Planned care programme

Introduction

The term 'planned care' covers all services provided for children or adults, 18 years or over, which are 'planned' (scheduled), including all. primary care, community and hospital services. CCGs focus on the legal rights to choice of provider and team for a first elective (planned) referral in physical and mental health services, as this is at the heart of the NHS choice policy. The commitment restated in the NHS Five Year Forward View highlights the longstanding promise to 'give patients choice over where and how they receive care', with one of the key aims of the latest planning guidance being to significantly improve patient choice by 2020.  Connected to this is the national standard of referral to treatment time, waiting times matter to patients. Most patients want to be referred, diagnosed and treated as soon as possible. Patients can and do use waiting times information to inform their choice of where to be referred and also to understand how long they might expect to wait before starting their treatment.

How are we doing

Top performing:

  • 9% used NHS e-referrals service to enable choice at first routine elective referral

This high level of achievement for utilisation of e-referrals builds on historic work when we had a team supporting the roll-out of Choose and Book when it was developed initially.  This is about using the new e-referral system and in Bradford we support GP practices in having a process in place that enables an administrator to complete the actual referral.

Greatest need for improvement:

  • just less than 9 out of every 10 are waiting less than 18 weeks
  • elective access (92% standard): 89.7% are waiting 18 weeks or less from referral to hospital treatment in Bradford City CCG. In March 2017 there were 5,542 on the waiting list and of these 571 had waited longer than 18 weeks.  One patient has waited longer than 52 weeks for hospital treatment this year. Specialities under pressure include ENT; general surgery; plastic surgery; trauma & orthopaedics and urology.

Elective access at our local provider Bradford Teaching Hospitals NHS Foundation Trust has deteriorated for the first time this year with the trust not achieving this standard since May 2016. Shortages of operating department practitioners has resulted from adherence to revised agency payments rules, which has resulted in cancellation of theatre lists, on average 11 lists per week impacting on around 39 patients per week.  Despite this, there have been improvements in the following specialties: gynaecology, gastroenterology, pain management and clinical haematology. Pressures continue to be experienced for: general surgery, ENT, plastic surgery and obstetrics.  A recovery plan has been written by the trust to resolve this and the trust expected to achieve the 18 week standard by the end of March 2017 by:

  • use of external providers for: ENT, ophthalmology and orthopaedics
  • pathway changes: pain management and urology
  • outpatient productivity improvements
  • theatre productivity improvements.

Elective access at our local provider Bradford Teaching Hospitals NHS Foundation Trust has deteriorated for the first time this year with the trust not achieving this standard since May 2016. Shortages of operating department practitioners has resulted from adherence to revised agency payments rules, which has resulted in cancellation of theatre lists, on average 11 lists per week impacting on around 39 patients per week. Despite this, there have been improvements in the following specialties: gynaecology, gastroenterology, pain management and clinical haematology. Pressures continue to be experienced for: general surgery, ENT, plastic surgery and obstetrics.  A recovery plan has been written by the trust to resolve this and the trust expected to achieve the 18 week standard by the end of March 2017 by:

  • use of external providers for: ENT, ophthalmology and orthopaedics
  • pathway changes: pain management and urology
  • outpatient productivity improvements
  • theatre productivity improvements.

What we have achieved in 2016/17

The main focus of the task and finish groups overseen by the planned care programme is to reduce inefficiencies within the system. This will be achieved through better management of the patient journey between primary and secondary care, reduction of procedures that yield limited benefit or have poor clinical evidence and reaching agreement between clinicians and patients as to when it is appropriate to refer back into community services or discharge.  

The local development of Map of Medicine is now complete, and the tool was rolled out to all Bradford GP practices from 1April 2017. This will underpin the work cited above and will allow the CCG to monitor the engagement of GP practices in delivering the efficiency work at a local level. Through the improvements being made, there should be a reduction in inappropriate referrals, follow-up appointments and clinically-ineffective procedures, therefore freeing up capacity within the system and allowing providers to achieve the 18 week referral to treatment (RTT) target.

Planned care - plans over the next two years

  • the demand management good practice guide suggests the following ways to improve delivery and sustain improvements, and these are being developed and implemented through the planned care board work and the Bradford Teaching Hospitals NHS Foundation Trust outpatient improvement programme,
  • alternatives to outpatient appointments - virtual clinics,
  • improved level of advice and guidance - e-consult,
  • shared decision making - patient decision aids,
  • improved pathways and criteria,
  • reducing unnecessary follow-ups is one of three priority areas which will be addressed through planned care Board and Outpatient Improvement Programme. This will include a review of current outpatient pathways, development of “One-Stop” clinic approach where appropriate and the use of virtual clinic.
  • we are working with BTHFT and other local providers to ensure that all specialties are available through e-referral, and also working with GPs to highlight the preferred referral pathway as more new specialties come on-line. This work is being led through planned care board and BTHFT outpatient improvement programme.
  • we are working with our partner CCGs and provider organisations to develop a new maternity programme board to deliver the recommendations of the Better Births review and build on work already underway. This will link into the Y&H maternity clinical network to deliver work across the footprint of the sustainability and transformation plan.
  • our CCG has actively engaged with the Healthy Futures programme and linked to efficiency work streams in particular those managed via our planned care programme including: procedures of limited clinical value, prescribing as well as the reduction in unwarranted or unnecessary follow-up appointments.

Our planned care programme plans for the next five years

  • map of medicine go-live for all GP practices,
  • review specialities,
  • increase e-referral usage by GPs,
  • update and review pathway policies,
  • strengthen links with the West Yorkshire planned care programme,
  • increase use of e-consults,
  • implement the first stage of revised back pain management pathway,
  • review procedures with questionable clinical effectiveness.