, Practice Manager (IM&T), Leicester

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Shropshire vaccine recruitment success

A huge recruitment drive in Shropshire, Telford and Wrekin has seen nearly 1,000 new staff added to the roster at vaccination centres. Most of the staff mobilised to work on the vaccination programme so far have been redeployed from their jobs elsewhere in the NHS. Having new dedicated recruits will bring stability and improve staff turnover at vaccination sites, while other health and care services can continue to be restored now that personnel can return.

The campaign began at Christmas with the slogan ‘Be A Part of History’ and has been lead by The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust (RJAH) supported by the Midlands and Lancashire Commissioning Support Unit (MLCSU) and other partners. People have stepped up to work as vaccinators, healthcare assistants, administrators and car park marshalls. More than 1,700 applications were received across the Shropshire and Telford system.

Sarah Sheppard, Director of People for both RJAH and MLCSU, said:

“It has been a phenomenal team effort to recruit so many people in such a short space of time.

“I’m so grateful to all colleagues across the system who have come together to make this happen. Recruiting so many people, so quickly, really is a stunning achievement.”

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Why vaccine uptake varies in communities

Data from the first wave of the pandemic showed that people from certain backgrounds and communities are at higher risk to virus prevalence and mortality, which may contribute to poorer health outcomes. When planning the rollout of the vaccination programme, it’s important to consider equality early on. We have been working as a collective with experts from across the Integrated Care System (ICS) in Lancashire and South Cumbria to assess how the COVID-19 vaccination programme could impact different population groups, and to ensure good uptake.

Vaccination programme across Lancashire and South Cumbria

For the vaccination programme across Lancashire and South Cumbria, an Equality and Health Inequalities Impact Risk Assessment (EHIIRA) was undertaken. It looked at potential impact for each of the nine protected characteristics under the Equality Act (2010) – age, race, religion, disability, sex, marriage and civil partnership, maternity, gender reassignment and sexual orientation.

We developed the EHIIRA, which is under constant review, using regional assessment work by the regional team at Public Health England.  The purpose is to highlight how the way vaccinations are delivered might impact the uptake from groups at risk, and to point out what needs to be considered.

Risk of impact

The assessment highlights considerations and equality risks for different groups. One example is black, Asian and minority ethnic communities, where we might need to think about language needs and how to establish a dialogue early on to encourage high take up.

Once the risk was raised, colleagues from the ICS set out to gain insight directly from the communities. They reached out to influential religious leaders of the Muslim community in Blackburn and Darwen, asking what we needed to think about and what we could do to get a good level of acceptance.

The result was “a significant uptake in vaccinations from eligible members of the community”, as picked up by Amanda Pritchard, NHS England and Improvement’s Chief Operating Officer, and NHS Improvement’s Chief Executive, in a bulletin to healthcare leaders on 5 February.

Potential impacts were also raised about vaccinations during the month of Ramadan, a religious festival which is celebrated by Muslims. Work is under way both locally and nationally to provide clear information about the vaccine and that the vaccine can be received during Ramadan.

Equality audits

We also developed an audit for considering equality related matters at individual vaccination sites. It examines issues of disability access, location and travel, signage and communication and religion and belief – especially relevant where religious sites were considered.

Equality assessment in Cheshire

Our equality and inclusion experts are also supporting Cheshire CCG with an ongoing assessment of how factors specific to different communities could impact vaccine uptake. For example, early on in the vaccination programme, we identified an impact for housebound patients. The only approved vaccine at the time had to be kept at very low temperatures meaning it could not be transported to their homes. To receive the jab, these patients needed to be helped into the vaccination centres, which posed further risks.

While the approval of other vaccines resolved this issue, other community characteristics continue to create impacts which could lead to low levels of vaccinations. As a result of highlighting the risk, the CCGs in Cheshire have brought in a specialist consultant to further investigate why there may be hesitancy.

The assessment in Cheshire identified potential barriers to accessing the proposed mass vaccination sites and highlighted factors such as signage, parking and welfare facilities. Local communities, such as the farming and boating communities, as well as groups with protected characteristics, were carefully considered as part of the plan for ‘hard to reach’ groups. Our advice and guidance will continue throughout the vaccination programme, supporting both mass sites and hospital hubs, GPs and pharmacies.

Equality assessment elsewhere in England

We believe the findings from the assessment in Lancashire and South Cumbria may have similarities with risks associated with equality impacts in other regions and nationally. This is why we shared the assessment template with CCGs in Leicestershire, Hertfordshire, Worcestershire, Cheshire, Wirral, Trafford, Staffordshire and the North West Regional Delivery Team.

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Free demographic & inequalities analysis

We produced a series of ‘Knowing Our Patch’ reports which provide a range of demographic and health inequalities data and analysis. Data covers different areas across the footprint of the Midlands and Lancashire Commissioning Support Unit (MLCSU) . The reports give a picture of groups at risk and look to address structural health inequalities which may contribute to poorer health outcomes and prevalence. Download reports below.

When considering service design or policy changes, health and care organisations are required by law to take into account the needs of protected characteristic groups. These are defined in the Equality Act (2010) and commissioners must ensure that appropriate engagement takes place.

Doing this at the beginning of projects helps to identify any potential negative impact to protected characteristic groups and demonstrate ‘due regard’ to the Public sector equality duty.

The reports provide valuable insight to support decision making processes including Equality and Health Inequalities Impact Risk Assessments. The demographic profiling of their area can also give organisations a greater understanding of the type of communities they serve, and their needs.

The reports are based on data from public sources such as Public Health England and the Office of National Statistics. This was then compiled and analysed by MLCSU’s Equality and Inclusion Project Team.

The reports were shared with all existing customers in the related areas last year and are now free to download and use by anyone interested in health inequalities data and vulnerability factors in these regions.

COVID-19 vulnerabilities report

The series includes a COVID-19 report which highlights that people from certain backgrounds and communities are at higher risk in relation to the virus prevalence and mortality. Findings are based on data from the first wave of the pandemic.

In exploring the issue and supporting decision making during and post COVID-19 recovery, the information can be used by decision makers to inform commissioning and commissioning intentions.

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Free model to ease COVID-19 vaccine queues

Our colleagues at the Strategy Unit have developed a capacity model to help people planning and running COVID-19 vaccine clinics to ease the flow of patients, reduce queueing and make the best use of facilities and staff for maximum effect.

Using modelling is a fast and cheap option for spotting problems and allows you to prevent them and plan ahead. The model is free for use by anyone and can help the design and operation of clinics.

This work stemmed from the Strategy Unit’s collaboration with the Wolverhampton Prevention and Population Health Unit team to aid in their advice on planning vaccine centres in Wolverhampton.

See model and instructions for use on the Strategy Unit’s website at www.stratgyunitwm.co.uk.

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Introduction: Workforce

Through a combination of centralised and embedded teams, we support organisations and staff through change. We help you understand your culture and create positive shifts in attitudes and behaviours, developing an effective, supported and flexible workforce. We use a population and place-based workforce planning approach to enhance recruitment and resourcing, increasing your resilience.

Find out more about how we can help: