ANNUAL DELIVERY AND DEVELOPMENT PLAN 2005 – 2006
Section One: The National Context and Guidance
1.1. National Guidance 3
1.2 Healthcare Standards and National and Local Targets 4
1.3 Commissioning & Choice Strategy 2004 – 2009 5
Section Two: Review of 2004/05
2.1 Sustaining Performance 7
2.2. Developing a Commissioning Strategy 8
2.3 Develop the concept and use of Choice 8
2.4 Clinician Engagement 8
2.5 Chronic Disease Management 9
2.6 Integration of Children’s and Adults Commissioning 9
Section Three: Financial Overview and Appraisal 2005/06
3.1 Payment by Results 10
3.2 National Tariff 10
3.3 Sources and Application of Funds 12
3.4 Financial Gap 13
Section Four: Our Plans for 2005/06
4.1 Health Inequalities and Prevention 14
4.2 Managing Long-Term Conditions 16
4.3 Public and Patient Involvement 17
4.4 Quality and Choice 18
4.5 Better Services: New Ways of Working 19
4.6 Partnership Working 21
4.7 Mechanisms for Enabling Change 22
4.8 Additional Priorities for Action 23
Section Five: 5 Conclusion 25
Appendices: Appendix A – National Targets 2005 - 2008
Appendix B – Key Targets 2005/06
Appendix C – Achievements against 2004/05 Strategic Objectives
Appendix D – Achievements towards delivering the 44 National Targets
2003 - 2005
Appendix E – Modernisation Agency: The 10 High Impact Changes
This is the third Lewisham PCT Annual Delivery and Development Plan (ADDP).
It describes the context, the priorities and the work the PCT will be undertaking
over the next year to progress the NHS plan in four main areas:
Improving the management of long-term conditions
Improving the health of our population
Improving access to services
Improving the patient’s experience
We reflect both on our achievements in 2004/05 and the progress we have made
to deliver the 12 national programme areas, and also on areas where we have
not achieved our targets, which will adversely affect our star rating.
Last year we published a Commissioning and Choice Strategy, which is a five
year plan for improving health services in Lewisham. It is our local interpretation
of the Government’s vision of a patient-led NHS. We consulted with the local
community, voluntary groups and statutory agency at all stages of its
The plan for 2005/06 sets out what we want and are expected by the
Government to achieve this year and how we plan to do it. It shows how we use
our resources to support our plans, the lessons we have learnt from past failures
and the risks that we face in achieving our objectives.
2005/06 will be another challenging year for the PCT. Although we have
achieved financial balance, in order to remain in balance across the year, we will
have to ensure that we pull back on our current level of expenditure and use and
manage our resources as effectively as possible. The introduction of new
systems of payment for activity in secondary care – Payment by Results and
Practice based Commissioning – will further test the PCT’s capacity, although
they give opportunities to bring commissioning and budgets closer to local
We remain passionate in our determination to see the NHS become truly patient-
led and our inspiration comes from the attitudes and actions of our front-line staff
who want to make a difference and do so much for local people.
Brian Lymbery Magda Moorey Lucy Hadfield
Chair Chair, Professional Chief Executive
Section One: The National Context and Guidance
This section outlines the range of national priorities and guidance that sets the
context for this year’s Annual Delivery and Development Plan (ADDP). This
section also recaps, our Commissioning and Choice Strategy, which provides the
framework for our strategic decision-making.
1.1. National Guidance
In July 2004, the Department of Health published “National Standards, Local
Action: Health and Social Care Standards and Planning Framework 2005/06 –
2007/08.” This document is the framework that the Department of Health (DH)
wants the NHS and social care to use in planning for the next three years and the
standards that all organisations should achieve in delivering NHS care. It also
sets out the standards against which the PCT will be monitored over the next
These standards reflect the priorities set out in the NHS Improvement Plan1.
This plan describes the key commitments that the NHS will deliver to transform
people’s experience of the NHS up to 2008. These are:
Putting patients and service users first through more personalised care;
A focus on the whole of health and well-being, not only illness;
Further devolution of decision-making to local organisations.
The PCT’s plans this year reflect these three “shifts” in the way health services
are planned and delivered. Our plans also reflect the emphasis in “Creating a
Patient-Led NHS”2, which sets out the NHS ambition to change the whole system
from one that delivers services to people to one which is totally patient-led. This
Providing a far greater range of choices and of information to help to make
Making sure all services and all parts of the NHS contribute to health
promotion, protection and improvement;
Encouraging primary and community services to develop new services
and new practices
Concentrating more on health improvement and developing local patient
pathways and services.
