GP Cluster 14 December 2017 Healthier. Stronger. Together PARKING - - PowerPoint PPT Presentation

• Healthier. Stronger. Together

GP Cluster 14 December 2017

PARKING - IMPORTANT

Whilst delegates are given free parking whilst attending an event at Somerdale, each individual is responsible for ensuring that their details are input completely and correctly to avoid incurring a parking ticket.

Live participation: How to use Slido

• Connect to Somerdale Pavilion wifi network
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• Healthier. Stronger. Together

Improving Access James Childs-Evans

Senior Commissioning Manager (Primary Care)

Improving Access: How we got here

June 2017: CCG / NHSE, Cluster meeting / Your Health Your Voice engagement sessions Summer 2017: Review of feedback within CCG / NHSE

• BEMS update to August Cluster meeting summarising feedback

so far Autumn 2017:

• Further engagement session at October Cluster meeting
• BEMS engagement with localities
• NHSE GPFV Time for Care (Dr Robert Varnham) session 14 Nov

Still awaiting procurement guidance – APMS suggested by NHSE as preferred contracting route Extended Hours expected to remain for 2018/19, changes possible in 2019/20

Improving Access: How we got here (2)

• Lots of shared local ideas over the types of services, staff models

and geographical footprints

• NHSE , LMC views over what is acceptable / required

However, a shared series of risks / concerns

• Limited evidence for additional demand as outlined in core

requirements (e.g. evenings and weekends)

• Divert / distract from existing schemes with similar aims

(Extended Hours / Winter Pressures / Early Home Visiting)

• Destabilising Integrated Urgent Care mobilising for May 2018,

drawing from similar staffing pool

• Confusion for public and health / social care community

staff over navigating / accessing appropriate services

Improving Access: How we got here (3)

Our interpretation of requirements and expectations of successful scheme:

• Small number of schemes, rather than 26 offerings (use natural

geographies where possible)

• Additional access funding is not just delivering additional, face

to face appointments with a GP (use of other staff groups)

• Model should allow all practices to book into additional

appointments (reduce unused appts. / improve access)

• Allow local provider(s) to access patient record for

appointment (patient safety / reduce potential indemnity costs)

Proposal for BaNES CCG

Propose a simplified model (GP / Nurse / HCA) to NHSE for approval:

• Located (initially) in x2 GP practices, in and out of Bath City
• 6-9pm Mon - Fri, 10-2pm Sat and Sun
• Phased in from end of Q2 2018/19 (Saturdays only) end Q3

(Saturdays and Sundays), end Q4 (Weekends / Weekday Evenings)

• Not (initially) located at UCC or Paulton
• Early Home Visiting / Winter Pressures to be referenced in

narrative to NHSE rather than hours calculations Why this approach?

Proposal for BaNES CCG (2)

• Already meets NHSE requirements (similar to Windsor model)
• Lower impact change in BaNES to minimise effects on existing

resilience

• GP practice locations will already be regularly open in evenings /

and or weekends as part of Extended Hours provision

• Limit confusion during mobilisation with Integrated Urgent Care –

particularly during winter 2018/19

• Opportunity to clarify actual demand in primary care

Provide future flexibility and contingency funding to:

• Make further case to NHSE for extending existing / different

provision based on actual demand data / experience

• Increase, reduce or change locations in BaNES
• Provide alternative services within existing footprints

Proposal for BaNES CCG (3)

Funding: 2018/19 £636k £100k for x2 hubs:10% end Q2, 30% end Q3, 100% from 31/3/19 £430k Early Home Visiting £100k Contingency (IT / Staffing) Total: £630K (all amounts tbc) Funding: 2019/20 £1.2m £400k for x2 hubs (full year effect) £430k Early Home Visiting £370K Contingency (e.g. IT / Staffing / Winter Pressures, Hub / Service changes) Total: £1.2m (all amounts tbc)

• Provider(s) - 2 GP practice based hubs – In / outside Bath
• GP, Nurse / other HP & HCA Model – GP appt available at all times

