PPCT Comm Eye Care Clinic Service spec v17 9th Mar by 0xr79J


									                                    SERVICE SPECIFICATION

Service                            Community Cataract Clinic
Commissioner Lead                  Julie Hall, Primary Care Commissioning and Development Manager
Provider Lead

1. Purpose

The purpose of this document is to set out the requirements for a Community Eye Care Clinic, which will operate
as an alternative to hospital based treatment.

This plan was developed to satisfy both national and local priorities in developing community based services as an
alternative to hospital based services, and in reducing outpatient activity in secondary care settings.

1.1 Aims
    The aims of this service are as follows:
        Provide suitable treatment, for cataract surgery, in a community setting.
        Improved patient choice.
        Reduction in waiting times for assessment in line with the 18 week referral to treatment targets.
        To improve communication and smooth the patient journey between specialist and primary care.
        To provide better value for money due to a more cost effective use of resources.
        A reduction in the number of times patients have to attend secondary care.
        To improve patient satisfaction through delivering a quick, accessible and quality service.
        To improve the education of patients around self-management of their conditions.
        To improve the quality of GP referrals and the management of cataracts.
        To encourage new providers into the market place.
        To develop a choice of eye care services over the next three years to increase the range of care

1.2 Evidence Base
     The following information shows the activity volumes of cataracts procedure for NHS Peterborough and NHS
     Cambridgeshire for the period April 2010 to March 2011.

                                           Number of Procedures
 Month                                     2007/2008   2008/2009         2009/2010    2010/2011
 April                                              86         116              78             63
 May                                               116          88              75             87
 June                                               92          94              95             79
 July                                               93         117              62             67
 August                                            110          78              86             51
 September                                          85         114              85
 October                                            90          56              70
 November                                           89          85              87
 December                                           96          52              83
 January                                           100          83              82
 February                                          115          72              64
 March                                              84          82              76
 Grand Total                                     1,156       1,037             943             347
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       The NHS environment is changing with Care Closer to Home being a choice for patients. The Department of
       Health White Paper January 2006 Our Health, Our Care, Our Say: a new direction for community services
       plans to give patient’s access to services within the community they may have found difficult to access
       previously. Primary Care Commissioning developed the Model Eye Care Enhanced Services Contract 9th
       February 2010, to use alongside the Commissioners toolkit to assist PCT’s to negotiate contracts locally and to
       assist in developing and delivering care closer to home. GP Commissioners have the opportunity to improve
       services and select new providers to improve patient pathways.

       This initiative will enable Commissioners to achieve Government targets by offering a service compliant with the
       most recent directives.

         Care Closer to Home

        Patients will have access to a Consultant Based Community Cataract Service. Accessed via Choose and
         Book or paper referrals.

        The patients will have continuity of care, seeing the same Consultant throughout their experience.

        Surgery will be performed by the Consultants at the health centre in accordance with the 18 Week Wait (WW),
         Referral To Treatment (RTT)

        Routine patients will be seen within 12 to 18 weeks

        Where it is clinically appropriate treatment will be expedited.

        Sustained performance against the 18WW

        Anticipation of the growth of the elderly population within Peterborough over the next 10 years. 2001 census,
         19% of the 160k population in Peterborough are 60+ with a forecast population increasing from 2007-2021
         age 65-74 by 60% 75-84 by 39% and 85+ by 81% http://www.peterborough.gov.uk/pdf/community-

        Anticipation of the service needs creating capacity to meet the demands of forecasted growth and increased
         demand for eye care services, within the current resources.

        If the service is not provided, the pressure for existing providers to meet national NHS 18 week targets could
         potentially be at risk of being compromised. In view of the forecast increase in the elderly population within the
         Eastern area.

        Commissioning Quality and Innovative (CQUIN) services in line with Department of Health guidance.

1.3 General Overview

       The service will operate in an NHS Peterborough community based setting. The following practices; Bretton
       Medical Practice Rightwell East, Bretton, Peterborough Cambs PE3 8DT and Thistlmoor Medical Centre, 6-8
       Thistlemoor Road Peterborough Cambs PE1 3HP have indicated an interest in hosting the service and may be
       approached directly to provide the premises for the service.

