1. The role of Vanguards Better Care Together
Christiane Shrimpton and Martin Reddy
7th June 2016

2. Vanguard Pilots for different ways of working
New Care Models – 29 chosen in March 2015
Integrated primary and acute care system - 9
Morecambe Bay Health Community

3. (47 practices, not all Federation members) NWAS
Population 365,000
Geographical area 1800 m2
Two CCGs
Four NHS Trusts
Morecambe Bay
Cumbria Partnership
Blackpool
Lancashire Care
Two County Councils
Two GP Federations
(47 practices, not all Federation
members)
NWAS
The Morecambe Bay footprint covers a significant geographical area (1,800km2 which is more than double the area for the national average trust (815km2;) and the population (365,000) is less than the national average (418,000).
•Within the Morecambe Bay area there is enormous diversity, with small, rural, isolated villages, such as Hawkshead and Coniston; a proportion of the Lake District National Park with high levels of tourist visits, especially in Summer; Lancaster, a city with a University campus, well connected to the M6 motorway and West Coast main line; Barrow-in-Furness, a fairly large urban town, with high levels of deprivation , geographically remote and 46 miles (well over an hour) from the nearest other major acute hospital services at Lancaster.
•The Trust has a very low level of spells per site i.e. activity (33,700) compared to the national average (73,800) as a consequence of the lower than average population and geographic spread which means working on 3 sites rather than the national average of 1.4.

4. The Triple Aim – our compass
Safe, Effective, Timely, Patient Centred, Equitable
The Triple Aim – our compass
Bay Care Partners Objectives
Understand our population's health and care needs and act positively on that understanding;
Work with local people and our diverse communities to improve their health and wellbeing;
Deliver safe, effective, and high quality health and care services, either from within the parties subject to this MoU or from other statutory and non-statutory providers;
Support and develop our teams and individual staff members, and foster a shared culture of continuous improvement;
Live within the financial resources available to us and create a sustainable health and care system.

5. Process we used

6. Core group Led by consultant ophthalmologist
BCT management lead support
2 GPs
2 optometrists
CCG representatives
Diabetic screening
Information analyst
Trust clinical service manager, lead nurse and clinical lead
Third sector representative (also patient voice)
Supported by IM&T, finance, HR, estates

7. Objectives Ophthalmology
Address capacity and demand mismatch
Achieve equity of access and provision bay wide
Integration of hospital and community services
Right professional, right time, right setting
Identifying and addressing educational needs

8. Task and finish groups Community Eye Care Cataract
Glaucoma and ocular hypertension
Paediatric ophthalmology
Age-related macular degeneration
Diabetic eye disease
Clinical standards
Agree protocols
Report back to steering group

9. Patient engagement
Third sector representative on steering group liaised with patients
Engagement events with patients, optometrists, third sector organisation staff and hospital eye service (HES) staff to discuss areas of possible changes in service delivery
Patient experience in current HES (emergency services, cataract, general clinics, I Want Great Care results)

10. Our Survey Patient population
52% between 65 and 85 (a group that is increasing in size)
57% female, 43% male
Distance for travel – about 30% travelled 6 or more miles – 1 more than 30
Only 1.5% required hospital transport
Additional 10% older, 10% children

11. What have our patients told us?
Need to be sure the person I see is fully qualified
Do not like current delays/waiting times
Patients want local access and parking
51% preferred to be seen in the hospital, 31% in a GP practice and 18% at a local optician
17% would like weekend appointments, 7% evening appointments

12. Challenges Poor availability of good baseline information
Adjusting to a different approach
Finding out who else you need to link in with
Few processes in place for wider communication and engagement
Being the first cohort
e.g. advice and guidance, referrals

13. What has worked well Taking a population needs approach
All working together and agreeing priorities
Having a keen optometrist workforce wanting to extend their scope of work
Members taking joint responsibility
For a sustainable model
For quality standards

14. Any questions ?