Brief for commissioning Option Appraisal for delivery of Primary by MJJKZn


									Brief for commissioning a project to deliver domestic abuse training and
advocacy in GP surgeries in Manchester


1.1 Public Health Manchester wish to commission a supplier to deliver a specialist
domestic abuse service with NHS General Practices in Manchester. This service has
been funded for twelve months through Public Health Manchester, as part of their
work to improve the response of the NHS to domestic abuse.

1.2 At this stage only twelve months funding has been found, but it is hoped that
continuing funding will be identified, if the project is positively evaluated.

 1.3 The project will build on the learning from IRIS (Identification and Referral to
Improve safety), IRIS
documents are attached for information and guidance.

1.4 In the IRIS model an Advocate Educator (AE), who is experienced in providing
domestic abuse advocacy to a range of clients and has the necessary training skills,
is recruited to work with a number of surgeries. The AE provides two training
sessions to the clinical team, the first session with a Clinical Lead. The IRIS Clinical
Lead fulfils a champion role with clinical colleagues in all the IRIS participating
practices. The AE also provides one training session to the reception administration
team in each practice. The AE provides consultancy and support to practice teams,
receives domestic abuse referrals from practice staff, undertakes Risk Assessments,
gives information to the patient on their options and supports the patient and any
children to keep safe. Care pathways are provided for female and male survivors
and female and male perpetrators. The IRIS Support Team have offered help and
support at the planning and implementation phases of this project and receive
funding to do this from the Health Foundation.

1.5 This will be a cost saving project for the NHS. It is an early intervention model
and the aim is to prevent patients who are experiencing domestic abuse from
needing to seek urgent care via Emergency Departments. The evaluation of the IRIS
randomised controlled trial has identified this as a cost effective measure.

2. Manchester

2.1 Manchester has high levels of deprivation and poor health. Domestic abuse
impacts on the lives of survivors and their children, leading to homelessness,
physical and mental ill-health, family disruption and safeguarding children issues. In
2009-10 there were almost 17,000 reports of domestic incidents to Greater
Manchester Police. Local data on presentations to healthcare services as a result of
domestic abuse are not consistently available, but research indicates that the
financial, health and social consequences of abuse are considerable. The cost of

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Domestic Abuse to the City of Manchester each year is calculated to be £40.6
million (based on Walby 20041)

2.2 Manchester’s multi-agency Domestic Abuse Management Group has recently
become a sub-group of the Adult and Children’s Safeguarding Boards. The Domestic
Abuse Strategy 2010-2014 aims to reduce and prevent domestic abuse. This project
will assist in achieving the aims of ensuring “ victims of domestic abuse and their
children are adequately protected and supported” and “improving early identification
and prevention of abuse”.

2.3 This project will help deliver NHS Manchester’s priorities in the Commissioning
Strategic Plan 2009-2014, including the priority to “improve the quality and availability
or primary care services”. It will also assist in the delivery of the emerging
commissioning plans of Manchester’s three Clinical Commissioning Groups.

2.4 A primary care Domestic Abuse Training Project, based at Central Manchester
Hospital Trust, has been in place since April 2009. Two trainers deliver training to
primary healthcare staff including GPs and their practice staff. This training is based
on Primary Care Domestic Abuse Guidance, which has been agreed by the Local
Medical Committee So far 17 practices have received
training and this project will be expected to work in liaison with the trainers.

3. Aims of the project

The project will
    Increase knowledge of Domestic Abuse issues and of help available for those
       affected by abuse among general practice staff.
    Improve the confidence of staff to ask questions about possible abuse in a
       safe way and make appropriate referrals and thereby improve patient care
    increase the number of patients referred from General Practices for help with
       domestic abuse issues
    improve data collection and analysis of the number of disclosures and
    improve the safety of patients by reducing repeat victimisation.

4. The project outline

4.1 The project will recruit an Advocate Educator to improve the identification and
response to Domestic Abuse in primary care. The project will provide practice staff
with training on domestic abuse and a direct referral route for patients to the
Advocate Educator (AE). Information on safe choices and support will be provided to
patients who have disclosed domestic abuse by the AE. It is hoped that the project
will enable help to be offered to the survivor and their children at an early stage
before the abuse becomes a serious risk to mental and physical health.