The fourth area of guidance, which is taken into account in this document, is the
Public Health White Paper “Choosing Health”3. Choosing Health aims to place
health promotion at the heart of the NHS. This will involve the NHS helping and
The NHS Improvement Plan: Putting People at the Heart of Public Services. June 2004
Creating a Patient-led NHS: Delivery the NHS Improvement Plan. March 2005
Choosing Health: making healthier choices easier. November 2004.
Delivering Choosing Health: making healthier choices easier. March 2005
supporting people to choose healthier lifestyles and giving them greater control
over their own health. Choosing Health also emphasises the links between
health, work, learning, leisure and recreation, crime and community cohesion,
emphasising the critical role of local government and other key local partnerships
in improving health and well-being.
Choosing Health is underpinned by three key principles:
Informed choice for all
Personalisation of support to make healthy choices
Working in partnership to make health everyone’s business.
The six priority areas in Choosing Health are:
Mental health and well-being
Reducing harm and encouraging sensible drinking.
1.2 Healthcare Standards and National and Local Targets
In 2005/06 the PCT will be assessed on a range of standards, national targets
and local targets. Quality is now at the forefront of the agenda for the NHS. This
year will see the system of monitoring performance moving from national targets
to one in which:
Standards are the main driver for continuous improvement in quality
There are fewer national targets
There is greater scope for addressing local priorities
Incentives are in place to support the system
All organisations locally play their part in service modernisation
From April 2005, the Healthcare Commission will assess the PCT’s performance.
This assessment will form part of the Commission’s annual review and will lead
to an annual performance rating.
Standards for Better Health
Standards for Better Health describes the level of quality the PCT will be
expected to meet in terms of safety; clinical and cost effectiveness; governance;
patient focus; accessible and responsive care; care environment and amenities;
and public health. In each of these areas (or domains) the standards fall into 2
Core Standards which bring together and rationalise existing requirements
for the health service, setting out the minimum level of service patients
and service users have a right to expect.
Developmental Standards that signal the direction of travel and provide a
framework for NHS bodies to plan the delivery of services that continue to
improve in line with increasing patient expectations.
National and Local Targets
This year the PCT will be monitored against 22 national targets. The PCT
working with the London Borough of Lewisham (LBL), NHS partners and other
organisations will be expected to contribute to the achievement of these national
priorities and targets.
The national targets cover four broad priority areas. These are:
Health and well-being of the population (covering health promotion and ill
Long-term conditions (supports health by promoting better self-care and
treatment in community settings or at home)
Access to services (ensures people have fair and prompt access to care)
Patient/user experience (promotes maximum information and choice).
The national targets 2005 – 2008 are set out in full in Appendix A.
The final strand in the planning framework is the freedom to set local targets to
work alongside the national targets.
Maintaining Existing Commitments
Although there are new priorities, we must meet and maintain the levels of
service and the 44 targets set through the 2003 – 05 planning round.
The PCT’s performance will be assessed not only on how we are doing on
national targets but also on achievement of high quality standards from on-going
National Service Frameworks and National Institute for Clinical Excellence
Our key targets for 2005/06 are a combination of the new national and existing
commitments. These are attached at Appendix B.
1.3 The Commissioning and Choice Strategy (2004 – 2009)
This sets out how we intend to modernise health services and in particular realise
the benefits from better management of the main diseases that affect local
people – cancer, coronary heart disease, chronic obstructive airways disease
and diabetes. It outlines how the PCT is designing services that will be more
sensitive to patient choice and more accessible to local people.
The Strategy sets a local vision for health and healthcare and we have adopted
seven principles to achieve this vision.
Our vision: “Working with you, we will sustain and improve the health and
well-being of all people in Lewisham.”
The seven principles are:
Move from a provider-led to a commissioner-led market
Continue to develop partnerships
Achieve our health improvement and inequalities targets
Promote self-care and offer choice within managed care so that people can
lead healthier lives and choose the care that’s best for them
Involve the local community and users in commissioning
Develop managed care across the “whole system”
Develop the most appropriate models of care by increasing the emphasis on
preventing illness and focusing on the needs of different groups.
These principles are translated in the strategy into seven priority areas that
reflect the national priorities described above.
These priorities are:
Health inequalities and prevention
Managing long-term conditions
Public and patient involvement
Quality and choice
Better services: new ways of working
Section Two: Review of 2004/05
In last year’s Annual Delivery and Development Plan we made a total of 137
commitments to take us towards achieving our ten strategic objectives and the
44 national Local Delivery Plan (LDP targets). Together with our partners we
have delivered most of our commitments and made significant progress in nearly
all of them. This is a huge achievement. Our achievements against our strategic
objectives are set out in detail in Appendix C and the progress made towards
the 44 national LDP targets is set out in Appendix D.
