Most advanced primary care clinical commissioning group

  Shortlisted  
• Horizon Health Commissioning
• Westmorland Primary Care Collaborative
• WyvernHealth.com

Sponsored by Chiesi

  Winner  
WyvernHealth.Com

WyvernHealth.Com is a group of 76 practices with a budget of £595m covering the entire population of Somerset. From the outset, the co-operative thought big by focusing on reducing emergency admissions. Their attention has since expanded to reducing elective referrals by introducing alternative pathways and managing the prescribing budget.

The group has achieved changes on a large scale with a focus on providing practices with information, regular and effective communication via meetings, website and newsletters and ensuring that all practices are engaged.

They have embraced the QIPP agenda and engaged secondary care and community care in service integration and redesign. They have supported NHS Somerset in achieving the best WCC rating in the first year and continue to address WCC with the local health community. They also held an event with NHS Somerset earlier in the year sharing best practice for other GP commissioning groups.

In the last year alone the group has achieved:

Savings of £1m shared across the practices as a result of cost-effective prescribing to be re-invested in services for patients.
£3.1m saved on emergency admissions as a result of admission avoidance schemes being implemented.
A newly commissioned diabetes specialist nursing service that has seen 300 patients in the community, without any travelling to hospital.
Over 30 practices have participated in a county-wide Primary Care COPD training programme.
Five new care pathways up and running.
A training package on the Gold Standards Framework for 30 residential and nursing homes has resulted in fewer call-outs for practices and fewer patients being sent into hospital.
Training for reception staff from St John’s Ambulance at 43 practices (over 50%) to improve the care and support offered to carers.
Free information packs for all newly diagnosed cancer and diabetes patients to support them to better understand their condition.

Key to success

In 2008/09, Somerset was one of 10 national pilots for development of PBC information. This started a process of development that continues to this day as the consortium moves into GP commissioning under the white paper proposals.

The key to sharing information is a local, bespoke Information Dashboard, which includes financial results, activity management information, referral trends and benchmarking, prescribing information and a practice message board.

It also includes a locally developed RISC High Climbers Report, which provides clinicians with a reference of those patients who have significantly increased their risk of unscheduled admission.

The PBC Dashboard includes a non-elective referral tracking tool for monitoring referrals to all destinations for unscheduled admissions.

Other initiatives include:

End of life care
In the last year, WyvernHealth.Com has commissioned end-of-life training for33 care homes, 27 nursing homes, and six residential homes. Aimed at reducing the number of terminally ill patients admitted as emergencies and dying in hospital against their wishes, the training means each resident in the participating care homes is offered an advanced care plan. Care home staff are now able to make informed decisions and support the wishes of patients and relatives. Additionally, the training has reduced the number of hospital admissions and deaths.

COPD programme
This is a community COPD service that started in February 2008 and consists of 14 clinics across the county of Somerset. The service aims to reduce avoidable emergency admissions, facilitate early supported discharge, and optimise COPD care through individual case management. It provides a seamless link between secondary and primary care and monitors community oxygen therapy. It has raised awareness of COPD and improved management of patients in primary care with 1,628 referrals in the past two years and a subsequent reduction in emergency admissions.

For more information or to book your place on the night:

Jennifer Knight, Events Co-ordinator
Telephone: +44 (0) 20 7921 8359
Email: jennifer.knight@ubm.com