1. Frimley Health and Care Integrated Care System

2. Our Journey: 2017 2015-16 2015 2014 2013 2012 Frimley Health and Care
Vanguard Programme driving real improvements for patients
2014
Risk Share contract with main acute provider
2013
CCG Five Year Strategy developed with partners
Establishment of CCGs, shared leadership of our system change projects
2012
Kings Fund and re-launch of system work with common aims and shared objectives
System Transformation Board

3. The journey continues:
Clinical Leadership
Engagement
Primary Care transformation
Self Care and Prevention
Mental Health
Vanguard
ICS

4. The changing NHS landscape
From:
To:
Vanguards and lots of CCGs
Independent assurance of providers and commissioners
Building successful well led integrated systems
Collective responsibility
Blurring boundaries between commissioning and provision
Integrated Care Systems
Systems changing at different paces, in different ways, different approaches

5. Population of 800,000 people in East Berkshire, North East Hampshire and Farnham and Surrey Heath CCG’s.
Involves 30 statutory bodies. Includes Local Authorities, CCGs, provider Foundation Trusts and others

6. Creating healthier communities
Your Local Authorities and local health organisations are working together as the Frimley Health & Care System to provide you with a joined up health, care and wellbeing system. This means you will receive the right care at the right time and in the right place.
This means you and your family will:
Be supported to remain as healthy, active and independent as you can be
Know who to contact if you need help and only have to tell your story once
Have easier access to information and services
Work together with a care and support team to plan and manage your own care
Access urgent or emergency care more easily closer to home
Treated in the best place for your needs
Increase your ability and confidence to take responsibility for your own health, care and wellbeing
Be confident that your care is provided in the best possible way.

7. Workstream Aims:
Prevention and self-care – ensuring people have the skills, confidence and support to self-care and to stay well
Integrated care decision-making – developing integrated teams of multi-disciplinary practitioners providing single points of access to services such as rapid response and re-ablement
GP transformation – laying foundations for a new model of general practice provided at scale to offer a wider range of services in the community, including development of GP federations to improve resilience and capacity
Support workforce – supporting the care support workforce so that it is fit for purpose and offers good career opportunities across the system
Care and support – transforming the social care support market and improved management of the market by health and social care working more closely together. Helping to make the best use of the money available across the Frimley Health and Care system and better plan for the future care support needs of local people.
Reducing clinical variation – ensuring that the population has access to the same high quality of services across the system wherever they live
Shared care record – helping people to tell their story once by implementing a shared care record that is accessible to professionals across the footprint

8. Developing services across health and care:

9. Transformation Initiatives Cross cutting Programmes
2018/19 System plan on a page
Our system on a page:
1.Prevention & Self-care: Ensure people have the skills, confidence and support to take responsibility for their own health and wellbeing .
Urgent & Emergency Care
National ‘must do’s’:
Primary Care,
Urgent and Emergency Care,
Referral to treatment times,
Cancer,
Improving quality
Financial sustainability
Development of high quality STP
National
Priority 1: Making a substantial step change to improve wellbeing, increase prevention, self-care and early detection
Priority 2: Action to improve long term condition outcomes including greater self management & proactive management across all providers for people with single long term conditions
Priority 3: Frailty Management: Proactive management of frail patients with multiple complex physical & mental health long term conditions, reducing crises and prolonged hospital stays
Priority 4: Redesigning urgent and emergency care, including integrated working and primary care models providing timely care in the most appropriate place
Priority 5: Reducing variation and health inequalities across pathways to improve outcomes and maximise value for citizens across the population, supported by evidence
Local
Five Year Priorities
Transformation Initiatives
Cross cutting Programmes
2.Integrated care decision-making: Develop integrated decision making hubs to provide single points of access to services such as rapid response and re-ablement
7.Shared Care record: Implement a shared care record that is accessible to professionals across the STP footprint.
6.Reducing clinical variation: Reduce clinical variation to improve outcomes and maximise value for individuals across the population.
5.Care and Support: Transform the social care support market including a comprehensive capacity and demand analysis and market management
4.Support Workforce: Design a support workforce that is fit for purpose across the system
3.GP Transformation: Lay foundations for a new model of general practice provided at scale, including development of GP federations to improve resilience and capacity.
Enablers
Workforce
Analytics
Estates
Digital & Technology
Mental Health & Learning Disabilities
Maternity
Children & Young People
Cancer
Communications and engagement

10. Next steps for engagement:
Continued engagement on priorities with local communities
Five to ten year national plan engagement programme
North East Hampshire and Farnham events plan