We also identified six key change areas, which addressed our greatest strategic
risks and where we needed to focus our corporate effort. These were as follows:
2.1 Ensuring that we sustain performance and achieve 2004/05 key
targets (including financial balance) through our investment and savings
Overall, the PCT sustained performance across the 44 national targets, which
included targets on access to services, financial balance, smoking cessation,
cancer and coronary heart disease. Waiting times reduced for inpatient and
outpatient waiters. The PCT also made good or modest progress across our
improving health targets. However, in the star ratings key targets the PCT failed
to achieve in two significant areas - smoking cessation and the A&E waiting time
target. In addition, performance was slightly down in two other areas – drugs
treatment and primary care access. The impact of this is that the PCT will not
retain the 2 star rating achieved in 2003/04.
It was also a challenging year in other areas. The PCT achieved financial
balance despite increased activity in urgent and emergency care in hospitals.
The year saw an increase in the urgent and emergency workload in hospital,
which made the 98% A&E target even more challenging. This year, the PCT will
concentrate on managing demand for urgent care.
A further financial issue over the year was the impact of the new contracts – the
new General Medical Services Contract, the new Consultants’ Contract and the
European Working Time Directive. In 2005/06 the PCT will be implementing
Agenda for Change, which will mean effectively that all staff contracts have been
Over £5 million of additional investment supported work within the acute sector
and in community services to support the management of long-term conditions,
emergency services improvement and enhanced access in primary care. The
PCT worked with GPs, pharmacists, nurses and other health care professionals
very successfully on medicines management through evidence-based, cost
effective and quality use of drugs. As a result the PCT kept well within the self
prescribing budget this year.
The New Cross NHS Walk-in-Centre opened in October 2004, and patient
attendances have been growing steadily since, making access to primary care
advice and treatment easier for many Lewisham residents.
2.2 Develop a Commissioning Strategy to clarify the future direction of
care in Lewisham
The process used to develop a commissioning strategy was timely and
successful in setting direction for the PCT. It engaged the Professional
Executive Committee (PEC), all directorates, public and users and independent
contractors, University Hospital Lewisham (UHL) and the London Borough of
Lewisham (LBL). It anticipated the requirements of the NHS Improvement Plan
and subsequent Department of Health (DH) guidance. Engagement (by
neighbourhood 4) in the Primary Care Collaborative was also timely and
complemented the vision and principles of the Commissioning and Choice
2.3 Develop the concept and use of choice to engage our users and local
The PCT is developing the infrastructure and ways of working with GPs and
hospitals to enable patients to have greater choice of hospital and time of
appointment for planned specialist care. This has involved an audit of general
practices to ensure IT hardware and software are in place to enable e-booking.
Engagement of primary care clinicians is critical to this programme called
Choose and Book. Thirteen practices are currently expressing interest in piloting
the e-booking system – the first step to offering patient choice for referrals to
Work has taken place to develop a menu of the choice of 4 – 5 hospitals.
Hospital service directories will be completed by the end of May 2005. Work will
then start with patient groups to develop information to patients to help them
make their choice.
An example of developing choice and engaging users this year has been around
the work to develop phlebotomy clinics in the community to increase accessibility
for patients and to reduce waiting times. The Patient’s Forum and a range of
community groups all identified local phlebotomy clinics as a development that
would enable better access and less waiting.
2.4 Ensure all clinicians are engaged in our (and other linked) reform
Relationships with our clinicians have been steadily maturing and we have made
great progress in many areas of clinical governance, resulting directly in higher
standards of patient care. There has also been progress with the South London
and Maudsley NHS Trust (SlaM) and with University Hospital Lewisham (UHL).
We can see more clearly what greater engagement could look like but we still
have some way to go. This has been demonstrated in the work undertaken to
develop Practice Based Commissioning (PBC) and the contracting collaborative
developed in Neighbourhood 4. The PCT has also supported GPs to achieve
against the new GMS Contract Quality and Outcomes Framework, resulting in
high achievement across the PCT against the standards. The work in which
clinicians have been engaged this year includes the GMS contract, clinical
panels, the emergency collaborative, the work to reduce delayed discharges and
lengths of hospital stays and the Professional Executive Committee review.
2.5 Demonstrate the benefits of management of the major chronic
diseases in the community, supported by specialist hospital care.
Our aspirations and commitment have been high for patient centred
management of long-term conditions. Work this year has been to build on
workforce capacity and support roles in the community as well as other
infrastructure to enable patients with long term conditions, such as Chronic
Obstructive Pulmonary Disease (COPD), diabetes and Coronary Heart Disease
to access care and support in community settings. A key example of this
approach has been the success of the Expert Patients Programme that has
supported patients with long-term conditions to manage and have more control
over their condition. This year, building on last year’s work, stroke support will be
included in this disease focused approach.
The expectation for 2005/06 is that clear monitoring and evaluation processes
will be established in order to measure the impact of providing more community-
based services and support for people with long-term conditions.