       The City Care Centre St Johns Close Thorpe Road Peterborough PE3 6DB will require an approach being made
       to NHS Peterborough PCT.

1.4 Objectives

       To provide a high quality, cost effective service to NHS Peterborough GP Practices and border GP Practices

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        Implementation of this service will meet the following National and local objectives:

         Care Closer to Home (Our Health, Our Care, Our Say)

     This proposal will bring diagnostic and treatment services out of the acute sector and into the community.
     This will release activity from the main hospital site and move it so that it is closer and more convenient
     to the patient.

• Access / choice

          At present patients have little choice as to where they wish to go if they need access to specialist advice.

• 18 week wait

          This service will support the organisations 18 week care pathway for cataract surgery. This will therefore ease
          the pressure on hospital services by eliminating a number of referrals.

• Patient / user experience

          Patient experience is a very important monitored component to this service and patient views expressed
          through experience questionnaires will be taken seriously. Providers will need to demonstrate commitment in
          modifying services as a result of patient feedback and will utilise this previous experience when delivering
          the new cataract service. Results from patient surveys will be used to ensure that the service is adapted
          wherever necessary to provide the best possible patient experience. The surveys will incorporate the whole
          patient experience from triage to patient booking; location convenience and facilities to clinician feedback. The
          format will be agreed by the commissioner and will include questions relating to preferential access times.
          Surveys would therefore need to reflect questions regarding the hours of service required. The survey should
          be available in other formats/languages if required, including different font sizes for intended audience.
          Regarding the questionnaires, the onus will be on the provider to liaise with Peterborough Primary Care Trust
          for agreement in process/questions asked.

• GP Commissioning

          This proposal is an ideal GP Commissioning scheme, as it will deliver on the aims of providing a good
          quality local service which represents value for money. It should prevent sufficient secondary care
          funding to pay for the cost of setting the service up as a minimum. The service will also take feedback
          from GP Commissioners to improve the care delivered to patients. GPs will also have access to locally
          known and respected ophthalmic expert advice, education and support. GPs can request to spend time
          in the service in order to update skills.

1.5 Expected Outcomes

          The community specialist service will:

          Ensure that all patient records will be maintained and secured in line with National guidance and local
          policies (for example, data protection act, confidentiality, Caldicott guidelines etc). Providers will work with
          the Trust’s IM&T Team to ensure the service is compliant.
          Submit the outcome of the appointment and / or treatment plan to the patient’s GP, 100% within 48hours .
          GPs will have a copy of the surgical threshold list.

    Submit the following information to clusters and Practice Based Commissioners (on request) and the
    Trust on a monthly basis:
     The number of referrals received and referral source
     Number of inappropriate referrals
     Number of new outpatients, by practice
     Number of follow up outpatients, by practice, clearly showing when they occur in relation to any procedure
     Number of patients referred to secondary care, by practice
     Number of patients discharged back to Primary Care, by practice and reason for discharge
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       Details of procedures / interventions undertaken, by practice
       Details of cancellation rates within 5 days of outpatient or surgery
       The DNA rate for appointments
       Average waiting time for new outpatients, procedures and follow up outpatients
       Ethnic monitoring
       Transfer of activity from secondary care setting to the community
       Reduction in health inequalities by improving access to the service.

        Patient satisfaction surveys will also be undertaken on a monthly basis initially as the service expands,
        then three monthly thereafter, with key outcomes being fed back to Commissioners. The patient surveys must
        be 80% positive. (80% includes good, very good and excellent)

        The number nature and outcome of all complaints

        The following specific clinical data will also be made available on a quarterly

        Numbers of onward referrals to secondary care consultants or optometrists.

        Number of patients referred per 1,000 pop per annum versus national rates

        During the Provider selection phase the Commissioner will agree a set of clinic metrics to be monitored.
        These will include infection rates and outcome measures.

2. Scope

2.1 Service Description

Patients will receive cataract surgery in a community setting.

Referrals from GPs will be triaged by the Provider with patients referred back to Primary Care if
necessary, or treated within the community service.

The provider will supply and maintain all equipment which will meet the National Guidance recommendations
for the equipment used.

