Council of Members 13 February 2019 Welcome Dr Jonathan Love, CoM - - PowerPoint PPT Presentation

Council of Members

13 February 2019

Welcome

Dr Jonathan Love, CoM Chair Dr Mitu Pandey, CoM Deputy Chair

Minutes of the previous meeting: 19 September 2019

Dr Jonathan Love, CoM Chair

CCG clinical lead: portfolio presentation

Dr Emily Gibbs

CCG Clinical Lead for Primary and Community Care

Clinical leadership role

• Governing Body Member, collective

responsibility with GB clinical leads for commissioning in Southwark

• Commissioning activity, delivery, issues and

planning

• Locality meetings with member practices,

sharing objectives for commissioning

• Getting better quality health services for the

people of Southwark.

Clinical Portfolio

• Delegated Primary Care Commissioning in

Southwark

• Primary care contracts and PMS Premium

Specification

• Supporting sustainable general practice
• Working with GP federations
• Community services development
• NHS Long Term Plan impact for Southwark

Involved in

• Clinical Effectiveness Southwark
• eRS service for primary care
• Digital primary care development
• GP access and extended hours primary care
• Planned care services development and

clinical offer (consultant connect/ visual DX, Advice and Guidance

• Cancer and end of life care development

Key relationships

• Primary Care Commissioning and Integrated

Commissioning team

• Conflict of Interest Guardian
• NHS England
• NHS Southwark CCG members, patient & public

stakeholders and provider organisations

• LMC
• NELCSU
• Healthwatch Southwark

Question and answer session

• f CCG Governing Body

Practice representatives

NHS Long Term Plan and what this means for Southwark CCG

Discussion at Council of Members meeting

13 February 2019

Objectives for this discussion

The purpose of this session is to start a discussion with the Council of Members about what the Long Term Plan means for us within Southwark. Today, we will focus in particular on three areas:

• What the LTP means for the development of ICSs and how we commission.
• What the LTP means for Community based Care, in particular the development of Primary Care

Networks (PCNs)

• What enablers and infrastructure are needed, particularly Digital, Information and Workforce

In each case we will set out:

• What the LTP is telling us
• What our local plans are that are already in place and / or need to respond to this

We will discuss:

• What are the ideas, considerations and expectations raised by the LTP
• How we engage further with General Practice in Southwark around the LTP.

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The Long Term Plan sets out how we will make the NHS fit for the future, and get the most value for patients out of every pound of taxpayers’ investment

Published on 07 January 2019, the NHS Long Term Plan (LTP) has been drawn up by those who know the NHS best, including frontline health and care staff, patient groups and other experts. They have benefited from hearing a wide range of views, whether through the 200 events that have taken place, and or the 2,500 submissions we received from individuals and groups representing the opinions and interests of 3.5 million people. The plan sets out how the NHS will increasingly be:

• more joined-up and coordinated in its care
• more proactive in the services it provides
• more differentiated in its support offer to individuals.

Our local strategy, the Southwark Five Year Forward View, and the other programmes of work we are undertaking as a CCG, are very well aligned with the LTP. However the Plan goes further in setting the vision and ambition for the NHS over the next five to ten years, and as a CCG we need to consider how we respond through our own local plans, building on the foundation of our work to date.

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What the LTP will deliver for patients over the next ten years:

Making sure everyone gets the best start in life Delivering world class care for major health problems Supporting people to age well

• reducing stillbirths and mother and child deaths during birth by 50%
• ensuring most women can benefit from continuity of carer through / beyond pregnancy
• providing extra support for expectant mothers at risk of premature birth
• expanding support for perinatal mental health conditions
• taking further action on childhood obesity
• increasing funding for children and young people’s mental health
• bringing down waiting times for autism assessments
• providing the right care for children with a learning disability
• delivering the best treatments available for children with cancer
• preventing 150,000 heart attacks, strokes and dementia cases
• providing education and exercise programmes to tens of thousands more patients with

heart problems, preventing up to 14,000 premature deaths

• saving 55,000 more lives a year by diagnosing more cancers early
• investing in spotting and treating lung conditions early to prevent 80,000stays in hospital
• spending at least £2.3bn more a year on mental health care
• helping 380,000 more people get therapy for depression and anxiety by2023/24
• delivering community-based physical and mental care for 370,000 people with severe

mental illness a year by 2023/24.