2.6 With the London Borough of Lewisham, clarify how to better
integrate services for children and vulnerable adults and approaches to
improving health and preventing disease.
The statutory responsibility for children and adult social care was split this year,
following the children’s white paper. This has resulted in the new Directorate for
Children and Young People and new Community Directorate in the London
Borough of Lewisham (LBL). Our joint work with LBL on the workstreams of
children, adults and reducing health inequalities has been intense. As a result
we have very developed plans for integrating commissioning for children and
adult services. Having the arrangements to use our funds together more flexibly
and creatively will bring greater value to our local population. It is also revealing
new demands on our services, which will give additional challenges to both the
PCT and LBL.
Section 3: Financial Overview and Appraisal 2005/06
In 2005/06 the PCT is facing a difficult financial scenario. There are a substantial
number of financial pressures impacting on the PCT and areas of uncertainty in
the context of major healthcare system reform across the NHS. These are
explored later on in this section.
The PCT has received a start revenue allocation of £382 million.
This section looks at the additional resources received by the PCT and
how these are being applied, and the following key issues impacting on
the allocation of resources:
Payment by Results4
3.1 Payment by Results
It was originally planned that the new system of payment for NHS secondary
care providers, Payment by Results (PbR) would be implemented in full in
2005/06 for all commissioning budgets. In January 2005, a decision was taken to
restrict PbR to elective activity in 2005/06 and delay the implementation of PbR
for non elective activity, e.g. outpatient services and emergency inpatients to
There was serious concern nationally that with the introduction of a new funding
mechanism for acute services, the instability in relation to emergency activity
could increase the financial risks in the NHS in the first year of a change in the
3.2 National Tariff
For 2005/06, a national approach has been adopted for funding generic costs on
all service level agreements, which follows from the national tariff approach that
was introduced for Foundation Trusts in 2004/05.
“Reforming NHS Financial Flows introducing Payment by Results. October 2002. This
represents a fundamental change in the way that funds flow through the NHS. Payment is now
linked to activity and adjusted for casemix.
The National Tariff: A nationally agreed set of prices for hospital activity.
The following cost pressures are covered by the national tariff.
% % %
Pay Inflation – to cover the cost of the pay award 2.8
of 3.225% for all staff excluding medical and dental
Non-pay inflation 0.7
Secondary care drugs 0.4
Revenue cost of capital schemes 0.2
Clinical Negligence 0.1
Reform and Quality
Consultant Contract and Junior Doctors Contract 0.4
Agenda for Change 1.0
NICE developments/appraisals 0.7
Investment in new Capital 0.4
Additional costs of Consultant Contracts that arose in 0.44
Efficiency Savings (1.70)
In relation to efficiency savings, all Trusts are required to secure a minimum
1.7% cash releasing efficiency saving. In addition there is an expectation that
PCTs should seek a further 1.0% efficiency saving either from increased activity
or quality, or by obtaining further cash releasing savings from providers.
3.3 Sources and Application of Funds
The schedule below shows a summary analysis of the PCT’s proposed sources
and application of funds for 2005/06.
Application of Funds £m
Cost of generic uplift in respect of services commissioned 18.324
by the PCT
University Hospital Lewisham (UHL)
Additional funding to meet the cost of the level of emergency
Guys & St Thomas
Additional resources to fund activity increases resulting from 1.500
developments in renal and cancer services.
Other Acute Providers
Outturn pressures on non-local acute SLAs, which are
estimated to cost the PCT an additional sum 0.700
South London and Maudsley NHS Trust
The PCT has set aside a further £750,000 to meet the cost 0.750
of developments in mental health.
Physical Disability and Older Adult Services
The PCT is facing additional pressures in meeting the costs 0.470
of placements in these services.
The PCT has set aside monies to meet the cost of the new 1.740
Pharmacy contract and inflation on drugs.
The PCT has set aside a further sum to fund the costs of 0.440
meeting the enhanced services target.
Local Development Plan Investments
The full year cost of investments commenced in 2004/2005 1.100
will cost the PCT an additional sum.
Connecting for Health £m
The PCT is required to make additional contribution to I.T. 0.550
developments within the LSL Care Community of
Applications identified 29.074
Additional funding 2005/2006 26.132
Shortfall in funding gap 2.942
3.4 Financial Gap
In producing the 2005/06 revenue budget, this report has identified a large
number of risks and uncertainties.
Based on the latest information the PCT is facing a shortfall of £2.942m at
Revenue Resource limit 382,101
Revenue Budget 385,043
Financial Gap 2,942
The PCT is facing a difficult and challenging financial scenario in 2005/06, and
the financial pressures are substantial. Work is required to reduce the revenue
gap of £2.9m without reducing the effectiveness of existing services. We have
set up an internal group chaired by the Chief Executive to identify measures for
bringing the PCT into recurrent balance with the target of saving £5m over the
next two years.
