Building healthy communities

Delivery models workshop

Agenda

1. Introductions All 5 mins

2. Update & Recap Stuart 5 mins

3. Scene setting/Background SN/IT 5 mins

4. Current state All 45 mins

5. Future state All 45 mins

6. Consolidation of discussions All 10 mins

7. Next steps SS/SN 5 mins

CHS Transformation programme- Update

listen and engage design and test procure service mobilise & go-live

Feb-Aug 2016 Mar- Sept 2016 Oct 2016-July-2017 Feb

2018

• PPE - Pubic event completed, Focus groups, Patient reps • Needs analysis - Collating needs & expectations, in line with objectives • Provider events - First event completed, Provider challenges identified • NCCG programs - Aligning with TST and ICP

• Vision and scope Vision defined, Scoping in progress • Delivery models Next two CDG workshops • Financial analysis First review done/ Children’s Prog • Pathways Align with ICP work

Recap from visioning workshop

• Scope

Objectives Principles Outcomes Scope

1. MCP hubs- one

stop shop

around primary

care

2. Risk

stratification

3. Shared care

records

4. MDT teams,

integrated

workforce

model

5. Manage

Demand and

capacity

effectively

6. SPA

1. Community as

default

location of

care

2. Integrated

health and

social care

3. Family as a

whole

4. Choice and

empower

patient

5. Prevention

and promotion

6. Reduce health

inequalities

1. Reduction in

hospitalisation

2. Improved

experience

3. Return to

independent

living

4. Get it right first

time

5. Reduction in

complication in

LTC

6. Increased EOL

care at home

1. All community

based services

not in scope of

acute or

primary

contracts

2. Specialist

services in

community to

support

pathways

3. Acute services

that can be

delivered in

community

4. Enablers

5. Out of scope

Focus for today- future model

What we want to achieve today

• Analyse and Agree Current State • Structure, Services, Constraints, Issues, Gaps

• Develop high level picture of future model • Scope criteria

• Delivery model

DO…

DON’T…

• Keep the patient in mind • Be forward thinking and challenge the

status quo • Accept the fact that there will be

differences of opinion • Be free to speak minds • Utilise today to explore new

opportunities- not just change the old • Think about functions rather than

services

• Be constrained by current service configurations

• Be constrained by current models of care

• Attribute ideas to individuals

• Let us not personalise or focus oj the negatives…let us use the lessons learnt to move forward

Ground Rules

Current State Analysis

Current state- Key questions Group 1

• What are the key constraints or issues with current state- patient/staff

• What are the usual points of failure in current community services

• What are sources of inefficienices, duplication and wasted costs

Group 2

• Does the current state meet demand adequately

• Are the current service lines fit for our future aspirations

• What are the gaps in our understanding of current state…what other information do we need

Group 3

• Current state work force model

• Current state IT infrastructure

• Current state estates for community health

Exercise: 10 minutes (Scenario on your tables)

How is Mohammed’s care being delivered today?

Can you identify the different

• Services he will use

• Access points to get care

• Providers involved

• Locations and facilities he needs to visit

• Sets of records that exist and needs to be viewed

11

Mohammed - Diabetes with Stroke (55 yrs old)

.

He has diabetes requiring insulin injections and regular checking of his blood

sugar levels. As a result of his diabetes he has kidney disease requiring dialysis

three times a week at Newham hospital. He sees his diabetes specialist in East

Ham but his GP surgery is near his home in Stratford.

He suffered a stroke two years ago and finds it difficult to move around the house - he

had physiotherapy in the past from the community stroke team and they came to his

home. They worked with the Occupational Therapists to install equipment including

grab rails and a raised toilet seat to help him manage at home.

He lives with his wife, who is his main carer, and children who find managing his health

conditions and appointments difficult. His wife isn't always sure who to ring first if

she needs help.

Camilla is Mohammed's Care Navigator - she is available in working hours during the

weekdays to help him and his family with things like booking transport to get to

appointments.

Mohammed has known his GP for many years and is happy having someone who

knows about him, his family, and his health problems. Sometimes though his GP has to

ask his wife what the other teams have agreed for his care as letters can take some

time to arrive in the post.

