NHS Five Year Forward View NHS Confederations Community Health Services forum New Care Models integration of community and primary care 6 November 2015 Louise Watson National 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 1
Health and wellbeing gap Radical upgrade in prevention 2 Care and quality gap New care models 3 Funding gap Efficiency and
investment Five new care models Multispecialty community providers moving specialist care out of hospitals into the community Enhanced health in care homes offering older people better, joined up health, care and rehabilitation services Integrated primary and acute care systems Acute care collaboration joining up GP, hospital,
community and mental health services local hospitals working together to enhance clinical and financial viability Urgent and emergency care new approaches to improve the coordination of services and reduce pressure on A&E departments 50 vanguards selected 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 Our core values Clinical engagemen t Patient involvemen t Local ownership National
21 22 23 38 39 40 41 42 43 44 45 46 47 48 49 50 Acute care collaboration (ACC) vanguards Salford and Wigan Foundation Chain Northumbria Foundation Group Royal Free London Dartford and Gravesham
Moorfields National Orthopaedic Alliance The Neuro Network (The Walton Centre, Liverpool) MERIT (Mental Health Alliance for Excellence, Resilience, Innovation and Training) (West Midlands) Cheshire and Merseyside Womens and Children Services Accountable Clinical Network for Cancer (ACNC) East Midlands Radiology Consortium (EMRAD) Developing One NHS in Dorset Working Together Partnership (South Yorkshire, Mid Yorkshire and North Derbyshire 24 25 26 27 28 29 30 31 32 33 34 35
36 37 Integrated primary and acute care systems (PACS) vanguards Wirral Partners Mid Nottinghamshire Better Together South Somerset Symphony Programme Northumberland Accountable Care Organisation Salford Together Better Care Together (Morecambe Bay Health Community) North East Hampshire and Farnham Harrogate and Rural District Clinical Commissioning Group My Life a Full Life (Isle of Wight) Multispecialty community providers (MCPs) vanguards Calderdale Health and Social Care Economy Erewash Multispecialty Community Provider Fylde Coast Local Health Economy Vitality (Birmingham and Sandwell) West Wakefield Health and Wellbeing Ltd Better Health and Care for Sunderland Dudley Multispecialty Community Provider Whitstable Medical Practice Stockport Together
Tower Hamlets Integrated Provider Partnership Better Local Care (Southern Hampshire) West Cheshire Way Lakeside Surgeries (Northamptonshire) Principia Partners in Health (Southern Nottinghamshire) Enhanced health in care home vanguards Connecting Care Wakefield District Gateshead Care Home Project East and North Hertfordshire Clinical Commissioning Group Nottingham City Clinical Commissioning Group Sutton Homes of Care Airedale and partners Urgent and emergency care (UEC) vanguards Greater Nottingham Strategic Resilience Group Cambridgeshire and Peterborough Clinical Commissioning Group North East Urgent Care Network Barking & Dagenham, Havering & Redbridge System Resilience Group West Yorkshire Urgent and Emergency Care Network Leicester, Leicestershire & Rutland System Resilience Group Solihull Together for Better Lives South Devon and Torbay System Resilience Group 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 launched 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 Addressing the key enablers of transformation 1. Designing new care models and enabling spread 8. Communication and engagement 2. Evaluation and metrics NATIONAL COHORT 7. Local leadership
and delivery LOCAL 3. Integrated commissioning and provision 4. Empowering patients and communities 6. Workforce redesign 5. Harnessing technology Examples of support community care 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. Further information 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
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