• increasing funding for primary and community care by at least £4.5bn
• bringing together different professionals to coordinate care better
• helping more people to live independently at home for longer
• developing more rapid community response teams to prevent unnecessary hospital

spells, and speed up discharges home

• upgrading NHS staff support to people living in care homes
• improving the recognition of carers and support they receive
• making further progress on care for people with dementia
• giving more people more say about the care they receive and where they receive it,

particularly towards the end of their lives. Focused action on prevention (smoking, obesity, alcohol, air pollution ) and stronger NHS action on health inequalities, alongside the key roles of Local Authorities

Five major, practical, changes to the NHS service model to bring this about over the next five years:

1. Boost ‘out-of-hospital’ care, and dissolve the primary and community health services divide 2. Redesign and reduce pressure on emergency hospital services 3. People will get more control over their own health, and more personalised care 4. Digitally-enabled primary and outpatient care will go mainstream across the NHS 5. Local NHS organisations will increasingly focus on population health and local partnerships with local authority-funded services, through new Integrated Care Systems (ICSs) everywhere

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• 1. Integrated Care Systems

What will be different as a result of the LTP?

Local NHS organisations will increasingly focus on population health – moving to Integrated Care Systems everywhere

• By April 2021, ICSs will cover the whole country,

growing out of the current network of STPs

• ICSs will have a key role in working with Local

Authorities at ‘place’ level

• ICSs will need streamlined commissioning

arrangements typically involving a single CCG for each ICS area

• Local approaches to blending health and social

care budgets

• CCGs will become leaner, more strategic
• rganisations that support providers to partner with

local government and community organisations on population health, service redesign and LTP implementation

• Funding flows and contract reform will support the

move to ICSs

• ICSs will agree system-wide objectives with NHS

England / NHS Improvement and will have the

• pportunity to earn greater autonomy as they

develop. In Southwark, this will help to support and accelerate our plans including:

• Working as an Integrated Care ‘System of

Systems’ across south East London

• Working to deliver commissioning functions at

the level of scale and collaboration that makes most sense:

• As an alliance of CCGs across south

east London (SELCA)

• Through joint working with our Local

Authority

• In collaboration with our local providers

(e.g. Partnership Southwark)

• Commissioning based on populations and
• utcomes through our Southwark Bridges to

Health and Wellbeing model.

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• 2. Community based Care

What will be different as a result of the LTP?

£4.5bn investment in primary medical and community health services over five years

• Fully integrated community-based health care
• Contracted primary care networks based on

neighbouring GP practices working together, covering 30 to 50k people

• Community multidisciplinary neighbourhood teams

aligned with PCNs to comprise GPs, pharmacists, district nurses, community geriatricians, dementia workers and AHPs, social care, voluntary sector

• Two hour community health crisis response and

reablement care within two days of referral

• From 2019, 111 direct booking into GP practices, as

well as referring on to community pharmacies

• Upgrade in NHS support to care home residents and

easier, secure, sharing of information

• Improved QOF with new Quality Improvement element

and shared savings scheme to incentivise PCNs to reduce hospital activity & over-medication

• Increased range and diversity of support through social

prescribing supported by PCN link workers. In Southwark, this will help to support and accelerate our plans including:

• Delivery of our community based care

programme which is overseeing delivery of the Southwark Five Year Forward View

• Our Local Care Network approach which has

been developing the model for delivering community based care within and across our nine Neighbourhoods

• The role of our GP Federations in developing

neighbourhood working from a general practice perspective, as well as holding place based infrastructure and contracts on behalf of general practice

• Clinical Effectiveness Southwark focused on

improving outcomes and reducing unwarranted variation through better referral behaviours

• Partnership Southwark which is the alliance of

system partners (GSTT, SLaM, CCG, Council, GP Federations) to deliver integrated community based health care across our neighbourhoods

