SW HFMA conference 27th September 2019 Integrating care Dominic Hardy Director of Primary Care Delivery and System Transformation NHS England and Improvement SW HFMA conference 27th September 2019 NHS Improvement

Health and Care challenges in England… Longest sustained funding pressure in NHS history Significant social care funding shortfall in local government Sustainable funding (Significant) shortages in key groups – GPs, nurses Rising numbers on waiting lists, with waiting times challenges Capacity Increasing frailty as population ages Greater burden of disease Widening inequalities Outcomes

… have lead to fragmentation People experience dislocated services No one team/organisation can solve that The way we work has to address this

What might the future look like? Dennis’s story

The NHS Long Term Plan addresses this “We will continue to develop ICSs, building on the progress the NHS has already made. By April 2021, ICSs will cover the whole country” + “£4.5bn of new investment will fund expanded community multidisciplinary teams aligned with new Primary Care Networks based on neighbouring GP practices that work together, typically covering 30-50,000 people”

ICSs PCNs …with clear aims: Bring together local organisations Focus on redesigning care and improving population health Deliver triple integration PCNs Support sustainable general practice Create capacity to integrate at local level Enable voice of general practice to be heard in systems

Integrating systems Focus on very local need PCNs have a key role Neighbourhood (30-50k) Decision-making/care delivery Key link with local government Place (250-500k) Enabling delivery Address issues once System (c1m)

ICSs and PCNs build on past work… Long history of GP collaboration 90%+ practices self-identified as ‘networks’ last year Neighbourhood focus – right size team

Progress so far: 1250 99% 1250 40k 14 ICSs covering 21 million people Primary Care Networks established Practices taking up PCN DES PCN Clinical Directors identified Average size of a PCN 1250 99% 1250 40k

Form? It’s about integrating care “Now this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning.” Success consists of going from failure to failure without loss of enthusiasm. You have enemies? Good. That means you have stood for something sometime in your life. A pessimist sees the difficulty in every opportunity; an optimist sees the opportunity in every difficulty.

Holding back expectations 5 new groups of staff to deploy MDTs to form with community services providers Relationships to build – internal and external 7 new service specifications to deliver ‘sort out’ access Deliver integrated care

How it feels now?

What needs to be different? What will be different and how will you make it happen? How will you build collaborative relationships? What are the population’s health and care needs? What is the inspiring plan? Vision Data Impact Leadership and behaviours

What will you do differently today to deliver integrated care?