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NHS Five Year Forward View
NHS Confederation’s Community Health Services forum
New Care Models – integration of community and primary care6 November 2015
Louise WatsonNational MCP Care Model Lead and Deputy Programme Director@lcewatson
NHS Five Year Forward View
• Published in October 2014
• A shared vision across seven national bodies
• New care models programme key to delivery
• Focuses on both NHS and care services
The challenges we face
Radical upgrade in prevention
Health and wellbeing
gap1
New care models
Care and quality gap
2
Efficiency and investment
Funding gap
3
Multispecialty community providers
moving specialist care out of hospitals into the
community
Integrated primary and acute care systems
joining up GP, hospital, community and mental
health services
Acute care collaboration
local hospitals working together to enhance clinical and financial
viability
Enhanced health in care homes
offering older people better, joined up health, care and rehabilitation
services
Urgent and emergency care
new approaches to improve the coordination of services and reduce pressure on A&E
departments
Five new care models
• In January 2015, we invited applications to become vanguards
• In March, the first 29 vanguards were chosen. There were three types – integrated primary and acute care systems; enhanced health in care homes; and, multispecialty community provider vanguards
• In July, eight urgent and emergency care vanguards were announced
• In September, a further 15 vanguards were announced – known as acute care collaborations, they aim to link local hospitals together to improve their clinical and financial viability
• The 50 vanguards were selected following a rigorous process, involving workshops and the engagement of key partners and patient representatives
50 vanguards selected
Clinical engagement
Patient involvement
Local ownership
National support
Our core values
Integrated primary and acute care systems (PACS) vanguards
1 Wirral Partners2 Mid Nottinghamshire Better Together3 South Somerset Symphony Programme4 Northumberland Accountable Care Organisation5 Salford Together6 Better Care Together (Morecambe Bay Health Community)7 North East Hampshire and Farnham8 Harrogate and Rural District Clinical Commissioning Group9 My Life a Full Life (Isle of Wight)
Multispecialty community providers (MCPs) vanguards
10 Calderdale Health and Social Care Economy11 Erewash Multispecialty Community Provider12 Fylde Coast Local Health Economy13 Vitality (Birmingham and Sandwell)14 West Wakefield Health and Wellbeing Ltd 15 Better Health and Care for Sunderland16 Dudley Multispecialty Community Provider17 Whitstable Medical Practice18 Stockport Together19 Tower Hamlets Integrated Provider Partnership20 Better Local Care (Southern Hampshire)21 West Cheshire Way22 Lakeside Surgeries (Northamptonshire)23 Principia Partners in Health (Southern Nottinghamshire)
Enhanced health in care home vanguards24 Connecting Care – Wakefield District 25 Gateshead Care Home Project26 East and North Hertfordshire Clinical Commissioning Group27 Nottingham City Clinical Commissioning Group28 Sutton Homes of Care29 Airedale and partners
Urgent and emergency care (UEC) vanguards30 Greater Nottingham Strategic Resilience Group31 Cambridgeshire and Peterborough Clinical Commissioning Group32 North East Urgent Care Network33 Barking & Dagenham, Havering & Redbridge System Resilience Group34 West Yorkshire Urgent and Emergency Care Network35 Leicester, Leicestershire & Rutland System Resilience Group36 Solihull Together for Better Lives37 South Devon and Torbay System Resilience Group
50 vanguards developing their visions locally
Acute care collaboration (ACC) vanguards 38 Salford and Wigan Foundation Chain
39 Northumbria Foundation Group
40 Royal Free London
41 Dartford and Gravesham 42 Moorfields
43 National Orthopaedic Alliance
44 The Neuro Network (The Walton Centre, Liverpool) 45 MERIT (Mental Health Alliance for Excellence, Resilience, Innovation and Training)
(West Midlands) 46 Cheshire and Merseyside Women’s and Children Services 47 Accountable Clinical Network for Cancer (ACNC) 48 East Midlands Radiology Consortium (EMRAD) 49 Developing One NHS in Dorset 50 Working Together Partnership (South Yorkshire, Mid Yorkshire and North Derbyshire
What will success look like?
• Nationally replicable models
• More accessible, more responsive and more effective health, care and support services
• Fewer trips to hospitals
• Care closer to home
• Better co-ordinated support
• 24/7 access to information and advice
• Access to urgent help easily and effectively, seven days a week
Future of Community Care – emerging themes
• Population health model - multi professional community care focused on the GP registered list
• MCP size from 30,000 ++ based in localities
• Integrated locality based health and care teams 24/7
• Risk stratification tools to help target interventions
• Shared records across all providers
• Cradle to grave methodology using prevention and wellness strategies to improve health outcomes.
Future of Community Care – emerging themes
• Greater emphasis on self care and community engagement
• Patient owned care plans
• Workforce integrated across community and primary care
• Weighted capitation contracts (including primary care services)
• Sophisticated use of IT and digital technologies
Challenges for Community Care – examples
• Interoperability to allow records to be shared across health and social care.
• Governance arrangements for integrated care delivered by a range of providers.
• Workforce planning across health and social care.
• Maximising the impact of risk stratification
• Evaluating which intervention makes the difference to enable spread.
• Lack of community data on which to develop capitated budgets and other innovative payment mechanisms.
Future of Community Care – examples
• South Hampshire have aligned the community and primary care services in localities a single locality leadership team
• Whitstable have introduced a paramedic practitioner as part of the community team – linked to practices with access support services to keep people in own homes
• Sunderland – recovery at home service in place across the city – 24/7 one telephone number to call
Future of Community Care – examples
• Stockport – out of a pilot cohort of 200 patients, 92% were able to die in a place of their choice
• Fylde Coast risk stratify the top 1.5% of their total population into their extensivist model
• West Cheshire are developing ‘healthpods’ in localities where people navigate resources and receive interventions.
• Support package published in July for the first 29 vanguards ards
• Developed following extensive engagement, including two-day visits to all sites
• Led by vanguards alongside national experts, the support package will help them implement change effectively and at pace
• It is also intended to maximise sharing of learning and practice across vanguards and with the wider NHS and care system
• Four design principles – we solve problems through joint national and local leadership; we create simple replicable frameworks; we encourage and support radical innovation; we work and learn at pace
Support package launched
Addressing the key enablers of transformation
1. Designing new care
models and enabling spread
2. Evaluation and metrics
3. Integrated commissioning and
provision
5. Harnessing technology
6. Workforce redesign
7. Local leadership
and delivery
8. Communication and engagement
NATIONAL COHORT
LOCAL
4. Empowering patients and communities
• Development of new, purpose designed contracts and funding mechanisms e.g. capitation budgets, MCP contract
• Resolution of information governance issues to facilitate sharing of information.
• Indemnity insurance for clinicians working in a range of community settings.
• Review of the options for new organisational forms.• Registration and regulation of new organisations.• Workforce development across the health economy.
Examples of support – community care
More details can be found on the NHS England website:
www.england.nhs.uk/vanguards
Or join the conversation on Twitter using the hashtag:
#futureNHS
Further information…