North Norfolk Primary Care
Quality Account
2021/22
“Putting the patient central to the delivery of quality healthcare for the local community and beyond”
CONTENTS
Section One: OUR MISSION, VISION, AND VALUES .................................................................. 3
1.1 Our Mission and Vision ........................................................................................................... 3
1.2 Our Values ................................................................................................................................ 3
Section Two: THE ORGANISATION - NNPC ................................................................................ 4
2.1 Introduction .............................................................................................................................. 4
2.2 Forward from our Chair & CEO............................................................................................... 4
2.3 CQC Statement of Purpose ..................................................................................................... 6
2.4 Our services ............................................................................................................................. 7
2.4.1 Core .................................................................................................................................... 7
2.4.2 Innovation, Elective Recovery, & Community Services ................................................. 8
2.4.3 Urgent and Emergency Care............................................................................................. 9
Section Three: CLINICAL QUALITY & SAFETY ......................................................................... 10
3.1 Clinical Governance strategy ............................................................................................ 10
3.2 Information Governance and data protection strategy ................................................... 12
3.3 Our Key Achievements in 2021/22........................................................................................ 13
3.3.1 Clinical, Quality Assuring, & Patient Safety auditing ................................................... 13
3.3.2 HSJ awards ...................................................................................................................... 14
3.3.3 CQC inspection June 2021.............................................................................................. 15
3.3.4 Supporting Staff – Culture & Well-being........................................................................ 15
3.3.5 Education and Training ................................................................................................... 16
3.3.6 Service Evaluations and performance ........................................................................... 16
3.4 Our Key Priorities in 2022/23 ................................................................................................ 18
3.4.1 Clinical supervision implementation ............................................................................. 18
3.4.2 Patient & Staff experience – bespoke questionnaires.................................................. 18
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3.4.3 Performance Scorecard .................................................................................................. 18
3.4.4 Quality & Safety Meetings at Service Level................................................................... 18
3.4.5 Development of Quality & Safety Committee Agenda .................................................. 18
3.4.6 Clinical education & Training ......................................................................................... 18
3.4.7 Development of investigations into incident reports ................................................... 18
3.4.8 Safeguarding .................................................................................................................... 19
3.4.9 Complaint Handling ......................................................................................................... 19
3.4.10 Communications............................................................................................................ 19
3.5 Patient Safety & Quality......................................................................................................... 19
3.6 Patient & Staff Feedback ....................................................................................................... 21
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SECTION ONE: OUR MISSION, VISION, AND VALUES
1.1 OUR MISSION AND VISION
Our mission is to be a “leading force in healthcare innovation and delivery, making the system better by working with and on behalf of Primary Care in North Norfolk and beyond – with improvement in patient care at the heart of our work” James Leeming, NNPC CEO Our vision is to be an outstanding provider of healthcare services with the unified, passionate drive to delivering innovative, high-quality services. We aim to ensure that the organisation is sustainable to enable it to attract a forward thinking, highly skilled and committed workforce to work towards this common goal.
1.2 OUR VALUES
Care – Quality patient focussed, holistic health care in the local community and beyond. Integrity – Acting ethically and remaining accountable
Collaboration – Partnering to work together to deliver quality health care services
CARE
INTEGRITY
COLLABORATION
CORE VALUES
Leadership – Leading the way, building relationships & trust and being efficient
LEADERSHIP
ACCESSIBILITY
TEAMWORK
Accessibility – Inclusive and open to all
Teamwork - We aim to ensure that our shared values are adopted and incorporated into our team. We aim to appreciate and value each other to enable us to undertake our work in a safe, happy environment
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SECTION TWO: THE ORGANISATION - NNPC
2.1 INTRODUCTION North Norfolk Primary Care Ltd (NNPC) was incorporated in July 2017. It is wholly owned by the 19 Practices in North Norfolk and has seen growth from a small company to an organisation with 65+ employees which has successfully embedded in the delivery of innovative, high quality health care services in North Norfolk and beyond. The aim of the organisation is to support resilience and sustainability by focusing on improving care for patients within the health care system of Norfolk and Waveney, in conjunction with supporting the diverse workforce within Primary Care. It also aims to provide high quality clinical services working closely with the NHS Norfolk & Waveney ICB to integrate communities and services for the benefit of patients. The ongoing aim and goal for NNPC is to form part of a team which co-ordinates innovation in healthcare delivery by developing a strategy together, and in partnership with, Primary & Secondary Care, Community services, Mental Health Services, Ambulance Trusts, local councils, Social Care, and Voluntary Sector providers. We aim to be key players in a system which is facing the biggest challenges in healthcare yet. The purpose of this Quality Account is to provide information and assurance to our patients, staff, Board and stakeholders about how NNPC does and will continue to provide safe, high-quality services which is responsive to the needs of patients, communities, staff and stakeholders. It will provide the reader with information to understand our organisation and how we implement measures to ensure that patient safety and quality of care is delivered and how we have performed during the 2021-22 year (April 2021 – March 2022). 2.2 FORWARD FROM OUR CHAIR & CEO Now in its 5 th year of operating, NNPC has continued to provide support to the 19 North Norfolk GP practices. Just to give some examples of the support we provide, we have continued to respond to the impact of the ever-present challenges of the COVID-19 pandemic of the past 2 years, supported with and co-ordinated the delivery core services, continued with providing a PCN support team, co-ordinated and supported with the employment of Additional Reimbursed Role Staff (ARRS) for the PCN’s . These challenges have required our workforce to adapt and change the way they work to respond to rapidly changing demands in Primary Care. We have continued to work in collaboration with the local Community Trust to plan and deliver a covid vaccination programme, amongst other pilot schemes to improve patient care to bring healthcare delivery to the heart of the community. We have also worked to support Secondary Care in their post-pandemic recovery in areas such as elective care / waiting lists – in specialities such as gynaecology, cardiology, ophthalmology, and ENT, which has brought patient care closer to home.