The ITT system will be SystmOne integrated with Choose and Book.

An effective community eye service will:-
     Be staffed by a team of expert professionals who work as a co-ordinated team;
     Support the person, their family and carers to contribute to their assessment and treatment plan.

The service will be expected to work in ways which are sensitive to social, cultural and spiritual requirements of
each patient and their carers. This will include access to translation and interpreting services where appropriate,
avoiding the use of friends and relatives.

       Training/Education – Impart knowledge to providers on an annual or 2 yearly basis. This can be done by a uate
        Post Graduate Centre or local Education Forum.

2.2 Accessibility/acceptability

        The service will see any patients who are registered with the NHS Peterborough and border practices which who
        require cataract surgery, as long as they meet the surgical threshold requirements (Appendix A).

        The following exclusions will apply:
            Patients less than 18 years of age (refer to secondary care)
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              Urgent conditions (refer to secondary care) except those cases which are a result of procedures carried out
               by the provider.
              Patients who are not registered with a NHS Peterborough or borders GP practice
              Patients who have been under the care of a secondary care consultant for less than 6 months
               (these will be accepted once they are stabilised after six months treatment)
              Diabetic retinopathy.

2.3 Whole System Relationships

       Key relationships will include primary and secondary care, social care and the voluntary sector. Links
       will need to be made to both in-hours and out-of-hours services where appropriate.

       The service will be well co-ordinated and flexible to ensure that service users and carers receive
       efficient and effective delivery of services.

       The service will link with the patients own GP, and accurate, timely communication will be expected
       between providers and GP’S. This will include a letter as the appointment time and relevant information.
       Similar communication will be maintained with the patient, and each patient treated by the service will
       be informed at each stage of what will happen during the treatment pathway.

2.4 Interdependencies

       The service will rely on building activity to the planned capacity levels, and as such will be
       dependent on referring clinicians being aware of the service and the appropriate patients to be referred
       into the service. Providers will market the service sufficiently to build this knowledge and awareness.

       The Provider will be expected to establish positive working relationships with other local providers to ensure that
       patients receive a comprehensive service, but also to ensure that clinical governance and education and
       development activities take place across the whole system.

2.5 Relevant networks and screening programmes

       Providers will ensure that all GPs within the boundaries of the service are aware of the service itself and
       of the referral mechanisms for referring patients into the service.

       The following considerations need to be in place prior to the service commencing:

              All clinicians, nurses and administrative staff complete a full induction and are conversant with the
               relevant services, policies and operational procedures
              Provide evidence of the competency of all staff in the clinical conditions included in this service
               specification, including working with vulnerable adults.
              Ensure CRB checks are conducted and professional registration is in place.
              Ensure that staff comply with the standards of conduct of their relevant regulatory body.
              Ensure the availability of suitably qualified staff to meet the maximum waiting time and for
               demonstrating their ability to deliver the service.
              Determine whether the personnel providing the service through the contract have appropriate
               personal indemnity cover to meet, in full, claims made against them as individuals. Providers must
               have such personal indemnity cover. Proof of cover of the provider must be submitted to the
              Ensure that managers and employees receive appropriate training and guidance in respect of
               equality and diversity and in particular the application in recruitment and selection. Equality and
               diversity should be included in the induction training for all new staff.
              There must be a complaints procedure in place.
              Patient satisfaction surveys must be completed.
              Prescribing requirements must be arranged through the Trust’s Medicines Management Team.

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2.6 Sub-contractors

        Providers may not sub-contract any part of the service.

3. Service Delivery

3.1 Service model

The commissioner is open to other suggestions

A referred patient shall only be counted once for the purposes of any part of the service, from referral for assessment
or treatment, to discharge, where the service provided is deemed to be part of a completed continuum of care. This
continuum shall be described as a ‘spell’.

Any patient routinely referred to and accepted by the Provider that cannot be satisfactorily treated in
the community service is referred to secondary care. No charge is raised by the Provider for the visit.

During the evaluation process the commissioners will focus on the clinical quality, effectiveness and clarity proposed by the
providers care pathway.

3.2 Care Pathways

Care plans will be individual to reflect each persons needs.