Section 4: Our Plans for 2005/06
This section sets out our plans for 2005/06. It sets out our activities within the
themes outlined in the Commissioning and Choice Strategy – the PCT’s five-year
strategic plan for improving and modernising local health services in Lewisham.
There are a number of key health facts about our local population, which inform
our plans and which enable us to make sure we target areas of real need.
Lewisham has a high level of premature mortality for a wide range of
conditions in people below the age of 75 years.
19% of all deaths in Lewisham are smoking related. This results in a higher
morbidity for cancer, circulatory diseases and respiratory illnesses.
Lewisham has an ethnically diverse population and some ethnic groups have
increased needs for services to tackle specific diseases, such as sickle cell,
diabetes, renal disease and stroke, HIV and AIDs and communicable
diseases like tuberculosis and Malaria.
Lewisham has a high infant mortality rate.
There is low uptake by older children of childhood immunisation programmes.
Lewisham has higher mental health needs than other areas across the
4.1. Health Inequalities and Prevention
What we will do
The PCT will concentrate on the six health priorities in “Choosing Health –
Making healthier choices easier”, which outlines the key steps required to help
people make healthy choices and reduce health inequalities. The six priorities
Mental health and well-being
Reducing harm and encouraging sensible drinking
Health inequalities in Lewisham will be tackled in four main ways:
A series of 12 equity audits in sexual health, teenage conceptions, mental
health, heart failure, diabetes, community development, domestic
violence, infant mortality, learning disability, smoking, nutrition and
Three health inequality Local Public Service Agreements for infant
mortality, teenage conceptions and smoking
The community development strategy: Health Action Plan for Health
Development of a comprehensive Race Equality Scheme
Choosing Health, health promotion and health improvement will be delivered in
three main ways:
Lewisham “Choosing Health” White Paper Neighbourhood Delivery Plans
Lewisham Health Promotion Strategy
Local Preventative Strategy and the National Service Frameworks.
The PCT will not be working alone. It will work as a key member of the Local
Strategic Partnership (LSP) and with other local agencies in Lewisham. One
important method for working in partnership will be the development of Local
Area Agreements. These are cross government and multi-agency delivery
agreements in four areas (Healthier Communities and People, Children & Young
People, Environment and Transport and Safer, Stronger Communities). This will
imbed the principles of reducing health inequalities and moving from treatment
towards preventative approaches in the way health services are commissioned.
Specific actions include:
The development of local neighbourhood action plans through the
Professional Executive Committee and the PCT’s neighbourhoods for
targeted “white paper” implementation.
The use of local area agreements and a community development approach to
imbed health inequalities and health improvement within local community
planning and commissioning.
Health equity audits linking to mainstream joint commissioning.
The delivery of the three health inequalities Local Public Service Agreement
(LPSA) targets for infant mortality, teenage conception and smoking.
The production of an action plan for developing race equality performance
targets with local contractors.
A review of the PCT’s ethnic monitoring action plan in line with the London
Planning and Priorities guidance on ethnic monitoring.
How we will measure progress
Steady progress towards meeting local smoking cessation and teenage
conception, life expectancy and infant mortality targets.
Delivery of three equity audits that inform commissioning of services.
Delivery of the three health inequalities local public service agreement
Measure the increase in preventative care using evidence from local
neighbourhood clinical practices.
By measuring the PCT’s progress towards achieving Stage 3 of the Race
Equality Performance Framework.
Front line staff who, due to high workloads concentrate more on managing ill
health rather than prevention and health improvement strategies;
Evaluation is not possible due to poor quality data;
Delays in clinical engagement due to planned changes in service and role
designs that will need to take place to deliver the reforms.
Unable to produce high quality ethnicity data to assess need and measure
4.2 Managing Long-Term Conditions
What we will do
The PCT together with social care, will develop more responsive and co-
ordinated services in the community to enable self-management by people with
long-term conditions, starting with diabetes, coronary heart disease and chronic
obstructive pulmonary disease (COPD). The outcomes of this will be better
quality of life, greater patient satisfaction and reduced emergency hospital
attendances and admissions, allowing better use of scarce NHS resources. This
work will build on the progress made last year in building workforce capacity in
the community and developing new community nursing and support roles to
begin to transform the management of these conditions.
This priority has three dimensions:
To enhance the capacity and integration at neighbourhood level of core
community and primary care services, such as district nursing, intermediate
care, primary care and pharmacy services.
To develop Practice Based Commissioning to support and improve
information systems to enable more timely analysis of patient flows across
clinical pathways and appraisal of unscheduled and urgent care in acute
Undertaking urgent tasks in the following areas:
Evaluating success and impact of existing managing demand projects.