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In the 2021/22 period, we have sadly seen the Phlebotomy and Enhanced Care Home Team being locally decommissioned. On a positive note, however, we have seen the continuation of the Dermatology Service providing remote advice and treatment services. This service was initially commissioned as a pilot in January 2021 by NHS Norfolk and Waveney CCG, in which NNPC facilitates the clinical delivery between practices and an external dermatology service provider. This service was subsequently successfully rolled out to North Norfolk and beyond, which saw the service continuate until May 2022. We have also been successful in the GP Front Door Steaming Service being effectively implemented at the James Paget University Hospital NHS Trust in late September 2021, which was followed by The Queen Elizabeth Hospital NHS Trust in early January 2022. Working in collaboration with the Trusts have made an impactful, demonstratable, positive difference to the patient experience and is reducing the flow of activity through the ED departments. In June 2021, we successfully developed and implemented one of the first Primary Care Led Rapid Diagnostic Service in North Norfolk, which was rolled out to other areas in September and December 2021. This service has brought together the Cancer Alliance and NNPC to deliver a vital service wholly to the benefit for patients who do not meet the 2 week wait cancer referral criteria but have suspicious symptoms. Needless to say, the patient feedback has been very positive and has provided much valued and needed support to the Acute Trusts and General Practice. NNPC has also continued to liaise and work in collaboration with other healthcare organisations, such as Norwich Community Health and Care (NCHC), East Coast Community Health (ECCH) & East of England Ambulance Service Trust (EEAST), as well as working with Acute services and other health service providers on pathway change and implementation. Throughout this time, our objectives have continued to be to: • Develop an at scale Primary Care provider that is ready to serve the local population • Drive funding into Primary Care • Develop the Primary Care workforce • Integrate and develop services where needed to improve efficiency and productivity • Support practice collaboration across North Norfolk • Influence, contribute and lead system change and transformation We remain fully committed to our mission, vision, values and strategy for the delivery of high- quality service provision for patients, whilst also supporting our staff in achieving these goals. We are enormously proud of the persistent hard work displayed by our teams who are all dedicated to ensuring high quality, patient-focused care. We aim to provide quality assurances to our patients, staff, Board, and stakeholders via this Quality Account, and to use this as a platform to demonstrate plans for continuous care quality improvements as we head into 2022/23.
NNPC Quality Account 2021/22 Dr Peter Lawson, Chair James Leeming, CEO
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2.3 CQC STATEMENT OF PURPOSE The objectives in the CQC statement of purpose reflects the organisations mission, vision, values, beliefs, culture, and purpose. NNPC has held an APMS contract for Improved Access and an NHS standard or sub-contracts for other services. Our clinical services are delivered in GP Practices, Acute Emergency and Urgent Care, and in the Community setting. They are delivered by a range of clinicians such as General Practitioners, Consultants in specialist areas, Advanced Nurse Practitioners, Clinical Pharmacists, Pharmacy Technicians, Physiotherapists, and Paramedics. The main aims outlined in the statement of purpose are: • To work in partnership with our service users towards a positive experience and understanding, involving them and their parents/carers/guardians in decision making about their treatment and care • To be a learning organisation that continually improves what we are able to offer patients • To treat service users as individuals and with the same respect we would want for ourselves or a member or our families, listening and supporting people to express their needs and wants and enabling people to maintain the maximum possible level of independence, choice and control • To ensure that we take close account of feedback about the services that we offer • To ensure that all staff have the competency and motivation to deliver the required standards of care ensuring that all members of the team have the right skills and training to carry out their duties competently • To operate with a wide range of policies that ensure the ongoing safety of patients, as well as delivering an effective and responsive service • To operate on a financially sound basis • To improve the service through feedback from patients • To ensure confidentiality and data protection for each patient
The skills framework for the Board encompasses General Practitioners, Senior Nurses, General Practice Managers, Finance, and Business Managers.
