One Halton and General Practice Strategy Presenter NHS Halton CCG 27/03/15

Key strategic issues Five Year Forward View –New models of care –A new deal for primary care Dalton review Care Act 2015 JSNA/BCF Co-Commissioning –Full delegation Collaborative commissioning 2015/16 tariff & PMS review A Call to Action Prime Ministers Challenge Fund 2015

General Practice Strategy for Halton Population of 128, practices (8 in Runcorn, 9 in Widnes) 74 GPs (headcount) 52 nurses Registered list sizes at practices range from over 14,000 to 2,000 A blueprint for co-commissioning general practice services from April 2015.

Progress update Case for Change Engagement Public Providers/ Partners General Practice High quality care for allCare continuityReducing unwarranted variation Clinical leadership and decision making Services at scale, delivered locally Co-production and co- design Outcomes focusServices working in community Improving access Focus on preventionSupporting aspirations of parity of esteem and the crisis care concordat General Practice in current guise not sustainable Principles Priority areas Mental illness Cancer and CVD Unplanned/urgent care Hypertension Gastrointestinal including liver disease Respiratory disease Accidents

Emerging Care Model – Multi-Specialty Community Provision Key features Driving concept is to strengthen services in the community, wrapping them around local people, ensuring needs are met through integrated health and social care services Practices working together A focus on areas/conditions where we can have a greater impact Innovative solutions and alternative funding approaches Embracing the role, skills and insight of the local Voluntary/Community sector Creation of Community Hubs – co-location of services Multispecialty Community Provider (MCP) model Prime Minister Challenge Fund 2015

Partners and providers (not exhaustive) Community nursingVoluntary groupsDistrict nursing Community midwivesCommunity groupsSocial care services Mental health teamsUrgent care centresElective pathways Well being servicesChildren’s servicesHealth improvement teams Family nursingOut of Hours provider Promotion, prevention and screening Community pharmacyOutpatient servicesDiagnostic services School nursingHealth visitingSexual health services

Proposed engagement approach PhaseApproachTimescale OneInsight work – understanding behaviours, thoughts and viewsOn-going * TwoInforming/warming up – mass publicity of work and engagement events 8 weeks (April – May) ThreeEngaging and co-producing – designing care pathways with public/patients, General Practice and providers/partners 16 weeks (June – Sept) FourConsultation – formally consulting on changes12 weeks (Oct - Dec) FiveImplementationBusiness As Usual (Jan 16…) ‘* Run in parallel with phases two and three Clear objectives for each phase Element of flexibility

Well it could mean…….. Right person, right service, right time, right place with best possible outcomes and experience? Tell your story once, get seen quicker, stay well longer? One assessment, One set of tests and One treatment plan? Plan together, Care together?

What we don’t want is…. Rigid old ways of working No more “like it or lump it” One Size fits all We don’t want centralised conformity, we want what is right for our population. Numerous hand offs and no diagnosis Long Waits to get better (treatment) Top down approach – we want to harness a collective energy.

What we want is…. A health and social care service to be proud of Services fit for the populations needs A multi speciality community model Everyone working together Improved care delivery Better outcomes Reduced inequalities Joint planning

What we want is Ideas We could see….. GP surgeries set up in hospitals/Urgent Care Centres Out patient clinics & diagnostics (x ray/blood tests) in the community Community services in different buildings (settings) Different services in the same buildings Specialist doctors and nurses in the community Non clinical models supporting services and people New creative (alternative) ideas

Rehabilitation End of Life Children Self Care Planned Care Urgent Care Prevention General Practice Social care Community Mental Health Acute Voluntary sector Public health One Halton Well being Pharmacy Learning Disability Trust Communication Culture Commitment Resource Integration Enablers – Resources, IM&T, Workforce, Estates, Communications & Engagement Co production

Next steps One Halton – direction of travel – have we got it right? General Practice Strategy - Co produced – co commissioned – Working Together Engagement and communication- clinical and beyond Commitment to deliver (this is what Halton does well) Alignment of work plans and priorities Multi agency / disciplinary teams BUT HOW?