2 nd Provider Event 9 June 2016 Building Healthy Communities - - PowerPoint PPT Presentation

Building Healthy Communities

2nd Provider Event 9 June 2016

Building Healthy Communities

Brainstorming Session 1

Q1a: Is the future model realistic? Are there any changes you would like to suggest?

• The model is a holistic and realistic model and forms part of the 5 year forward view,

however huge transformation required within such short timeframe

• Fairly standard and deliverable but requires a level of GP development
• IT Challenge
• Issues of mobilisation
• 2022 sounds more realistic as a timeframe
• Ambitious
• Lot of communication to handle
• Risky for a single provider
• Bringing different big services together

Q1a: Is the future model realistic? Are there any changes you would like to suggest?

• Responsibility where does the buck stop?
• Need to define role of SPA – i.e. more details and accessibility
• Model will rely on buy-in from primary care
• Baseline activity required
• Adult social care engagement is key in their delivery role, not just as commissioners

especially for re-ablement services

• Must define integration/alignment of the health and social care including TUPE

arrangements

Q1b: Are there any core functions not included in the draft scope that are essential to deliver integrated care?

• Define the expectations around management of the interface between the GP

federation and the providers

• Mental Health should be integrated as part of the model this would significantly reduce

cost and enable people to mange anxieties

• IAPT should also feed into Primary Care
• Ensure the risk stratification includes screening and referral process into Health & well-

being services

• Must have a lead navigator plus social workers to prioritise navigation
• Maturity of organisations is key
• Be clear about boundaries e.g. what is in or out & definition of IAPT, LD scope
• Expectations around care navigations roles and also extended primary care

Q1b: Are there any core functions not included in the draft scope that are essential to deliver integrated care?

• ASC is a core part of elements delivery – pressures in that area
• DoS
• Demand management element
• IT systems element
• Future proofing
• More flexibility to enable innovation from providers especially after ‘go live’
• Linking in with services commissioned by Local Authority
• Impact of TST contracts across the borough

Q1c: What would providers expect the CCG to facilitate in order to make this future model achievable?

• Ring fence spend with provider for provision of prevention and well-being
• Capitated budget model could allow lead provider to sub contract health and well being

to voluntary organisations

• The CCG should ensure that Prevention/Health- wellbeing includes outreach in the

community

• Voluntary sector access – need to engage
• Provide portfolio of other organisations
• Assist with engagement with GPs and voluntary organisations
• Define how smaller providers connect with more than one provider
• Be helpful in opening up the process of dialogue
• Assist with GP integration as there maybe challenges. What is their readiness?

Q1c: What would providers expect the CCG to facilitate in order to make this future model achievable?

• Obtain acute trusts ‘buy in’
• Management of possible conflicts of interests
• During mobilisation the CCG should retain capacity to link the providers
• Social care framework and NHS outcomes framework defined
• Assist with the negotiations for newer/different contracts and also allow innovation
• To positively market the change to the existing workforce as a joint/CCG provider model
• Engagement and links with the GP federation is key at a sessions with providers and the

federation may be required as the outcome may influence the final specification

• Pleased with 80k hub population size feels about right but more efficiencies possible if

some services can be centralised

• Electronic care navigation and SPA are people really needed and if so their role needs

clarification

Q1c: What would providers expect the CCG to facilitate in order to make this future model achievable?

• Ensure opportunities to meet with LBN, GP federation, MH
• Partnership working post contract award is essential throughout the whole contract
• length. Needs to be developed as part of the negotiation workshop
• A few realistic KPIs are preferable compared to many
• Need to discuss how services can evolve within a longer contract
• Longer contract length welcomed because these contract are loss making initially,

service users don’t like change and embedding change takes time

• Consideration of wider context i.e. TST and other procurements to be communicated
• Joint learning and development with provider initiative
• Lead on a wider community & family approach to encourage third party/voluntary
• rganisations

Q1c: What would providers expect the CCG to facilitate in order to make this future model achievable?

• IT recording and access
• Specialist services e.g. COPD
• Exclusivity contract will be a barrier for other interested providers and can the CCG

facilitate this as a fair process

• Provide clarity around what is in scope
• Facilitating discussions on integration and support across whole health economy
• Share client/patient record across all stakeholders, including voluntary and charity

sectors

Building Healthy Communities

Brainstorming Session 2

Q2a: How can CCG best support providers in ensuring the estates strategy is fit for purpose and can support the delivery of the future care model?