The CQC Registered Manager is James Leeming, CEO.
The nominated individual for regulated activities is Dr Peter Lawson, Chair.
The CQC regulated activities for NNPC are:
- Treatment of disease, disorder and injury - Diagnostic and Screening procedures - Maternity and Midwifery Services
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2.4 OUR SERVICES
2.4.1 CORE Improved Access (IA) & Extended Hours (EH)
IA and EH has been delivered since the inception of NNPC and we have traditionally delivered this from HUB sites in the early evening and at weekends. Over the course of the COVID-19 pandemic, IA was used to deliver a ‘Hot Site’ and extra clinical capacity to practices via V irtual Clinical Teams. When we stood down the Hot Site in March 2021, we then progressed with discussions within the PCNs to understand exactly what practices wanted from the IA service. As expected, each PCN wanted something slightly different, and more practices wanted to become HUB sites – which is now standing at 8 hub sites. We deliver a more locally bespoke service within each PCN than what was initially launched. We utilise a ‘locum’ workforce and/or local practice GPs, ANPs and NPs to staff this service. With the advent of extended hours being evolved into enhanced access though the network contract DES in October 2022, it is expected that NNPC will again provide a bespoke model to the PCN’s to support delivery of this model. This will involve working closely with the PCN’s to ensure that it meets the needs of the patients with flexible working for staff. Primary Care Network (PCN) support Team - Additional Roles Reimbursement Scheme (ARRS) The PCN support team has continued to work with the 4 North Norfolk PCNs to develop networks, shared ways of working, interpreting NHSE and local policy, general practice direction of travel and the implementation of the Additional Reimbursable Roles Scheme (ARRS) within the PCN areas. The PCN Support Team has also continued to work throughout the year to support the recruitment and employment of incoming shared staff to the networks via the Additional Roles Reimbursement Scheme (ARRS), such as Clinical Pharmacists, pharmacy technicians, and First Contact Physiotherapists. By end of March 2022, NNPC directly employed 22 members of staff in ARRS roles over the 4 PCN areas and has facilitated in the employment of many more which are directly employed by the Practices. The PCN Clinical Support Manager role was developed in 2021 to act as a facilitator between NNPC and the practices ensuring smooth induction and ongoing clinical supervision as well as dealing with day-to-day HR issues. NNPC provides quality assurance in many aspects of the management of the ARRS staff. Phlebotomy In October 2019 NNPC commenced the Phlebotomy Service located at Cromer Group Practice providing primary care-based phlebotomy for practices who were not signed up to the LCS for Phlebotomy. The service continued to support the Practices and was decommissioned by Norfolk & Waveney CCG in March 2022 due to the introduction of the new LCS for phlebotomy to being delivered at local Practice level.
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Enhanced Care Home Team (ECHT) As an award-winning team, the ECHT has continued to provide flexibility and support to the Practices throughout the year, working to support care homes with extra capacity for general home visiting and the delivery of the care home covid vaccination programme. This service was decommissioned as of 31st March 2022 with Norfolk & Waveney CCG. NNPC Health and Safety Service The appointment of a Health and Safety (H&S) Officer in February 2020 has enabled NNPC to provide a service to practices throughout the pandemic, and beyond. The H&S Officer has visited practices to complete risk assessments for safe working environments and helped practices with changes to Fire Safety, PPE and IP&C requirements. The H&S officer has also provided expertise to practices in completing risk assessments and checking policies in preparation for CQC visits and to help practices comply with their legal responsibilities. COVID specific health and safety risk assessments have been completed at practices were requested and for NNPC staff. 2.4.2 INNOVATION, ELECTIVE RECOVERY, & COMMUNITY SERVICES Elective Recovery – Primary Care Triage and Elective Waiting List Optimisation As part of the national drive to deliver elective care recovery we were awarded short term contracts in October – December 2021 to provide elective triage to patients who have waited for elective care in excess of 40 weeks within the North Central London CCG. This service has been provided in partnership with Prescribing Services Ltd (PSL) and uses Eclipse Live, a risk-assessment system which applies an algorithm to assess the health risk to patients in conjunction with the patient’s own views on their health and condition, including pain, quality of life and need to be seen quickly. The service is provided under an NHS contract and has potential to be rolled out more widely if this contract is successful. Community Gynaecology Service The community gynaecology service demonstrated collaborative working with the Norfolk & Norwich University Hospitals NHS Trust (NNUH) and was commenced primarily for patients who were on a waiting list with a Heavy Menstrual Bleeding referral. The aim of the service was to review, assess and treat (where necessary) 150 patients in the community setting. This commenced on the 1 st to15 th March 2022, and it is hoped that this type of specialist service will lead to further work in this area and other specialties with other Acute Trusts to aid patient care in a timely manner. After this project has ended, a service evaluation will take place to provide stakeholders with evidence of the value of the service for them and patients alike. Community Dermatology In January 2021, NNPC launched the Dermatology pathway providing remote advice and treatment services. This service was commissioned by NHS Norfolk and Waveney CCG and NNPC facilitated the clinical delivery between practices and an external Dermatology provider. This was initially rolled out to 6 practices in North Norfolk before being implemented more widely across Norfolk & Waveney. The service operates by providing practice clinicians with specialist advice on dermatological conditions via a digital communication platform called Cinapsis. This allows dialogue between the practice clinician and the specialist to establish a detailed management