Defining hospital and community activity and outcome measures and
establishing data capture and analysis systems.
Understanding public and user behaviour in seeking care.
Rigorous project management approach to all development activity.
Early implementation of planned changes for urgent care.
How we will measure progress
A reduction in the number of A&E attendances of Lewisham GP registered
patients from the 2004-05 baseline.
A reduction in the number of emergency admissions of Lewisham GP
registered patients from the 2004/05 baseline.
The development of appropriate patient pathways and services particularly
concentrating on long-term conditions and intermediate care services.
Increased attendances of patients at the New Cross NHS Walk in Centre from
31 March 2005 baseline.
The PCT remains unable to systematically measure the impact of changes
Clinician engagement in changing practice.
Poor quality information and data could impact on the PCT’s ability to
Financial constraints to implement the planned changes in all areas.
Delays in implementing new and enhanced roles because of time lag for
training and preparation of staff to undertake the redesigned / new roles and
lack of flexibility of Colleges of Education to respond to special training needs
outside of the college timetable.
It is patients’ choice to attend A&E rather than primary and community based
4.3 Public and Patient Involvement
What we will do
The PCT will undertake a range of initiatives this year to continue to engage with
the Patient’s Forum and a broad range of users and community groups in order
to influence the way services are commissioned, planned and delivered in the
The PCT will:
Work in partnership with the public and patients to develop materials and
protocols to assist in the choice process.
Ensure a meaningful Public and Patient Involvement process informs the
PCT’s planning process, in particular the Local Delivery Planning process.
Develop action plans for improvement around the key messages coming from
the 2003/04 Patient’s Survey.
Involve the public and patients in designing health services in Lewisham.
Assist and encourage GP practices to involve patients in the Practice Based
Implement the targets set out in the Community Development Strategy,
including co-ordinating and performing joint consultation.
Roll out the Expert Patient Programme to assist patients with long-term
conditions to take control in self-management; for example developing the
patient passport for Chronic Obstructive Airways Disease.
How we will measure progress
By the production of an information set for patients.
The results of the 2004/05 Patient’s Survey.
The level of involvement with children and Children First Lewisham in the
further development of the interior of the new Children and Young People’s
The number of joint consultations over the next 12 months.
The number of programmes delivered to support patients with long-term
Unable to develop the appropriate strategies to engage public and patients
given the complexity of guidance for Practice Based Commissioning,
Payment by Results and Choice.
Lack of public interest or understanding of services outside of hospital.
Lack of GP Practice resources to support effective involvement in Practice
4.4 Quality and Choice
What we will do
The PCT plans to offer choice at the point of referral across the year so that
by December 2005, all patients are offered a choice of 4 to 5 hospitals. In
order to do this we will need to empower people to make informed choices
and work will be carried out with the Patient’s Forum and other user and
community groups to develop a framework to support informed choice.
To work to achieve the standards set out in the National Service Frameworks
for Cancer, CHD, Older People, Children, Mental Health, Diabetes and Renal
Continuing the implementation of the Clinical Governance Strategy and
clinical audits to improve quality.
Practices will be supported to achieve the requirements of the Quality and
Establish Sentinal reporting for clinical incidents, ensuring learning takes
place within the organisation in line with the Department of Health’s “Fair
Blame” (solutions based) approach.
To develop a managed pathway for elective care, to achieve a six month
waiting time by December and a maximum three month wait by December
We will implement “Essence of Care” which promotes good practice and
identifies areas of improvement within community and primary care services.
Linking with UHL benchmarks will be completed across primary and
secondary care in order to improve the patient journey and promote a
seamless service. The target benchmarks this year will be continence and
bladder and bowel care and pressure ulcers.
How we will measure progress
Implementation of electronic booking in General Practice.
Achievement of the Choose and Book national targets.
Delivery of milestones within the National Service Frameworks.
The PCT’s submission to the Healthcare Commission against the Core
Increased number of consultations / procedures undertaken in primary care.
Meeting the national waiting time and access targets.
Monitoring through the Sentinal system clinical incidents and defining learning
as result of incidents.
Action plans completed for the privacy and dignity benchmark.
Achieving the six month waiting time target for elective care by December
Clinical engagement in e-booking.
Delays in the availability of electronic booking software from NHS Connecting
for Health (CfH).
Pace of delivery in establishing GPs with special interests (GPSIs) and
practitioners with special interests (PWSIs).