The aims of care planning and care co-ordination, which all providers will be expected to deliver are to:

       Ensure access to a comprehensive range of services
       Ensure the co-ordination of care across all agencies involved with the patient
       Ensure that there is continuity of care and that patients are followed throughout their contact with the
        treatment system
       Avoid duplication of assessment and interventions
       Prevent patients falling between services

Post operative patients will be given an emergency phone number and written instructions on how to contact the
service for advice. This is a 24 hour service covering weekends and bank holidays. The patient will be contacted 24
hours post-operatively to ensure that they have no concerns about their condition.

The provider will need to ensure that serious complications are covered by referral direct to secondary care, which will
need to be evidenced at submission using a relevant significant event form.

Patient information literature will be available relevant to patient needs.

The service will have an agreed supervision structure. Annual appraisal must be in place. Induction training must be in
place for new staff. Team composition will not be dictated by NHS Peterborough; however the provider will be
expected to have in place staff with the skills and competence in line with national requirements.

3.3 Workforce

The Service Provider MUST demonstrate that they use clinical staff of appropriate levels of skills and training to
perform cataract surgery/follow-up.

Clear policies on staff accreditation and registration in line with national guidance must be demonstrated and adhered
to along with staffing requirements as set out by the Royal College of Ophthalmologists. The service provider will

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       An enhanced level of knowledge and skills
       Good communication skills
       Competence in teaching and training health care professionals
       Commitment to cascade knowledge and skills.
        Further details concerning workforce requirements are included within the Quality section below on page 9.

4. Referral, Access and Acceptance Criteria

      Patients requiring cataract surgery will be referred by their own GP to the service.
  4.1 Geographic coverage/boundaries

       The service will accept referrals from general practitioners and allied health professions from across the NHS
       Peterborough area and border practices.

  4.2 Geographic coverage/boundaries

  Patients registered with GPs in NHS Peterborough and border practices.
       Ailsworth Medical Centre
       Alma Road Primary Care Centre
       Botolph Bridge Community Health Centre
       Bretton Medical Practice
       Burghley Road Surgery
       Orton Bushfield Medical Practice
       Dogsthorpe Medical Centre
       The Grange Medical Centre
       Hampton Health
       Hodgson Medical Centre
       Huntly Grove Practice
       63 Lincoln Road Surgery
       Millfield Medical Centre
       Minster Medical Practice
       Nene Valley Medical Practice
       North Street Medical Practice
       Old Fletton Medical Practice
       Orton Medical Practice
       Park Medical Centre
       Parnwell Medical Centre
       Paston Health Centre
       Thistlemoor Medical Centre
       The Thomas Walker Surgery
       Thorney Medical Practice
       Thorpe Road Surgery
       Welland Medical Practice
       Westgate Surgery
       Westwood Clinic
       Regional Medical Centre, RAF Wittering
  Border Practices
       The New Queen Street Surgery, Whittlesey
       Jenner Health Centre, Whittlesey
       Yaxley Group Practice, Yaxley

As GP commissioning develops it is foreseen that Welland commissioning group (part of NHS Lincolnshire)
will join with NHS Peterborough and Borderline commissioning groups. This Specification will allow for all

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Welland practices to be part of this AWP contract in the future.
 4.3 Location(s) of Service Delivery

      The Provider will ensure that all relevant quality standards are adhered to in the delivery of the commissioned
      service, particularly with reference to infection control.

      The service can operate from the following sites:

             Bretton Medical Practice Rightwell East, Bretton Peterborough Cambs PE3 8DT
             City Care Centre St Johns Thorpe Road Peterborough PE3 6DB
             Thistlmoor Medical Centre 6-8 Thistlemoor Road Peterborough Cambs PE1 3HPThistlemoor Road

      in line with care closer to the patients home

      Locations of site should be accessible to public transport and parking facilities.

      Existing sites should be utilised where possible. Sites that are not currently used for NHS service delivery
      must demonstrate compliance with all the relevant building regulations, DDA compliance and must be fit for
      purpose, clean and comfortable. Premises must meet general health and safety requirements.

      The Provider will be responsible for ensuring CQC accreditation of the services and the facility.