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plan for the patient, all within 72 hours of the initial contact. This service was provided until March 2022, after which a business case was requested by the Commissioners. This is due to be considered by the ICB CEO’s in June 2022. Community ECG Service Commenced in early March 2022 and is due for completion by September 2022, the community ECG service was a collaboration with the James Paget University Hospital NHS Trust (JPUH) and the Queen Elizabeth Hospital NHS Trust (QEH) to provide a high quality ambulatory diagnostic cardiology service which enables the patient to receive a package of care delivered at home instead of having to travel to the Acute Trust to be provided and fitted with an ambulatory ECG machine. This service has seen the advent of an innovative, remote monitoring system solution which is patient friendly with no gels, patches or wires. It provided a full disclosure ECG data and diagnostic reports which are provided within 24 hours of test completion. Referral Support Service The referral support service commenced in October 2021 and is due to be completed in June 2022, with the aim of reducing the numbers of patients waiting to be seen by multiple specialties. This work was in collaboration with the Royal Free London NHS Trust (RFL) to identify patient groups who were ‘referred but waiting to be seen’. These patient cohorts were reviewed, triaged, optimised or escalated by a Primary Care Team. An overview of the numbers of patients who will benefit from this service is 700 ENT Patients, 1335 Dermatology Patients, & 2000 Ophthalmology Patients. Rapid Diagnostic Service Commenced in April 2021, NNPC was awarded a contract to provide a rapid diagnostic service across Norfolk & Waveney which supported the national cancer plan. This hugely valuable service provided support to both GP’s and the acute Trusts for the benefit of patients who did not meet the 2 week wait cancer referral pathway, but still had identifiable suspicious symptoms. It continues to provide the patients with timely access to dedicated GP’s, whom NNPC employs, who co-ordinates a plan of care to identify a diagnosis by access to timely investigations and clinical expertise. The service has a mixture of telephone triage, and face to face appointments. As this type of service remain a national priority until March 2024, and NNPC are hopeful that we can retain funding from the Cancer Alliance and bid for substantive funding from the commissioners to establish and expand the service as a permanent pathway across the system.
2.4.3 URGENT AND EMERGENCY CARE GP at the Front Door (GPFD)
In late September 2021, we commenced a ‘ GP at the front door ’ service at the James Paget Hospital University NHS Trust (JPUH) and at the Queen Elizabeth Hospital NHS Trust (QEH) in early January 2022. The clinical delivery is based on a simple streaming model, and it function as a GP ‘branch practice’ . With full access to patient records, it enables the safe and effective delivery of primary care to patients who would have otherwise been seen in the ED department.
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SECTION THREE: CLINICAL QUALITY AND SAFETY
3.1 CLINICAL GOVERNANCE STRATEGY
We have a well-established Quality & Safety Committee reporting system to the Board which provides assurance on the provision of safe and high-quality care to the population of patient who we serve. The Committee is established in accordance with the Articles of Association and Board Terms of Reference. The implementation of our clinical governance strategy, which is incorporated into the Quality & Safety Committee, includes:
1. Clinical Effectiveness ▪
Clinical audit
▪
Prescribing compliance Policies and protocols
▪
▪ Project/service delivery review and evaluation
2. Service user safety ▪
Incident reporting and management
▪
Safety alert management
▪
Risk management
▪
Fit and proper persons/safe staffing
3. Service user experience ▪
Patient feedback
▪
Service user experience surveys Quality of care surveys/audits
▪
4. Staff experience ▪
Mandatory training
Revalidation & appraisal Education and training
▪
▪
The Committee has the duty and responsibility to review and have oversight of quality, safety and information governance in relation to the following areas, which are standing items on the monthly agenda: Pan Domain: Project/service overview for existing & developing services, which incorporates all aspects of risk management, governance (clinical and IG), quality and safety in the delivery of healthcare Safety & Caring Domain: Review, approve and monitor those risks on the Corporate Risk Register which relate to Patient Safety & Quality and high-risk operational risks which could impact on patient care. Ensuring that an appropriate comprehensive quality & information governance framework and system is in place throughout the NNPC organisation which is in line with national standards. New projects are designed and implemented using Project Initiation documents which include Quality, Equality and Data Protection Impact Assessments with risks being identified and managed throughout. All new projects are taken through the Quality Committee for quality assurances and reported through to the Board.
