BACKGROUND What: Mapping the future, 5 Year Forward view all about moving services into the community , specifically services for frail people, office-ollogies, community services and health and social care co-ordination and integration. Why- Patients like services close to home if possible, GPs and practices are the natural leaders of communities of care. Quality improves with integration. Continuity of care and clinical leadership “de-siloise” care. Hospital centric care puts tension in health economy. But Practices can’t do this on their own and the CCG needs a consistent service

HOW Provision; Federations; a way of GP practices being able to provide more services across a wider area. Three levels Sharing of capacity and capability to deliver GMS Clusters of practices to share more specialist services and staff (population 30000) and Federation wide services (eg for urgent care)

authority authority Silos Commissioners authority authority authority Business risk Community Social care Ambulance trust GP surgery Other trusts accountability information authority accountability information authority accountability information authority accountability information authority accountability information authority At the moment, practitioners have to be accountable to their boards in how they manage risk, and the boards risk intolerance affects practitioners’ behaviour in turn Clinical risk Practitioners Practitioners Practitioners Practitioners Practitioners Where is the patient? What are the quality and financial costs of silos?

….Citizen centred care accountability Commissioners information authority authority Commissioners information authority authority Business risk Community Social care Ambulance trust GP surgery Other trusts Clinical risk Practitioners Practitioners Practitioners Patient with care plan If practitioners are to become more accountable to patients and to their Multi Disciplinary Teammates, we need to have a system that allows the patient and the care plan to hold the ring in terms of authority, information and accountability Practitioners Practitioners

Multisystem Community Provider ….Citizen centred care With integrated provision accountability Commissioners information authority authority Clinical & Business risk Multisystem Community Provider Practitioners Practitioners Practitioners Patient with care plan If practitioners are to become more accountable to patients and to their Multi Disciplinary Teammates, we need to have a system that allows the patient and the care plan to hold the ring in terms of authority, information and accountability Practitioners Practitioners

HOW Commissioning: There is considerable uncertainty about how these new models of care will develop. It seems likely that the present clear boundaries between contracts and providers may need to change. Co-commissioning is one way to develop. We need to get this right for our population, providers and commissioners. Governing Body will learn more about co-commissioning with members and the LMC and produce proposal for members at the October AGM