primary care networks update january 2020 · 2020-04-15 · hastings and rother ccg | high weald...
TRANSCRIPT
Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG
Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCG
SussexClinical Commissioning Groups
Primary Care Networks Update
January 2020
Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG
Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCG
Contents
1. The Journey so far in Sussex
2. Year 1 delivery
3. Year 2 onwards delivery (national service specifications)
4. Primary Care Governance
5. PCN Programme development plan
6. Integration and Partnerships
7. PCN engagement and GP voice
8. Next Steps
Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG
Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCG
GP Five Year Forward View laid foundation for change in
General Practice …
GP5YFV published 2016:
• Represented a turning point in investment in General Practice – committing an additional
£2.4bn a year to support general practice services until 2020/21
• Ambition to strengthen and redesign general practice
• Vision built on the potential for transformation in general practice
– Enabling self care and direct access to other services
– Better use of the talents of the wider workforce
– Better use of digital technology
– Working at scale across practices to shape capacity
– Extended access to general practice including evening and weekend appointments
Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG
Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCG
Now continuing support through NHS Long Term
Plan (LTP)
LTP Aims:
• Everyone gets the best start in life
• World class care for major health problems
• Supporting people to age well
How:
• Primary Care Networks as the foundation of Integrated Care
Partnerships
• Preventing ill health and tackling health inequalities
• Supporting the workforce
• Maximising the opportunities presented by data and technology
• Continued focus on efficiency
Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG
Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCG
Future landscape – integrated commissioning & provision
Sussex Integrated Care System
East Sussex CCGs /
councils
Voluntary care
Mental health care
Brighton and Hove
CCG / councils
West Sussex CCGs / councils
Acute care
Primary care
Community care
N CP N
P
C N
P
Locality and
Borough
Place
System
Neighbourhood
and Primary Care
Networks
C
Underpinned by citizen
engagement
Strategic partnerships
Collaborative & integrated
commissioning for improved
population health outcomes
Integrated care partnership
Delivery of integrated health and
social care across primary,
community and secondary care
Primary care networks
Local needs analysis and proactive
population health and prevention.
Integrated delivery / MDTs
Key planning, commissioning
and delivery Units
Primary Care General practice Community
pharmacy
DentistryPrimary Care
Independent providers meeting the
needs of list base local population
Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG
Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCG
Purpose of PCNs
• Bring practices together to deliver the collective DES and form the foundation for practices to come together with other providers to develop and deliver integrated services
• Provide the building block for developing services with partners more widely than GP practices e.g. pharmacy, opticians, dentistry, community and voluntary care
• Put in place seamless care across primary care and community services for physical and mental health and remove the historic separation of these parts of the NHS
• Focus on the local population and address the inequalities at a local level
• Deliver care as close to home as possible in neighbourhoods rather than around organisational boundaries
• Integrate primary, community and acute care in PCN neighbourhoods with more clinically appropriate secondary care in primary care settings
• Assess population health – focusing on prevention and anticipatory health – and maximise the difference we can make operating in partnership with other agencies
• Promote and support people to care for themselves wherever possible
• Build from what people know about their patients and population
• Make a tangible difference for patients and staff:
– Improve outcomes for patients and provide an integrated care experience
– Development of sustainable and satisfying roles for staff & multi-professional teams
Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG
Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCG
The Network DES
The Network Contract will be a Directed Enhanced Service (DES).
As a DES, it is an extension of the core GP contract. It is established in
accordance with Directions given to NHS England. This compels CCGs or
NHS England to offer the Network Contract DES to all practices.
The Network Contract DES has three main parts:
1. the national Network Service Specifications. These sections set out what all
networks have to deliver. National investment and services grow in tandem.
