Primary Care Transformation Programme Workstream 2, REDESIGN The context of this workstream- briefing for reference group members Isabel Hodkinson Clinical commissioning support for New Models of Care delivery

THCCG Primary Care programme- two workstreams: Workstream 1: RESILIENCE- Immediate, fast, practical help to be offered to practices that would like operational support, initial pilot collaborative, fast follower delivery Workstream 2: REDESIGN- Over the next two years more suitable long term solutions for primary care will be co-designed with general practices alongside the Vanguard programme, with the aim of future-proofing primary care services in Tower Hamlets

Patients at the centre- THIPP Vanguard staff engagement

Changing culture- “What matters to me” rather than “what is the matter with you?” Outcomes- the person defines at least some of them

Concepts to support effective care for people with multimorbidity What’s important to me: The person’s story What do I find helpful/ how I cope My hopes and fears for the future What’s important for me? Person centred evidence informed medicine Medical generalism and challenges to over medicalisation now and in the future Effective multidisciplinary working Relationship Continuity of care Relationship Continuity of care

6 Tower Hamlets GP networks Pop: 28,956 Pop: 23,868 Pop: 38,529 Pop: 33,948 Pop: 27,692 Pop: 25,549 Pop: 36,433 Pop: 30,034 Priced on ‘ideal delivery’ 70% payment up front 30% on year end performance Networks initially not legal entities Requirements for network level clinical leadership Network management structure: Management resource - 150K per network Delivering ‘care packages’ for LTCs and for prevention Network has total control on how to allocate these funds

SYSTEMS thinking essential- the House of Care a useful checklist

Building a system of care- some of the elements we are working on- New models of allocating funding- work on capitated budgets, moving away from tariff Outcomes based commissioning for the system Learning together, eg CEPN Wellbeing in Tower Hamlets programme IT and informatics

Science and informaticsReal-time access to knowledge Digital capture of the care experience Patient–clinician partnerships Engaged, empowered patients IncentivesIncentives aligned for value Full transparency Continuous learning culture Leadership-instilled culture of learning Supportive system competencies The learning health care system:

NOW: GP infrastructure for proactive care for defined populations- FUTURE- proactive care across the system All practices EMIS Clinical Effectiveness Group trusted data processor Single centrally written data entry templates and searches powering call and recall, and payment Monthly performance dashboards to networks Monthly network meetings with specialist support

About this CCG primary care reference group Not a decision making body Perspective needs to be wider than a clinical reference group Members are not representatives but there to share their own personal expertise and perspectives as part of a well rounded oversight function Where people are geographically located in Tower Hamlets aim for best possible spread 13

THIPP Vanguard workstreams have a system strategic focus in line with the Vanguard workplan. Where appropriate they will also manage strategy to support the THIPP transformation plan for CHS. THIPP VANGUARD DELIVERY GROUP THIPP BOARD OPERATING MODEL THIPP BOARD STAKEHOLDER COUNCIL Patients, carers, staff, voluntary and community sector and other statutory partners THIPP VANGUARD WORKSTREAMS 1. Organisational form & governance 2. Service user / carer and stakeholder focus (Sub group Community Capability?) 4. Quality, outcomes and performance (Sub Group Evaluation) 5. Workforce and OD 6. IT and technology 7. Finance 3. Access and Clinical Pathways (Sub group SPA / LYOL) SYSTEM MANAGEMENT COMMITTEE QUALITY & SAFETY COMMITTEE STRATEGIC FOCUS 8. Partnerships & Communications CHS Mobilisation/Transformation Project Team OPERATIONAL FOCUS LOCALITY INTEGRATED CARE BOARDS Note: THIPP Vanguard workstreams have a system strategic focus in line with the Vanguard workplan. Where appropriate they will also manage strategy to support the THIPP transformation plan for CHS. THIPP VANGUARD PROGRAMME BOARD Note: The THIPP Vanguard Programme Board is part B of the THIPP Board and includes CCG. 9. Estates THIPP VANGUARD CLINICAL REFERENCE GROUP CCG representation here CCG involvement in these- many now joint workstreams How to link up with this?

Primary Care workstream 2: REDESIGN We will not jump to solutions but spend time diagnosing and understanding the issues We are aiming to co-produce proposals and consult widely, the reference group being an important element of this There will be lots of other ways to be involved- we will be feeding back through the usual channels and see our webpage.