      Carbon Reduction

      The provider organisation will meet the requirements of the provider checklist for commissioners document:
      ‘Commissioning for Sustainable Development’ which can be found at:

      www.sdu.nhs.uk/page.php?page id=167

  4.4 Days/Hours of operation

      The service will be available initially across the range of a working week; however it will have the adaptability
      to change the appointments outside of these hours if there is a demand. Patient feedback will be monitored to
      identify whether there is a demand to provide appointments outside of these core hours.

  4.5 Referral criteria & sources

      Referrals will be made by GPs direct using Choose and Book or a paper referral to the service. Referrals will
      be screened on receipt and inappropriate referrals will be returned to the originating GP, with accompanying
      reasons. If a referral to secondary care is required it should be requested by the referring GP.

Case-mix and Referral Criteria

  4.6 Referral route

      Referral into the service will be by letter, which will be sent either by post or via secure email (from / to
      nhs.net email accounts) or by Choose and Book.

      Patients will be referred from primary or secondary care.

      If a referral was made to the community service and was deemed to be of a secondary care nature, the
      provider should send the referral on to secondary care. Information should also be sent to the referring GP
      with information advising of the onward referral and the reasons why.

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  4.7 Exclusion criteria

     Services not specifically stated as part of this specification are excluded from this schedule. Any services
     provided outside the Terms of Agreement must have NHS Peterborough’s specific consent in advance. NHS
     Peterborough will not pay for any activity not so authorised.

     The service will not treat –
      Patients under the age of 18
      Treatment that should be provided under a standard GMS or PMS contract
      2 week cancer referrals
      Diabetic retinopathy
      Patients who are unable to give informed consent, unless accompanied by a responsible carer
      Patients who are systemically unwell (Fever, malaise, rigors).

  4.8 Response time & detail and prioritisation

     Once a referral has been sent to the service, the service will triage the referral within 3 working days.

     Referrals should be managed within the 18 WW RTT ,,routine patients will be seen within 12 to 18 weeks,
     where it is clinically appropriate treatment can be experdited,
     all patients should routinely have a minimum of 3 weeks notice of their appointment.

     A letter detailing the diagnosis, treatment, prognosis and any other supporting advice will be returned to the GP
     100% within 48hrs of discharge from the service.

     The letter should be typed with no abbreviations unless clarified. The provider to give the patient a print out of
     the information.

     The service will also provide advice and guidance to patients relating to the procedure after they have been
     discharged by the service. Patients can telephone, write or email the service and expect a clinical response
     within two working days.

     The service will also provide advice and guidance to GPs to support better primary care management of
     ophthalmic conditions. GPs will be able to email the service directly, for advice and expect to receive a
     response within three working days.

     Patients who DNA for a new appointment will be sent a further two appointments, while patients who DNA for a
     follow up will receive a further one appointment. Should that patient fail to attend all three appointments for
     new or both appointment for follow ups then they will be returned to the care of the referring clinician with an
     explanation of the reasons for the return. Patient referrals will be logged as part of the data capture to ensure
     that patients are not lost in the system.

5. Discharge Criteria & Planning


       Patients will only be discharged from the service when it is clinically appropriate to do so. They will either be
       discharged back to the care of their own GP, or to secondary care ophthalmology consultant services. In
       either case, a full report will be prepared and sent to the relevant clinician.

     Discharge letters from the service will be sent back to the patients own GP within 48hrs, with a copy to the

                                                 Page 9 of 15
     The letter will be typed with no abbreviations unless clarified. Copies will also be sent to the patient and to the
     relevant secondary care consultant where appropriate with an advisory letter to the GP. Discharge letters can
     be sent by post or from / to secure email accounts.

     Letters should include the following details:

            The procedure carried out
            Medication given
            Advice given to the patient
            Specific advice to the referring clinician should it be required
            Advise regarding the information being available on SystmOne

       Patients do have the right to choose to cease all or some of their treatment. In such instances, the service
       will ensure that the patient fully understands the consequences of such a decision and has the capacity to do
       so and that this is recorded. Any such decision will be communicated to the patient’s GP by the next working
       day. Providers will ensure that patients know how to re-enter the care pathway, if they so decide at any time.
       Again, the GP will be notified by the next working day.

