Posted on: 18 January 2019
This week’s leadership message comes from Carol McKenna, Chief Officer for North Kirklees and Greater Huddersfield Clinical Commissioning Groups. Carol is also the lead CEO for West Yorkshire and Harrogate Primary and Community Care Priority Programme.
Hello my name is Carol
Primary and community care includes a whole range of professionals, such as GPs, pharmacists, dentist, opticians, community nurses and social workers. It is central to the work we do across our six local areas (Bradford District and Craven; Calderdale, Harrogate, Kirklees, Leeds and Wakefield) and wider Partnership ambitions. It is the very foundation of all our care no matter where we live.
Its good news that people are living longer, however, we need to do more to ensure that people benefit from as many years as possible in good health. With more care intended to be delivered locally in the future, and a growing, ageing population with complex multiple needs, we know that the challenges facing primary and community care - including the pressure on workforce - need to be addressed.
We need to continue breaking down the traditional divides and artificial boundaries between primary care, community services and secondary care (hospitals). These boundaries can sometimes limit personal choice and prevent joined-up working, which we know is better for people. Our ambition is that people never have to tell their story to a healthcare worker more than once.
Transformation of our approach to community and primary care delivery is a fundamental element of the West Yorkshire and Harrogate vision. The challenges before us include facilitating a system-wide shift enabling people to self-care and stay well for longer living independently. To do this we will embrace new and existing technology as well as sharing best practice and new ways of working across all sectors. This is where West Yorkshire and Harrogate primary care programme can make a real positive difference if we get it right.
Naturally our ambitions are supported by our six local place plans – this is where the majority of care is delivered and received. We are all aiming to support integrated, local approaches to delivering person centred care that meets the growing expectations of people. It’s the role of the Partnership to ensure we learn from one another, share good practice and work together to improve care whilst avoiding duplication, reducing differences in care which may exist and making the most of the skills of health care staff.
We’re at a fairly historic moment for 'the first time in the NHS' 70-year history' primary, community and mental health care services are being guaranteed investment rising 'faster than the overall NHS budget'. The NHS Long Term Plan highlights the need to grow the GP workforce; although we’re waiting to hear more detail on this as well as information about additional resources for workforce development and training.
Chapter One of the NHS Long Term Plan sets out how the NHS will move to a new service model in which people get more options, better support, and better joined-up care at the right time and in the right care setting. GP practices and hospital outpatients currently provide around 400 million face-to-face appointments each year. Over the next five years, everyone will have the right to online ‘digital’ GP consultations, and redesigned hospital support will be able to avoid up to a third of outpatient appointments. Primary care networks / communities – typically covering 30-50,000 people – will be funded to work together to deal with pressures in primary care and extend the range of convenient local services, creating genuinely integrated teams of GPs, community health and social care staff. Expanded community health teams will be required under new national standards to provide fast support to people in their own homes as an alternative to going to hospital and to ramp up NHS support for people living in care homes.
The Long Term Plan therefore sets out action to ensure people get the care they need, fast, and to relieve pressure on A&Es. Of course, we need to ensure that we have the right workforce in the right place to deliver services and one of the major workforce challenges for West Yorkshire and Harrogate is the shortage of trainee and qualified GPs.
In West Yorkshire there are around 124 GPs a year being trained; factor in net loss to other areas and participation rate (the degree to which the GP workforce works less than full time) and this output is reduced to around 108 full time equivalent GPs. This may be just sufficient to replace retirements but does not achieve growth or make up for the current shortfall.
So how will this be resolved? The government has announced a 25% increase in medical student places in England. This has the potential to increase the supply of doctors to West Yorkshire and Harrogate. Leeds medical school is seeking to increase its numbers and University of Bradford continues to aspire to establish its own medical school.
Growing more of our own GPs will pay dividends in the long term but in the meantime we are taking action to bolster the numbers of medics in general practice locally. The Partnership has launched a three-year recruitment drive to bring more international GPs to West Yorkshire and Harrogate. You can find out more here.
The project is being funded by NHS England, following a successful bid for cash by the Partnership. Medics from countries such as Spain, Portugal and Greece are being targeted, as well as those from outside Europe, beginning with Australia and New Zealand. Qualified overseas medics already in the UK but not currently practicing are also eligible to apply.
Can we hope to entice GPs from warmer climes to sunny Yorkshire? We think so.
A recent pilot programme to recruit European GPs to the Humber, Coast and Vale area was successful and we feel that Yorkshire’s unique character and international reputation – ‘Brand Yorkshire’ – will lead to lots of interest.
One GP who has already made the move to West Yorkshire is Dr. Penelope Navarro. She’s a general practitioner in Wakefield who has shared her experience of coming from Spain to work here. You can watch her film watch her film here or below.
Finally it would be remiss of me not to mention the importance of social care, independent sector and the role of community organisations. Joining up care requires input from all and it will be interesting to see the proposals set out in the Government’s Social Care Green Paper to ensure we can tie it altogether to deliver the best care possible for the 2.6million people living across West Yorkshire and Harrogate.