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• 2. Community based Care

Delivering fully integrated care within and across nine neighbourhoods in Southwark

• Supported by families and local communities
• Enabled and empowered to access care in a way which

works for them

The Person

The Person The GP Practice Team Primary Care Network GP Federation Partnership Southwark

• Provision of resilient and sustainable core general

practice

• Coordination and planning of holistic, personalised

accessible care

• Geographically contiguous teams of practices caring for

30 to 50k people

• Delivery of data driven integrated multidisciplinary team

based services

• Operating through a common model to support the

development and delivery of PCNs

• Delivering efficiencies of scale, infrastructure,

coordination, leadership support to general practice and PCNs

• Interface with Partnership Southwark
• Alliance of commissioners and providers across health

and social care and broader voluntary and community sector

• Working with PCNs to deliver fully integrated community

based care

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• 3. Enablers and infrastructure

What will be different as a result of the LTP?

Digitally enabled care will go mainstream across the NHS, including

• Digital ‘front door’ through the NHS App will provide

advice, check symptoms and connect people with healthcare professionals – including telephone / video

• Digital first primary care with telephone or online

consultations a new patient right within 5 years

• Redesign of outpatient services with up to a third of

face-to-face visits avoided over next five years

• By 2020, every patient with an LTC will have access

to their health record through the Summary Care Record accessed via the NHS App

• Population health management solutions to support

ICSs deployed during 2019. In Southwark, this will help to support and accelerate our plans including:

• Rolling out online consultation across general

practice in Southwark through the eConsult platform

• Building on the regional rollout of electronic

referrals to focus on outpatient transformation

• Moving to common population level outcomes

data and analytics as part of CBC programme

• Planning for a step change in how information

is used for direct care and analytics through London’s Local Health and Care Record Exemplar programme.

• Local rollout of the GP Forward View –

Workforce Programme

• Developing primary and community workforce

within each Neighbourhood as part of the CBC programme

• Expanding our training and development for

the community workforce (including CEPN)

• General practice nurse development and Ten

Point Plan. The NHS workforce will be given the support it needs

• Expanding the number of nurses, midwives, AHPs and
• ther staff
• Growing the medical workforce, including continued

commitment to an additional 5,000 doctors

• Supporting current NHS staff with improved

development and retention schemes

• Doubling the number of volunteers over the next

three years

• Funding of community roles and social prescribing

link workers as part of PCNs.

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Table Discussions

We have two objectives for this evening:

• DISCUSSION PART 1: What are the ideas, concerns and expectations raised by the LTP
• DISCUSSION PART 2: How should we engage further with General Practice and other stakeholders

in Southwark around the LTP?

• PLENARY / PLAYBACK AND DISCUSSION

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GP FEDERATION

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Next steps

Sustainability and Transformation Partnerships (STPs) and Integrated Care Systems (ICSs) now need to develop and implement their own strategies for the next five years. Planning and delivery milestones will require join up and concerted effort:

• January 2019 – publication of the NHS Long Term Plan
• February 2019 – publication of the new Primary Care Network contract
• March to June 2019 – stakeholder engagement on the LTP (and PCN Contract)
• By April 2019 – publication of CCG and STP plans for 2019-20, this includes…
• …the CCG Operating Plan and Financial Framework (we need to sign off at March CoM)
• …a refreshed Primary Care Strategy (STP level)
• By end of May 2019 – agreements in place for all nine Primary Care Networks in Southwark
• By Autumn 2019 – publication of five year plans for each STP area.

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Table discussion

Table work

Areas of focus for discussion:

• 1. What the LTP means for the development of ICSs and how we commission.
• 2. What the LTP means for Community Based Care, in particular the development of

Primary Care Networks (PCNs).

• 3. What enablers and infrastructure are needed, particularly digital, information and

workforce. On table groups, we will consider:

• 1. What are the ideas, concerns and expectations raised by the LTP.
• 2. How we engage further with General Practice and other stakeholders around the

LTP.

Any other business

• a. 360° Stakeholder Survey - reminder
• b. Suggestions for future CoM agenda items

Dr Jonathan Love, Council of Members Chair

Date of next meeting: 27 March 2019

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