We plan and buy the following NHS services:
Urgent and emergency care
Urgent care includes services delivered by out of hours GP services, NHS 111, minor injury units, A&E, and the ambulance service.
People should only use urgent care services if they need it urgently. At other times when they have a medical need, they should visit their GP or consult a pharmacist or nurse.
Anyone with a life threatening condition should visit the Emergency Department/A&E.
We have recently been reviewing urgent care in Dartford, Gravesham and Swanley and how this is provided and we will continue to look at this area, working with local people and clinicians as we do.
Recent work on urgent care has included:
- The CCG together with Medway and Swale CCGs established a programme to review and redesign urgent care services across the North Kent areas. This led to a series of patient and clinical reference groups, arriving at a recommended solution within each CCG area. The programme was paused following a national directive, to enable publication of requirements for a more integrated urgent care service, including 111 and primary care out of hours services. This guidance has now been reviewed, and the re-design programme has restarted.
- Implementation of the integrated Primary Care Teams (iPCTs) has continued, with the existing teams of community nursing, mental health practitioners, dementia nurses/practitioners and social care practitioners joined by palliative care nurses from the Ellenor Hospice. Future expansion will include geriatrician support and pharmacist input. Members of the CCG commissioning team have been assigned groups of practices, and act as the focal point to identify and resolve any issues related to the teams.
- The CCG and KCC have jointly funded a Care Navigator, working at one of the GP practices in DGS. This is a non-clinical post, working within the integrated Primary Care Teams (iPCTs) to coordinate team members, manage the multiple disciplinary team meetings and support relationships and communication within the team. They also work with the voluntary sector, referring patients to relevant bodies for support, advice and care with the intention of reducing the demand on statutory services. Due to the positive feedback on this service, the CCG/KCC are now considering expansion into a wider group of practices.
- A range of initiatives and schemes continued in 2015-16 with aim of prevention of falls. This included a pilot with Kent Fire and Rescue Service to identify people at risk of falling, better engagement with care homes, and good joint working between providers which resulted in a reduction in hospital admissions related to falls.
- Projects to improve end of life care, including support for GP practices by the Ellenor Hospice to identify and support palliative patients, reviewing all end of life care pathways, improvements in prescribing and support to care homes.
- Continuation of the Integrated admissions avoidance and Discharge Team (IDT), and closer working across social services and community nursing to facilitate timely discharge to patient’s own home, or to a community setting.
- Closer working between NHS 111 and the primary care out of hours service, to enable joint planning for busy holiday periods, and to improve experiences for patients.
- Joint working across all providers on a coordinated communications campaign, informing people of when and where to seek medical advice rather than going to A&E.
Primary care (GP services)
In 2016, the CCG took over commissioning of GP services from NHS England.
We commission services from 31 GP practices across the area.
GP practices have traditionally worked as separate businesses but we are working more closely with them now as commissioners and encouraging them to work together more.
By working together, practices will not only be able to support each other at a time when GPs face huge pressures and demand but also focus on finding ways to address some of the health issues specific to local people.
Planned care and cancer
Planned care is services and treatments which are not carried out in an emergency. It is usually care which patients have been referred to by their GP.
It includes operations and procedures and can be carried out in hospitals and community settings.
Recent work in Dartford, Gravesham and Swanley has included a whole system ophthalmology review. A number of community pilot services were implemented and have resulted in a number of benefits (see case study below)
A review of the CCG’s physiotherapy provision was undertaken during 2015-16 and a procurement process was launched in March 2016.
Case Study – Improving local access to ophthalmology services
One of the major themes of a recent review of ophthalmology services was that patients generally have to attend a hospital setting, even for relatively minor eye conditions. In particular, patients often attend A&E for rapid onset conditions that could be treated in the community where this is commissioned. The CCG undertook engagement with patients who had used hospital eye services and the clear message was that they wanted services to be more locally available.
Based on this feedback, and other successful models elsewhere nationally, the CCG commissioned a pilot Primary Eyecare Assessment and Referral Service (PEARS). This service is provided by local optometrist practices and can treat a variety of routine and urgent eye conditions, and, crucially, can see patients quickly and at a time to suit them. This has the advantage of ensuring timely and appropriate treatment for these conditions, without the need to travel to hospital, meaning that the limited capacity of hospital eye services is prioritised for those patients with more serious conditions.