Commence April 2020 onwards
2. National schedule of Network Financial Entitlements, akin to the existing
Statement of Financial Entitlements for the practice contract. National entitlement
increases financial certainty for everyone. Alongside these entitlements come
clear transparency requirements, including for subcontracting arrangements
3. The Additional Roles Reimbursement Scheme (ARRS)
• From 2019 Clinical Pharmacists and Social Prescribing Link Workers
• From 2020 Physician Associates and First contact Physiotherapists
• From 2021 First Contact Community Paramedics
Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG
Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCG
The journey so far across Sussex
What has been achieved in Sussex:
• 38 Primary Care Networks (PCNs) across Sussex covering 100% of population:
• All PCNs have signed their Network Agreement and appointed a Clinical Director
• All practices are delivering Extended Hours DES from July 2019
• PCNs have begun recruiting to additional roles (Clinical Pharmacists and Social Prescribers). Preparations
underway to support recruitment to further additional roles from 20/21 (Physicians Associates and First Contact
Physiotherapists).
• Some PCNs are working with local provider partners to provide joined up responsive care
• Sussex wide Clinical Directors Network Events established and development programme being designed
• Primary Care Programme Board established to provide a structure for governance of primary care strategy and
oversight of plans
• Development of Primary Care Strategy as part of the wider STP strategy
• Deployment of PCN development and accelerator monies to support organisation, leadership and infrastructure
maturity.
• Successful bid to NHSE/I for Sussex STP to become a part of Population Health Management Programme to
deliver on this ambition for the Sussex system.
Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG
Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCG
What is expected of PCNs by March 2020
The Network Contract DES began on 1 July 2019
01 July 2019 Network Contract DES goes live across 100% of the country
July 2019 – Mar 2020 National entitlements under the 2019/20 Network Contract start:
• PCNs deliver Extended Hours Access appointments to all patients within their
PCN
• Year 1 of the Additional Roles Reimbursement Scheme (ARRS) –
Employment of a Clinical Pharmacist and Social Prescribing Link Worker
• Ongoing support funding for the Clinical Director
• Ongoing £1.50/head from CCG allocations
Apr 2020 onwards National Networks Services start under the 2020/21
Network Contract DES
Year 1 Timeline
Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG
Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCG
Service Specifications
• The first five draft service specifications to be delivered by PCNs (from April 2020) under the GP
contract framework (in collaboration with community services and other providers) were recently
published and NHSE/I are currently seeking feedback on these.
• The GP contract framework set out seven national service specifications that will be added to the
Network Contract DES: five starting from April 2020, and a further two from April 2021. The five
services are:
• Structured Medication Reviews and Optimisation
• Enhanced Health in Care Homes (jointly with community services providers)
• Anticipatory Care (jointly with community services providers)
• Personalised Care; and
• Supporting Early Cancer Diagnosis.
• A Sussex wide response to the consultation on service specifications will be coordinated via the
primary care board as well as detailed proposals on how PCNs will be supported to deliver each of
the new service specificaitons.
Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG
Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCG
Metric description
1 The number of individual SMR episodes undertaken, including:
• The number of SMR processes undertaken (number of individual patients given
one or more SMR appointment)
• The number of SMR follow-up appointments
2 Outcome measurement to monitor impact of SMR
3Prescribing rate of nationally identified medicines of low value that should not be
routinely prescribed
4 Prescribing rate of low carbon inhalers
5 Prescribing rate of medicines that can cause dependency
6 Prescribing rate of anti-microbial medication
PCN members will support direct tackling of the over-medication of patients, including inappropriate use of
antibiotics, withdrawing medicines no longer needed and support medicines optimisation more widely
Structured Medication Review and Optimisation
Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG
Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCG
Enhanced Health in Care Homes
Metric description
1 The rate of emergency admissions for people living in care homes.
2 The rate of urgent care attendances for people living in care homes.
3The proportion of people living in a care home who have a personalised care and support plan
in place.
4The number of people living in a care home who receive an appointment as part of the weekly
care home round
5The number and proportion of people living in a care home who receive a structured
medication review.
6The number and proportion of people living in a care home who receive a delirium risk
assessment.
