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Leicester City Clinical Commissioning group

NHS Leicester City CCG was legally established in April 2013 as part of the Government’s reforms of the NHS. Our responsibility is to plan and buy many health services needed by people living and working in the city of Leicester and we are one of the successor organisations to the previous Primary Care Trust. Our CCG is led by local GPs. This is because family doctors are in close contact with patients on a daily basis. They understand what communities and patients need most because they hear about it first-hand as they treat and care for them. As a result they are best placed to make decisions about healthcare in Leicester to meet the needs of our diverse population. As a CCG we work together with patients and health and social care partners to design how the local NHS works. We do this by planning and buying many health and care services including planned hospital care, urgent and emergency care, rehabilitation, community health and mental health and learning disability services.

Updated:
8 October 2015
Location:
East Midlands
Sectors:
Clinical Commissioning Group, Health, Hospitals and Hospital Trusts, Local Authorities, Medical, Voluntary Sector, Commissioners Sector
Local Alliances:
Leicester, Leicestershire and Rutland Dementia Action Alliance

1. Action Plan

1. The National Dementia Declaration lists seven outcomes that the DAA are seeking to achieve for people with dementia and their carers. How would you describe your organisation’s role in delivering better outcomes for people with dementia and their carers?

Dementia is a significant area of the CCGs joint Dementia Commissioning Strategy with Leicester City Council.   There are 4 strategic themes within the Strategy:

  • early diagnosis and access to care and support services;
  • improved experience of hospital care;
  • Improved quality of care in residential/care homes and personalisation of care
  • living well with dementia in the community.

Leicester City CCG had a national target to increase diagnosis of patients with dementia from a baseline of 53.7% of prevalence (1752 patients) as at 31st March 2013 to 60% (2036 patients) within two years.

Leicester City CCG achieved 59.2% of the target with ta total of 1966 patients of the 1994 patient target for year 1.

 NHS England went on to issue a revised target to increase this to 67% of prevalence (2300 patients) by 31st March 2015, an increase over two years of 548 patients. 

 

We are working with our partner agencies to address a number of key outcomes for people with dementia and their carers.  We are working with GP practices to identify gaps in service provision, particularly with hard to reach groups and to increase dementia diagnosis. Working with city council and Alzheimer’s Society to increase dementia awareness within general practice and throughout the CCG; working with Leicester Partnership Trust to improve the memory clinic pathway to ensure that, post-diagnosis, patients are signposted to the relevant support services and carers and referred for a health check and assessment.

2. What are the challenges to delivering these outcomes from the perspective of your organisation?

The main challenges to the organisation include, but are not limited to the following:-

 

  • Implementing a strategy with stakeholders
  • Complex commissioning involving primary care, secondary care, LA and Private sector [care homes] = ambitious!
  • Engaging Primary Care [GPs], Appetite, skills, renumeration
  • Contracting issues ,memory clinics – capacity, community services
  • Financial risks
  • Overlap with other agendas (frail elderly, reablement, end of life, Proactive care]
  • Historical legacy – dementia has never been perceived as a glamorous or high priority area of health care. There is a lots work to be done to change established attitudes
  • Confused identity and ‘ownership’ – dementia care crossed health and social care boundaries to an extent that is almost unique. Not always clear where responsibility lies.
  • Pressure on public services makes any new area of investment a challenge, especially where the emphasis is on quality improvement

2. Actions

  • To review the City dementia strategy and to work with key partners/stakeholders/providers to improve the dementia pathway, access to services and to raise the dementia profile across the City.

    Review the dementia strategy with City Council to include clear and achievable patient outcomes City Council

    Work with stakeholders/providers to firm up contracting issues within memory clinics

    Ensure collaborative working across  CCG projects to ensure there is a link (where appropriate) to dementia initiatives and services

    Raising the dementia profile across partner agencies/stakeholders/providers within Leicester City via awareness events

    Work with GPs to discuss national and local dementia targets;  raise awareness with all staff in general practice;  ensure that GP dementia registers are actively monitored and assessed and set clear KPIs for dementia outcomes;  work with practices to actively ‘case-find’ patients at risk of dementia

    Review joint commissioning for health and social care via the revised strategy

    Work with partner agencies to review existing services – ensuring they provide value for money and provide positive patient and carer outcomes.

    Raise awareness of dementia to primary care staff including CCG staff

    Raise awareness of dementia within the many diverse communities within Leicester City

     

    Status:
    Delivery

    2014 - Third Quarter Update

    New Member

  • Work with practices to increase the number of assessments offered to patients at risk of dementia and offer referrals for diagnosis – increasing dementia register numbers.

    We are working with Leicester City GP practices to provide the tools and relevant information to ensure that patients are a) identified patients at risk of dementia; b) offer an assessment to detect for possible signs of dementia in those at risk; c) offer a referral for diagnosis where dementia is suspected; d) support the health and wellbeing of carers for patients diagnosed with dementia. We need to be able to address the issues/barriers to increasing dementia diagnosis, both from a patient and practitioner perspective.

    We are looking at a gap analysis and forming an action plan to address these concerns.

    Status:
    Delivered

    2014 - Third Quarter Update

    New Member

  • Look at changing the way patients/carers access support services

    Feedback from service providers and users tells us that there can be significant delays in accessing post-diagnosis support.  This is clearly unacceptable, particularly at a time when both patient and carer/family are at their most vulnerable.  The CCG, in partnership with Leicester city council will be looking into the referral process to identify where the obstructions are and putting in alternative solutions to ensure that patients/carers/families are provided with the help, support and advice they require, when they need it most.  We also need to ensure that the needs of patients from BME and harder to reach groups are identified and met.

    Status:
    Case study, Initial Scoping

    2014 - Third Quarter Update

    New Member

  • Raise awareness and communicate key message of the Alliance to the widest audience possible in Leicester City supporting the vision of the Alzheimer’s Society

    Promotion where possible internally to staff, externally to media/stakeholders/patients/public/voluntary sector/heard to reach groups/BME groups and our 4,500 members. Working together with communication and engagement leads in the Alliance to promote consistent messages and produce appropriate materials for targeted groups. Identify key case studies for media opportunities.

    Status:
    Planning

    2014 - Third Quarter Update

    New member