NHS Five Year Forward View
NHS Confederation’s 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
Integrated primary and
acute care systems
Acute care
collaboration
offering older people
better, joined up health,
care and rehabilitation
services
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
engagement
Patient
involvement
Local
ownership
National
support
50 vanguards developing their visions locally
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
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 Women’s 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