The aim of this service will be to enable all care homes to be supported by a consistent multi-disciplinary team of
healthcare professionals, delivering proactive and reactive care. This team will be led by a named GP and nurse
practitioners, organised by PCNs.
Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG
Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCG
Metric description
1 Number of individuals in receipt of the Anticipatory Care model
2Number of needs assessment carried out for individuals in receipt of the Anticipatory Care
model.
3Number of individuals in the active cohort of the anticipatory care model with a
personalised care and support plan.
4Number of individuals in the active cohort of the anticipatory care model receiving a falls
risk assessment.
5Number of individuals in the active cohort of the anticipatory care model receiving a
delirium risk assessment
6 Number of SMRs for the active cohort on the anticipatory care model
7 Number of SMR follow-ups in the active cohort on the anticipatory care model
8Number of individuals in the active cohort on the anticipatory care model given a referral to
social prescribing service or where social prescribing is declined
Anticipatory Care
PCN GP practices and other member providers will work collaboratively to introduce more proactive and intense
care for patients assessed at being high risk of unwarranted health outcomes, including patients receiving
palliative care
Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG
Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCG
Personalised Care
The Comprehensive Model of Personalised Care has six main evidenced based components:
• Shared decision making
• Enabling choice (including legal rights to choice)
• Personalised care and support planning
• Social ‘prescribing’ and community-based support
• Supported self-management
• Personalised health budgets and integrated personal budgets
This model will be developed in full by PCNs under the Network Contract DES by 2023/24. the minimum national
activity levels for all elements of the model will increase gradually over time in line with increases in capacity. As
part of the national requirements, PCNs will need to contribute to the ICS plan and the ICS will also need to set out
what it is doing locally, given some of the services are best delivered within a framework of wider local coordination
and support.
Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG
Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCG
Metric description
1The number of personalised care and support plans delivered (including measure of
delivery rate for required cohorts)
2 The quality of personalised care and support plans
3The number of shared decision making conversations completed (including measure of
delivery rate for required cohorts)
4 The quality of shared decision making conversations
5 The number of social prescribing referrals made
6The number of patient activation measurement assessments undertaken (including
measure of delivery rate for required cohorts)
7 The number of Personal Health Budgets
Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG
Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCG
Supporting Early Cancer Diagnosis
PCNs will have a key role in helping to ensure that all their GPs are using the latest evidenced-based guidance to identify people
at risk of cancer; recognise cancer symptoms and patterns of presentation; and make appropriate and timely referrals for those
with suspected cancer.
Metric description
1The proportion of cancers diagnosed at early stage (stage 1 and 2) – progress towards local
Cancer Alliance target
2 PCN-level participation in breast, bowel and cervical screening programmes
3 Proportion of urgent cancer referrals that were safety netted
4The number of new cancer cases treated that have resulted from a two week wait referral
(the ‘detection’ rate)
5 The number of two week referrals resulting in a diagnosis of cancer (the ‘conversion’ rate)
6 Number of cancers diagnosed via emergency presentation
Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG
Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCG
Primary Care Governance
Primary Care Programme Board
• The Primary Care Programme Board has been established across Sussex CCGs to provide oversight and consistency of primary care development across
Sussex and successfully deliver the primary care strategy.
• A PCN programme plan has been developed to provide oversight and governance around PCN work streams. This has been aligned to PMO methodology
from digital and estates primary care programmes.
Primary Care Programme
BoardReporting to :
7 CCGs Governing Bodies
Primary Care Co Commissioning
Committees
NHSEPCN Development Group
Primary Care Estates
Primary Care Digital
Primary Care Workforce
Primary Care Development Group
• The Primary Care Development Group reports to the Primary Care Programme Board, and supports the development and delivery of Primary Care
initiatives, including Primary Care Networks, General Practice Forward View (GPFV) and Long Term Plan (LTP), across Sussex. Its core purpose is to
facilitate the delivery of the local primary care strategy and underpinning plans.