• Share the estates strategy in its entirety although weird that its fixed
• What are the hubs: who, what, where, where e.g. disposal, numbers etc
• Provide information on total costs of running the buildings and facilities e.g. cost of

cleaning, catering, service charges etc.- specifically East Ham Care Centre

• What is planned with the LBN? Are there any joint ventures, any shared buildings
• What are risks to the current providers and need to have an impact assessment
• Estates vital and essential to succeed
• Some see LIFT as an opportunity because it will be readily available and well maintained
• Condition of GP premises would be useful to foster joint working
• Facilitation required re shared premises

Q2a: How can CCG best support providers in ensuring the estates strategy is fit for purpose and can support the delivery of the future care model?

• Contract needs to be flexible enough to allow for radical new innovation or change over

a 7 year period

• CCG needs go online to support interoperability, reasonable data sharing and mobile

working

• Create a formal use of technology such as use of apps, alarms etc
• CCG’s role should support providers to negotiate leasers/rent/service charge
• Logging and capturing equipment maintenance
• Ensure combined package (60:40) consideration of innovation
• How can innovation be encouraged given the long contract length
• Provide further information on the details of GP Hubs v/s community hubs

Q2a: How can CCG best support providers in ensuring the estates strategy is fit for purpose and can support the delivery of the future care model?

• Ensure the infrastructure supports the facility
• Site visits welcomed
• Hub model is key – need to be combine adminstrative and clinical hub
• Premises must be right
• Lift building, size, functionality, capacity
• Ensure that contract allows flexibility and innovation
• No restriction and tie-in
• Allow co-location of services
• Information current state, future state
• Provide clarity on current plans for the future

Q2b: What technology enabled services should be in scope of a transformation programme given the timelines of 5-7 years?

• Near patient testing
• Virtual consultations – protocols for confidentiality etc such as skype consultations
• This cannot be absorbed by efficiency savings because of level change & growth which

may require pump priming

• Facilitation of translation services via apps/technology
• Algorithms – symptom trackers
• Population training in use of technology to access modern community health services
• CCG’s role must include support to consent to interface
• CCG’s role should include buying in new innovation
• Data collection and ability to capture information across providers

Q2b: What technology enabled services should be in scope of a transformation programme given the timelines of 5-7 years?

• Training of new staff using new IT services
• Standardisation is essential for all information
• Use of apps, telemedicine
• Define the outcomes and providers to explain how they will use technology to achieve

these outcomes through innovative working practices e.g. via SPA

• Providers to define interoperability and CCG not to prescribe
• Blocks from GP practices could hinder delivery
• Free flow of internet provision across the hubs/GP practices
• Consistent IT infrastructure across all services and supportive
• Provider allowed to be innovative

Q2b: What technology enabled services should be in scope of a transformation programme given the timelines of 5-7 years?

• Self- help
• Point of care testing
• Wireless monitors – build on national diabetes prevention programme work
• Scan transfer/remote reporting technologies
• Mobile working for feedback from patients anonymous and also for recording visits/notes

from visits

• Connected technology for patients
• Ability to use technology at virtual hubs and clinics, hence for less face to face

appointments

• Support move from paper to electronic records
• Utilisation of emails, awareness of what can be delivered
• All services should be supported by technology

Q2c: What do providers think should be the CCG’s role in delivering the technology vision?

• Lead on prevention
• Best use of workforce and reduce carbon footprint/cars increase use of apps
• Ensure infrastructure robust in all 4 hubs with wifi in all practices with sufficient capacity

for all to log on not just three people/limited capacity

• CCG to support providers remotely and create a standardised process e.g. the use of

iCloud

• Training to be centrally coordinated, to generate consistency
• Defining targets for people accessing services remotely
• Should the CCG own the roadmap and workplan for developing EMIS
• Provide clarity to providers, what’s on offer facilitate large and small organisation
• Working with acute providers regarding consultation very limited at the moment

Building Healthy Communities

Brainstorming Session 3

Q3a: What outcomes would you like to suggest

• ther than those mentioned in the presentation?
• MDT Plan for primary/secondary prevention for those with LTC
• Prevention of co-morbidity
• % of patients who have accessed all education services/ screening, immunisations e.g.

