A Summary of our Sustainability and Transformation Partnership (STP) April 30th 2018 Sally King and Julie Mackie Service Development Managers, GCSNHST

Introduction to STP’s National planning guidance from NHS England tasked local systems to develop a shared, system level, strategic plan to set out how we will deliver services over the next 5 years

One Gloucestershire We are working to a local footprint for the STP, collaborating together in a joined up way as ‘One Gloucestershire’

The scale of the challenge

Top Line Messages We will invest in keeping people healthier for longer by enabling communities to support each other, and support self care and prevention We will reduce variation in prescribing and services, cut waste, and fund interventions that can deliver the greatest health benefit for our population We will review the patients’ care journey, to ensure that care is delivered efficiently and effectively, and when appropriate, closer to home We will join up care around communities, creating 16 GP practice clusters delivering integrated care with community services to support physical and mental health needs

Top Line Messages We will have a clear joined up approach to urgent care provision, so that people will know when and where to access urgent care, when they need it We will introduce urgent care centres and streamline assessment services when we are clear this will improve quality and safety, and reduce waiting times for our population We will have a ‘one county’ approach to IT, Estates, and other system enablers We will introduce countywide leadership, training, education and learning opportunities to support the shift to new roles and responsibilities for staff

Our Plan on a Page

Enabling Active Communities Radical Self Care and Prevention Plan Clinical Programme Approach Reset Pathways for Dementia and Respiratory Deliver the Mental Health FYFV Reducing Clinical Variation Choosing Wisely Medicines Optimisation Diagnostics Review One Place, One Budget, One System Place Based Commissioning Reset Urgent care and 30,000 community Model System Enablers Primary Care Joint IT Strategy Joint Estates Strategy Workforce Enabling Active Communities Our approach will include: Supporting people with non-medical needs through social prescribing i.e. GPs referring to sources of community support and community activities Developing a county-wide programme to tackle obesity Promoting healthy workplaces and schools, including improving employee health through the workplace well-being charter Using innovative technologies to support self-care e.g. Diabetes Strengthening support for Carers.

Clinical Programmes Approach Enabling Active Communities Radical Self Care and Prevention Plan Clinical Programme Approach Reset Pathways for Dementia and Respiratory Deliver the Mental Health FYFV Reducing Clinical Variation Choosing Wisely Medicines Optimisation Diagnostics Review One Place, One Budget, One System Place Based Commissioning Reset Urgent care and 30,000 community Model System Enablers Primary Care Joint IT Strategy Joint Estates Strategy Workforce Clinical Programmes Approach Our approach Ensures care is safe, joined up and provides value for money Places an emphasis on prevention and self- management advice at an early stage Ensures people get the right treatment, in the right place, at the right time Focuses on local priorities, including respiratory care (e.g. lung disease) and dementia.

One Place, One Budget, One System Enabling Active Communities Radical Self Care and Prevention Plan Clinical Programme Approach Reset Pathways for Dementia and Respiratory Deliver the Mental Health FYFV Reducing Clinical Variation Choosing Wisely Medicines Optimisation Diagnostics Review One Place, One Budget, One System Place Based Commissioning Reset Urgent care and 30,000 community Model System Enablers Primary Care Joint IT Strategy Joint Estates Strategy Workforce One Place, One Budget, One System The ‘People and Place’ community model GP practices at the core, working with health, social care and the voluntary and community sector, covering populations of around 30,000 GP practices working together in closer partnership to provide a wider range of local services Other health professionals working more closely with GP practices e.g. clinical pharmacists, paramedics and mental health staff to support local people Joined up health and social care teams – more care in people’s own homes and in the community, supported by specialist staff if needed Development of Centres of Excellence for rehabilitation at a number of community locations.

Improved access to GP services – including evenings and weekends Enabling Active Communities Radical Self Care and Prevention Plan Clinical Programme Approach Reset Pathways for Dementia and Respiratory Deliver the Mental Health FYFV Reducing Clinical Variation Choosing Wisely Medicines Optimisation Diagnostics Review One Place, One Budget, One System Place Based Commissioning Reset Urgent care and 30,000 community Model System Enablers Primary Care Joint IT Strategy Joint Estates Strategy Workforce Development of a network of centres and services to meet people’s urgent care needs Improved access to GP services – including evenings and weekends Community based urgent care centres – bringing together increased access to GP care, out of hours services, diagnostic tests and minor injury and illness services Increased support from hospital based specialists in the community Continued development of high quality and joined up Mental Health Crisis services.