The pilot has been in place since April 2015 and over 705 patients have accessed the PEARS service since then. The number of optometrists offering this service has grown steadily and feedback has been extremely positive, with patients complementing the quick and easy access to this local service. If more specialist clinical input is required PEARS providers can refer patients directly to hospital eye services, although positively, the number of patients requiring referral to hospital services has been small and has reduced throughout the pilot, as providers’ confidence in diagnosing and treating patients increases. The CCG closely monitors quality and patient feedback to ensure that the service continues to offer genuine value.
Another benefit is that the service provided by the PEARS providers does not require consultant-level input and, therefore, the costs associated with hospital treatment. This in turn allows savings to be generated and reinvested by the CCG in other local healthcare.
The introduction of this service, therefore, is beneficial from a patient care and experience, access and financial perspective. PEARS will be a key part of the CCG’s ongoing procurement process to commission increased community Ophthalmology services, which will result in further eye-care services being available to local patients.
Community health services
Community health services cover ‘cradle-to-grave’ services that many of us take for granted. They provide a wide range of care, from supporting patients to manage long-term conditions, to treating those who are seriously ill with complex conditions.
Adult community services
Since 2016, Virgin Care has been responsible for delivery of:
- Adult Community nursing services
- Adult Intermediate care services
- Adult Community neuro-rehabilitation
- Adult speech and language therapy
- Adult continence service
- Adult community podiatry service
- Adult community specialist nursing services
How can I contact the community services now run by Virgin Care? / Who do I contact for a referral?
Virgin Care’s Care Co-ordination centre manages referrals into all of the services Virgin Care delivers in Dartford Gravesham and Swanley and Swale. Individual contact details for the services Virgin Care provides are available here: http://www.virgincare.co.uk/service-hub/north-kent-adults/
Which hospitals does Virgin Care now run services in the Dartford Gravesham Swanley and Swale (DGSS) areas?
Virgin Care provides services from some of the community hospitals in the Dartford, Gravesham and Swanley area, but does not run the hospitals themselves. Virgin Care provides services at:
- Sittingbourne Memorial hospital
- Sheppey Hospital
- Gravesham Hospital
- Livingstone Hospital
Virgin Care holds patients’ records in line with the same security and governance that any organisation providing NHS records does. Information is only used to provide NHS services, and isn’t shared with any third parties – including other parts of the Virgin Group. You can find out more, and how to access your records if you are a patient on their website: http://www.virgincare.co.uk/information-governance/
Other community services
The following community services are provided by other organisations:
- adult physiotherapy
- learning disability services
- epilepsy and lymphoedema nursing services
- children’s services
- maternity services
- minor injuries units
- walk-in centres
- out of hours GP service
Children’s and maternity services
Parents and carers have told us that when it comes to accessing health services they want to tell their story only once, have integrated services that are responsive to the child’s needs, close to home and with caring staff who know the child and their needs.
Children’s and maternity services are provided by a number of different organisations and places including GP practices, community providers, hospitals and mental health trusts who look after different aspects of care and support.
Darent Valley Hospital
Provides hospital-based services such as the children’s specialist diabetes nurse service, children’s resources centre and link in with the community children’s nursing team.
Sussex Partnership Trust
SPT provide mental health services for children and young people in Kent and Medway
Kent Community Health Foundation Trust
KCGFT is the main provider of children’s community services in Kent and Medway including children’s nursing and support with long term conditions, health visiting and health assessments.
Kent County Council
KCC is responsible for public health such as childhood immunisation and public health programmes and education services and looked after children’s services. The CCG is jointly responsible alongside KCC for many aspects of children’s and young people’s health and care services. You can read more about the help available on the KCC website.
Mental health services including talking therapies
Mental health services are provided for adults and children. They include talking therapies such as counselling and psychotherapy, and services for people with severe mental illness such as psychosis.
The mental health programme has recently had a particular focus on preventing admission, avoiding crisis and discharge from secondary care mental health services. We have been enhancing the services and care available to people in the community in the following ways:
- Implementation of the Kent Transformation Plan for Children, Young People and Young Adults. Using the money received from NHS England, the CCG has invested in projects that will provide support for children and young people with, or at risk of developing mental health disorders and also help raise awareness in schools and in the community through a media campaign.
- The CCG signed up to work with other partners across Kent as a concordat to improve Crisis Care for mental health patients across Kent and Medway. Some of the other partners include KCC, Medway Council, SECAmb, Kent and Medway NHS and Social Care Partnership Trust, the Police, Healthwatch, Sussex Partnership NHS Foundation Trust and seven other CCG’s. The agreement ensures that each of the partners works together focusing on four main areas: access to support before crisis; urgent and emergency access to crisis care; quality of treatment and care when in crisis; and recovery and staying well.