Have a good weekend.
Carol
What else has been happening this week?
West Yorkshire and Harrogate Health and Care Partnership Public Health Co- ordination Group
The group met this week. The meeting was chaired by Dr Ian Cameron, Director of Public Health for Leeds City Council and included colleagues from councils and Public Health England. There was a discussion on population health management. Put simply, this work is all about the management of risks in a population’s health. This could be based on where someone lives, communities and health needs. Whilst linked, these are fundamentally different problems, requiring different service responses. A group of public health colleagues are working together to look at how they can share learning, data and insight into what works in one area and whether these methods can be used elsewhere across West Yorkshire and Harrogate. There was also a discussion on tobacco, workforce, alcohol programmes and mental health, specifically suicide prevention. You can read our Suicide Prevention Strategy here. Engagement with Yorkshire Sport Foundation – healthy weight, physical activity and eye health was also on the agenda.
Digital Programme
The Northern and Yorkshire Directors of Informatics met on Friday. This included colleagues from across West Yorkshire and Harrogate who met with their peers from other areas to discuss national priorities such as the health system led investment fund. We are waiting on approval for year one of these funding allocations for projects such as the electronic patient record scheme for Mid-Yorkshire Hospitals.
West Yorkshire and Harrogate Chief Information Officers also met on Friday. Peter Dyke, from NHS England attended the meeting to discuss the potential for Microsoft Office 365 licensing deal. There was also a conversation about developing the digital strategy across West Yorkshire and Harrogate and how this aligns to the NHS Long Term Plan.
West Yorkshire and Harrogate Priority Programme Meeting
The Programme Oversight Group met on Thursday. The meeting was chaired by Ian Holmes, Director for the Partnership. The meeting includes colleagues working on West Yorkshire and Harrogate priorities including cancer, digital, preventing ill health, workforce, mental health, maternity and improving planned care. Other colleagues at the meeting included those from NHS England and the Academic Health Science Network. Ian gave colleagues an update on the NHS Long Term Plan. This was a key focus of the meeting. For example, there was a discussion on workforce and how we address the needs and challenges within our priority programmes. This led to an update on a forthcoming recruitment programme for advanced care practitioners and their work with primary care hubs and universities. Programme leads also gave an update on their areas of work.
Maternity programme
A key focus for the maternity programme is looking at the NHS Long Term Plan. This will build on the recommendations detailed in the National Maternity Review: Better Birth.
The Local Maternity Systems (LMS) were established as a result of the review. They aim to bring together the NHS, local authorities and other local partners together with the aim of ensuring women and their families receive seamless care, including when moving between maternity or neonatal services or to other services such as primary care or health visiting.
Alongside our existing plans, which you can view here, the LMS will continue to focus on reductions in stillbirth, maternal mortality, neonatal mortality and serious brain injury by 2025.
Having a baby is now safer than 10 years ago. Since 2010, despite increases in some risk factors such as age and comorbidities of mothers, there has been an 18.8% reduction in stillbirths [69], a 5.8% reduction in neonatal mortality [70] and an 8% reduction in maternal mortality [71]. Maternal mortality occurs in less than 1 in 10,000 pregnancies nationally.
The intention is that by spring 2019, every trust in England with a maternity and neonatal service will be part of the National Maternal and Neonatal Health Safety Collaborative. Every national, regional and local NHS organisation involved in providing safe maternity and neonatal care has a named maternity safety champion.
Regional variation in extended perinatal mortality still exists and the West Yorkshire and Harrogate LMS is looking at work to address this.
Part of this work included employing a clinical leadership fellow who will start in August 2019. Interviews for the role took place this week. Some of the post holder’s work will be with obstetricians and medical staff to ensure greater engagement across the LMS. The engagement in our LMS is already good but the work of the clinical fellow will look to improve on this. Engagement with clinical staff is an important part of the work.
The LMS Implementation Group met on Tuesday. This is the operational part of the LMS Board. The meeting discussed the NHS incentive scheme and how to move forward with ‘Getting it Right First Time’. This is a national programme designed to improve the quality of care within the NHS by reducing unwarranted variations. The first area of work the LMS is looking at is variations in induction of Labour.
There was also a national leadership meeting this week, for all LMS leads. This was attended by our programme lead, Karen Poole. Work around the digital programme is picking up pace and in particular will look at progressing work around the Maternity Digital Maturity Assessment
Continuity of carer teams are being developed and launched across West Yorkshire and Harrogate – The national target for March 2019 was that 20% of pregnant women will be offered the opportunity to have the same midwife caring for them throughout their pregnancy, during birth and postnatally. We are anticipating that our LMS will meet the March 19 target due to the hard work carried out by all maternity teams. The continuity of carer target for March 2020 is 35%.
The next WY&H LMS Board Meeting will be held on 15th February 2019. We will keep you update on the above and other elements of the Long Term Plan in future weekly updates.