Effectiveness & Responsive Domain: Demonstrating service improvement and safety through audit which, for example, demonstrates compliance with safeguarding adults & children, infection
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prevention & control, and all aspects of patient care delivery. Ensuring that information is effectively managed, and that appropriate policies, procedures and management accountability are provided and approved in relation to confidentiality, security and records management. Effectiveness & Well Led Domain: Demonstrate to the Committee any education, training and research which contributes to the delivery of high standards in patient care and clinician support. Assuring the NNPC Board that all person identifiable information is processed in accordance with the General Data Protection Regulations and that all staff are aware and comply with the NHS Code of Confidentiality and other professional codes of conduct. An example of how quality assurances are achieved is through the consistent approach of an impartial, detailed, qualitative and quantitative internal and / or third-party service evaluation. We aim to provide these for all of our pilot projects to demonstrate clinical effectiveness through critical appraisal in a way to suggest quality improvements where required. There will be illustrations of these for selected clinical services later in this account.
NNPC Clinical Governance Framework
LEARNING AND SHARING
IMPROVING QUALITY OF CARE
ACCOUNTABILITY & TRANSPARENCY
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3.2 INFORMATION GOVERNANCE AND DATA PROTECTION STRATEGY NNPC recognises the need for an appropriate balance between openness and confidentiality in the management and use of information. Information Governance requires the organisation to set a high standard for the handling of information. The aim is to demonstrate that we can be trusted to maintain the confidentiality and security of personal information, by helping individuals to practice good information governance. NNPC’s Data Security and Protection Toolkit overall score for 2021/22 was ‘standards met’ . NNPC has appointed an external Data Protection Officer (DPO) and the information Governance Lead and SIRO meet every other month to discuss IG risks and how these are managed. The fair processing, privacy notices and systems access lists are reviewed annually and approved by the Data Protection Officer.
The NPPC Senior Information Risk Officer (SIRO):
• leads and fosters a culture that values, protects and uses information for the success of the organisation and benefit of its customers. • owns the organisation’s overall information risk policy and risk assessment processes and ensuring they are implemented consistently by Information Asset Owners / Administrators. • Owns the organisation’s information incident management framework. The nominated NNPC Caldicott Guardian is a member of the Board, alongside with the SIRO and the DPO, is committed to the privacy of its patients, staff, and the public. In the year 2021/22 there has been no data security or data protection incidents reported. The annual data security audit did not highlight any issues. This was validated by the DPO.
NNPC Information Governance Framework
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3.3 OUR KEY ACHIEVEMENTS IN 2021/22
3.3.1 CLINICAL, QUALITY ASSURING, & PATIENT SAFETY AUDITING Clinical audit is undertaken to systematically review the care that the Trust provides to patients against best practice standards and is an essential activity to take actions to improve the care provided. In 2021-22 we have conducted audits which evaluates the quality and safety of services across infection control, safeguarding, administrative, information governance, and quality assurance. Examples of some of the audit activity is listed below in Table 1, relevant to the services we provide. The way in which audits are presented provides a clear and concise method, benchmarks of standards, outcomes of the audit, and action plans put in place when required. These are all agreed and validated by the service and clinical leads who then presents them to the Quality Committee monthly. The number of clinical and administrative audits carried out in 2021/22: 27 across all services which demonstrated critical evaluation of evidence based clinical practice with organisational learning and changes to practice made, where required. Here are a few examples:
Table 1
Service
Standard Area
Audit Aim
Date
Outcomes: Key findings
Recommandations, changes, comment, or improvements Lessons learned from this is that the re-audit has clearly demonstrated that to provide regular, ongoing support, targeted teaching, clinical supervision does go some way to improve the outcomes and quality of the ECHT’s the quality of their consultation documentation. Outcome: Bespoke teaching and education programme is continually reviewed to meet the needs of the team. Clinical supervision sessions continue to be integral to the support given to the team.
Enhanced Care Home Team (ECHT)
Quality Assurance & Patient Safety
This ongoing audit is designed to demonstrate compliance with good governance in documentation of consultations and to facilitate the identification of any further ongoing training needs.
06.2021, undertaken quarterly
This audit demonstrated an overall 90% compliance with the standards set in each of the 8 criteria’s (previously 72.5%, 83%, & 72%). Therefore, this demonstrates some success in the ongoing training and education programme, and the implementation plans of 1:1 clinical supervision. The implementation of both of those elements were based on the results of the 2 nd re-audit, and the results of the 3 rd re-
audit clearly demonstrates some measurable success in those plans.