4.2 This project will provide training and an advocacy service to at least 30 General
Practitioners and their practice staff based in approximately 10 practices of a range
of sizes in Manchester. This number of practices is less than the 25 practices linked
to one AE in the IRIS model and reflects the time needed to set up the project locally.
The service will be offered to surgeries in areas of Manchester with a range of levels
    Walby, Sylvia (2004) The Cost of Domestic Violence London Women and Equality Unit
Val\DA\GP and IRIS\Tender brief MIRIS Oct 2011 v 0.5
of reporting of domestic abuse. The experience of the IRIS project showed that there
was a need for the service in areas where reporting was low as well as where
reporting was high. In addition, some practices will be chosen due to their interest in
improving their response to domestic abuse.


The AE will need to attend 3 days training, delivered by the IRIS Team and the
Clinical Lead will attend with the AE on 2 of the 3 days training. Training in domestic
abuse awareness, use of safe enquiry and referral pathways will then be delivered to
practice staff by the AE and the Clinical Lead. The AE will work with the Clinical
Lead and the IRIS support team to develop training packages, using the IRIS
Training model and reflecting the local context. The AE will consult with the Primary
Care Domestic Abuse Trainers to establish which staff could be accredited with some
parts of the training and where co-training could be appropriate.

4.4 Identification and Referral Identification of domestic abuse will be improved by
the provision of a ‘pop-up’ template, which appears on the clinician’s computer
screen when particular symptoms are identified during a consultation. This prompts
the healthcare worker to ask brief questions of the patient, using a template. This
technology has been developed by IRIS for EMIS, the IT system which is used by
approximately 80% of Manchester’s surgeries. Support for implementing this system
will be available from the IRIS team.

4.5 Data
The IT system will enable data to be collected on disclosures and referrals. The
successful bidder will also be expected to collate data on types of help provided and
outcomes, in partnership with the practices.

4.6 The role of the Clinical Lead will need to be developed to take account of our
local resources - the Primary Care training team and the training already delivered in
Manchester. The proposal should take account of this. Any costings at this stage do
not need to include the costs for the recruitment and payments for the IRIS Clinical
Lead. Support will be given by Public Health Manchester in establishing links with a
nominated clinical practitioner to undertaken the role of Clinical Lead with all the
participating practices.

4.7The successful bidder will be required to set up a Steering Group consisting of
    AE
    AE’s Manager
    Agency manager
    Public Health representative
    Clinical lead/ GP representative
    Domestic Abuse Service user
    Co-opted members as agreed, eg Community healthcare worker, Primary
      Care Domestic Abuse Training Project, Children’s Safeguarding Training

   The Steering Group should be convened on a monthly basis, with progress to bi -
   monthly meetings as agreed by the members.

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5. Programme monitoring and contract management

5.1 The successful bidder will be expected to provide monthly reports on activities
and progress with the project

5.2 .The successful bidder will be expected to attend Contract Management

6. The successful bidder will:
     Be a specialist Domestic Abuse or Violence Against Women agency with
       knowledge of local services
     provide office accommodation, telephone, mobile phone, IT etc for the
       Advocate Educator
     provide regular supervision for the AE by a manager experienced in domestic
       violence work and delivery of training
     ensure that MSCB and MSAB procedures and protocols are implemented.
     have a range of internal expertise on domestic abuse to support the AE
     be able to respond appropriately to the needs of BMER patients
     be able to respond appropriately to the needs of patients with protected
       characteristics (eg disability, age, religion)
     have good working relationships and positive links with other local specialist
       and generic services which can provide additional support.

Proposals should include

   o Organisation’s CV, Annual Report where available
   o Detailed costings
   o Details of proposed project responses to male and female victims and male
     and female perpetrators
   o Details, methods and timescales for:
     o Selection and appointment of ‘Advocate Educator’
     o Engagement with stakeholders, including service users
     o Promotion of the project and recruitment of practices
     o Delivery of training,
     o Setting up and management of a steering group
     o Reports to the Steering Group (quarterly reports and a final report)
     o Exit strategy.

This brief will be circulated to specialist Domestic Violence agencies and Violence
against Women and Girls agencies. Enquiries may be addressed to Val Armstrong.

Closing date for proposals
Proposals to be returned by 12 noon on 2nd November 2011 to:
Val Armstrong, Public Health Team, Public Health Manchester, Parkway Business
Centre, Parkway 3, Manchester M14 7LU
Tel 0161 765 4467 07855942321

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