Our values: clinical engagement, patient involvement, local ownership, national support www.england.nhs.uk/vanguards #futureNHS Our values: clinical engagement, patient involvement, local ownership, national support www.england.nhs.uk/vanguards #futureNHS New care models Developing new models of care Samantha Jones Director, New Care Models Programme @SamanthaJNHS 18 May 2016
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Our values: clinical engagement, patient involvement, local ownership, national support
www.england.nhs.uk/vanguards #futureNHS
Our values: clinical engagement, patient involvement, local ownership, national support
www.england.nhs.uk/vanguards #futureNHS
New care models
Developing new models of care
Samantha Jones
Director, New Care Models Programme
@SamanthaJNHS
18 May 2016
Our values: clinical engagement, patient involvement, local ownership, national support
www.england.nhs.uk/vanguards #futureNHS
Clinical engagement
Patient involvement
Local ownership
National support
Our core values
2
Our values: clinical engagement, patient involvement, local ownership, national support
www.england.nhs.uk/vanguards #futureNHS
Integrated primary and acute care systems
Multispecialty community providers
Enhanced health in care homes
Urgent and emergency care
Acute care collaboration
5 new models of care with a total of 50 vanguards:
9
14
6
8
13
50 vanguards selected
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Our values: clinical engagement, patient involvement, local ownership, national support
www.england.nhs.uk/vanguards #futureNHS
Integrated primary and acute care systems (PACS) vanguards
4
PACS are similar in concept to Accountable Care Organisations that have emerged in the USA and other countries. They are provider models, but are being co-developed with commissioners.
The PACS are whole system care models that join up primary care, hospital, community, mental health and social care services to improve the health and wellbeing of the whole population.
PACS are likely to offer a broader range of services than MCPs (including all hospital services) and may serve a larger population (each PACS typically covers c. 200,000-400,000).
Our values: clinical engagement, patient involvement, local ownership, national support
www.england.nhs.uk/vanguards #futureNHS
Integrated primary and acute care systems (PACS) vanguards
5
Core components of a successful PACS vanguard are emerging
Targeted population
health
Enhanced primary care
Integrated community care
teams
Integrated access to acute and emergency care services
Improved access to
specialist and elective care
Self-care, prevention and person-centred
care
Third sector and community
engagement and activation
Our values: clinical engagement, patient involvement, local ownership, national support
www.england.nhs.uk/vanguards #futureNHS
Northumberland Accountable Care Organisation’s new specialist emergency care hospital
provides A&E consultants 24/7 and specialty consultants 7 days, 12 hours a day. It is
complemented by 3 primary care hubs based in 3 local district general hospitals, staffed by a
mix of hospital doctors, GPs and emergency nurse practitioners. Early evaluation has shown
the model reduced emergency admission rates by 30% in 2015/16 c.f. 2014/15, and delivered
an estimated £6.64 million of savings (FYE).
Northumberland’s care model is being supported by the formation of an Accountable Care
Organisation, which would bring together all providers in Northumberland, with a focus on
health outcomes; being mutually responsible and working
together, removing perverse incentives in the current system.
A partnership between the CCG and Local Authority will take the role
of Strategic Commissioner. This would use a single contract; set
strategy and health outcomes; and allocate a capitated budget to the
ACO.
Integrated primary and acute care systems (PACS) vanguards
Our values: clinical engagement, patient involvement, local ownership, national support
www.england.nhs.uk/vanguards #futureNHS
Addressing the key enablers of transformation
Our values: clinical engagement, patient involvement, local ownership, national support
www.england.nhs.uk/vanguards #futureNHS
1.
Designing new care models 2.
Evaluation and metrics
3.
Integrated commissioning and provision
4.
New operating models
5. Governance, accountability and provider
regulation6.
Empowering patients and communities
7. Harnessing technology
8.
Workforce redesign
9.
Local leadership
and delivery
10. Communications and engagement
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Our values: clinical engagement, patient involvement, local ownership, national support
www.england.nhs.uk/vanguards #futureNHS
Our values: clinical engagement, patient involvement, local ownership, national support
www.england.nhs.uk/vanguards #futureNHS13
New technology, workforce, and commissioning models will underpin success across the new care models
Harnessing digital technology, including fully integrated datasets, and
real time business intelligence with predictive analytics.
Expansion of online services and service redesign will make the most of mobile technologies, wearables and
apps.
Mid-Nottinghamshire Better Together PACS’ Telehealth service: patients use Florence (Flo), to monitor their condition and to retain more freedom and independence.
Evidence is showing improved patient experience through improved ways of accessing care and involvement in their healthcare, promotes independence, reduces anxiety levels and improve outcomes.
In Primary Care, for COPD and Hypertension, 83% of patients had a reduced number of GP consultations
Multi-disciplinary teams deliver care, with redesigned jobs that are more
rewarding, sustainable and efficient.
New roles such as health coaches, physician assistants and care navigators,
pharmacists employed in community hubs or primary care, and community
paramedics will be widespread.
West Wakefield health and wellbeing MCP has trained a cadre of care navigators (over 100 so far) to break down the automatic assumption that a GP appointment is the best first place to go for any problem. Care navigators are:
• based at reception, offering patients who arrive at the practice advice
• signposting people to the most appropriate health, social or voluntary service for their needs
• backed by a digital platform and care record
• expected to save around 4.65% of GP time.
Joined up commissioning and shared contractual mechanisms that promote
integration and population health
New contracts will ultimately bring together health and social care into a
single seamless contract enabling the full integration of services around the patient
South Somerset Symphony PACS is developing a joint venture between primary care and the hospital, able to hold a single outcomes-based commissioning budget, and which will shift resources to where they are required.
The joint venture will manage a new operating company, which will own participating general practices. The operating company is already live, as a subsidiary of the local NHS Trust, and has taken over control of its first 3 practices. The aim is to expand this to 9 local practices.
The joint venture will be supported by the development of an innovative commissioning approach by Somerset CCG, Somerset County Council and the Area Team.
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Our values: clinical engagement, patient involvement, local ownership, national support
www.england.nhs.uk/vanguards #futureNHS 14
How the national health bodies will continue to support the
vanguards in 2016/17
Multi-year MCP and
PACS contract for
populations and
services within care
models based on the
registered list
Multi-year whole
population budgets
to cover populations
and services within
care models - based
on the registered list
Effective gain/risk
share approach and
P4P that aligns
financial incentives
across the local health
system
Codifying local
solutions to
implement a shared
care record, with IT
systems that work
together
MCP, PACS and care
homes framework
documents will
provide a blueprint
and enable spread
through the STP
process
Standard models for
one of a set number
of organisational
forms that have been
tested with vanguards
National and local
metrics that
measuring progress
and evaluating
success against the
triple aims of the
5YFV
A set of solutions to
key workforce
challenges around
recruitment, MDT
working and skills
development
A place-based
regulatory and
assurance
framework, co-
produced with
vanguards
Common approaches
to data and LPF
analytics that enable
population health
approaches based on
evidence-based
segmentation and
targeted interventions.
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Our values: clinical engagement, patient involvement, local ownership, national support
www.england.nhs.uk/vanguards #futureNHS
Our values: clinical engagement, patient involvement, local ownership, national support