Healthier Together Joint Committee Wednesday 15th June 2016

Developing Integrated care in GM Primary Care Update Developing Integrated care in GM Building on our Healthier Together Commitments Rob Bellingham, Director of Commissioning

Context The Healthier Together made a series of commitments relating to the development of primary and joined up care, (integrated care) across GM. This has given us a platform upon which significant aspects of our GM Strategic Plan, “Taking Charge” has been built. This presentation describes these next steps in the context of the wider GM transformation programme. Members will recall the “venn diagram” depicting Primary, Integrated and Acute Care and our ambition to achieve a so called “total eclipse” of the Primary and Integrated Care circles. We believe that the work described in this presentation achieves this objective via the development of our GM Locality Plans and their vision for integrated care serving neighbourhoods of circa 30-50k populations. Scaled, population health and wellbeing management is core to our strategy to transform community based care and support. This part of our new models of care and support are central to our ability to maximise the demand reducing potential of those new models. An understanding of those characteristics of the new models essential to managing population health improvement and reducing demand on acute services is key to ensuring all parts of GM are developing models which will contribute to clinical and financial sustainability

Delivering our ambition: aligning reform across GM H&SC TRANSFORMATION WIDER REFORM ACROSS GM

Proposed method for a consistent approach to developing an LCO DRAFT FOR DISCUSSION Proposed method for a consistent approach to developing an LCO The 10 stage approach to the left starts to illustrate an overall development approach to fully establishing an LCO. GM colleagues consider the value of consistent approaches at key stages such as: Risk stratification & population segmentation approaches how we define an LCOs core characteristics at both a basic and advanced level to reach for the higher ambition on scope and development A reliable costing methodology inform investment and implementation considerations and a standard GM approach to Cost Benefit utilising the New Economy model, of interventions delivered by an LCO. 1. Identify target population 2. Assess potential impact by area of spend 3. Use ‘logic model’ to define reinvestment potential 4. Define core elements of delivery model 5. Translate the core elements to activity 6. Identify and model the workforce requirements 7. Model the financial requirement 8. Conduct segment level Cost Benefit Analysis comparing savings and investment 9. Translate into payment mechanisms 10. Identify performance “dashboard” and approach

Key Assumptions & principles Assets & strengths of people & communities Equally involved Carers & Family Integrated Record & Care Plan for health & care needs Involved in decisions on care & support Key Assumptions & principles Use of risk stratification & population segmentation Well managed needs 2 or more health/complex needs Mostly Healthy 3 or more health/complex needs Increasing health and social care needs Resources & approach reflective of intensity of support required People & carers empowered to self care Advice & support Care & support co-ordination Integrated team GP Tailored increase in resources for self-care, carer involvement & primary & social care e.g. longer appointments, same day access, social prescribing, 24/7 cover Home pharmacy GP Practice Cluster/Group Better connections of existing teams alongside development of new roles Mental Health Physio Case management Nurse practitioner Pharmacist Clinical lead Physician associate Existing services Specialists Care Co-ordination VCSE New/ emergent roles OT Behavioural health Social worker Extra Care Housing Diagnostics JCP Intermediate Care Network enablers Connecting all who contribute to health benefit Voluntary & Community Sector Wider Public services (housing, fire etc) Diagnostics Community Pharmacy Primary & social care care at Scale 999,111, OOH Acute & urgent care Recognising organisational & cultural development Cultural & people integration: Human to human, individual to team, team to team - local staff moving towards a single organisation Financial Integration: Capitated budgets for a defined population with aligned incentives developed within longer term contracts Systems and operational integration: shared IT & systems supported with robust governance arrangements

LCO’s are likely to be made up of interventions addressing these types of issues: 1 Prevention and health improvement: GM and locality programmes such as EY NDM, work and health schemes, dementia utd, Falls. Improved community and social capital Asset based care through culture and system change Work place health programmes Improved screening and early diagnosis Use of practice registers and patient level data 2 Population level activity: Identification (risk stratification and segmentation) and enrolment in programmes of risk individuals 3 Self care, Independence and well being: Patient activation framework and measures GM and local social marketing campaigns Full use of digital technology for better self management and healthy lifestyles Personal health budgets Patient empowerment and self management programmes such as expert patient 4 Care planning and care coordination Care navigation and communication systems across a range of health and care settings 5 Case management 6 Integrated hospital/care home diversion and discharge: Integrated health and care teams Access to specialist opinion Rapid response teams Virtual wards Aligned intermediate/reablement 7 A health and care system aligned to wider public services: Strong partnerships with: education, skills and work Housing Voluntary sector 8 New models of pricing and contracting: Pricing & incentives to drive improvement in population health Population outcome based contracts for community provision 9 Optimising elective care 10 Better integrated EOLC