7 CCGs
Executive meetings
Clinical Director meetings
Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG
Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCG
Overview – PCN programme
There is a need to ensure there are sufficient primary care and community services to meet the needs of an ageing population with increasingly complex health and care needs. This national
Primary Care Networks programme has bought together general practices to work at scale around a combined patient population to improve each practices ability to recruit and retain staff,
to manage financial and estate pressures, to provide a wider range of services to patients and to more easily integrate with community services and the wider health care system.
ObjectivesTo ensure governance and oversight of the PCN
development programme covering:
• Implementation of the Network DES service
specifications
• PCN maturity, development and planning
• Developing adequate and appropriate PCN
workforce.
• System working and alignment to the ICS
priorities;
• Integration and partnerships
• Primary Care estates;
• Digital transformation and client records
across providers
Highest risks1. Insufficient workforce / not
developed to provide new
specifications.
2. Non alignment of community
nursing teams to PCNs reduces
the ability to deliver integrated
services
3. No single PMO process leads to a
lack PCN programme oversight.
4. Insufficient Clinical director
support leads to PCN lacking vison
and leadership
5. Lack of clinical system integration
is a risk to effective collaboration
and patient care
Milestones
• July 2019 –PCNs signed off
• August 2019 – PMO process agreed
• Sept/Oct 2019 – PCN self assessment
completed and development plans
agreed
• March 2020 – PCNs ready to deliver new
specifications network DES Key details
1. There are 38 PCNs in Sussex; all with
Clinical Directors; across 7 CCGs. Nationally
the PCN programme has been implemented
at pace with a national prospectus
2. Integration relies on community services
aligned to each network
Planned Outputs
1. Single process to have oversight of PCN
development
2. PCNs delivering the services outlined in
the network DES specifications
3. Primary and community care teams
delivering integrated patient care.
Resources
• £1.50pp to PCN for development
• Legal advice
• PCN Clinical Director funding
• PCN Workforce funds to provide
new staff
• PCN Development fund
• PCN Accelerator funds
Interdependencies
• Community services integration
• PCN and Clinical Director Development
plan
• GP Forward View Programme
• NHS Long Term Plan
• Primary Care Strategy
Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG
Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCG
PCN Development
• £1.3million allocated for PCN and Clinical Director development across Sussex for 19/20 (recurrent)
• NHSE have launched the following support documents:
• Maturity matrix for PCNs - outlines core components that underpin the successful development of
networks.
• Prospectus - sets out key components that should be used as the basis of any support offer
• PCNs will use the matrix to self-assess their development and prospectus to formulate a development plan
• PCNs will be supported by CCG primary care leads and network events to self-assess and develop plans to
deliver their PCN and ICP ambitions for their neighbourhoods
Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG
Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCG
PCN Development – indicative timeline
Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG
Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCG
PCN Development - update
• All Sussex PCNs (38) have completed self-assessments against the NHSE/I maturity matrix and begun to
formulate development plans. Monies were allocated to PCNs at end of Q3.
• PCN development funding is overseen by the Sussex CCGs Primary Care Programme Board with approach
to allocation agreed by PCCCs. PCN development monies have been top sliced 10% and allocated equally
between the 38 PCNs to earmark a specific fund for PCNs to use on leadership development. The
remaining has been allocated according to PCN population size.
• Self-assessment of the developmental domains outlined in the matrix indicate similar levels of maturity
across Sussex PCNs.Below
foundation
Foundation Step 1
Leadership, planning and partnerships 2 28 7
Use of data and population health management 2 32 4
Integrating care 1 34 3
Managing resources 3 35
Working with people and communities. 6 29 3
Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG
Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCG
• The top 3 themes for development identified from our 38 Sussex PCN self-assessments were:
• Organisational Development
• Team development and Support to set up new teams/services
• Leadership and change management
• Other areas identified include:
• Using Public Health population data
• Wider engagement including councils, community, PPGs, patients etc.
