Governing Body report
Paper: 4.1
Date
20th January 2015
Title of paper
Whole Systems for Older People
Presenter
Dr Richard Hooker, Clinical Lead for Whole Systems
Author
Helen Pyecroft
Responsible Director
Jayne Liddle
Clinical Lead
Dr Richard Hooker, GP
Confidential
Yes
The Governing body is asked to:
- Agree the West London Older Adult Whole Systems Model of Care, noting the recommendation is to develop the
business case for a target population of over 65
- Agree the self-care model
- Agree approach to phasing and implementation, including
 phased implementation commencing Qt1 2015/16

a focus on the north and a hub at St Charles and a focus in Qt2 in the south
- Note high-level cost assumptions, upon which to build a more detailed cost model.
Summary of purpose and scope of report
1. Model of Care (including self care model)
The West London CCG’s Whole System’s Older Adult Pioneer Model of Care has been co-designed by front-line staff,
service users, commissioners and providers from across health and social care and the voluntary sector. The codesign activities, six principles behind the model and the model itself (including self-care model) are included in the
supporting PowerPoint report.
The Whole Systems Programme Team is also working closely with the Older Adult Support Team, Community
Independence Service, Mental Health Whole Systems Pioneer and GP Federation workstreams to ensure integration
and alignment of the services provided for patients and to coherently deliver the CCG’s Out of Hospital Strategy.
The Model of Care has been recommended by the cross-organisational Whole Systems Steering Committee. It is
being presented to the Governing Body for approval and will also be subject to formal approval by the all affected
partner organisations, including the local authorities.
2. Implementation Approach
In anticipation of approval of the model, we are planning for a phased operationalisation of the model across our
geography, with the first phase to be operating in Q1 2015/16. As above we expect Phase 1 to be in the north of the
borough where a North Hub Project Board (previously St Charles Project Board) will lead the design. We expect the
second phase of the project to be in the South where we are going to establish a South Project Board to design how
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Paper: 4.1
this will operate.
The key components of operationalisation will include:
•
Phasing and operational design – working with key front-line staff to design when and how the model will be
delivered on the ground, this will include working with GPs to secure sign-up
•
Business case and data and analytics - development of the business case for our Whole Systems pioneer,
including a detailed understanding of the investment required to deliver it and the impact on providers
•
Ongoing service user engagement – to continue to drive co-design, patient centred services and to use their
insight to design, deliver and evaluate the service
•
Estate – working towards ensuring the right estate is in place to support delivery in the north and south of
the borough
•
Contracting, commissioning and provider development - develop and agree a service specification and
Memorandum of Understanding with all providers
Organisational development – delivering a programme that supports the cultural change required to deliver
on this vision
•
•
Governance – to ensure appropriate scrutiny and approvals of the model, investment and delivery
3. Developing the Business Case
At a high-level we have developed a series of assumptions about the level of investment required to support the
implementation of this model in 2015/16. These will change over the coming months as more detail about the
model emerges. Significant work to validate assumptions and build a detailed business case is underway.
Quality & Safety/ Patient Engagement/ Impact on patient services:
The objective of the Whole Systems Pioneer is to provide coherent and integrated health and social care services to
older adults in West London. We have undertaken broad patient and clinical engagement to inform the development
of the model. This has included front-line staff from across our provider partners (including GPs) and service users
from across the geography and representatives of services users. Engagement has included:
•
Putting clinicians and service users at the centre of our governance and co-design
•
Running two large co-design events at which approximately 150 people (including service users and frontline staff) attended
•
Model of care working groups and sub groups to include representation from the whole system
•
Establishing a patient panel – a group of patients from across RBKC and Westminster who have supported
the co-design of our model of care
•
Establishing sub-working groups of health and social care professionals (e.g. the Primary Care Design Group
and the Social Care Working Group)
•
Wider PPE events – including Older People’s Fair, Silver Sunday, workshops with the BME forum and
meetings with different voluntary sector partners
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Governing Body report
Paper: 4.1
•
Consultation through CLS meetings
•
Healthwatch and K&CSC led work to interview thirty hard-to-reach individuals across our geography and run
case studies with organisations who work with hard to reach groups
•
NWL Collaborative Lay Partner Forum and Lay Partner Advisory Group and clinical engagement
The feedback we have received has been instrumental in designing the model. We will continue to use the Primary
Care Design Group and Patient Panel to co-design the detail of how patient services will evolve.
Financial and resource implications
As outlined in the supporting report a high-level business case for investment in primary care has been developed,
informed largely by the high-level design work led by the Whole Systems Model of Care Working Group and Primary
Care Design Group. It was discussed and received a warm response from the CCG’s Governing Body at its December
development session.
A detailed business case for investment is under development and will be informed by the design work we need to
undertake with GPs and partners to understand the operationalisation implications of the model
Additional investment could include:
•
Additional GP led sessions per week with average 20 minute appointments
•
Investment for additional staff (e.g. across nursing, PCNs, HCAs, integrated care working etc.)
•
Additional investment in bolstering voluntary and other services at the base level
•
Investment in OD for frontline staff
•
Additional GP equivalent cover for every operational base in hours and cover out of hours
The cost assumptions and business case will also be aligned with wider North West London Primary Care
Transformation Project
Equality / Human Rights / Privacy impact analysis
During Q4 2014/15 and as the detail of the model emerges we will undertake equality and privacy impact
assessments. All necessary actions will be taken to mitigate any risks and reported to the GB as appropriate.
Risk
List any potential risk associated with this report/ action/ work. Link to the relevant Board Assurance Framework
entry.
Supporting documents
Please see attached PowerPoint report: Governing Body Presentation_Whole Systems 20.01.2015
Governance and reporting (list committees, groups, or other bodies that have discussed the paper)
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Governing Body report
Paper: 4.1
Committee name
Date discussed
Outcome
Whole Systems Steering Committee
12.12.2014
Approved model of care
CCG Operations Group
02.12.2014
Approved model of care
Whole Systems Patient Panel
04.12.2014
Approved model of care
Whole Systems Model of Care
Working Group
02.12.2014
Approved model of care
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