6. Self-Care and Patient and Carer Information

       The service will provide advice and guidance to patients for this episode of care after they have been
       discharged by the service – patients can telephone, write or email the service and expect a clinical response
       within two working days. If further advice and guidance is required after this period, patients will be required
       to re-visit their GP for re-assessment.

       Patients will be supported to maximise their self-care potential by being given education and information to
       make informed choices and if required a self-management plan.

       Patient information will be held electronically, and the information will be backed-up to secure servers on a
       regular basis. The Provider will be required to use SystmOne, integrated with the Choose & Book system,
       which will be operated as a stand alone system.

       The Provider will have sufficient confidentiality policies in place to ensure that only appropriate personnel from
       the Provider have access to the patient-level data.

       The Provider will be expected to provide a copy of their own complaints procedure, which must be compliant
       with NHS Peterborough’s requirements.


       Full records of each patient contact should be maintained in such a way that aggregated data and details of
       individual patients are readily accessible in electronic and / or written form. Providers should maintain access
       to the database as part of the regular service reviews, which will be carried out in conjunction with the NHS
       Peterborough and border area practices on a minimum of a quarterly basis.

       Providers will gather information on activity on a weekly basis, and provide monthly reports to commissioners
       on activity carried out within the community eye care service, as documented in 1.5.

       Providers will carry out an annual audit and review of the service which will be distributed to practices that
       refer patients into the service. This audit and review will also be distributed to local commissioners as part of
       the annual review of the service.

       Providers will be subject to an annual governance review.
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       NHS Peterborough expects that the Provider will be registered with CQC comply with all National quality
       requirements as set out within Care Quality Commission essential standards of quality and safety and
       Essence of Care. 2010

       Respect and Dignity including care areas designated single sex Principles of Self Management (embedded
       within this is Self-Management Programmes)

       Record keeping should be contemporaneous and signed and dated. All records are to be kept confidential and
       in a secure place. for 6 years

       The Care Quality Commission (CQC) carries out a series of reviews each year including reviews of clinical
       areas and reviews of developmental standards. NHS Peterborough expect the Provider to work with NHS
       Peterborough in aspiring to achieve a “good” or “excellent” rating in any such reviews.

       The production of evidence upon request that the CQC essential standards are being met.

       The Provider should comply with all Department of Health (DH) and NHS guidance on accepted current and
       future best practice, including NICE guidance. Where the Provider has deviated from any national or locally
       agreed clinical guidance, the Provider is required to update NHS Peterborough in writing at the earliest
       opportunity, along with the reasons for non-compliance. The provider will comply with all requests from the
       NPSA alerts which relate to the service.

       Each patient will be given a patient experience questionnaire, which will enable the service provider to taylor
       the service appropriately to meet the needs of the service user.

Clinical Quality Performance Indicators and Consequences

   o   NHS Peterborough will monitor the Provider on all items within the performance indicators included in the

   o   NHS Peterborough expects that the Provider will provide information in the format and frequency specified in
       order to support this monitoring. The Provider shall produce a quarterly Clinical Quality Performance Report,
       detailing performance against the agreed schedule. Reports will be reviewed at regular Clinical Quality Review

Infection Control

      The provider should carry out frequent and regular audits for infection control recording the information, which
       will inspected at the annual governance review.

   o   NHS Peterborough expects the Provider to comply with the Code of Practice for the Prevention and Control of
       Healthcare Associated Infections and implement best practice from Saving Lives in respect to hand hygiene
       and comply with NHS Peterborough policy on infection control.

   o   The provider should carry out annual audits on their compliance to Code of Practice for the Prevention and
       Control of Healthcare Associated Infections. Results of this audit and associated actions plans should be
       submitted to NHS Peterborough.

   o   In the event of any potential infectious risk the provider will work with the Matron in infection prevention and
       control for NHSP where clinical priorities will take precedence.

   o   NHS Peterborough expects the provider to adhere to current standards and requirements for day case
       operating theatres.