Core Hours Mon - Fri Evening Hours Mon - Fri Weekend Hours 6-6.30pm 6.30-9pm 10-2pm Hub 1 Mon Tue Wed Thu Fri Total Mon Tue Wed Thu Fri Total Sat Sun Total Total hours Opening Hours 0.5 0.5 0.5 0.5 0.5 2.5 2.5 2.5 2.5 2.5 2.5 12.5 4 4 8 23 GP 0.5 0.5 0.5 0.5 0.5 2.5 2.5 2.5 2.5 2.5 2.5 12.5 4 4 8 23 PN/Physio/Other tbc 0.5 0.5 0.5 0.5 0.5 2.5 2.5 2.5 2.5 2.5 2.5 12.5 4 4 8 23 HCA 0.5 0.5 0.5 0.5 0.5 2.5 2.5 2.5 2.5 2.5 2.5 12.5 4 4 8 23 Hub 1 staff hours 1.5 1.5 1.5 1.5 1.5 7.5 7.5 7.5 7.5 7.5 7.5 37.5 12 12 24 69 Core Hours Mon - Fri Evening Hours Mon - Fri Weekend Hours 6-6.30pm 6.30-9pm 10-2pm Hub 2 Mon Tue Wed Thu Fri Total Mon Tue Wed Thu Fri Total Sat Sun Total Total hours Opening Hours 0.5 0.5 0.5 0.5 0.5 2.5 2.5 2.5 2.5 2.5 2.5 12.5 4 4 8 23 GP 0.5 0.5 0.5 0.5 0.5 2.5 2.5 2.5 2.5 2.5 2.5 12.5 4 4 8 23 PN/Physio/Other tbc 0.5 0.5 0.5 0.5 0.5 2.5 2.5 2.5 2.5 2.5 2.5 12.5 4 4 8 23 HCA 0.5 0.5 0.5 0.5 0.5 2.5 2.5 2.5 2.5 2.5 2.5 12.5 4 4 8 23 Hub 2 staff hours 1.5 1.5 1.5 1.5 1.5 7.5 7.5 7.5 7.5 7.5 7.5 37.5 12 12 24 69 Total Hours 3 3 3 3 3 15 15 15 15 15 15 75 24 24 48 138

Proposal for BaNES CCG – NHSE Submission

• Provider(s) - 2 GP Practice based hubs – In / outside Bath
• GP, Nurse / other HP & HCA Model – GP appt available at all times

Proposal for BaNES CCG

Core Requirement Delivery Model Met

minimum additional 30 minutes consultation capacity per 1000 population, rising to 45 minutes per 1000 population 200,000 pop, 101 consultation hours required 138 hours consultation capacity delivered 41 mins per 1000 population

✓

weekday provision of access to pre-bookable and same day appointments to general practice services in evenings (after 6:30pm) – to provide an additional 1.5 hours a day 6pm - 9pm weekdays - 2 hubs

✓

weekend provision of access to pre-bookable and same day appointments on both Saturdays and Sundays to meet local population needs 10am - 2pm sat/sun - 2 hubs

✓

provide robust evidence, based on utilisation rates, for the proposed disposition of services throughout the week Facilities open 46 hours per week (23 hours per hub) Consultation hours delivered: 11% core 54% in Evenings 35% at Weekends

✓

• Narrative to note Early Home Visiting and Winter Pressures as

part of plan

Breakout Session

The Model

• Comments or questions?
• Are there any amendments you would like to

see? Main Room Breakout Area Bath Sulis Chew Keynsham Bath Aqua Norton Radstock

• Healthier. Stronger. Together

Dudley Visit on 30th November

GP Cluster 14th December 2017

Why did we go?

Opportunity to learn more about Dudley’s:

• multi-specialty community provider (MCP)

model, inc practice integration

• contractual & procurement framework
• MDTs and how they work at practice &

locality level

• overarching outcomes framework & QoF

replacement

• GP leadership
• pharmacy point of delivery model

About Dudley

• Selected to join NHS England’s Vanguard

programme in 2015

• 315,000 population
• Co-terminus with Borough Council
• One main acute provider – 80% of activity
• 177 contracts, £445m total budget
• Currently 79% activity based, 18% fixed budget,

3% outcome based

• Drivers for change – demand & financial

challenges (LTCs and frailty) and primary care resilience

Primary care

• 45 practices, soon to be 44 – many small with

sustainability issues

• Moved from PMS to GMS
• £50m primary prescribing budget
• Outcome based contract replacing QoF, LES’s &

