The Accountable Care System in Brief October 2017

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 What is the ACS? An Accountable Care System (ACS) is the evolved structure of Sustainability and Transformation Partnerships (STPs). The ACS involves commissioners and providers working together to ensure health and care is integrated and better co-ordinated for the local population. The ACS works across organisational boundaries to a place-based plan. NHS England announced plans to replace the 44 STPs and set up the first eight Accountable Care Systems (ACS) in June 2017. South Yorkshire and Bassetlaw is one of these. The other seven are •Frimley Health •Nottinghamshire •Blackpool and Fylde Coast •Dorset •Luton, with Milton Keynes and Bedfordshire •West Berkshire •Buckinghamshire.

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 What is the ACP? The Accountable Care Partnership (ACP) is part of Sheffield’s place-based plan (Shaping Sheffield). PCS have been involved in the early stages of development of the ACP on behalf of general practices as providers. The vision for the ACP is: “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” The aims of the ACP are: • To improve public engagement and empowerment • To support a happy, motivated and high performing workforce • To tackle persistent health inequalities • To deliver tangible improvements in local health and wellbeing • To ensure the sustainability of the Sheffield care economy.   The ACP is to be governed by an ACP Board with representation from the city’s six main health and care organisations (both providers and commissioners): Sheffield City Council, NHS Sheffield Clinical Commissioning Group (CCG), Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield Health and Social Care NHS Foundation Trust, Sheffield Children’s NHS Foundation Trust and Primary Care Sheffield. The ACP Board will have significant influence and authority to make decisions over how resources are used and allocated within Sheffield’s health and care system. The Board brings commissioners and providers together and aims to dissolve barriers between the organisations. In many areas, Accountable Care Systems are dominated by acute trusts however in Sheffield general practices have a voice and an influence in the conversations through PCS. This is an emerging framework and as such is yet to be tested, however it can be viewed positively that the proposed structure gives general practice an equal representation and equal say with other ACP members. How will the ACP Board work? The proposed structure of the Accountable Care Partnership Board is based on each organisation’s representative holding delegated authority from their Board. Each of the six organisations will be entitled to have one representative and one vote at ACP Board meetings. On the ACP Board, PCS will be representing general practices as 80 independent providers of services. It is clearly not possible for PCS to hold the same delegated authority for all practices as other Board members who are representing single organisations. This is a point currently under discussion and PCS would welcome the views of practices on this.

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

Vision, aims, objectives and outcomes Outcomes (TBC) 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 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 a collaborative, person-centred culture and behaviours that transcend organisational boundaries 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

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

Implications for General Practice It is clear that ACS’s will happen whether GP’s engage or not as 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.

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? What are the timescales? The timescales proposed for implementing the ACP are particularly ambitious, with the first development phase outlined for completion by September 2017. This timescale does not allow for the engagement with practices to fully explore the issue of delegation of authority and so there is risk in meeting the planned date. How will the ACP Board be implemented? The implementation of the ACP is to be in three phases: Development – establishing principle of partnership working and delegation of authority Shadow – initial delivery of new integrated models of care within existing frameworks, moving towards joint strategic commissioning arrangements and future models Operational – fully functional ACP with defined place-based commissioner and integrated provider model.