4.5 Better Services: New Ways of Working
The challenge for the PCT is to manage urgent and emergency demand through
continuing to enhance the capacity and integration of core community and
primary care services in neighbourhoods, developing Practice Based
Commissioning and improving information systems. Following the completion of
a multi-stakeholder exercise to identify a future system of urgent and emergency
health and social care across Lewisham (the Matrix report), an urgent care
programme will be undertaken this year. The programme will be expected to
make a significant break-through in reversing patient flows to hospital. The
system will deliver access targets, is consistent with our strategic objectives and
will inform UHL’s outline business case for a new A&E Department and feed into
their strategic review.
What we will do
Workforce development and the continued implementation of new contracts
for Consultants, GPs and Agenda for Change and the coming changes in new
contracts for pharmacists, optometrists and dentists.
Implement the Modernisation Agency’s 10 high impact changes. (These are
attached at Appendix E).
Continue to achieve national targets for access and manage service demand
and clinical pathways.
Rollout the new Care Records Service with the NHS Connecting for Health
Develop integrated children’s services and pooled budgets.
The development of community based services, for example phlebotomy and
anticoagulation services, to offer more choice and better access to patients to
Increase the number of non-medical prescribers.
Use local health intelligence to ensure mainstream services are delivered in a
way that recognises the diversity of Lewisham’s population.
How we will measure progress
Through the introduction of the new pharmacy contract.
Through upgrading IT equipment in community services and implementing to
timetable the rollout of the initial Care Records Service.
Blood taking waiting times to be reduced to less than 90 minutes.
Evaluation of the pilot community anticoagulation clinic.
Through an action plan within the PCT’s Race Equality Scheme to ensure
equality in service delivery.
Financial constraints for upgrading IT equipment in the community
Lack of organisational capacity in Neighbourhoods to effectively take on
secondary care services without appropriate resources and manage the
associated clinical risks.
Lack of resources to develop the knowledge and capacity of health
professionals to deliver a culturally competent health service.
4.6 Partnership Working
We believe that partnership working with all local stakeholders is integral to
delivering high quality health and social care services to the local population.
This year there are two main areas of Borough and PCT integration underway
which will lead to better working and more seamless care for residents. The PCT
has agreed to lead the strategic commissioning of adult health and social care;
and the Borough is leading on the strategic commissioning of Children’s services
as part of the new Children Act. These new arrangements for adults and children
now give a clearer relationship with the Local Strategic Partnership (LSP).
Partnership working between the PCT and UHL is essential to the future stability
of healthcare in Lewisham. Most of UHL’s work is for Lewisham residents and
therefore commissioned and funded by the PCT. UHL faces multiple challenges
this year including a significant financial deficit, under performance of access
targets, the building of a new ward block and preparation of a case for a new
What we will do
This year the PCT will:
Work with the London Borough of Lewisham to establish a joint planning
process for adult health and social care and children’s services.
Establish the Joint Commissioning Unit and the supporting Joint
Support UHL in the management of their recovery plan and in their
strategic review to secure a viable future acute hospital for Lewisham
How we will measure progress
Production of a joint service development and finance plan for 2006/07.
The new governance arrangements implemented for adult health and
The Units fully operational and staffing establishment completed.
The number of new Section 31 arrangements agreed in 2005/06.
Agreed vision for the future of UHL.
Delay in implementation of the new arrangements for Children’s services
and adult services may divert attention from achieving key targets;
Communicating the integration arrangements effectively to staff;
Achieving a satisfactory organisational development plan.
Insufficient management capacity to lead effective strategic review
processes for future hospitals across South East London and in
Progress on improving health and developing primary care is delayed by
unstable hospitals and partnership relationships are damaged.
4.7 Mechanisms for Enabling Change
This year Payment by Results (PbR) will be restricted to elective (booked) activity
only. This means that during the year, the PCT will work to develop the systems
that will enable full rollout of PbR in future years. For Practice Based
Commissioning, the devolving of commissioning resources to some
neighbourhoods will enable clinicians in primary care to have responsibility for
budgets to commission services for their patients.
The year will also see the rollout of Agenda for Change across all non-medical
staff in the PCT. This is the final new contract to be implemented and it follows
the nGMS Contract and Consultant’s Contract implementation last year. Its
implementation will demand intensive work from staff and all managers.
What we will do
Further rollout of the system of Payment by Results.
Develop good and timely information processes so that activity and other
information to support both Payment by Results and Practice Based
The new contracts will continue to be vehicles for change and not only pay,
for example implementing the pharmacy and dental contracts, and the
preparatory work for the new Optometry contract;
The roll-out of Practice Based Commissioning within neighbourhoods;
Agenda for Change supported by redesigning roles of community staff;
How we will measure progress
Information is provided to analyse activity and patient flows;
The Quality and Outcomes Framework will show whether practices are
maintaining or increasing achievement;
Through achieving the Agenda for Change targets by October 2005;
Staff satisfaction through the Staff Survey.
