Trafford Integrated Care System: How and Why? Dr ND Guest Dr P Jackson Dr M Sangha 1 December 2016 www.traffordccg.nhs.uk

Key Components? Primary Care Secondary Care Community Social 3rd Sector Patients! www.traffordccg.nhs.uk

Questions? Does everything need integrating? Who holds the ring…controls? Who feels disenfranchised? What is it we are trying to achieve? Is integration the way? www.traffordccg.nhs.uk

What? Patient centric, sensitive and responsive Locally delivered (where possible) Highest possible standards Highest quality outcomes Economically sustainable www.traffordccg.nhs.uk

How? Big Bang? Incremental ? Financially driven ? Infrastructure driven www.traffordccg.nhs.uk

Trafford Experience ICO attempt 2010….not supported Commissioned ‘Integrated Care’ Community / Primary Care Interface Enhanced Community Support Community Matrons Domiciliary IV Rapid Response Community Nursing re-design www.traffordccg.nhs.uk

Trafford Experience Lacked Co-ordination TCC…Co-ordination Centre Commissioned £15m over 5 years Directory of services Risk stratification Referral Management Discharge Facilitation Care Co-ordination www.traffordccg.nhs.uk

Trafford Experience Community + Social Care Integration Utilising TCC Joint Management Aligned/integrated teams Aligned IT www.traffordccg.nhs.uk

Trafford Experience Primary Care investment TCC Nursing Homes LES Extended Hours 7 Day access ATT Enhanced Screening ..Cx Cytology www.traffordccg.nhs.uk

Trafford Experience Issues Lots of components Partially successful Dependent on Primary Care Engagement Incentive? Solution? www.traffordccg.nhs.uk

Primary Care Expanding demand Low morale Recruitment issues Retention / retirement pressures Low investment Estate variance www.traffordccg.nhs.uk

Primary Care Solution Single System Common Ethos / Ownership Single Leadership Single Management Team Common SOPs Common Outcome Targets New ‘QoF’ Performance Managed www.traffordccg.nhs.uk

Primary Care Solution Enablers TCC Workforce Development Single Advanced IT system VDI / Phones TCC Workforce Development 50/50 Nurse / Dr ratio Expansion/Re-definition Estates Rationalisation / Standardisation Partnership Working Community/MH/Secondary Care/3rd Sector/Patients www.traffordccg.nhs.uk

Primary Care Re-design De-constructed into component parts Prevention ‘Routine Care’ Delegation…DocMan/prescribing/paperwork Urgent… neighbourhood provision Domiciliary Nursing home/residential/housebound/visits Specialised Intra and inter practice/system referral Private www.traffordccg.nhs.uk

Form Follows Function! Single system 4 neighbourhood delivery ? Super partnership ? ‘John Lewis’ style Common ownership All salaried Mutual benefit/gainshare www.traffordccg.nhs.uk

How does it work? Single System Ethos Common goal Common standards Common outcome driven targets Performance managed/supported High quality efficient management Happy and motivated workforce Maximised local care Integrated and co-ordinated services www.traffordccg.nhs.uk

How does it work? ‘Consume own smoke’ Reduced referral Reduced unscheduled care Reduced scheduled care Increased quality Increased range of services Increased local access Income generating www.traffordccg.nhs.uk

Economics Requires investment In Greater Manchester Devolution System ‘Bid’ for transformation funds Circa £17m for £25m return over four years? www.traffordccg.nhs.uk

Summary Started with failure Slow build of supportive services Recognition of Primary Care role Radical solution required Ready to go!? www.traffordccg.nhs.uk

Questions / discussion Thank you for your time Trafford New Models of Care Project Team administrator: Rochelle Huddlestone, r.huddlestone@nhs.net www.traffordccg.nhs.uk