DES’s with focus on holistic assessment & person centred care planning

• Offered as a voluntary opt out to QoF
• One system (EMIS) – training, education & IT

provided in-house by CCG, inc template writers

• Piloting pharmacy POD

Services in scope

• All community services – adult, children, physical

health, mental health, learning disability

• Inpatient LD/MH
• Public health commissioned services
• Urgent Care Centre and GP Out of Hours
• Out patient services – predominantly medical

specialties and for long term conditions

• Emergency admissions associated with falls, from

care homes and ambulatory care sensitive conditions

• LCSs – discretionary commissioning
• Primary medical services

Laying the tracks…

• Primary care at the heart of the model supported

by a MDT in each practice

• Population need driving model of care
• 15 year population health outcomes based

contract – new legal entity

• Three options for practices in MCP
• One capitated budget (£234m plus £40m for GMS)

– 55% fixed, 38% activity & 6% on outcomes

• Outcomes framework for Dudley – four domains
• Now in competitive dialogue phase with one

bidder

Cultures working in partnership

The Dudley GP Outcomes Framework has been developed locally to replace QOF. An extensive range of screening, case finding, disease monitoring and management outcomes have been set and the first year of this initiative underway with data capture and reporting via the GP EMIS Web system. The Dudley GP Outcomes Framework is interpolated within the wider MCP Outcomes Framework which is incentivised through the Improvement Payment Scheme of the new NHS ACO Contract for Dudley.

MCP Outcomes Framework Outcomes focus in Dudley

Our reflections

• Need to put more weight behind primary care –

rebalance the scales to a GP-led system

• MDTs and locality structure crucial to support

primary care

• More collaboration at the front line
• Leave organisations at the front door
• Leadership, trust & relationships crucial across

system

• Each part of the system needs to understand,

respect and value cultural differences

Our reflections (2)

• Significant Vanguard funding to develop MCP

model & associated infrastructure – something we don’t have

• Much of Dudley learning/evidence is transferrable
• Secondary care working on a population basis
• Lack of clarity on contract form & implications for

practices, inc estate

• Alternative to QoF ambitious & heavy on GP input
• Good chance to ‘chat,’ don’t get many
• pportunities to do this

Next steps

• Business case to trial a B&NES pharmacy POD
• Work with Virgin Care to develop the MDTs at

practice and locality level

• GP integrator role opportunity – leadership

development funding

• More opportunities to meet up informally –

curry nights!

• Healthier. Stronger. Together

TEA BREAK

Bath and North East Somerset community health and social care update Kirsty Matthews – Managing Director

Virgin Care private and confidential www.virgincare.co.uk

Overview

28

New Managing Director – Kirsty Matthews Our structure Key contacts Progress to date Feedback from GPs Transformation update Our commitments to you

Virgin Care private and confidential www.virgincare.co.uk

B&NES Management structure

Jayne Carroll Regional Director Operations South West

Alison Tucker Deputy Director of Operations – Adults and Specialist Services Anne Heath Head of Health & Wellbeing Deborah Patten Head of Learning Disabilities & Complex needs, Strategic Lead for Social Care Val Scrase Head of Children’s Services Lisa Cronan Professional Lead for Nursing and Quality

Kirsty Matthews Managing Director Joanna Scammell Head of Transformation B&NES Vivienne McVey Chief Strategy Officer

Virgin Care private and confidential www.virgincare.co.uk

Adult Operations and Specialist Services Structure

30

Alison Tucker Deputy Director of Operations Alison.tucker@virgincare.co.uk Rosemary Carroll Head of Specialist Nursing Services Rosemary.carroll @virgincare.co.uk Emma Caleb Head of Specialist Rehabilitation Services Emma.caleb@virginca re.co.uk Mandy Miles Head of Ambulatory Care and AHP Lead Mandy.miles@virg incare.co.uk Nikki Woodland Head of Integrated Hospital Services Chiquita Cusens NES Locality Manager and End

• f Life Lead

Chiquita.cusens @virgincare.co.u k Caroline Latham Bath Locality Manager Caroline.Latham @virgincare.co. uk

