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…