Primary care workforce network event
This event took place on Wednesday in Leeds and was hosted by the Local Workforce Action Board (LWAB) and NHS England. The event included representatives from our six local places, local medical committees and advanced training practices. The purpose of the event was to build on the networks developed at the workshops held in 2018 and to show case the good work taking place across the area. This included an update on the pilot that is seeing paramedics working in GP surgeries, international recruitment (please see Carol’s blog post above) and making the best use of volunteers in communities. Findings from the event will inform the work of the new primary care workforce steering group led by LWAB and NHS England.
West Yorkshire and Harrogate Health and Care Partnership – Communication and Engagement Network
Communication and engagement colleagues from across the area met on Thursday in Leeds. There was an update on the NHS Long Term Plan and the approach around how we share communication messages consistently across West Yorkshire and Harrogate to ensure all staff, partners, stakeholders and communities are part of the conversations taking place. A draft communication and engagement plan has been drafted and this will be published on our website once all colleagues have contributed. We will be working with Healthwatch across the area to build on our work to date.
Colleagues also led a number of table conversations on political engagement; working with the media; campaign planning and statutory consultations. Colleagues also received an update on the West Yorkshire and Harrogate ‘looking out for our neighbours’ campaign; electronic care records and the forthcoming diabetes awareness work – which starts in February.
Visit to West Yorkshire and Harrogate from national and non-executive directors
A number of national executives and non-executive directors (NEDs) from NHS England, NHS Improvement and NHS Digital visited West Yorkshire and Harrogate on Thursday and Friday. It began with a round table discussion, Chaired by our Partnership CEO Lead Rob Webster on Thursday. This focused on the approach that our partnership is taking and our vision and ambitions for people living across our area.
They are also visited hospital NEDs at Leeds NHS Teaching Hospitals for an overview on the Leeds Digital Way – which includes the development of electronic patient records. There was also visited one of the wards at St James’s University Hospital to see digital applications in clinical use. This included Scan for Safety, E-medicines and E-observations.
Leaders also gave visitors an update on the Yorkshire and Humber successful bid to become a Local Health and Care Record Exemplar (LHCRE). At the moment, in many areas GPs and other care professionals are often not able to access crucial patient information quickly if it is held in another part of the health service – sometimes having to rely on post or fax instead. This new way of working aims to address these issues by using technology and digital innovations to link systems across health and care organisations, enabling care providers to work more closely together. This will result in the creation of a new Yorkshire and Humber Care Record, which will provide people with access to their information and encourage them to be more involved in looking after their health.
Tom Riordan, Chief Executive of Leeds City Council, Eve Roodhouse, Chief Officer of Economic Development and Sir Alan Langlands, Vice Chancellor of the University of Leeds showcased Nexus. This enables businesses from all sectors to connect with the expertise, talent and facilities at the University of Leeds to drive forward innovation and the Leeds Institute for Data Analytics as well as the Leeds Academic Health Partnership.
On Friday (today) they will visit WDH to find out more about the Telecare Centre which provides person-centred support to older and vulnerable people so they can live independently. This is an important part of Wakefield (Connecting Care). There was also an update on primary care developments and joined up care with health and housing partners - covering work towards creating ‘Connected Communities, Connected Neighbourhoods, Connected Homes and Connected Workforce’. Telemedicine in Extra Care to Housing Support and Coordination on the acute and mental health hospital wards with a Demonstration of Care Link was also included in the two day visit.
Long Term Plan update
Julian Hartley Chief Executive of Leeds Teaching Hospitals NHS Trust has been asked to lead the new workforce implementation plan for the NHS. Julian has been asked to lead this important piece of work by the chair of NHS Improvement, Baroness Dido Harding, following the publication of the NHS Long Term Plan last week. The programme will bring together professional representatives and other bodies to build an implementation plan to deliver the vision set out in the Long Term Plan.
To do this, leaders will take an inclusive approach and establish a national workforce group, which will include senior representatives from Health Education England, NHS England, the Department of Health and Social Care, Royal Colleges and other bodies, so that the plan addresses frontline workforce priorities across the system.
Julian will serve in this role on a full-time basis until the end of March 2019 before returning to his chief executive position within Leeds Teaching Hospitals NHS Trust. Dr Yvette Oade, chief medical officer and deputy chief executive will step up to lead the trust in the interim.
What’s happening next week?
- The Joint Committee of the Clinical Commissioning Groups, Patient and Public Involvement Assurance Group meets on Monday. The meeting is chaired by Fatima Khan-Shah, who is a lay member for the Joint Committee.
- West Yorkshire and Harrogate Health and Care Partnership System Oversight and Assurance Group meet on Monday. This is chaired by Rob Webster, our CEO partnership lead.
- Improving Planned Care and Reducing Variation in Commissioning Policies Board meet on Tuesday.
- The first West Yorkshire and Harrogate Health and Care Partnership Housing Programme Board meet on Wednesday. This is chaired by Jacqui Gedman, CEO for Kirklees Council.
- West Yorkshire and Harrogate Finance Leaders meet on Friday.