                                                Page 11 of 15
Safety and incidents

   o   The Provider is responsible for ensuring the safety of patients whilst on the premises which are being used,
       under the care of their staff and departments and throughout the discharge process. NHS Peterborough
       expects that they have robust risk management systems in place including incident reporting and learning, and
       risk assessment. NHS Peterborough requires the Provider to share action plans resulting from incidents with
       NHS Peterborough for agreement at regular Clinical Review Meetings.

   o   NHS Peterborough requires that the Provider supplies it with a quarterly report of the total number of incidents.
       NHS Peterborough will be looking for assurance that the proportion of serious incidents is not increasing, in
       line with best practice in the embedding of a safety culture. Robust internal reporting systems and reporting
       cultural investigations should be in place with evidence that lessons have been learnt and shared across the

   o   The provider will contemporaneously report any Serious Incidents (SI’s) following NHS Peterborough’s Serious
       Incident policy.
       The responsibility to investigate incidents remains the responsibility of the service provider, in a timely fashion.
       Any recommendations from the investigation should be implemented as soon as possible.

   o   NHS Peterborough expects that appropriate representation from Information and Clinical Governance will
       attend if requested meetings with other key stakeholders in order to share learning across the health economy.

   o   NHS Peterborough expects the Provider to notify NHS Peterborough of the number and type of any drug
       errors and to share any learning and resulting action plans with NHS Peterborough at the Clinical Review

Care of the Client

   The Provider will:

   o   Ensure that they collect equality and diversity monitoring information in accordance with the requirements
       within Care Quality Commission essential Standards quality and safety and will provide these to the
       Peterborough PCT if requested to do so.
   o   Adhere to all legal requirements and National initiatives / targets regarding Equality and Diversity. It will be
       expected that the Provider will demonstrate compliance to legislation, with the aim of improving health
       outcomes and reducing health inequalities in the six key equality dimensions of race, disability, gender, age,
       sexual orientation and religion or belief and will publish Equality impact assessments and action plans. Any
       concerns regarding compliance will be raised at Clinical Review/Contract meetings.
   o   Ensure that the team cultural, religious, and life style beliefs are respected at all times
   o   Regard the physical and mental health needs of patients at all times
      Ensure that any required interpreting and communication support services are provided where necessary,
       either by direct provision or by contract with a third party, in order to: minimise clinical risk arising from
       inaccurate communication

Compliments, Complaints

   o   The Provider is expected to have in place services that meet the requirements of the NHS Complaints Process
       In addition, the Provider should be learning from specific events and trends analysis. NHS Peterborough
       expects the Provider to produce a quarterly report of the total number of complaints and the response.
   o   NHS Peterborough expects that, in line with good practice, the Provider grades all formal complaints, and this
       grading is reflected in the quarterly report identifying trends and themes.

   o   NHS Peterborough requires evidence of an action plan in place for all complaints, which has been agreed with
       NHS Peterborough and a member of the team will attend Clinical Review Meetings if requested.

   o   NHS Peterborough expects that the provider will report identified trends and themes for any complaints.
       Complaints should be reported monthly.

                                                 Page 12 of 15
Patient Experience

    NHS Peterborough aims to ensure that information about patient experience is used systematically to support
    commissioning. NHS Peterborough expects that the Provider will give patients the opportunity to comment on their
    experience of using services on an ongoing basis, through patient surveys, patient and public Involvement work,
    complaints and other activities, the information provided to the PCT will include how concerns can be raised.

    o   The Provider will inform patients of how to raise concerns.
    o   The Provider will provide NHS Peterborough by the end of quarter one a detailed plan of how it intends to
        deliver this expectation over the following 12 months.
    o   The provider will demonstrate how it has used patient experience feedback to improve the quality of the
        service delivered. This will be reported to NHS Peterborough.
    o   The Provider will ensure they collect equality and diversity monitoring information is reported in accordance
        with the Care Quality Commission Standards and will provide these to NHS Peterborough if requested to do

Safeguarding Adults

NHS Peterborough expects the Provider to adhere to NHS Peterborough’s Safeguarding Policy. Providers must be
fully compliant with the regulations of the Vetting and Barring Scheme of the Independent Safeguarding Authority from
July 2010.

Working Together

It is expected that the Provider will participate in attending meetings as required within the GP Commissioning Group.