Child Safeguarding audit: Who is accompanying the child and clear documentation of who has given consent
Safeguarding To ensure compliance with standards set in the NNPC Policies - consent, safeguarding children, and phlebotomy & blood
06.2021
57% overall compliance against expected standards.
Education and training implemented to address areas of education and learning for staff. Recommended to re- audit in 6-8 weeks after training is put into place Outcome: Achieved 100% compliance in 08.2021
handling. To highlight any areas of learning required by the clinical staff
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Corporate – IG, Patient & Clinical Safety of the
Quality Assurance & Patient Safety
To identify and address actual and potential patient and clinical safety issues across ALL services
02.2022
Completed for all clinical services and general aspects of the clinician and patient safety in S1 Community Unit. Shared with DPO / Governance Lead. Separate document to evidence audit & shared with Quality & Safety Committee. Plan to keep the audit updated as issues and resolutions to these arise, where required .
Outcome: As a result of this audit, there were several measures implemented to improve patient and clinician safety – such as the introduction of Docman, the admin processing of tasks and communications & letters, information governance procedures and handling. This is an ongoing process to assure the Board of corporate compliance with data privacy and security.
SystmOne Community Unit
3.3.2 HSJ AWARDS
NNPC and Xyla Elective Care became the proud finalists in the 2021 Health Service Journal (HSJ) awards in the category of ‘ Primary Care Innovation of the Year ’ for the tele-dermatology project which was delivered across Norfolk & Waveney from January to December 2021. The HSJ award ceremony was held on the 18 th of November 2021, and was attended by the NNPC Chair, Senior Management Team, the service and clinical leads who were involved in the service delivery. Although not winners of the category, the service was recognised for the impact of the service on reducing waiting times from 50 weeks to 48 hours with photo advice and guidance. This hugely valuable service is a good example of how innovative ways of working in partnership can have a positive impact on patient care. It also demonstrated how the application of education and training can benefit the clinicians in Primary Care.
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3.3.3 CQC INSPECTION JUNE 2021
The first CQC inspection took place in September 2019 and resulted in a ‘Requires improvement’ rating. Whilst we were disappointed in the rating of ‘ Requires I mprovement’, our reinspection of those areas, on 17 th June 2021, led to us being overall rated as ‘ Good ’.
3.3.4 SUPPORTING STAFF – CULTURE & WELL-BEING Our staff have a strong focus on the needs of the patients and the communities we serve, which is reflected in a display of outstanding resilience, flexibility, adaptability, commitment and dedication. The support which is embedded in the organisation has resulted in no staff safeguarding concerns being reported. The ‘Freedom to Speak up Guardian’ and the deputy both sit on the Quality & Safety Committee and ensures that the staff are up to date with information on how to report any concerns which they may encounter. This validated by confirming that staff have undertaken their mandatory training, it is accurately recorded, and that the updating of policies is in line with requirements. A clear display of who and how to report any concerns is present in the appropriate areas of work. The organisation has developed a more effective sickness recording process, improved policies and processes with full access to an occupational health service to support staff with health conditions. Core and clinical staff surveys will be undertaken as an aid to highlight any areas which we are doing well and could do better. These will be used to formulate plans to make improvements, where required.
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3.3.5 EDUCATION AND TRAINING Dermatology Teaching Events
As part of the development of the dermatology service in January 2021, NNPC embarked on developing and delivering a Primary Care led dermatology events which focussed on elements of referrals which were the most common. These were held in November 2021, and February 2022. The feedback from this was positive, with 100% of scores either being ‘agree’ or ‘strongly agree’ to the events being valuable . Podcasts NNPC developed a ‘Health Watch’ podcast channel on Spotify and A pple Music. In July 2021, a monthly podcast was launched by our lead Nurses. It covers the NICE Guideline updates and is titled ‘NICE to see you, to see you… ..NICE ’ . The target audience was initially North Norfolk clinicians who can access these in short, easy-to-access sessions and is accompanied by a NICE newsletter update. Over time, the podcasts have widened its listening to a world-wide audience. We also have a broader podcast that is specifically written to showcase NNPC as an organisation and highlight the services and work that we do; this broadcast raises NNPC’s profile with Norfolk and the wider NHS. Journal Publications In July 2022, NNPC celebrated its first journal publication. This publication is entitled Testing for SARS-CoV-2 Infection in Care Home Residents and Staff in English Care Homes: A Service Evaluation and can be found at the Journal of Long-Term Care, (2022), pp. 154 – 162. DOI: https://doi.org/10.31389/jltc.99 This was jointly published with the University of East Anglia Norwich Medical School research team. As an aside to this, NNPC had two members of staff who sat on the advisory panel for a missed-methods study into exploring and understanding the lived experience in care homes for older people during the COVID-19 pandemic. Further journal publications are planned across some of our clinical services.
