The Accountable Care System i n Brief

1. The Accountable Care System in Brief October 2017

2. What is the Accountable Care System(ACS)? • 44 Sustainability and Transformation Partnerships (STP’s) Nationally. • 8 most advanced ‘Exemplar sites’ given ACS status June 17 – including South Yorkshire and Bassetlaw (Sheffield is one of 5 ‘places’ within) • Driven by the centre as politicians aim to make efficiencies by rationalising services across wider footprints, move work into the community from more costly secondary care settings and to drive integration of services across both health and social care and physical and mental health. • Commissioners and providers working together to coordinate system transformation via place-based plan

3. What is the Accountable Care Partnership (ACP)? • Structure for Sheffield’s place-based plan • City’s 6 main health and care organisations • Governed by ACP Board • Decides allocation of resources in Sheffield’s health and care system • Delegated authority from Boards of each organisation • PCS represents general practices as providers

4. ACP Governance STH SCT PCS SH&C SCC (social Care) SCC (commissioner) SCCG Delegation from Sept 17 Onwards (TBA) Accountable Care Partnership (ACP) Board DPH CEs CEO (Lead) Co-Chairs Chairs Prog Dir. ACP Executive Delivery Group CE Co Chair CEO Co chair Prog. Dir Clinical / Care Lead Functional Exec Directors CE Sponsors Workstream 1 Workstream 2 Workstream n CE Sponsor W/S Lead Delivery Resources (as appropriate) Clinical Lead Project Mgt and support Enabling Workstreams

5. Vision, aims, objectives and outcomes Empowering individuals to take greater ownership of their health and wellbeing To improve public engagement and empowerment Developing new ways of working with residents and service users Engaging the public in decisions about care services Improving the health and wellbeing of the workforce as an employer Developing new workforce roles and models, aligned to changing patterns in workforce skills and service demand To support a happy, motivated and high-performing workforce Developing a collaborative, person-centred culture and behaviours that transcend organisational boundaries Improving the health and wellbeing outcomes of Sheffield’s 550,000 residents through the development and delivery of a world class health and care system Developing distributed leadership competence across Sheffield Enabling equity of access Supporting improved educational attainment in Sheffield To tackle persistent health inequalities Focusing on the wider determinants of health, by connecting the opportunities presented by industry, higher education, health, and all the other organisations involved health and wellbeing Targeting the use of resources where they will have the most impact • Focusing (collaboratively) on health promotion, prevention and self-care To deliver tangible improvements in local health and wellbeing E.g. achieving a healthy life expectancy that is no worse than the rest of the country • Developing integrated, proactive, and person-centred services Consistently meeting quality and performance targets Supporting economic growth in Sheffield To ensure the sustainability of the Sheffield care economy Reducing duplication of effort and increasing financial efficiency Aligning incentives and removing barriers to enable appropriate flows of resources across the partnership

6. Priorities and Principles • Mutuality • Accountability to the partnership and to the population of Sheffield • Working across organisational boundaries • Ongoing engagement and service co-design with service users and the general public • Working in the best interests of the wider system rather than those of individual organisations • Leveraging the knowledge, skills and experience of partners in the design and delivery of services • Population outcomes • Adopting a population health and wellbeing management approach • Focusing on health and wellbeing outcomes rather than traditional service line KPIs • Shifting the model of care towards prevention and early intervention rather than treatment and cure • Delivering integrated services focused on the local needs of individuals, their carers, and their families through a neighbourhood model • Working with partners to consistently address each of the wider determinants of health • Supporting people to self-care and reducing the inappropriate demand for provided services • Risk and reward • Removing barriers to collaboration related to money • Ensuing transparency of resources across the system • Enabling flows of resources across the system to support people’s needs, develop services, and tackle health and wellbeing inequalities • implementing systems to enable the fair and equitable apportionment of risk and reward across the partnership • Values and governance • Defining our shared values • Developing a high-performing shared culture aligned to our principles and objectives • Creating a culture of greater accountability to service users and the public • Greater involvement of the public in the configuration and delivery of services within the ACP construct Urgent and Emergency Care Mental Health Planned Care Demand Management Long-Term Condition Management Children’s Services Communities, wellbeing and social value Neighbourhood development Commissioning Workforce Finance, contracts and payment mechanisms Digital and technology Back office Governance Communications and engagement

7. Implications for General Practice • It is clear that ACS’s will happen whether GP’s engage or notas national drive for scale and efficiency • Push towards primary care contracting at a greater scale with proposed new contractual frameworks. • There is a real risk that ACS is secondary care dominated and that resources do not follow the work shift into community and primary care settings. • There is also however an opportunity for General Practice to present a unified and coordinated approach within the system, influencing its future and remaining at the heart of patient care. • PCS’s involvement with the ACP presents Sheffield GP’s with a clear mechanism to do this.

8. Next Steps • Primary Care needs to exert itself on the ACP/ACS. • Unanimous practice support for PCS’s business plan including system leadership in ACP. • Practices’ views sought: • Need to explore model for delegated authority reflecting 80 independent contractors • How will we contract with the ACS in future and what does this mean for core GMS/PMS? • Where do neighbourhoods fit? • How do you want PCS to engage with your practice regarding the ACP? • Do we need an additional MoU?