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5 Year ForwardNew models and new ways of working
Food for thought
HE NHS England October 2014
Future changes in 5 Year Forward some of the key concepts Published October 2014
Multispecialty Community Provider Model (MCPS)
Expert generalist
FederationsNetworks
Single practices
Digital technology
Target people with complex
needs
Provide OPD services in
community & AC
Employ consultants as partners & or
non med senior practitioners
Credentialing GPs direct
admission rights to acute services
OOH inpatient care supervised
by new role resident
hospitalists
Run local comm. hospitals &
expand diagnostics
Expanded Leadership AHP Pharmacy, HCS
nurses
Funding may be delegated NHS
budget & or H&HSC
responsibility
Renewable energy of carers, voluntary,&
service users accessing hard to reach & new
ways to changing behaviours
Primary and Acute Care (PACS)
Single organisation to provide NHS list based GP & hospital
care with MH & community care
Most radical PACS take accountability for whole health
needs of reg. list under capitates budget similar to Accountable Care
Organisations in USA, Spain & Singapore
One option such as indeprived urban areas where
GPs under strain hard to recruit – hospitals will be permitted to open up own GP services with
lists
The leadership required for these vertically IC PACS may
vary in different localities
A range of options will permit a new variant of IC allowing single
organisations to provide NHS list based GP, Hospital Services, MH
and Community Care services
Other circumstances next stage in development of MCSP could
be that it takes over running main DGH
Urgent and Emergency Care networks
Evening & Weekend access to GP’s or nurses in
community bases with increased range of tests &
treatments
Ambulance services able to make more decisions, treating
patients, referrals & greater use of pharmacists
Ensure hospital patients have access to 7 day services where this
makes a clinical impact on outcomes
Develop networks of linked hospitals so most serious
needs get to specialist emergency centres
A strengthened clinical triage & advice service
linking systems together & help patients navigate the
systems
Proper funding of mental health crisis services
including liaison psychiatry
New ways of measuring quality of urgent & emergency
services
New funding arrangements & new responses to workforce requirements to make new
networks possible
Workforce implications – some thoughts
• New accountabilities• New partners• New teams • New skills• New ways of working• New roles• New culture• New concepts• New geographies
• New opportunities – staff, local people
• Generalist & specialist changes• New & or additional knowledge & skills
• Changing public relations• New career options• New ways of learning• A flexible workforce across services
Annual lecture – Simon Steven’s December 2014
• A chance to bring about a vision partly articulated some time ago.
• “Doctors and specialist will move freely from the hospitals to the health centres, to the maternity and child welfare clinics, and from them back to the hospitals and between the medical officers of health…This will be an essential feature of the whole service; between the local government, the specialists, and the hospitals, there must be absolute and complete cooperation, and no jealously between one and the other.
• “They must be able to use each other’s services without any difficulty and hindrance, and the way in which it will be done…will be the right of the individual patient…to use of the medical service wherever it is. The right of the individual will be the uniting principle in the whole service.”
• That was Nye Bevan in 1946. Sixty-eight years later, let’s give it a shot.
Five Year Forward - Simon Steven’s December 2014
‘The forward view is a compass, not a map’
Four new dynamics - Simon Steven’s December 2014
•First, we have the opportunity to move away from care geared towards the “median” patient. Personalisation
• Second, and at the same time, we are going to have more standardisation in the way care is provided. Standardisation ‘For the first time we’re drawing back the veil on unjustified variation to have more standardisaton’
• Third, anticipatory care - moving away from healthcare systems that principally rely on people pitching up to see a health professional when they get sick - towards healthcare systems that are much better able at stratifying risk, identifying upstream care opportunities, and targeting interventions accordingly.
• And fourth, getting real about co-production; recognising that it is often the “experts by experience” who bring the assets, insights and commitment that will reshape the way care is provided.
Push and pull factors - Simon Steven’s December 2014