Virgin Care private and confidential www.virgincare.co.uk

Progress to date

31

Social Care – 3 conversations model, which focuses on the capabilities of people, families and communities. Discharges from the RUH – joint working with RUH and now taking 25 discharges a week into reablement teams seven days a week. Community hospital review – implementing action plan to improve discharges and reduce length of stay Falls pick up service – joint working with RUH and SWASFT to continue to develop service, reduce hospital admissions and increase referrals to Falls clinic Immunisations – health visitors are focusing on increasing the uptake of immunisations and talking about the importance of immunisations with families Breast feeding figures have risen to 96% in Q2 with increased support from health visitors which support better longer term health outcomes

Virgin Care private and confidential www.virgincare.co.uk

Feedback from GPs

32

Challenges in referring to the Health Access Team (single point of referral) Concerns about turnover of patients from Virtual Ward Unhappy about the reconfiguration of health visiting around Children’s Centres and communication between Health Visitors and GPs MDTs work well in some clusters but not others

Virgin Care private and confidential www.virgincare.co.uk

Feedback Local actions to date Future plans MDTs work well in some clusters but not others

• Review areas of best practice
• Work with GPs to agree best practice

and what is to be done

• Look to review MDTs

and function as part of restructure of localities around GP clusters Challenges in referring to the Health Access Team (single point

• f referral)
• Introducing intelligent phone system
• Two new starters in HAT team to

improve capacity

• Automate processes in SystmOne
• Move to Care

Coordination will incorporate referrals from all services Turnover of patients from Virtual Ward

• We are keen to understand examples of

where GPs feel this could work better

• Caseload reviews of

Community Matrons by Service Design team Reconfiguration of health visiting around Children’s Centres and communication between Health Visitors and GPs

• Part of national contract
• 60 health visitors and low turnover and

sickness – retired health visitors come back on bank

• Every GP practice has a link health

visitor (normally Safeguarding GP) and they meet every six weeks.

• New Head of Health Visiting – happy to

meet with GPs and keen to work collaboratively

• Continue delivering

national contract and focus on wider public health role and collaborative working with GPs

Feedback from GPs

33

Transformation update Joanna Scammell – Head of Transformation

Virgin Care private and confidential www.virgincare.co.uk

Our current focus and updates

Services update; Community hospitals Reablement Social Care 3 conversations Mental health and wellbeing reviews Care Coordination Mobile working Integrated care record Commissioner transfer and contract changes

35

Virgin Care private and confidential www.virgincare.co.uk

ICR and Care Coordination

Functions Enablers

Signal point of access

Risk stratification Clinical pathways/ processes Integrated Care Records Data sharing Mobile working Referral Management IT infrastructur e

Real time data/ remote monitoring

Coordinate Rapid Response Triage Signposting/ booking Health coaching Case Management Support self management Community wide care plan Scheduling First Assessment MDT

Care Coordination is the management of an individuals health and social care to support them to maintain good health and happiness. Focusing on wellbeing and promoting a healthy lifestyle to enable individuals to remain in their own home as long as they desire. Single

Virgin Care private and confidential www.virgincare.co.uk 37

ICR Sprints

Benefits (evidence base) Capabilit y

Plan

Benefits (evidence base)

Plan

Benefits (evidence base)

Plan Plan

Benefits (evidence base)

Plan

Benefits (evidence base)

Securing stakeholder support (by iterative design)

Capabilit y Capabilit y Capabilit y Capabilit y Recurrent Benefits Recurrent Benefits Recurrent Benefits Recurrent Benefits

Jan 2018 Apr 2018 July 2018 Oct 2018 Jan 2019 Apr 2019 Population Cohorts

Virgin Care private and confidential www.virgincare.co.uk

Next steps

• Citizen’s panel style

model for primary care

• Survey of interests

launched in Jan

• Early adopter ICR
• GP lead ICR

Virgin Care private and confidential www.virgincare.co.uk

Our commitments to you

40

We want to work collaboratively and engage GPs to agree ways to improve joint working and local services We will be aligning our localities to GP clusters – moving from 3 localities to 4 localities around Bath Aqua, Bath Sulis, Norton Radstock and Chew Keynsham. We will include updates about community services in the GP CCG newsletter Escalation of any concerns – please contact your locality manager: North East Somerset Bath Chiquita Cusens Caroline Latham T 0117 9461066 T : 01225 396479 m: 07515191914 M: 07545423426 If your concern is not resolved then please contact Alison Tucker followed by Kirsty Matthews t: 01225 831773 t: 01225 831434 m: 07976918900 m: 07977 435175