Summary and recommendations The Healthier Together Joint Committee is asked to: Note that the work which initially took place in line with the initial Healthier Together commitments has developed as described in this presentation Note that this new phase of work directly connects to the GM Strategic Plan, “Taking Charge” and the development of the 10 Locality Plans Note that each area of GM is developing Locality Care Organisations, in line with the models and characteristics set out in this presentation Consider, in the light of the above, how the Joint Committee wishes to be appraised of progress on this agenda.

Sophie Hargreaves, Programme Director Programme Update Sophie Hargreaves, Programme Director

Purpose of meeting Joint Committee’s role is to assess whether adequate progress is being made towards implementation of Healthier Together This meeting is structured to provide an update on the GM and sector progress as well as key risks and dependencies The Committee will be asked to comment on this at the end of the agenda

Highlights since March Joint Committee 11/6/2017 Highlights since March Joint Committee Assurance: 3 of 4 sector stage 1 reviews completed HR and workforce: Recruitment principles agreed Baseline taken Finance: Finance ongoing discussions regarding capital Equalities: Standards baseline taken Access appraisal underway Clinical: Standards baseline taken Clarification of the general surgery model completed Quick win recommendations identified (item 7) NWAS audit underway Evaluation: Manchester University partnership established Sophie

Programme Status Programme - AMBER 60% 90% 60% NWAS – AMBER / GREEN 11/6/2017 Programme Status Programme - AMBER Stage 1. Establish Sector Programme 2. Design of model of care and pathways 3. Completion of Business 4. Operational specification and detailed design 5. Preparation of Estate and facilities 6. Planning for Implementation IMPLEMENTATION 7. Post Implementation review MAT NE NW SE 60% TBC 90% Sophie 60% NWAS – AMBER / GREEN

Programme Plan - Approach 11/6/2017 Programme Plan - Approach Complex made up of many moving parts! Many dependencies and interconnected activities Risks and dependencies to be identified through Programme Board and managed through Risk/Dependency register Therefore reviewed on a rolling basis – and updated quarterly for Joint Committee Sophie

Healthier Together Implementation Plan 2016 2017 May June July Aug Sept Oct - Dec Jan - Mar Apr – Jun Aug - Sep Sector Stage Milestones Indicative – will vary by sector Clinical Pathfinder Radiology &Paediatric Surgery Finance HR & Workforce Equalities Benefits Management and Evaluation Stage 1 Stage 2 (Model of Care) Stage 3 (Bus .Case) Stage 4 (Operationalise) Stage 6 (Transition Planning) Stage 7 (Evaluate) First Sector Goes Live Stage 5 (Build) NWAS Forwards Audit NWAS backwards audit (depending on outcome of audit) Scope Plan Quick Wins Business Case content requirements Capital agreed Business Case assurance process Assurance of business cases Confirm required GM workforce Develop GM principles Confirm required GM workforce Develop campaign GM recruitment Trainee changes notice given Trainee changes enacted Plan trainee doctor changes requirements Analyse and Report baseline Sector Action plans National and automated benefit collection Analyse and report baseline Full benefits data collection Develop automated / streamlined data collection processes Scope Grants application Evaluation

Pan GM timeline (as of Wednesday 30th March 2016) April to September 2016 Baseline audit returned and analysed Recruitment Framework complete Finance Framework complete Source of capital and transition funding agreed Paediatric surgery and radiology plans completed NWAS Pathfinder audit completed Doctors in Training - agreement of the impact September 2016 to March 2017 1st wave of Recruitment to workforce Business cases completed and assured First clinical ‘quick wins’ delivered Agreement on requirements for NWAS Pathfinder tool Capital builds underway, where possible March 2017 Radiology Hubs in place First high risk general surgery patient movements (Sectors to have been through stages 1-6 of the Assurance Framework) Beyond March 2017 Implementation of outstanding sectors following required capital build and assurance