Well Person

Minor Illness

Community EPCT

Urgent Care /111/ OOH

Emergency/ A&E

Outpatient Care / Acute

Transition Care

LTC Chronic Care

End of Life

Rehab/ Enablement/ CHC Case Management/ Care Navigators Care

Co-ordination Self Care / Prevention

• Cardiac rehabilitation • Community neuro rehab &

stroke service • CHC Wards – Fothergill Ward &

sally Sherman Ward • Cazaubon Ward • Pulmonary Rehab • SLT • PWLD • Free nursing care & Continuing

case management (FCN)

• Virtual Wards (VW) • Care Navigators • Telehealth • Supported Discharge • Hospital in-reach & Early discharge

• Rapid Response • SPA • District Nursing • New Entrants • Geriatrician – specialist

support • Clinical support to VW • Falls Service • Foot Health • continence

• Diabetic Service

CHS Services CHS Services CHS Services CHS Services

End of Life

• Palliative care including Cancer

• OT Palliative Care & OT community Hands

CHS Services

Community Care Home

CHS: Current Person/Patient Journey Pathway mapped to services

Virtual Ward/ Rapid Response

Frailty Unit

Complex Discharge

Rehab / 2˚Prevention

OP Community Service

Re-admission Avoidance

Enhanced Homecare

GP Services Acute Care Community Care/ Home

Care Plans / MDT Services

Ambulatory Care

LTC Chronic Care

Current delivery model

Primary Care ELFT Other Contracts Social Care

• Extended Primary

Care Services

• GPs

• Some AQPs for

both Cardiology &

Diabetes

• Integrated Adult

community Health

Services

• Specialist Services

• Inpatients/outpatien

ts

• Day hospital

• Falls service

• Continuing care

/Case management.

• St Joseph’s

Hospice

• Homer ton NHS

Foundation Trust

(contracted activity)

• NELFT (contracted

activity)

• Patients First

• Ihealth

• Accelerate (tariff

based)

• InHealth

Delivery Team

• Enablement

• Care management

• Assessment

• Hospital discharge

Commissioning Team

• Homecare &

settlement

• Stroke prevention

• Dementia

ESTATES

Vicarage

Lane HC

Lord

Lister

HC

Shrewsbury

House HC

Stratford

Office

Village

West

Beckton

HC

East

Ham

Care

Centre

The

Centre

Manor

Park

Appleby

HC Romford

Rd HC

Clinical

ED

building

Sickle

Cell &

TC

Brainstorm

Current state- Key questions Group 1

• What are the key constraints or issues with current state

• What are the usual points of failure in current community services

• What are sources of inefficienices, duplication and wasted costs

Group 2

• Are the current service lines fit for our future aspirations

• What are the gaps in our understanding of current state…what other information do we need

Group 3

• Current state work force model

• Current state IT infrastructure

• Current state estates for community health

Brainstorm- Feedback

Context and background for Future Care Models

What do we need to define

• Model of delivery of community services

• Suitable Contracting model

• Detailing the different elements of the future model • Estates • Workforce model and care team structure • IT • Ideal Partnerships/ working relationships • Role of primary care • Role of the community care provider • Role of Acute care • Role of social care/ LBN • Any roadmap if service reconfiguration is to be staggered • Integration points

• Core pathways

• Outcomes, KPIs, Outputs

• Scope of services to meet future objectives (including TST/ICP)

Future CHS care model options

• Option 1- Continue with current state • One block contract with ELFT plus multiple AQPs

managed by CCG

• Option 2- Multiple Specialist Provider model • Multiple specialist providers by services or bundles

managed by CCG or in partnership models- Alliance model

• Option 3- MCP Model with EPCS locality hubs • Hub and Spoke model wrapped around primary care.

Multiple specialist providers managed through one Lead provider/contractor who is the integrator

Multispecialty Community Provider model

• Fully integrated provider of out-of-hospital care with a clear and robust

governance structure, and its own organisational capability.

• Built around the registered list, focused on population health and self care, to

enable greater scale and scope of services that dissolve traditional boundaries

between primary and secondary care.

• Making the most of digital technologies, with joined-up electronic health records for

its registered population, risk stratification and patient population segmentation, and

targeted services for different groups of patients.

• New skills and roles for expanded multi-disciplinary community-based teams,

including for example pharmacists, social workers and nurse leaders.

• Based on population sizes of at least 30,000 - 50,000.

• Responsibility for managing new capitated contracts for population health and care.

