Developing the locality place based plans: using a structure of priorities and workstreams Paper 2b NE 13.9.17

Building the priorities and workstreams of the locality plans It is important that the plans set out the ambitions of the localities in a coherent and comprehensive manner. Successful implementation is dependent on detailing the why, what, how, when and who of any proposed changes. The plans should be structured into a series of overarching priorities with a number of aligned workstreams that contribute to achieving the priorities. The priorities should be considered as the outcomes of the plans; the improvement that the locality is aiming to achieve as a result of plans. Built into the priorities should be the underpinning argument for why change needs to occur. The workstreams should be collectively exhaustive in articulating what changes the localities are planning to make to the current state, how it will be done and when it will take place. It is likely that individual workstreams will be aligned to more than one priority.

Completing the priority structure The priorities should work in conjunction with parts B & C of the plan to set out the case for change; the challenges that the locality is facing and why they are driving the need for change. Priority title Describe the target outcome and the group that will benefit e.g. patients, workforce etc Background A short introduction to the priority area; giving the context on the current situation and an overview of the problem.  Challenge Clear articulation of the issue(s) that are driving the case for change, these should ideally be underpinned by data that is referred to in the appendix. Any issues raised need to be relevant to the priority and add to the argument for implementing change. Objectives The fundamentals of any proposed changes. This builds upon the priority title; setting out more detail on the desired outcome that the locality are aiming to achieve.

Completing the workstream structure Proposed solution Delivery scope Benefits Existing funding (£) New funding (£) required Implementation steps CCG support Duration The title of the workstream and its primary objective - A single statement summary that describes the workstream and its primary aim. What change is the workstream aiming to deliver in the locality? What is in scope? - The scope represents the entirety of work that must be completed to satisfy the primary objective of the workstream. - Structure what needs to be delivered into a set of mutually exclusive and collectively exhaustive statements. - Consideration of how the service will be delivered and the provider structures - Initially focus on the major elements of the scope, after adding these, break them down into more detail so that the activities that are required to achieve the different elements of the scope can be more easily defined. - If the scope is made up of multiple elements, it may require splitting into separate workstreams.   What positive difference will delivering the workstream achieve? - If all the elements in scope of the workstream are delivered, what benefit will this have for primary care or patients in the locality? - Structure the benefits by the effect they will have; e.g. improve patient care or outcomes, improve workforce recruitment or retention, result in financial savings. - Define if the benefit will be new to the locality or if it will be because of an improvement to an existing process/ workstream/ service. Can the workstream be delivered by using existing funding sources? - Can the workstream be delivered within current core contractual funding? - Will the workstream require a change to an existing LIS / LES? If so what will this be? Will the workstream require funding that is additional to current sources? - In addition to using existing sources of funding, will the workstream require new funding? - Is this recurrent or non- recurrent? - What does the funding pay for (workforce / infrastructure / estates)? - The basis of calculation should be provided separately. This should include an estimate of savings from secondary care, where relevant. How will the scope of the workstream be achieved? What steps need to be taken to make the objectives of the workstream a reality? - In chronological order, define the sequence of activities that result in delivery of the elements in scope. - Only a low level of detail is required e.g. develop a business case, or conduct a feasibility study. What support will be required by the CCG? - What will the CCG need to do to make the initiative a reality? How long will it take to deliver the scope of the workstream? - Estimate the total duration to complete the implementation steps.

Example workstream structure Proposed solution Delivery scope Benefits Existing funding (£) New funding (£) required Implementation steps CCG support Duration Cluster level centralised telephone system All patients who wish to make an appointment can be redirected to a central telephone system that books the appointment directly for them at a practice or at a hub. A strict protocol means that all calls will be answered in a set time and bookings made immediately 8-8. Patients identified with highest needs are transferred “live” to a GP or added to the triage list for response. Patients phone their own practice number Patients can still talk to their own practice reception and clinicians Practices can still triage in their own way Practices may choose not to adopt the system provided they demonstrably meet all the criteria. They may also, for example, choose to divert calls if the call wait time exceeds a certain time. More consistent access with assurance that patients can reach their GP when they need to both in and out of hours. Practice resilience to help reduce time spent on less clinically critical/purely administrative work and free up GP time for clinical work by encouraging better discharge planning Peer support and distribution of workload through networks Retains funding in primary care through reinvestment into community & GP services within networks Can the workstream be delivered by using existing funding sources? The scheme is dependent on current extended access scheme. Will the workstream require funding that is additional to current sources? £140,000 non-recurrent infrastructure funding for procurement of system (one per cluster) – based on price per call from market testing of providers (to attach basis of costing). Future funding will be met from the core contract. The call centre will based in one of the two practices currently delivering extended hours and staffed on a rotational basis by the current practice receptionists. However, over time, this may be procured separately and integrated with 111. How will the scope of the workstream be achieved? What steps need to be taken to make the objectives of the workstream a reality? Initial market testing and procurement of central telephony system. Agreement with member practices on their participation Rota development and training of receptionists. Alignment with 111 It is assumed that there will be no infrastructure costs for estates as a result to implement the programme; future efficiencies could lead to rationalisation. What support will be required by the CCG? Support for central procurement. How long will it take to deliver the scope of the workstream? 2 months testing; 1 month changeover