1. 5 Year Forward New models and new ways of working Food for thought HE NHS England October 2014

2. Future changes in 5 Year Forward some of the key concepts Published October 2014

3. Multispecialty Community Provider Model (MCPS) Expert generalist Federations Networks Single practices Digital technology Target people with complex needs Provide OPD services in community & AC Employ consultants as partners & or non med senior practitioners Credentialing GPs direct admission rights to acute services OOH inpatient care supervised by new role resident hospitalists Run local comm. hospitals & expand diagnostics Expanded Leadership AHP Pharmacy, HCS nurses Funding may be delegated NHS budget & or H&HSC responsibility Renewable energy of carers, voluntary,& service users accessing hard to reach & new ways to changing behaviours

4. Primary and Acute Care (PACS) Single organisation to provide NHS list based GP & hospital care with MH & community care Most radical PACS take accountability for whole health needs of reg. list under capitates budget similar to Accountable Care Organisations in USA, Spain & Singapore One option such as in deprived urban areas where GPs under strain hard to recruit – hospitals will be permitted to open up own GP services with lists The leadership required for these vertically IC PACS may vary in different localities A range of options will permit a new variant of IC allowing single organisations to provide NHS list based GP, Hospital Services, MH and Community Care services Other circumstances next stage in development of MCSP could be that it takes over running main DGH

5. Urgent and Emergency Care networks Evening & Weekend access to GP’s or nurses in community bases with increased range of tests & treatments Ambulance services able to make more decisions, treating patients, referrals & greater use of pharmacists Ensure hospital patients have access to 7 day services where this makes a clinical impact on outcomes Develop networks of linked hospitals so most serious needs get to specialist emergency centres A strengthened clinical triage & advice service linking systems together & help patients navigate the systems Proper funding of mental health crisis services including liaison psychiatry New ways of measuring quality of urgent & emergency services New funding arrangements & new responses to workforce requirements to make new networks possible

6. Workforce implications – some thoughts New accountabilities New partners New teams New skills New ways of working New roles New culture New concepts New geographies New opportunities – staff, local people Generalist & specialist changes New & or additional knowledge & skills Changing public relations New career options New ways of learning A flexible workforce across services

7. Annual lecture – Simon Steven’s December 2014 A chance to bring about a vision partly articulated some time ago. “Doctors and specialist will move freely from the hospitals to the health centres, to the maternity and child welfare clinics, and from them back to the hospitals and between the medical officers of health…This will be an essential feature of the whole service; between the local government, the specialists, and the hospitals, there must be absolute and complete cooperation, and no jealously between one and the other. “They must be able to use each other’s services without any difficulty and hindrance, and the way in which it will be done…will be the right of the individual patient…to use of the medical service wherever it is. The right of the individual will be the uniting principle in the whole service.” That was Nye Bevan in 1946. Sixty-eight years later, let’s give it a shot.

8. Five Year Forward - Simon Steven’s December 2014 ‘ The forward view is a compass, not a map ’

9. Four new dynamics - Simon Steven’s December 2014 First, we have the opportunity to move away from care geared towards the “median” patient. Personalisation Second, and at the same time, we are going to have more standardisation in the way care is provided. Standardisation ‘For the first time we’re drawing back the veil on unjustified variation to have more standardisaton’ Third, anticipatory care - moving away from healthcare systems that principally rely on people pitching up to see a health professional when they get sick - towards healthcare systems that are much better able at stratifying risk, identifying upstream care opportunities, and targeting interventions accordingly. And fourth, getting real about co-production; recognising that it is often the “experts by experience” who bring the assets, insights and commitment that will reshape the way care is provided.

10. Push and pull factors - Simon Steven’s December 2014 Co-production & Triple integration Digitisation & Miniaturisation Specialisation V Generalism