• Data analyst support (CCG performance data)
• Vision and strategy setting
• Scaling and connectivity will be overseen by the primary care board. A further update on PCN maturity and
use of resources against development plans will be requested in Q4.
• Review of PCN development monies allocation approach will be undertaken in Q4 by the primary care
board with a view to taking forward proposals through PCCCs in 20/21.
PCN Development - update
Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG
Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCG
PCN development : accelerator sites
To support PCNs to move at pace, ahead of the national minimum requirements, an accelerator programme will be established to
drive progress, support the desired integration of services, and reduce clinical variation across the Sussex STP foot print. The
aims of the programme are as follows.
Progress
faster
• To support PCNs across Sussex STP who want to develop faster in 2019/20, and deliver more than the national PCN specification requirements.
Integration
• Test out how PCNs and local health, care or voluntary sector providers can come together to better integrate and transform care and services for their local population with PCNs as a key part of the local transformation approach.
Clinical variation
• Identify and demonstrate how practices in the PCN can come together to enable local transformation and delivery of elements of the Sussex STP clinical variation programme and or LTP ambitions in their PCN to improve population health.
Four specific areas of focus have been identified, for PCNs to accelerated and respond to the challenges and focus on:
1. Development and acceleration of the PCN through the maturity matrix
2. Delivery / test the Sussex STP Clinical Variation Programme ambitions and requirements (Musculoskeletal falls, Diabetes, and Cardiovascular disease)
3. Delivering the requirements of the LTP (including anticipatory care, personalised care and early diagnosis for cancer)
4. Integrated joint working of the PCN with other providers to better support integrated care, MDTs and improve the PCN population health; and better
integrate urgent or planned care pathways to improve system flow, avoid admission and improve value for money).
Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG
Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCG
PCN development - accelerator sites - update
• £20K per PCN across Sussex has been made available to support accelerator sites. The deadline for
submission of bids aligning with the areas of focus outlined is end Q4 19/20.
• As of end December 2019 – 21 PCNs submitted bids for this funding. Bids were evaluated by the Primary
Care Development Group, which has representatives from NHSE, the LMC, primary care clinical and
commissioning; and approved through the primary care board.
• The bids can be broadly categorised into three areas;
a. Bids that support PCN and community provider integration and plans to redesign some services to meet the
PCN population health needs
b. Bids that support the MSK clinical variation programme and the introduction of First Contact Practitioner
roles
c. Bids that support PCN governance and maturity and bids that support the early diagnosis of cancer.
• Deployment of funding will be monitored and outcomes reported through the Primary Care Board.
Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG
Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCG
PCN development – additional accelerator sites - update
• An additional £20K accelerator opportunity has been made available for up to 10 PCNs only who can
demonstrate that they will use the additional fund to progress initiatives and plans either at a faster pace, or
greater scale. The criteria for the additional PCN funding includes:
• Readiness to share the learning
• Fast tracking the project
• Patient outcome focused
• Focused on integrated teams addressing a PCN population need
• 24 PCNs have bid for the additional accelerator funding across Sussex.
• Bids are being reviewed through the primary care development group for decision on the 10 sites that will
receive monies, for final approval via the Primary Care Board in February 2020.
Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG
Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCG
PCN and provider engagement, integration & partnerships
• All PCNs are at a different place in their maturity, ambition and aspiration. There are many local examples of integration of primary and
community services in PCN neighbourhoods and places across Sussex.
• A PCN development and engagement programme is being developed to provide the forum to build on and share the learning from these
examples of joined up care, supporting PCN CDs to engage with local voluntary, acute and community care providers, stakeholders and the
public.
