Welcome to my belated September blog. This month I focus on leadership and recent changes at the ICB and in the system, the ICB restructure, primary care collective action and clinical transformation.

Leadership Updates

We have some exciting changes in senior roles across the ICS. I’m pleased to introduce Dr. Mike Smith as our new Deputy Medical Director at the ICB. A practicing GP partner, Mike has extensive experience in integrating primary care and enhancing community health services. His impressive background includes roles as a special advisor at Mid & South Essex ICS and as CEO of a GP Federation. I would like to thank Dr. Andy Griffiths for his service and wish him a happy retirement.

In other leadership news, Dr. Faisil Sethi has now joined NSFT as their new substantive Chief Medical Officer. He brings a huge amount of experience and is a wonderful addition to our system’s leadership. Dr Caroline Kavanagh has already started as Medical Director at NCH&C and succeeds Dr David Vickers to also take the reins as Medical Director of CCS following his recent retirement. Geraldine Rogers has also been appointed as the new Director of Patient Safety and Quality at ECCHC, and very hot off the press, Dr Bernard Brett has been appointed as the substantive Medical Director at the NNUH.

ICB Restructure

The new ICB structure is now live, bringing some significant changes that aim to improve our services and enhance collaboration across different sectors. Here’s a look at the key updates and how they will strengthen our efforts moving forward.

1. Strengthened Health Inequalities Team

The Health Inequalities Team has been expanded to take on a larger role, including oversight of armed forces health and the implementation of the health-related aspects of our 10-year framework for action on health inequalities. The team is now supported by a new VCSE (Voluntary, Community, and Social Enterprise) manager, dedicated to improving our work with over 12,000 informal and voluntary organisations. These partners range from large groups like Mind and Age UK to smaller, highly specialised organisations that provide essential support to specific communities.

To amplify their efforts, we have our VCSE assembly to bring these groups together, increasing their collective voice and impact. Tim Gardiner of Headway Norfolk and Waveney has just been appointed as its new Chair.

• Commissioning and Performance Team

The commissioning and performance team is now responsible for overseeing our largest contracts, with nearly 50% of our c£2.5 billion budget currently allocated in blocks to our acute trusts. This team will also develop service specifications and clinical outcomes in collaboration with the transformation teams, ensuring we maintain high standards and align our spending with the best possible outcomes for patients.

• Primary Care Interface Team

We have increased our focus on the collaboration between primary and secondary care to enable us to address interface issues as they arise and to proactively work together to plan improvements.

With these structural changes, we are confident that the ICB is now better positioned to deliver high-quality care and work more effectively with our partners, ensuring that the needs of patients and communities remain at the heart of everything we do. Stay tuned for further updates as these teams continue to make progress.

Primary Care Collective Action and Interface Update

There have been some really positive developments around Primary Care Interface that I’d like to share: 

• ICE Access for Practice Staff: We have successfully reached an agreement to upload practice staff onto the ICE system for requesting. This will help streamline workflows, save time and improve communication across practices.
• Improved PID Process: The PID process for reporting shifts in workload and contractual breaches is functioning much more effectively now, thanks to the appointment of named leads from each trust and closer working across our system. Working with the LMC, we are nearly there with an updated version of these forms, which will make it even easier for everyone involved to report and respond to these.
• Long-Term Conditions Local Enhanced Service (LES): We’ve agreed the LES for long-term conditions, which clarifies important aspects, including monitoring for individuals with MGUS (monoclonal gammopathy of undetermined significance).
• Pathway Improvements: We’ve addressed the CMPA (cow’s milk protein allergy) pathway and clarified the pathway for children and young people with ADHD. Additionally, a new process is now in place that includes formal arrangements for shared care and treatment.

Thank you to those who have provided valuable feedback regarding the primary care vision and principles. Your insights are crucial as we strive to create a framework that is both recognisable and meaningful for those working in primary care. Please do continue to share your thoughts.  

Ongoing Clinical Transformation Initiatives

As we continue to evolve our healthcare services, I’d like to highlight some of the ongoing clinical transformation work that aims to improve patient care and streamline processes. Here are some key developments across various specialties:

• Musculoskeletal (MSK) Services

We are currently implementing a single point of access for assessment and treatment of musculoskeletal issues. While the work on the single route in, and for self referral, has gone really well, we acknowledge that there have been some challenges in the northern and western regions particularly for the assessment and treatment aspects. We are working to resolve these teething difficulties to ensure a seamless experience for all patients.

• Ophthalmology Updates

In ophthalmology we are transforming the cataract pathway by shifting all post-operative care to community optometrists. Additionally, low-risk glaucoma monitoring will also be transitioned to community optometry. The new service specifications are now live, allowing any provider that meets the criteria to undertake this work.

• Innovations in Dermatology

Several months ago, we conducted a comprehensive engagement initiative led by Dr Ian Hulme to define the ideal dermatology pathway. Following this, proposals were presented to our Clinical Care Pathway Authority for input. The Commissioning and Performance Committee has now approved the intention to commission dermatology services through a lead provider, who will be responsible for offering an integrated service across our whole system. This will encompass:

• Advice and guidance
  • Teledermatology via a single platform
  • Virtual and community clinics
  • Cancer and hospital-based care

By incentivising innovation and focusing on delivering care closer to home, we hope this will reduce waiting times and enhance patient access and outcomes.

• Aural Microsuction and Hearing Support Services

We have also reviewed the provision of aural microsuction. This review highlighted significant variations in quality, volume, access, and pricing across the region. In response, we are developing a unified service specification, similar to our approach in ophthalmology, to standardise the service and tariff.

• Speech and Language Therapy (SALT) Review

Finally, we have recently approved a review of Speech and Language Therapy services. This review will assess the current landscape, identify gaps and variations in service delivery, and work towards addressing these issues.

These clinical transformation efforts are part of our ongoing commitment to enhance healthcare delivery and improve patient outcomes. By focusing on collaboration and innovation across various specialties, we are paving the way for a more integrated and efficient healthcare system. Stay tuned for further updates as we continue to advance these important initiatives.

Best wishes, Frankie