NHS Five Year Forward View

1. NHS Five Year Forward View NHS Confederation’s Community Health Services forumNew Care Models – integration of community and primary care6 November 2015 Louise WatsonNational MCP Care Model Lead and Deputy Programme Director @lcewatson

2. NHS Five Year Forward View • Published in October 2014 • A shared vision across seven national bodies • New care models programme key to delivery • Focuses on both NHS and care services

3. The challenges we face Health and wellbeing gap Radical upgrade in prevention 1 Care and quality gap New care models 2 Funding gap Efficiency and investment 3

4. Five new care models • Acute care collaboration • local hospitals working together to enhance clinical and financial viability • Multispecialty community providers • moving specialist care out of hospitals into the community • Enhanced health in care homes • offering older people better, joined up health, care and rehabilitation services • Urgent and emergency care • new approaches to improve the coordination of services and reduce pressure on A&E departments Integrated primary and acute care systems joining up GP, hospital, community and mental health services

5. 50 vanguards selected • In January 2015, we invited applications to become vanguards • In March, the first 29 vanguards were chosen. There were three types – integrated primary and acute care systems; enhanced health in care homes; and, multispecialty community provider vanguards • In July, eight urgent and emergency care vanguards were announced • In September, a further 15 vanguards were announced – known as acute care collaborations, they aim to link local hospitals together to improve their clinical and financial viability • The 50 vanguards were selected following a rigorous process, involving workshops and the engagement of key partners and patient representatives

6. Our core values

7. 50 vanguards developing their visions locally

8. What will success look like? • Nationally replicable models • More accessible, more responsive and more effective health, care and support services • Fewertrips to hospitals • Care closer to home • Better co-ordinated support • 24/7 access to information and advice • Access to urgent help easily and effectively, seven days a week

9. Future of Community Care – emerging themes • Population health model - multi professional community care focused on the GP registered list • MCP size from 30,000 ++ based in localities • Integrated locality based health and care teams 24/7 • Risk stratification tools to help target interventions • Shared records across all providers • Cradle to grave methodology using prevention and wellness strategies to improve health outcomes.

10. Future of Community Care – emerging themes • Greater emphasis on self care and community engagement • Patient owned care plans • Workforce integrated across community and primary care • Weighted capitation contracts (including primary care services) • Sophisticated use of IT and digital technologies

11. Challenges for Community Care – examples • Interoperability to allow records to be shared across health and social care. • Governance arrangements for integrated care delivered by a range of providers. • Workforce planning across health and social care. • Maximising the impact of risk stratification • Evaluating which intervention makes the difference to enable spread. • Lack of community data on which to develop capitated budgets and other innovative payment mechanisms.

12. Future of Community Care – examples • South Hampshire have aligned the community and primary care services in localities a single locality leadership team • Whitstable have introduced a paramedic practitioner as part of the community team – linked to practices with access support services to keep people in own homes • Sunderland – recovery at home service in place across the city – 24/7 one telephone number to call

13. Future of Community Care – examples • Stockport – out of a pilot cohort of 200 patients, 92% were able to die in a place of their choice • Fylde Coast risk stratify the top 1.5% of their total population into their extensivist model • West Cheshire are developing ‘healthpods’ in localities where people navigate resources and receive interventions.

14. Support package launched • Support package published in July for the first 29 vanguards ards • Developed following extensive engagement, including two-day visits to all sites • Led by vanguards alongside national experts, the support package will help them implement change effectively and at pace • It is also intended to maximise sharing of learning and practice across vanguards and with the wider NHS and care system • Four design principles – we solve problems through joint national and local leadership; we create simple replicable frameworks; we encourage and support radical innovation; we work and learn at pace

15. Addressing the key enablers of transformation 1. Designing new care models and enabling spread 2. Evaluation and metrics 3. Integrated commissioning and provision NATIONAL 8. Communication and engagement COHORT LOCAL 4. Empowering patients and communities 7. Local leadership and delivery 6. Workforce redesign 5. Harnessing technology

16. Examples of support – community care Development of new, purpose designed contracts and funding mechanisms e.g. capitation budgets, MCP contract Resolution of information governance issues to facilitate sharing of information. Indemnity insurance for clinicians working in a range of community settings. Review of the options for new organisational forms. Registration and regulation of new organisations. Workforce development across the health economy.

17. Further information… More details can be found on the NHS England website: www.england.nhs.uk/vanguards Or join the conversation on Twitter using the hashtag: #futureNHS