1. On behalf of the Steering Group Dr. Jonathan Serjeant Clinical Director of BICS March 2015 ProActive Care

2. Contents 2 1.Where do you find more information? 2.ProActive Care pathway 3.“I” statements 4.Cluster ProActive Care team 5.Highlighted issues and challenges 6.Still to do prior to completion of the service specification 7.What is coming up over the next four weeks? 8.Questions for clusters to discuss 9.How to find out more information 10.Links to ProActive Care documents

3. Where do you find more information? 3 You can also stay in touch with us on the following email address: BICS.proactivecare- communications@nhs.net  The ProActive Care website has lots of information and we will be key coding papers and highlighting the most important information. www.proactivecare.org www.proactivecare.org

4. Proactive Care Pathway 4 Pharmacist Community Navigator Social Care Provider GP IPCT TeamOthers… Extended MDT Patient Cohort Whole Person Assessment Risk Stratification Cluster Prioritisation Cluster Proactive Care Team Care Coordination Decision

5. “I” Statements 5 Who I am… What I understand about my health & wellbeing now… What I fear… What I want to happen / my goals are… What I don’t want to happen… What I do when things go wrong … My main friend(s) / supporter(s) / carer(s) are… My named key contact is… My social / personal needs are… My medicines are… My advanced care wishes are

6. Cluster Proactive Care Team 6 Patient Care Advisor (PCA) Data support Non- clinical support worker (NCSW)

7. Highlighted issues and challenges 7 IT procurement and cost Cluster membership Communication of information Cross cluster sharing information Evidence for NCSW Finance Visibility How does this connect to LCS

8. 8 Business case for the next phase Cluster Prioritisation process / LCS Outcomes Process of Care Coordination Decision making Click here to view our Project Plan Still to do Still to do prior to completion of the service specification…..

9. What is coming over the next 4 weeks? 9 Click here to see our Development plans Recruitment and training Organisational development (MDT and cluster level) Implementation What next?

10. Questions for clusters to discuss 10 How will we progress project implementation for ProActive Care for clusters during 15/16? BICS to support each cluster Clusters go it alone Key issues for each cluster? How is this best implemented and supported in each cluster? Proposed governance arrangements

11. Where do you find more information? 11 You can also stay in touch with us on the following email address: BICS.proactivecare- communications@nhs.net  The ProActive Care website has lots of information and we will be key coding papers and highlighting the most important information. www.proactivecare.org www.proactivecare.org

12. Links to documents 12 Vision- http://www.proactivecare.org/wp-content/uploads/2015/02/ProActive-Care- vision.pdf http://www.proactivecare.org/wp-content/uploads/2015/02/ProActive-Care- vision.pdf Service Specification- http://www.proactivecare.org/wp- content/uploads/2015/03/ProActive-Care-Service-Specification-final-draft.dochttp://www.proactivecare.org/wp- content/uploads/2015/03/ProActive-Care-Service-Specification-final-draft.doc Patient Pathway- http://www.proactivecare.org/?page_id=122http://www.proactivecare.org/?page_id=122 Cluster Development Plan- http://www.proactivecare.org/wp- content/uploads/2015/03/Cluster-Development-Plan-Template-DRAFT-v01.docxhttp://www.proactivecare.org/wp- content/uploads/2015/03/Cluster-Development-Plan-Template-DRAFT-v01.docx Cluster Development Plan – Tracker- http://www.proactivecare.org/wp- content/uploads/2015/03/Cluster-Development-Plan-Template.xlshttp://www.proactivecare.org/wp- content/uploads/2015/03/Cluster-Development-Plan-Template.xls Job Descriptions- http://www.proactivecare.org/?page_id=131http://www.proactivecare.org/?page_id=131