3.3.6 SERVICE EVALUATIONS AND PERFORMANCE Community Gynae Service (CGS) What went well
a) Superb collaborative working between NNPC, the Norfolk & Norwich Hospital Foundation NHS Trust (NNUH), & Lionwood Medical Practice (LMP) which focussed solely on delivering a high-quality service to patients. The overall delivery team comprised Consultants, GPs, managers, IT specialists, administrators, NNUH SSD and others. A special note of thanks is given to: i. NNUH Outpatients Booking team who worked tirelessly to contact patients and offer a choice of attending the CGS ii. NNUH Gynaecology OP Team who gave much of their time and expertise, often at little or no notice, in developing the initial stock list and then providing stock several times throughout the project b) 115 patients were seen in the CGS who would otherwise have continued waiting to be seen at NNUH c) Patients were seen on time and appointments did not overrun d) Patient experience feedback suggests that the vast majority of patients were extremely happy with the service, the location, and the clinical staff. e) The project ran to time and budget
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What could be improved a) Any future CGS would comprise a direct pathway from Primary Care which would mitigate some of the difficulties faced by the Pilot service but, for completeness, the following items should be noted: i. Manual processes pose many risks e.g., potential data breaches, uncertainty as to whether a sent email has been received etc. Any future service will benefit from all administrative processes being automated wherever possible ii. Administrative processes split across more than one team always create additional work and increase the risk of errors iii. The process to identify and contact patients who could be appropriately seen in the CGS was more complex than had been though at first, hence there was a delay in getting referral information across to NNPC. It is probable that more patients would have been seen if appointments could have been booked earlier. Dermatology Carried out in January 2022 with NNPC in collaboration with the University of East Anglia’s medical school, the service evaluation of the dermatology service highlighted that: • 67% of completed dialogues have resulted in the patient being retained in primary care rather than becoming additions to wait lists for secondary care. • Median elapsed time from dialogue initiation to decision was under 9 hours; more than 90% of dialogue outcomes were decided within 36 hours. • 20% of cases were transferred to the two-week cancer pathway. • With regard to wait list growth for secondary dermatology care, Norfolk and Waveney ICS is performing comparably to all-rest-England and a local comparator area (Lincolnshire CCGs). • Referrer feedback is overwhelmingly positive. Clinician feedback on resulting educational activity is overwhelmingly positive. • Patient feedback is limited but has been positive (as of October 2021). • Identification of most commonly asked clinical questions and cases and delivered learning outcome-based education to primary care work force which was highly positively received. GPFD at James Paget University Hospital NHS Trust (JPUH) & The Queen Elizabeth Hospital NHS Trust (QEH) Performance The GPFD service at JPUH commenced on 22.09.2021, and by 31.03.2022 had streamed 17,531 patients and seen a total of 5, 560 patients in a total of 2, 228 hours of service delivery. This equates to an average of 32% of all patients who were streamed were seen at GPFD, based on a 12 hour per day service delivery. The GPFD service at QEH commenced on 04.01.2022 and by 31.03.2022 has streamed 8, 033 patients and had seen a total of 2, 050 patients in a total of 1 011 hours of service delivery. This equates to an average of 25.5% of all patients who were streamed were seen at GPFD, based on a 12 hour per day service delivery. The data accumulated for both GPFD services from inception to current time will form a basis for full-service evaluation, research paper opportunities, and service development. It is anticipated that as both services develop over time that the service performances will only increase.
NNPC Quality Account 2021/22
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3.4 OUR KEY PRIORITIES IN 2022/23
3.4.1 CLINICAL SUPERVISION IMPLEMENTATION
As the result of a clinical supervision audit, it has been identified that NNPC could do better to ensure that clinical supervision is implemented for the care, development, and support for our ARRS clinicians. A staged plan will be developed and agreed with the Quality & Safety Committee. 3.4.2 PATIENT & STAFF EXPERIENCE – BESPOKE QUESTIONNAIRES For the enablement of excellent quality patient and staff feedback, it is planned to develop and implement bespoke questionnaires to aid the improvement in service delivery and staff support.
3.4.3 PERFORMANCE SCORECARD
We aim to develop a performance scorecard which summarises the organisational strategies in areas such as quality performance, workforce management, health & safety, finance, and services performance. This will enable a demonstration of performance to stakeholders and the Board members. It will aid the identification of areas in which we can improve and learn from.