The provider is expected to provide formal training and impart knowledge to referrers of the service on an annual or
alternate year basis in a location such as the local postgraduate centre or any other local education forum.

The Provider will record all service activity on an agreed format in a timely and accurate fashion. Activity data should
be supplied to the Commissioner within 10 days of the month end and quarterly reconciliations should be implemented
to ensure accuracy of data. In addition, the Provider will provide supplementary information as reasonably requested
by the Commissioner based on a minimum data set. Records should be harmonised with other possible records held
for the same patient

Failure to supply agreed information may result in the withholding of payments by NHS Peterborough for the
month or quarter in question at a rate 10% patient referrals in the said month or quarter.
The Commissioner and the Provider will jointly monitor and review the in-year activity for the service on a quarterly
basis. NHS Peterborough may require additional information from the Provider to enable them to monitor other
performance targets including those in the Local Delivery Plan and to meet any reporting requirements of Choose and
Book once on the system.

Any disputes concerning performance or payment shall be dealt with in the first instance by both meeting with the aim
of resolving the dispute amicably. If no such resolution can be achieved then senior officers from both organisations
should meet to resolve the differences.

Professional arbitration may be sought should there be no resolution.

8.Quality and Performance Standards
Quality performance        Threshold                                       Method of              Conseque Report Due
indicator                                                                  measurement            nce of
                           20% return of questionnaires as a minimum       Patient satisfaction
Service user experience    to be valid with an overall positive response   questionnaire
                           of 80%                                          Improved
                                                 Page 13 of 15

                              10% cancellation rate due to diagnostic tests Provider
Service user experience
                              not being taken / available from referring GP information returns

                              100% of referrals to be triaged within 3           Provider
                              working days from the provider receiving the       information returns
Access                        letter. An acknowledgement of receipt of the       100% of letters
                              letter should be sent to the referring clinician   date stamped of
                              (and prior to patient being seen in clinic)        receipt of letter
                              100% of patients who have been triaged as          Provider Returns
                              not being suitable are sent back within 24hrs      information
                              All patients offered appointment date within       Provider
                              21 working days                                    information returns
                              100% Serious Incidents are reported in line
                                                                                 Provider    serious
                              with NHS Peterborough Serious
Patient Safety                                                                   incident
                              Investigations Policy and Procedures
                                                                                 information returns
                              Appendix D.
                                                                        Performance and
                              Clinicians delivering service governance
Patient safety                                                          Governance
                              arrangements lapse
                          100% monthly activity returns are supplied Provider
Data quality
                          within 10 working days                        information returns
                                                                        Monthly Reporting
                                                                        return          and
Post Operative Infection
                          No more than 1% of preventable infections     regarding       any
Rate Monitoring
                                                                        reported infections
                                                                        including the route
                                                                        cause analysis.
                                                                        6           monthly
                                                                        reporting          /
Qualifications / Training                                               monitoring which
                          100% Evidence of correct staff qualifications
Certificates         and                                                can              be
                          and checks completed for the post.
Necessary Checks                                                        unannounced
Formal     Education      /                                                      Alternate years
                              100% Education Completed
Training Completed
Discharge Letters             100% within 48hrs

                                                    Page 14 of 15
8.1 Activity Plan

                    Support equitable access to healthcare for people for whom English is not a first language
                    Support effectiveness of services in reducing health inequalities
                    Promote best practice and health promotion particularly in relation to the effects of smoking;
                    Sustain a service managing holidays and absence and ensuring business continuity

8.2 Capacity Review

Capacity reviews will be undertaken on a regular basis to ensure that agreed waiting times are met for all referrals
received. Should meeting waiting times become unfeasible, this will be highlighted by the Provider and discussed
between the Provider and Commissioner.

9. Continual Service Improvement Plan

        Service improvement will be driven primarily by patient feedback, however, the service will also be evaluated
        on a six-monthly basis, and this evaluation will form the basis of the iterative changes needed to the service
        during the pilot period. Findings from the pilot period will drive the service specification for the final service.

10. Prices & Costs

Providers are invited to submit costs in accordance with the care pathway they submit see paragraph 3.1.

Appendix A – Surgical Threshold

Appendix A - Cataracts Policy

                                                  Page 15 of 15

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