Progress to date - assessment 3 / 4 Stage 1 reviews complete Good progress in areas, common themes of areas to work on Agreement of model of care key on critical path Stage 1 themes paper sets out actions for sectors on these themes GM levers can also be used to support implementation

Recommendations for sectors 11/6/2017 Recommendations for sectors Understand current performance issues relevant to HT and develop action plans to address identified risks Develop plans to support relationship building across clinical teams and to address the cultural changes Review and share outputs from the Clinical Alliance in sectors Development of ‘quick win’ plans for each specialty, supported by HT Clinical Champions Identification of resource to commence modelling work and standardisation of baseline data Sectors to establish Patient Participation Groups and integrate patient participation into their plans Joint Committee asked to support this and ensure actions are completed in sectors

11/6/2017 Commissioning Levers Demonstrate commitment to change through commissioning intentions: Specifying single teams for general surgery in commissioning intentions from a set date – for example January 2017 Specifying movement of high risk elective patients (~100 per site per year) in commissioning intentions from a set date – the date will need exploration but could be for example April 2017 Action: Joint Committee are asked to endorse this approach and reflect in local commissioning intentions. Action: CCGs to report proposed commissioning intentions for Healthier Together to September Joint Committee. Action: Sector to identify Head of Commissioning Lead to work with CFO lead on this The rationale for proposing this is that the movement of elective patients will require single team working to be embedded and effective so that all surgeons continue to undertake high risk elective work and maintain skills. Therefore plans should be in place in advance to support this. These are elective patients and as such plans can be made in advance to ensure appropriate resourcing and theatre/bed capacity. Each site treats ~100 high risk elective patients per year and so this would represent ~2 patients per week per sector. From April we could include, insertion of the model of care to contracts with KPIs/CQINNS within the contract, improvement goals and implementation timescales over the 1718 period.

Other GM Levers Supporting model of care agreement: 11/6/2017 Other GM Levers Supporting model of care agreement: Stage 2 review meeting dates set GM event is planned for sectors to share this in August Support in finalising data Clinical Effectiveness: Sharing of national data and the baseline identifying leads for best practice from across GM ‘Theme of the month’ Cultural challenges: Engagement with GM Organisational Development Group to discuss the implementation challenge Healthier Together poses and draw on existing experience in managing change in GM Collation of key clinical concerns and mitigations across sectors

Healthier Together HR & Workforce Update – Katy Coope, Assistant Director HR & Workforce

Recruitment Framework Approach Key Principles: Current Recruitment: What can and should be actioned immediately Future Recruitment: The proposed way we will manage recruitment to ‘new’ vacancies as a direct result of the Healthier Together changes.

Follow Recruitment Process Recruitment Approach Work as a sector Inform Candidates Job Role Information Follow Recruitment Process Current Recruitment:

Future Recruitment (Recruitment Plan): Recruitment Approach Develop an attractive offer Use new recruits flexibly GM Recruitment Campaign for some roles International Recruitment Future Recruitment (Recruitment Plan):

Work Areas for Recruitment Plan 1. Understanding the Gap The gap between the current workforce and required workforce to deliver the standards needs to be fully understood 2. Agreement of Greater Manchester Principles A consistent approach to avoid competition between sectors will be developed including Consultant Contract, Recruitment Premia etc 3. Development of a Greater Manchester Recruitment Campaign To attract candidates outside Greater Manchester materials and communications will be developed centrally to support sector recruitment

Suggested Timeframe for Recruitment Plan Central Team Provider May - June Analysis of the baseline Comparison to April 15 and confirmation of required consultant workforce for GM Clarification of the baseline Provide details to central team around current Consultant Contract, Recruitment & Retention premia etc July - August Development of Greater Manchester Principles Development of a Greater Manchester Recruitment campaign Sector workforce modelling to deliver model of care and understand recruitment locally Share rota design August – November Share materials and comms with sectors Commence GM Recruitment for specific roles Commence Recruitment