3.4.4 QUALITY & SAFETY MEETINGS AT SERVICE LEVEL
Alongside the monthly corporate Quality & Safety Committee meetings, we will ensure that the teams who run our services will implement weekly meetings to discuss and identify areas for improvement, review of incidents, complaints, clinical outcomes and audit findings, safeguarding issues, clinical governance, learning from service level performance trends, and to provide a forum for group support. It is aimed that a standard agenda will be developed to facilitate these meetings. This will triangulate the development and implementation of an embedded quality and patient safety culture to the organisational structure. 3.4.5 DEVELOPMENT OF QUALITY & SAFETY COMMITTEE AGENDA The structure of the Quality & Safety Committee agenda will be evaluated to ascertain where improvements can be made to maximise the value of the outputs from the meeting. This will be led by the to be appointed executive Director of Clinical Services & Quality and the non-executive Director for Quality. The purpose of this is to easier identify quality and safety issues which are required to be presented to the Board via an executive summary.
3.4.6 CLINICAL EDUCATION & TRAINING
The fundamental elements of clinical education and training is aimed to be incorporated into our clinical services by further development of educational events, educational podcasts, support for clinical development via clinical supervisors, 3.4.7 DEVELOPMENT OF INVESTIGATION INTO INCIDENT REPORTS To demonstrate the maturation of the investigation into reported incidents and significant events, there will be the development of a measured root cause and patient harm RAG assessments (where required). This, in turn, will correlate with the reporting indicators on the Performance Scorecard and reporting incidents and significant events to the Quality & Safety Committee. It should then provide a clearer structure for reporting the outcomes of investigations in relation to the demonstration of lessons learnt and changes put into place because of an incident.
NNPC Quality Account 2021/22
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3.4.8 SAFEGUARDING Auditing
Safeguarding children and adults is an important priority for NNPC. The mandatory training schedule is monitored to ensure that all staff are up to date with the training, the aim is to develop an auditing tool to ensure that this is maintained and improved where required. The adoption of and development of a safeguarding auditing tool will further embed the commitment to the protection of vulnerable children, young people & adults. 3.4.9 COMPLAINT HANDLING In 2021/22, NNPC has developed joint partnerships in service delivery with external providers, so aims to work in collaboration in the approach to complaint handling. The aim is to initiate formal processes via policy to embed a standardised approach to complaint handling across both organisations.
3.4.10 COMMUNICATIONS Website Development
We aim to update and improve our website for the benefit of our patients, our staff, and the stakeholders. We now have a broad range of services, and a website improvement is required to also communicate to both internal and external partners. We aim develop a ‘members only’ area solely for ou r 19 practices to enable us to streamline information flow that currently takes up resource in developing and sending. We believe that having an encrypted area of the website will enable practices and PCNs to access data, reports and fiscal updates easily and quickly.
3.5 PATIENT SAFETY & QUALITY Patient Safety Alerts
NNPC has nominated registered individuals for MHRA alerts via the Central Alerting System and these alerts are cascaded to all relevant staff in a timely manner. Where actions are identified these are checked although the majority of these take place at GP practice level, where the practice takes responsibility. Significant Events Significant Event reporting and analysis takes place to encourage review, feedback and learning from incidents in an open and no-blame culture. All significant events are discussed and documented within the regular clinical team meetings and are reported to and reviewed at the Quality Committee Meeting. Where pertinent significant events are identified, these are escalated to initially to the Senior Management Team and Board for consideration and discussion. Duty of Candour is applied to all patients where an error or mistake has occurred. These are recorded and used as opportunities to learn and improve as well as giving patients the opportunity to let us know where things can be better.
In the year 2021/22 there were a total of 28 significant events reported, with no reported Serious Incidents.
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Total of 28 reported significant events 2021/22 - RAG assessment
No Harm
7%
Low Harm
7%
Moderate Harm
Severe Harm
0%
86%
Staff Recruitment The NNPC Recruitment Policy sets out the standards under which employees are appointed in line with regulatory and statutory policy and guidance, which sets out how we safeguard patients by employing fit and proper persons and that they are trained to do the job for which they are appointed. Mandatory Training compliance and achievement A vital factor in continuously improving our clinical services is giving our staff the opportunities for ongoing learning and training. Throughout 2021/22, we continued to implement our mandatory training requirements via providing staff with a programme of induction and mandatory training, so they feel comfortable and safe in their working environment. Further to this, there is a programme of probationary interviews which give new recruits the opportunity to raise queries and discuss issues at the earliest opportunity. We have implemented a series of improvements in the way in which training is recorded to ensure a demonstration of regulatory compliance. Continuing Professional Development is encouraged and facilitated by participation in appraisal, revalidation, and attendance at training events. NNPC is committed to provide a structured and effective education, clinical supervision, and training programme for all NNPC employed staff. All development activity is documented as part of individual learning portfolios. Non-clinical staff are encouraged to attend events related to their own specialism or professional development needs. We have recognised that the locum workforce may require stronger support from NNPC to ensure the continued delivery of patient safety and high quality of care, so this has been incorporated into the 2022/23 improvement plans.
NNPC Quality Account 2021/22
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