What they are

Example MCP models Modality Birmingham & Sandwell (70,000)

• larger centres will expand the range of social, mental, community and enhanced secondary care

services on offer to patients by delivering community outpatient and diagnostic services

• health and social care system accessible through GP practices, with a care-coordinator to

support patients on their journey.

West Wakefield Health and Wellbeing Ltd (63000)

• Over 100 care navigators, the majority of which are administrative staff who generally have first

contact with patients, are working in practices and are trained to direct patient to the most

appropriate care

• development of integrated community teams; the combined skills of different professionals

including physical health, mental health and social care

• more ways for people to digitally access healthcare- email, skype, social media, health apps,

video consultations

Stockport Together (300000)

• new model of care builds on the GP registered list and will be integrated around the GP practice

at neighbourhood level (20-30,000 population), at locality level (80,000 population) and at

borough level (300,000 population).

• Hospital urgent care will be redesigned, with a single point of access that is integrated with

community teams

• People with complex conditions or at the end of life will have an integrated team working with

them to support them and help them make the best decisions about their plan of care

Example MCP models Better Local Care (Southern Hampshire) (220000 through 3 sites)

• initial focus on launching three rapid implementer local sites

• support people to take a more active role in self-managing their care, co-develop a care plan

that will help them to maintain their independence and stay at home

• CHS integrated with urgent care services and access

Lakeside Healthcare (Northamptonshire) (100000)

• 100,000 patients are brought together in a single list

• a nationally acclaimed and respected Urgent Care Model (the ‘Corby Care’ model – delivered

both in community and front-of-hospital locations)

• an Ambulatory Care service, particularly designed to relieve pressure at the ‘front door’ of

hospitals

• a bespoke and effective long-term condition management service for the frail elderly and other

vulnerable patient groups which might include admission to short-stay community beds

managed by Lakeside

• a highly focused GP-led complex-care management service

• a number of hospital outpatient and planned care services, including dermatology,

ophthalmology, MSK, geriatric medicine and mother & baby services.

NHS EXAMPLE

NHS EXAMPLE

Southern Health- Hampshire

Brainstorm

Future CHS care model options

• Option 1- Continue with current state • One block contract with ELFT plus multiple AQPs

managed by CCG

• Option 2- Multiple Specialist Provider model • Multiple specialist providers by services or bundles

managed by CCG or in partnership models

• Option 3- MCP Model with EPCS locality hubs • Hub and Spoke model wrapped around primary care.

Multiple specialist providers managed through one Lead provider/contractor who is the integrator

Pros and Cons

Large acute based services

Multiple disconnected

Small community

services

Social care system- separate

CHS Transformation

Integrated Community

Hub

Nursing/

Residential homes

Enhanced primary

care

Voluntary service

Social Care

Multiple access points and

teams

MDT teams Care Close to home

Reduce hospital visits &stay

Improved outcomes & experience

Care locally accessible and responsive to patient needs provided in community or in people’s homes rather than hospital

Newham Community Services Proposed Programme Vision

Scoping Process

• Identify priorities

and outcomes

• Analyse current

services and gaps

• Develop future

model- pathways,

services to deliver

• Define scope

• Detail specifications

Scope Principles

Adult Community Services that should be considered in scope for

the re-procurement are those that:

• Fall outside the definition of primary care and acute service

provision

• Do not require hospital infrastructure for delivery

• Can be linked to the provision of social care

• Are necessary to deliver the community elements of the CCG’s

5-Year Plan

• Are already being delivered or can be delivered in a

community or home setting

Brainstorm

33

Exercise

Scoping Criteria For Community health services- 5mins

Identify services that should be in scope- 10 mins

Case management Care navigation Supported discharge OT/PT Rapid response/VW Telehealth MDT Phlebotomy Wound care MH (CMI) Geriatrician services

Assessments Care management Enablement services Hospital discharge support Home care Home and settle service Stroke prevention services Dementia support services Neighbourhood teams

Remote advice Virtual consults

Ambulatory care

Consultant clinics in

community

Stay-well partnership Marie-Curie Hospice care

Hub

Diagnostics

Screening

OP consultations

OP procedures

Ambulatory care

End of Life care

District nursing

Specialist services

MH (SMI)

Rehab/ Reablement

Nursing/

Residential homes

Enhanced primary

care

Voluntary service

Social Care

Borough level services Equipment/ Appliances Wheelchair services SPA Continence services Teaching/training MSK