AAA, breast, bowel, cervix and if diabetic, diabetic retinopathy, flu, PPV, herpes

• % of patient who have a management plan for illness or further disease
• Pre-diabetes prevention plan Qdiabetes score
• CVD prevention plan if CVD - 20% score
• Smoking, obesity, physical inactivity – signpost or plan appropriately
• Hypertension – medication plus diet plus physical activity plus other provider
• Speed consent of patient to share information
• Pathways to check

Q3a: What outcomes would you like to suggest

• ther than those mentioned in the presentation?
• What is the outcome related to the patient education service? Does it include reduction
• f risk of developing another LTC?
• Outcome measures left hand column ok
• Right hand column – is this in the gift of the provider?
• Remember acute care is appropriate at times
• Important to have achieve able targets
• Outcomes list looks relevant, not too many but quite specific and measurable
• Could consider 1 or 2 specific ones relating to local priorities i.e. diabetes, capitated

budgets or some mechanisms and system performance allowing innovation

• The measures should include STP and associated funds
• Care close to home – increase incentive for group working, MDTs
• Patient outcomes/questionnaires tied with data activity and avoid duplication

Q3a: What outcomes would you like to suggest

• ther than those mentioned in the presentation?
• Increase EoL care at place of choice rather than at home
• Independent living should not be applicable to certain cohorts - currently 1 rehab, 2

elderly care wards

• Smaller contributory measures e.g. number of people, take up of technology, how does

it relate to patient outcomes?

• Integration with social care covered – is there a more direct way of measuring

integration?

• How do we weave in IT requirements? How do we measure non-patient activity?
• How do you decipher around unavoidable hospital visits? Some outcomes involve

multiple stakeholders and how do you measure achievement of this?

• Provider to work collaboratively so that pressure isn’t on one provider but the whole

system

• How do we demonstrate enablers, on what could be outcomes/enablers
• Staff retention rate/turnover

Q3ai: What percentage of contract value should be linked to outcomes?

• % contract values – incremental payment
• 25% seems a bit high, partial payments is a better option
• Conservative/low targets – high percentage and vice versa
• Difficult to agree targets without baseline
• Depends on the contracting model – a percentage
• Like 1st year to define baselines
• Not 5% rising to 25% - some elements not in control
• Good to link to numbers but increment not too large
• It has to be high value to make it work and it requires good balance
• Clarity on what’s it being linked to. If just activity most providers will challenge as may

not within their control

• Financial penalties should not be severe

Q3b: What other payment mechanisms will incentivise providers to deliver better value for money in contracts?

• How to get started to do the work
• All levers point in the same direction
• Capitated specific pathways – self contained pathways for certain age groups
• More mandated contracting, contracting that force and enable providers to work together
• Local providers contracted in and not allow them to be pushed out

Q3c: Working in your groups, come up with what you think is the ideal contracting model for this procurement? Give 2 reasons for/against your choice

• One contract provider by function
• Coordination across functions
• Outcomes to be aligned across the whole system
• The contracting model is for the provider but CCG needs to specify its appetite for riskier

arrangements

• Prime provider model is much better and the biggest organisation need not lead but

could have sub contractors. However risks will have to be done properly

• Alliance model – smaller or some organisation lose out and take a long time to establish
• Vat issues for 3rd part/voluntary organisations
• Initial joint venture, phased out after 2 years into contract
• Lead provider with mandated contract model implemented

Provider Feedback Form Summary

• 47 attended the event of which 27 were providers
• 19 of which provided feedback on the event
• 84% felt the event provided them with all the information they were

expecting

• 89% confirmed they would be interested in participating in a future

event

Agenda and papers could’ve been released in advan ance ce Could envisa sage ge the pros and cons of t the model More informat rmatio ion on E EMIS S Having ing a final l positio tion for elemen ments ts i.e. preven ention tion is key Good open discussi cussions s and brain instorm tormin ing Abil ility ty to network rk with potential tial prime e contrac racto tors rs/le /lead ad provid iders ers Genuin inel ely y feels ls like e the CCG is listen ening ing Involvem lvemen ent t with the GP Federat ration ion

Next Steps

• Further event to be planned for July
• Current plans are to issue the PQQ in August
• For further information, please contact the programme team on

bhc@newhamccg.nhs.uk