- During 2015/16 the CCG increased its provision of psychiatric liaison at Darent Valley Hospital, and the service now runs 9.00am to 12.00 midnight seven days a week for patients who attend A&E with mental health problems. We have also used NHSE money to pump prime Children and Adolescent Mental Health Services (CAMHS), to provide a psychiatric liaison service to ensure children and young people with mental health problems attending A&E are appropriately supported.
- There is strong evidence that appropriate and inclusive services and pathways for people with mild to moderate mental health problems, specifically depression and anxiety, reduce an individual’s usage of other NHS services whilst contributing to overall mental well-being and economic productivity. During the year the CCG continued to invest in IAPT services locally to provide preventative, first-line treatment for people aged 18 and over suffering from anxiety and depression. The national standard access rate target is 15% of identified need to enter treatment and 50% of patients to reach recovery. In DGS, 15.3% patients with an identified need entered treatment and 50.23% of these were in recovery during the most recently recorded period (April 2015 to January 2016).
Medicines prescribed by GPs, consultants and other NHS practitioners
We have a medicines management team which ensures medicines are prescribed appropriately.
We work with GP practices and hospitals and patients to make sure the right medicines are given at the right time.
One priority in this area is currently reducing the amount of money spent on medicines. The CCG pays for medicines which are provided on prescription.
We have been running a campaign to encourage better use of medicines, discouraging over use of antibiotics, asking people to make sure they have a ready supply of medicines for minor ailments, encouraging people to renew their repeat prescriptions in good time but to only order what they need.
We have also been asking those people who get prescriptions for over the counter medicines such as painkillers to think before requesting a prescription for these items as they are usually much cheaper to buy at a pharmacy than the price the NHS pays for them.
Specialised services are those provided in relatively few hospitals, accessed by comparatively small numbers of patients but with catchment populations of usually more than one million. These services tend to be located in specialised hospital trusts that can recruit a team of staff with the appropriate expertise and enable them to develop their skills.
There are a range of services that are classed as specialised, from renal dialysis and secure inpatient mental health services, through to treatments for rare cancers and life threatening genetic disorders. The commissioning of specialised services is a direct commissioning responsibility of NHS England.
This is our joint commissioning programme between health and social care. The integrated health programme area includes personal health budgets, learning disabilities, dementia and carers. Some of the projects included are as follows:
- Integrated dementia care, delivered through an expanded older adult mental health nursing team and improved pathway for memory assessment. This has seen a significant rise in the number of people with a confirmed diagnosis of dementia with an early and rapid diagnosis achieved. Improved integrated working between physical and mental health has enabled shared care plans to be developed and patient’s needs met in a holistic and joined up approach.
- A range of initiatives were implemented to enable people who have carers to remain/return to their own home thus facilitating discharge and admission avoidance. These also included flexible replacement support for carers to take a break from their caring role to maintain their health and wellbeing and prevent carer breakdown.
- Initiatives associated with the Dementia Challenge Fund including education and training in primary care and dementia friendly communities. This continues to expand with over 300 primary care staff trained in dementia awareness and active Dementia Action Alliances have been established in local communities to progress a range of initiatives to become dementia friendly environments.
- The Alzheimer and Dementia Support Service (ADSS) bridging service continues to be a real success for patients, their carers and the urgent care system as a whole, and an admission avoidance pathway has been developed for Dementia/Cognitive Impairment patients in conjunction with the service. The bridging service supported over 150 hospital discharges for people with cognitive impairment throughout the year by ensuring patients and their carers had appropriate support services to enable people to reintegrate back into their home after a hospital stay. Building on the success of this service, we are proposing to expand the service to establish additional capacity to support admission avoidance out of hours
- The CCG formalised its integrated commissioning arrangement for learning disability with KCC and the other Kent CCGs. This will ensure people with a learning disability receive integrated care from KCC, the community trust and mental health trust. Under this programme of work the CCG has continued to deliver its commitments against the Transforming Care Programme. The additional investment in enhanced community teams has helped to prevent any CCG admissions of people with a learning disability / autism to specialist in-patient units during 2015-16. The new integrated commissioning arrangement is bringing partners together across Kent to develop further the plans which will support the safe and timely discharge of people in specialist in-patient beds.
We do not commission:
- Dental services
- Community pharmacies
- Specialised healthcare such as heart and brain surgery and neonatal care
- Secure psychiatric services
- Prison health
- Health services for serving members of the Armed Forces
(The above services are commissioned by NHS England)
- Public health and health promotion services
(These services are commissioned by Kent County Council)