The purpose of these PCN provider forums are for PCN CDs and local providers to :
• Review the PCN population health data and agree priority areas for focus to improve PCN population health
• Develop population based commissioning and delivery and further develop plans to join up care
• Formation of integrated multidisciplinary care configured around PCNs neighbourhoods
• Development of Integrated Care Partnerships
• Gain consensus on how to get PCN CD provider voice and representation at system / place / local forums
• Share examples of best practice and learning and feedback from wider meetings
• Support PCNs to identify how to best engage with and listen to the public and patients
Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG
Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCG
• We have established PCN Network Events across Sussex PCNs to support partnership working, PCN
development and integration throughout 20/21.
• The next PCN Operational Event is on 21st January 2020 at the Amex, Brighton.
• The next Sussex Wide PCN Event is on 18th March at the Amex, Brighton.
• The focus of these sessions will be around the following areas
• Understanding and utilisation of population data
• Supporting implementation of the DES service specifications
• Citizen engagement
• Partnership working and integration
PCN network forums
Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG
Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCG
Primary,
community &
acute, health and
care providers
delivering the
Long Term Plan
priority areas
Local
general
practice
resilience
needs
Primary Care
Strategy
GPFV priorities
PCN development
Practice resilience
Workforce plans
STP
Population
Health
Check
Integrated Care
Provider Partners
• PCNs
• Social care
• Physical and Mental
Health
• Voluntary sector
• Independent sector
Commissioners
• Local authority
council partners
(borough, district,
unitary & county)
• CCGs
• NHS England
(NHSE)
Local engagement
• Public
• Patients
• Patient
representative
groups, including
general practice
PPGs
Primary and community care - a landscape for integration
Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG
Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCG 29
Integrated care
model operates at
three levels, and is
underpinned by
three fundamental
building blocks.
29
You can access a wide
range of professionals
within primary care, who
will work together to
support your social,
physical and mental health
needs wherever you liveExtended access to
GP appointments and
improved access to online
resources
We will share best
practice and use our skills
and knowledge to deliver
safe and coordinated care
for you in your home,
local community, hospital
and beyond
Hospitals will work together to provide the
best quality, safety, value and equity of care
in a timely manner
Care will be based on the
best knowledge available
We will provide
health and social
care at or as close
to home as possible
All decisions about your
care will be inclusive:
made with you
EstatesWorkforceDigital
Services designed to address the
wider determinants of health
Enabling people to manage their own
health and care better, supported by
services
Preventionto improve population health and wellbeing
Seamless end to end care
across all services to
provide the best possible
outcome for you along a
coordinated pathway
You, your family and
carers will be supported to
have the knowledge, skills
and confidence to self-
manage your health and
wellbeing to start well, live
well, age well and die well
We will
harness
research and
innovation to
meet local
needs
In your local area
(~250-850k
population), primary,
community and local
hospital services will
provide joined-up
place-based care
through Integrated
Care Partnerships, at
or close to home.
In Sussex (1.8m
population), we will work
in partnership to deliver
high quality specialist and
complex services to
achieve the best
outcomes based upon
the best knowledge
available.
Each neighbourhood
(30-50k population) will
be supported by a
Primary Care Network
where a range of
professionals work with
you to manage your
social, physical and
mental health needs.
Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG
Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCG
Next steps
Primary Care Strategy
• Finalise the Primary Care Strategy at Governing Bodies – November 2019
• Gain and incorporate stakeholder and membership views on Primary Care Strategy
PCN development
• Develop aggregated plan for PCN development and implement process for support funding
• Deployment of advanced accelerator monies
• Implement Sussex wide process for ARRS and support workforce expansion and retention
• Provision of data offer PCNs for segmentation and stratification to support specification delivery
• Support PCNs to prepare for the delivery of the new services specifications
Integration of primary, voluntary, community, acute, health and care services
• Establish Sussex wide PCN, place based and individual PCN and provider
• Support the Primary Care Networks in Sussex to work as part of an Integrated Care Partnership providing care to each neighbourhood
• Support PCNs to engage with the public, patients and stakeholders in the design and development of PCNs and Integrated Care
Partnerships