Development of Centres of Excellence at our two general hospitals Enabling Active Communities Radical Self Care and Prevention Plan Clinical Programme Approach Reset Pathways for Dementia and Respiratory Deliver the Mental Health FYFV Reducing Clinical Variation Choosing Wisely Medicines Optimisation Diagnostics Review One Place, One Budget, One System Place Based Commissioning Reset Urgent care and 30,000 community Model System Enablers Primary Care Joint IT Strategy Joint Estates Strategy Workforce Development of Centres of Excellence at our two general hospitals When you need specialist hospital services, our plan is to: Ensure specialist staff see enough patients to maintain their skills and the right number of staff are available 24/7 Speed up assessment and decision making about people’s treatment and onward hospital care Improve the patient environment Improve links between related services – making services more joined up. To do this we believe we should continue to bring together some services to ensure quality and safety.

Reducing Clinical Variation Enabling Active Communities Radical Self Care and Prevention Plan Clinical Programme Approach Reset Pathways for Dementia and Respiratory Deliver the Mental Health FYFV Reducing Clinical Variation Choosing Wisely Medicines Optimisation Diagnostics Review One Place, One Budget, One System Place Based Commissioning Reset Urgent care and 30,000 community Model System Enablers Primary Care Joint IT Strategy Joint Estates Strategy Workforce Reducing Clinical Variation Our approach will include: Developing a ‘Best use of medicines’ programme – helping people take the right medicines correctly to benefit their health, avoid taking unnecessary medicines and reduce waste Priority funding the drugs and treatments that have the greatest health benefit for our population Campaigns highlighting how the public can help – e.g. choosing alternatives to A&E when it’s not an emergency, cancelling appointments if we can’t make them or not stockpiling medicines Reducing duplication and improving service efficiency e.g. looking at how we provide tests and follow up outpatient appointments.

System Enablers - Technology Enabling Active Communities Radical Self Care and Prevention Plan Clinical Programme Approach Reset Pathways for Dementia and Respiratory Deliver the Mental Health FYFV Reducing Clinical Variation Choosing Wisely Medicines Optimisation Diagnostics Review One Place, One Budget, One System Place Based Commissioning Reset Urgent care and 30,000 community Model System Enablers Primary Care Joint IT Strategy Joint Estates Strategy Workforce System Enablers - Technology Our approach will include: Joining up your Information – secure access to patient records for clinicians and care workers, where and when they are needed Providing access for patients and their carers to their digital health records Helping people to take greater responsibility for their health through use of technology Developing on-line resources to guide people through their care and treatment, including community support information Extending the role of technology to support direct patient care e.g. e-consultations and video consultations.

System Enablers - Workforce Enabling Active Communities Radical Self Care and Prevention Plan Clinical Programme Approach Reset Pathways for Dementia and Respiratory Deliver the Mental Health FYFV Reducing Clinical Variation Choosing Wisely Medicines Optimisation Diagnostics Review One Place, One Budget, One System Place Based Commissioning Reset Urgent care and 30,000 community Model System Enablers Primary Care Joint IT Strategy Joint Estates Strategy Workforce System Enablers - Workforce Our approach will include: Offering county-wide leadership, training, education and learning opportunities to support new ways of working and ensure staff have the right skills Joining up teams and introducing new roles to improve continuity of care and support for people Joining up our approach to recruitment: promoting Gloucestershire as a great place to live and work Minimising the use of expensive agency and temporary staff.

Examples from ‘Place Based’ Clusters Community Dementia Project – Stroud ‘Rural’ To support GPs with dementia diagnosis and provide best care for people with dementia in partnership with GPs and Integrated Community Teams Ensure that people with dementia access right care, right time, right place by the right health care professional Improve service user and carer experience Work closely with GPs / Practice Nurses and across organisations to reduce duplication Work towards becoming a Dementia Friendly Town Collaborate with other agencies (Age UK etc)

Examples from ‘Place Based’ Clusters First Contact Physiotherapy – Aspen and St Pauls People with musculoskeletal problems are given an appointment with a physio working within the practice. More appropriate care for patients, improving patient experience Releasing GP time and skills for other appointments Providing quicker access for patients to be seen by a physiotherapist Reducing (appropriate) prescribing expenditure Reducing unnecessary diagnostic tests Supporting people to return to work

Next Steps – what can you do to be involved Formal consultation will be announced – we would like to hear your views In the mean time You have kindly given a list of the WI groups and which of the 16 clusters they are most closely linked to We would like to be able to contact those groups if we need help in developing projects and engaging with communities about them

Where to find out more http://www.gloucestershireccg.nhs.uk/gloucestershire-stp/

We would be pleased to answer any questions you may have, or hear any comments you wish to make.