Staff engagement in Agenda for Change;
The ability of providers to develop information systems to support Payment by
Results and Practice Based Commissioning.
4.8 Additional Priorities for Action
The implementation of new contracts for staff under Agenda for Change is the
major focus this year. Coupled with this will be the benefits realisation work
required as part of the modernisation agenda, which will define the improved
service provision expected from the implementation of Agenda for Change. As
part of this process and to support Board level and management decision-
making, workforce information will be developed and refined in order to better
understand workforce demographics and to support recruitment and retention.
The PCT received IWL Practice status in 2003 and is now working towards
“Practice Plus”. As part of this process the PCT will be assessed across a
number of areas including our Human Resources Strategy, equalities and
diversity policies and learning and development.
We will continue to consult with staff and listen to their views on working in the
PCT. Our consultations to date have shown two major areas of concern for staff
– car parking in the Borough for community clinical staff, such as district nurses,
health visitors and occupational therapists as they carry out their duties and
access to computers for all community based staff. The PCT will be working to
solve these concerns over the year.
Management Team – Fitness for Purpose
Last year, there were major changes in the senior management team, which
were smoothly handled. In order to maintain performance, continue to develop
services and provide the business focus required to achieve best value from our
resources, the PCT needs to be certain it has the management capacity to
deliver. We will review our current management functions to obtain the best fit, in
terms of resources and roles, to meet the challenges and large agenda facing the
PCT. These include performance management, keeping within resources and
meeting the Gershon targets6 of 2.7% efficiency.
As part of Gershon, we will be undertaking a review of the most effective
methods of providing support services together with Lambeth and Southwark
PCTs. This review is likely to have an impact on the future of the South East
London Shared Services Partnership7 (SELSSP).
Gerson Review is a government efficiency review covering all public services. Targets have
been set for all government departments, and the NHS has been set an efficiency target of 2.7%
across the NHS in 2005/06.
SELSSP – A shared services agency for Lambeth, Southwark and Lewisham PCTs, hosted by
Lewisham PCT and providing services including Payroll, Recruitment and ICT.
There is growing public concern about MRSA infections in hospital. We are
awaiting the government’s target on MRSA, and we will work closely with UHL to
reduce MRSA infections and develop effective strategies to reduce the incidence
of hospital bound infections.
NHS Connecting for Health
The National Programme for IT now known as “NHS Connecting for Health” is a
national programme to develop and implement the NHS Care Records Service
(CRS). The PCT is working towards implementing the CRS and will support
community and primary care services by improving IT infrastructure and
developing skills through training, to prepare for the implementation of new
systems and applications. This year, the PCT will be rolling-out the electronic
booking system in general practice and identifying community based services to
pilot initial CRS.
LIFT8 and Other Capital Developments
The Lambeth Southwark and Lewisham LIFT programme will move to financial
close this summer. This means that the Lewisham LIFT development to build a
new primary care resource centre on the old Waldron Health Centre site can
progress. As the next stage the LIFT Strategic Partnering Board will develop a
Strategic Service Development Plan to identify future developments to support
service provision and demand in Lambeth, Southwark and Lewisham.
The PCT is working to develop a range of other capital developments this year.
These include the new Children’s and Young People’s Centre which will be
completed in June 2006, a range of new surgeries and modernisation projects in
primary care and participation with the London Borough of Lewisham in the
Downham project to develop a lifestyle centre combining community and health
LIFT – “Local Improvement Finance Trust”
The PCT is entering a new phase of its development. The biggest challenge the
PCT faces this year is to reduce the current flows of emergency and urgent
demand into the acute care system. This reduction is essential if we are to
achieve a better quality range of urgent care service choices across Lewisham
and enable the PCT to maintain financial balance.
The devolution of responsibility for commissioning to primary care providers
(Practice Based Commissioning) will give new opportunities to improve
responsiveness, quality and value for money for services. The new local
commissioners will be working with the PCT and hospitals to deliver the new
elective inpatient wait target of six months by 2006. This is on the way to the
2008 target of three months from GP referral to inpatient treatment. This new
patient pathway will transform patient experience of the NHS.
The success of the public health White Paper, Choosing Health, depends on
working with the local community so that people are more engaged in promoting
and adopting healthy lifestyles.
There will be new opportunities for much closer working with local communities in
planning what is needed to maximise the value of NHS resources.
The PCT has started a new phase in the level of integration with LBL of planning
and delivering health and community well-being services for children and adults.
We need to consolidate the break-throughs we have made and demonstrate
improved outcomes for the public. Linking the use of resources between
agencies will be an important part of this.
The PCT will help to identify and promote new leaders and create an
environment to work more closely with local communities. Good relationships
between the statutory, voluntary and community sectors will continue to be
critical for us to achieve improved health outcomes for the people of Lewisham.