NHS Five Year Forward View

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NHS Five Year Forward View NHS Confederations
Community Health Services forumNew Care Models
integration of community and primary care6
November 2015 Louise WatsonNational MCP Care
Model Lead and Deputy Programme
Director _at_lcewatson
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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

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The challenges we face
Radical upgrade in prevention
Health and wellbeing gap
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New care models
Care and quality gap
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Efficiency and investment
Funding gap
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Five new care models
Integrated primary and acute care
systems  joining up GP, hospital, community and
mental health services
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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

 
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Our core values
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50 vanguards developing their visions locally
Integrated primary and acute care systems (PACS) vanguards
1 Wirral Partners
2 Mid Nottinghamshire Better Together
3 South Somerset Symphony Programme
4 Northumberland Accountable Care Organisation
5 Salford Together
6 Better Care Together (Morecambe Bay Health Community)
7 North East Hampshire and Farnham
8 Harrogate and Rural District Clinical Commissioning Group
9 My Life a Full Life (Isle of Wight)
Multispecialty community providers (MCPs) vanguards
10 Calderdale Health and Social Care Economy
11 Erewash Multispecialty Community Provider
12 Fylde Coast Local Health Economy
13 Vitality (Birmingham and Sandwell)
14 West Wakefield Health and Wellbeing Ltd
15 Better Health and Care for Sunderland
16 Dudley Multispecialty Community Provider
17 Whitstable Medical Practice
18 Stockport Together
19 Tower Hamlets Integrated Provider Partnership
20 Better Local Care (Southern Hampshire)
21 West Cheshire Way
22 Lakeside Surgeries (Northamptonshire)
23 Principia Partners in Health (Southern Nottinghamshire)
Enhanced health in care home vanguards
24 Connecting Care Wakefield District
25 Gateshead Care Home Project
26 East and North Hertfordshire Clinical Commissioning Group
27 Nottingham City Clinical Commissioning Group
28 Sutton Homes of Care
29 Airedale and partners
Urgent and emergency care (UEC) vanguards
30 Greater Nottingham Strategic Resilience Group
31 Cambridgeshire and Peterborough Clinical Commissioning Group
32 North East Urgent Care Network
33 Barking Dagenham, Havering Redbridge System Resilience Group
34 West Yorkshire Urgent and Emergency Care Network
35 Leicester, Leicestershire Rutland System Resilience Group
36 Solihull Together for Better Lives
37 South Devon and Torbay System Resilience Group
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 Womens 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
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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

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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.

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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

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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.

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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

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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.

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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

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Addressing the key enablers of transformation
5. Harnessing technology
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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.

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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