improving services through co-production (1): primary care communities – a new future for primary...
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Health and Care Innovation Expo 2014, Pop-up University, Day 2. S155 day 2 - 1430 - improving services through co-production (1) Primary Care Communities – a new future for primary and community care? Dr John Howarth MBBS DTM&H FRCGP FFPH GP Cockermouth Director of Service Improvement Cumbria Partnership Foundation Trust #Expo14NHSTRANSCRIPT
Primary Care Communities – a new future for primary and
community care?
Dr John Howarth MBBS DTM&H FRCGP FFPH
GP Cockermouth
Director of Service Improvement Cumbria Partnership Foundation Trust
The baby boomers are coming!
Cumbria 65+ Population: selected health projections (numbers people)
0
5,000
10,000
15,000
20,000
25,000
2008 2010 2015 2020 2025
Year
Nu
mb
er o
f p
eo
ple
Unable to manage at leastone mobility activity
75+ registerd blind or partiallysighted
Dementia
LTLI caused by heart attack
Falls (A&E attendance)
Severe depression (lowestestimate level)
LTLI caused by stroke
Falls (hospital admission)
Older and more frail
Multimorbidity
How do we spend our money now?- example healthcare budget for a town
Acute Hospital =
52%Payments by results
(excludes mental health and
diagnostics)
Prescribing20%
General Practice 15%
Community services
13%(includes comunity
Hospital)
c. £2.5 million
c. £2 million
c. £1.8 million
c £7.5 million
“Every system is perfectly designed to deliver the results that it gets”
We need a new paradigm for healthcare
We need a whole system that:
• Delivers much more care outside hospital
• Delivers a step change to prevention
• A step change towards more self care, information (Health Literacy) and empowerment of patients
• Operationalises public health and reduces inequalities
Primary care communities (PCCs) are where general practice, social care, community services and community assets come together to provide both person centred coordinated care and organised approaches to improving the population health.
Primary Care Communities
5
55
3
32
‘One extended Primary Health and Care Team’ wrapped around
clusters of practices
Built up from practice lists
Looking after a population
Minimal handoffs or
referrals
Circa 23 in total
(We currently have 46 district nurse
teams plus over 100 other teams e.g. therapy teams,
STINT, LTCs, case managers etc.)
Holding a devolved budget
Primary Care Communities - purpose
5
55
3
32
Much more care delivered outside hospital
More prevention (Asset Based Approaches)
More care planning
More support for self care
More efficient, less waste
Better coordinated ‘one team’
approach
Public health building blocks – closing the gaps
Data driven measurement for
improvement
Primary Care Communities - Enablers
5
55
3
32
Supported by a ‘common
platform’ of IT, estate, workforce planning
Enabling primary care
by developing better
support systems such
as admin, management,
mobile working etc
CLIC – Cumbria Learning and Improvement Collaborative
Developing the ‘Cumbria
production system’ at
primary care community level
Cumbria Health and Care Alliance
Primary Care Communities – specialist support
5
55
3
32
‘Teams without walls’
Mental Health
Children and families
‘Teams without walls’
Urgent Care Network
Elderly Care network
Other specialist services such as
diabetes, neurology,
rheumatology etc.
Upskilling and capacity building, fewer outpatients, less waiting, more team working, multidisciplinary
Primary Care Communities - Implementation
5
55
3
32
‘’Readiness’ assessment
Prototypes from
Integrated Care Pilots
Joint CCG GPs and
community leadership
Capacity for change – dedicated
team
‘Alliance’ priority
Pathfinder sites e.g. Workington
Creating the ‘blueprint’ through
co-production
Pathfinders starting by summer and 10 by the
end of the year
“You don’t have to see the whole staircase, just take the first step.”- Martin Luther King, Jr.
“In my experience of large enterprises, I have found it is often a mistake to try to settle everything at once. Far off…we can see the peaks of the delectable mountains…We know where we want to go, but we cannot foresee all stages of the journey.”
-Winston Churchill