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

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 Radical upgrade in prevention Health and wellbeing gap 1 1 New care models Care and quality gap 2 2 Efficiency and investment Funding gap 3 3

Multispecialty community providers moving specialist care out of hospitals into the community Integrated primary and acute care systems joining up GP, hospital, community and mental health services Acute care collaboration local hospitals working together to enhance clinical and financial viability Enhanced health in care homes offering older people better, joined up health, care and rehabilitation services Urgent and emergency care new approaches to improve the coordination of services and reduce pressure on A&E departments Five new care models

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 50 vanguards selected

Clinical engagement Patient involvement Local ownership National support Our core values

Integrated primary and acute care systems (PACS) vanguards 1Wirral Partners 2Mid Nottinghamshire Better Together 3South Somerset Symphony Programme 4Northumberland Accountable Care Organisation 5Salford Together 6Better Care Together (Morecambe Bay Health Community) 7North East Hampshire and Farnham 8Harrogate and Rural District Clinical Commissioning Group 9My Life a Full Life (Isle of Wight) Multispecialty community providers (MCPs) vanguards 10Calderdale Health and Social Care Economy 11Erewash Multispecialty Community Provider 12Fylde Coast Local Health Economy 13Vitality (Birmingham and Sandwell) 14West Wakefield Health and Wellbeing Ltd 15Better Health and Care for Sunderland 16Dudley Multispecialty Community Provider 17Whitstable Medical Practice 18Stockport Together 19Tower Hamlets Integrated Provider Partnership 20Better Local Care (Southern Hampshire) 21West Cheshire Way 22Lakeside Surgeries (Northamptonshire) 23Principia Partners in Health (Southern Nottinghamshire) Enhanced health in care home vanguards 24Connecting Care – Wakefield District 25Gateshead Care Home Project 26East and North Hertfordshire Clinical Commissioning Group 27Nottingham City Clinical Commissioning Group 28Sutton Homes of Care 29 Airedale and partners Urgent and emergency care (UEC) vanguards 30Greater Nottingham Strategic Resilience Group 31Cambridgeshire and Peterborough Clinical Commissioning Group 32North East Urgent Care Network 33Barking & Dagenham, Havering & Redbridge System Resilience Group 34West Yorkshire Urgent and Emergency Care Network 35Leicester, Leicestershire & Rutland System Resilience Group 36Solihull Together for Better Lives 37South Devon and Torbay System Resilience Group 50 vanguards developing their visions locally Acute care collaboration (ACC) vanguards 38Salford and Wigan Foundation Chain 39Northumbria Foundation Group 40Royal Free London 41Dartford and Gravesham 42Moorfields 43National Orthopaedic Alliance 44The Neuro Network (The Walton Centre, Liverpool) 45 MERIT (Mental Health Alliance for Excellence, Resilience, Innovation and Training) (West Midlands) 46Cheshire and Merseyside Women’s and Children Services 47Accountable Clinical Network for Cancer (ACNC) 48East Midlands Radiology Consortium (EMRAD) 49Developing One NHS in Dorset 50Working Together Partnership (South Yorkshire, Mid Yorkshire and North Derbyshire

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, 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 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 Support package launched

Addressing the key enablers of transformation 1. Designing new care models and enabling spread 2. Evaluation and metrics 3. Integrated commissioning and provision 5. Harnessing technology 6. Workforce redesign 7. Local leadership and delivery 8. Communication and engagement NATIONAL COHORT LOCAL 4. Empowering patients and communities

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. Examples of support – community care

More details can be found on the NHS England website: Or join the conversation on Twitter using the hashtag: #futureNHS Further information…