Local Healthcare Updates and Incentive Schemes in May 2023

ICB update May 2023

Happy International Nurses Day Thank you for all you do

Update on ICB Wirral Place CQC update Commissioning services in Primary Care Lithium update Primary Care Quality Scheme 23/24 Team updates

Currently For GP services, we will only inspect where there is risk of harm to people using services. This means that some previously planned inspections will not now go ahead. Going forward Bringing together specialist sector teams (adult social care, hospitals, primary medical services) into one Operations group CQC teams can have better conversations with you about how things are working between your service and the other services you interact with in the local area.- More of a system view They ll provide more tailored and efficient support in their relationship with your service. You can speak with members of our local teams for different types of advice They ll have an up-to-date view of quality and better understanding of what is driving poor or outstanding care

Local Incentive Schemes GP Dementia Shared Care Shared Care Monitoring (lithium monitoring has just been added from 1 April 2023) Anticoagulation Identification & Monitoring ADHD LEAP IUD fitting for heavy menstrual bleeding Homeless Scheme Minor Surgery & Joint Injections Primary Care Quality Scheme Covid Vaccination Programme (via PCNs) Ear Wax Removal Community Phlebotomy Service Minor Ailments Service

Lithium Shared Care Monitoring What happens currently? What is Lithium: Lithium is a well established treatment for mood disorders. Currently, lithium monitoring in the community is inconsistent across Wirral, with monitoring being undertaken either by the Community Mental Health Teams or within some practices. It can also be prescribed by consultant neurologists for prophylaxis of cluster headache (unlicensed indication. What does this mean for you? Regular blood tests are important as part of the ongoing management of lithium treatment. Additional training may be required for primary care staff, however CWP may be able to support with this prior to the change in the Shared Care Monitoring LIS What will change? This proposal sets out the intention to incorporate lithium monitoring into the current Shared Care Monitoring Local Incentive Scheme commissioned from general practice, with the aim of reducing the existing variation in the lithium monitoring approach across Wirral and maximising effective clinical care. This change in pathway ensures all patients are receiving the same quality of care. Increase capacity in the Community Mental Health team to manage more complex patients.

PCQS 2023-24 1. Antibiotic Prescribing Reduction 1.Practices will be issued with individual targets* for the reduction of total antibiotic prescribing measured by STAR-PU or to maintain total prescribing at or below 0.871 per STAR-PU (contributing to Metric 44a) 2.Each practice to have < 10% broad spectrum antibiotic prescribing overall (contributing to Metric 44b). 3.> 75% of prescriptions for amoxicillin 500mg prescribed as a 5-day course.

1a Quality Improvement Project i) Review of all patients on long term prophylaxis for UTI (if not already completed in 22-23) ii) Implement a process for review of patients on long term and repeated antibiotics for prevention and treatment of acne vulgaris iii) Rescue packs for COPD iv) Audit of antibiotic course lengths (all antibiotics) v) Audit of compliance with best practice management for a clinical condition following the TARGET toolkit audit Antibiotic stewardship tools, audits and other resources: Audit toolkits (rcgp.org.uk). Choose one area from the below. Cough Otitis media Rhinosinusitis Sore throat Non-catheterised patients > 65 years - - - - -

2. Opioid Prescribing Reduction Aim: To continue and build upon progress made by PCQS 2022/23 to reduce the level of opioid prescribing in Wirral. Requirements 2a)Utilising information gained in 2022/23, identify and implement an initiative for your practice to improve prescribing. This can be a generic change practice wide or targeting a particular patient cohort. 2b)Appoint a GP Opiates Champion for your practice. -Develop a work programme to include activities such as disseminating information throughout the practice, acting as a central point of contact for clinical staff, identifying and actioning any training needs and facilitating discussions/activity to support improvements within practice and forming links with other Champions across Wirral and wider as appropriate. 2c)Submission of a case study as a result of the initiative undertaken in 2a) Including methodology, outcomes and any points of learning.

3. Dementia Coding Aim: National target of 66.7% for dementia diagnosis rate. Current dementia diagnosis Jan 2023 was 62.3% for Wirral Place. Requirements 3a) To progress towards achievement of the national dementia diagnosis rate of 66.7% Ensure all patients with a diagnosis of dementia are coded with the correct SNOWMED codes and are on the dementia register. Complete, and review the results of an EMIS search (provided by BI) to ensure that all patients prescribed a dementia drug are coded with a diagnosis of dementia. 3b)To support an improvement in the quality of dementia care on the Wirral: All practice staff to be familiar with the Wirral Dementia Strategy 2022 2025. Each practice should sign up to and fulfil the objectives within the Wirral Dementia LIS. 3c) All appropriate practice staff to undertake eLearning, if not already done so.

Team Changes Sue Fogarty- Designated Professional Safeguarding Adults To be appointed Head of Quality and Safety Improvement Quality Manager Quality Compliance Coordinator cmicb-wi.qualityteam@nhs.net