Ear, Nose and Throat Service

The NHS supports the development of improved access to community-based provision as part of the drive to reduce waiting times and improve choice for patients. This development is part of an overall strategy to ensure that ENT services are undertaken at the right stage of a patient pathway and in the most appropriate clinical setting.

Currently all patients registered with Greater Preston CCG (GPCCG) or Chorley & South Ribble CCG (CSRCCG) practices with an ENT condition are referred to secondary care for treatment. In 2013, ENT was identified by the CCGs as an area that would benefit from service redesign and also one that could provide a more efficient use of resources when provided in a community setting. A pilot was commissioned, which ended in March 2016, the outcome of which indicated that a Community ENT service should be procured.

GPCCG and CSRCCG are, therefore, seeking to commission a Community ENT Service to manage conditions that do not require specialist intervention at secondary care level. This will enable improved patient flow through ENT services, and support the management of increasing demand for secondary care services. All healthcare services need to be pathway efficient and represent value for money. The service described in this specification encourages providers to deliver care as cost effectively and conveniently for patients as possible and to utilise the skills of a variety of clinicians. This will also support the sustainability of 18 week referral to treatment (RTT) compliance. It is expected that the service will commence on 1st April 2017.

This community based ENT service is to diagnose and treat a range of ENT conditions, and manage relevant follow-up activity within the service before final discharge back to the care of the patient's own GP, or onward referral to secondary care, where necessary, via the RMC. The service will provide patients with timely access to diagnostics and treatment, providing a 'one-stop' service where possible and appropriate, and will be delivered by a range of appropriately trained and accredited clinicians that may include: • GPs • GPwSIs (must be appropriately trained and accredited) • ENT Specialist Nurses • Audiologists • ENT Staff Grade Doctors • ENT Consultants The service should improve access to ENT services, enabling a reduction in waiting times and improved choice for patients. It will allow GPs to refer patients for investigation without the need for a secondary care referral, and within a shorter timeframe.

Additional information: In delivering a Community ENT Service, the provider will be expected to offer a service in accordance with best practice in healthcare, and to comply with the standards and recommendations of the following national and local policies and guidelines: National: • Care Closer to Home • NICE guidance, pathways and quality standards for ENT • NHS Outcomes Framework 2015-16 • NHS Constitution • Map of Medicine pathways • Working Together To Safeguard Children 2013 • Safeguarding Adults: The role of Health services 2011 • No Secrets 2000 • The Equality Act 2010 and Human Rights Act 1998 • Guidance and best practice Issued by the British Clinical Royal Colleges and British Medical Association • Data Protection Act 1998 • Freedom of Information Act 2000 • The Health & Social Care Act (2012) Code of Practice on the Prevention and Control of Infections and related Guidance

Local: • Our Strategy for Commissioning Better Health 2014-2019 • Two Year Operational Plan 2015-2017 • Our Health Our Care, Central Lancashire Local Delivery Plan 2016/17-2020/21 • Lancashire Principles for the Commissioning of Health and Healthcare

Local Population:

CSRCCG serves a population of approximately 180,000 people, registered with 31 GP practices and GPCCG serves a population of approximately 212,000 people, registered with 33 GP practices.