Southwark PCT Underlying capability gap summary

1
Southwark PCT - Underlying capability gap summary
APPENDIX 2
Diagnostic Category
Details of Diagnostic Section
3
2
1
Financial Review, goals and planning.

• Strategic planning.

2
Some long term goals are not realised where the
PCT has to respond to short term constraints.
Development Plan Content Experts

• Interviews with
• Chris Bull, Malcolm Hines, Chris Costa

Underlying Capability Gap

• Unknowns tariff uplift and next CSR allocation,
  limits accuracy of forecasting.
• L/T vision sometimes subjugated by S/T
  expediency, PCT has had to focus inwardly.
• Current PCT structure limits availability to
  motor forward on L/T objectives.
• Information about finance and activity not
  universally brought together across whole
  organisation, lack of routine reports.
• Budgetary regime needed strengthening.
• Communication/ messages of L/T strategy of the
  PCT not always heard, understood or remembered
  throughout all levels in the organisation.
• Exec team needs to refresh its own vision.
• Cross cutting themes included in Organisational
  Strategy priority

Source Fitness for Purpose Diagnostic, team
analysis
2
Southwark PCT - Underlying capability gap summary
Appendix Two
Diagnostic Category
Details of Diagnostic Section
3
2
1
Health review

• Strategic Planning

1.5
The PCT has not made significant progress in the
priority areas identified in the past
Development Plan Content Experts

• Interviews with
• Alan Maryon Davis, Margaret Connolly, Jin Keat
  Lim, Gillian Holdsworth.

Underlying Capability Gap

• Health information Issues about quality and
  timeliness of data. Ethnic coding progressing too
  slowly (some practitioners reluctant to ask
  ethnicity question). Lacks systematised training
  of data input staff.
• Strategy, prioritisation, commissioning
  multiplicity of strategies and insufficient
  clarity concerning public health priorities
  within this. Needs to be systematic and
  risk-managed, and communicated across whole PCT
  and partners. Practice-based commissioning in
  particular must take account of public health
  issues and priorities, including recommendations
  from the annual PH report.
• Need to strengthen PH links with Southwark
  Council. DPH should report direct to the LA CEO
  and have parity with other directorate leads
  within the Council.

Source Fitness for Purpose Diagnostic, team
analysis
3
Southwark PCT - Underlying capability gap summary
Appendix Two
Diagnostic Category
Details of Diagnostic Section
3
2
1

• Strategic Planning

Patient Experience Review and Goals

1.5 2
The PCT has insufficient incentives for providers
to ascertain patient experience.
Development Plan Content Experts

• Interviews with
• Lesley Humber, Rosemary Watts.
• Jane Fryer, Mee Ling Ng

The PCT does not benchmark itself against its
peers.
Underlying Capability Gap

• Need to systematically use data from PALS,
  complaints and a range of other sources,
  currently measured using complaints and PALs data
  but unclear re baseline measures or targets set-
  challenging to benchmark against peers.
• Greater use of patient/ carer surveys of
  services- using a range of methodologies with a
  more systematic linkage with patient satisfaction
  surveys into service redesign and action steps
  (for greater spread and depth of understanding).
• Lack of customer service focus amongst in-house
  provider services and independent contractors- no
  clear training and development or OD strategy to
  change this.
• Lack of leadership skills amongst
  frontline/operational leaders to develop spread
  of a greater patient-centred focus.
• Needs greater explicit Board leadership to ensure
  Pt. Exp. changes are embedded across the PCT.
• Develop an organisational understanding that
  taking into account patient views underpins a
  high performing organisation ( key part of PCT
  organisational development plan). Include PPI as
  an objective in for all teams 07/08
• Patient experience measures not well specified in
  SLAs or contracts, business planning- doesnt set
  clear quality standards with patients, for
  patients and include in monitoring.

Source Fitness for Purpose Diagnostic, team
analysis
4
Southwark PCT - Underlying capability gap summary
Appendix Two

Diagnostic Category
Details of Diagnostic Section
3
2
1
Practice-based Commissioning

• Care Pathway Management

Is PBC changing PCT commissioning to deliver
better patient care and/or better value for
money?
2.5
Development Plan Content Experts

• Interviews with
• Jane Fryer, Sarah Desai, Lesley Humber, Dr Femi
  Osonuga, Dr Amr Zeineldine, Graham Bullier,
  Michael Williams, Ciaran OCarroll.

Underlying Capability Gap

• Clarify with practices the 3 savings to be
  demonstrated.
• Spread Good examples (Ref. Mgt.) across all PBC
  groups and practices including PPI as a key
  factor in good service redesign.
• Define the correct information requirements of
  the different parties (PCT /practices PBC group)
  and commit to providing this in a timely way
  this will include readily accessible and easily
  understood peer group review and comparison.
• Develop a systematic programme of clinical
  leadership development to support PBC that will
  be driven by the development of a PCT wide OD
  strategy.
• Ensure a clear understanding in PBC groups of the
  need for high quality governance, including
  clinical governance.
• The PCT Exec. Team and PBC groups need to develop
  a mature understanding of the tensions and risks
  implicit in the devolvement of power to PBC
  groups.
• Realignment of resources to deliver the above
  needs to be reviewed within the PCT. (generic
  issue?)

Source Fitness for Purpose Diagnostic, team
analysis
5
Southwark PCT - Underlying capability gap summary
Appendix Two
Diagnostic Category
Details of Diagnostic Section
3
2
1
Referral Management

• Care Pathway Management

Does PCT have triage strategies to manage AE
attendances and emergency admissions? PCT has
not had sufficiently effective AE management
efforts in the past.
1.8 1.5
Development Plan Content Experts

• Interviews with
• Jane Fryer, Sarah Desai, Lesley Humber, Kate
  Moriarty

Underlying Capability Gap

• Clear direction of travel now agreed with Kings-
  monitor and review success of this approach.
• Need roll out of good project management approach
  to achieve our goals, to include strong
  leadership and commissioning.
• Not systematically using wealth of demographic
  and referral patterns to focus the change
  programme.
• Changes to AE need to happen in the wider urgent
  care context.
• PCT needs to commit to improving the quality of
  community services so other parts of system are
  confident, specifically addressing extended care
  skills gap in urgent care) .
• Generic issue PCT doesnt market what was good
  or systematically change what isnt good enough.
• Cross cutting themes included in Organisational
  Strategy priority

Source Fitness for Purpose Diagnostic, team
analysis
6
Southwark PCT - Underlying capability gap summary
Appendix Two
Diagnostic Category
Details of Diagnostic Section
3
2
1
Mental Health Commissioning

• Provider Management

1.6
PCT not taking an intelligence led approach to
mental health commissioning
Development Plan Content Experts

• Interviews with
• Rod Craig, Sarah Ives, Phil Atkinson

Underlying Capability Gap

• Up to date overarching mental health strategy
  agreed and driven by the relevant Partnership
  Boards.
• Only a basic system in place that connects
  activity, performance, quality and value for
  money. This system should drive the modernisation
  of care pathways and include more coherent
  sect.31 pooling and lead commissioning
  arrangements for

Adults with mental health needs Adults with
learning disabilities and more complex mental
health needs Mental health of older
adults CAMHS Drugs and alcohol services Healthy
Southwark initiatives

• All of the above need to demonstrate the
  connection between universal primary care and
  specialist mental health services.
• Co-ordination and oversight of the above
  work streams including the skill sets of
  commissioners.

Source Fitness for Purpose Diagnostic, team
analysis