1. Ian Williamson Chief Officer Greater Manchester Health and Social Care Devolution NW Finance Directors Friday 15 May 2015 Ian Williams Chief Officer Greater Manchester Health and Social Care Devolution Chief Officer Greater Manchester Health and Social Care Devolution Joined Up Care – Progress & Developments 20 th May 2015 Rob Bellingham

2. Objective of presentation To provide an update on progress towards the delivery of the Healthier Together Primary Care Standards in the wider context of the development of joined up care across Greater Manchester 2

3.  By the end of 2015, everyone living in Greater Manchester who needs medical help, will have same-day access to primary care services, supported by diagnostics tests, seven days a week;  By the end of 2015, people with long-term, complex or multiple conditions such as diabetes and heart disease will be cared for in the community where possible, supported by a care plan which they own;  Community-based care will focus on joining up care with social care and hospitals, including sharing electronic records which residents will also have access to;  By the end of 2016, residents will be able to see how well GP practices perform against local and national measurements. Primary/ Joined Up care standards in Healthier Together

4. Integrated Care – All Parts of GM are developing integrated models with these common characteristics Collaboration & Partnerships Built on a whole systems vision and the product of genuine co-production Spreads personalisation and makes the best use of community assets Commissioning, information and governance Reallocates resources across the system to secure early intervention & prevention Sits as part of a strategy which responds to the total economic challenge Establishes and pools resource according to the model of care Confirms a clear contracting, pricing & incentives methodology to support the model of care Enables information flows across the system to support care planning, care delivery, payment and performance monitoring Population, Impact & Evidence Has agreed whole systems outcomes to be delivered Has segmented the population according to a broadly based risk stratification process Has an agreed evaluation methodology for the community based model Can confirm the population currently supported and engaged through the model of care Can provide a description of impact against agreed monitoring metrics The Model of Care Has established multi-disciplinary teams at the neighbourhood level bringing all relevant providers together on the basis of the GP’s registered population. The Teams provide: An individual care plan for each patient identified A named accountable professional for each patient Has agreed the process and timescale for full borough coverage Is progressing a plan for workforce development which will secure immediate and ongoing sustainability for the model of care

5. Community Based Care / Integration 5 GM Integrated Care Steering group – Attended by Integrated Care Lead from each economy – Monthly opportunity to share progress and learn from each other – Identification of common barriers for joint work & external support – Connections becoming established to National Pioneer Support Programme – Learning Network with GM, Leeds and NW London established in April facilitated by The Kings Fund Agreed common metrics – Aim to truly understand and compare each locality To enable better and more focused sharing of strengths and weaknesses amongst the group To highlight overall pace against plans and encourage sharing of obstacles – Both outcomes and process (measures of progress)

6. All localities have risk stratified their population and started the process of roll out 6 Greater Manchester 2.8 million 72% (358 out of 496 Practices) >40,000 patients (national enhanced scheme) 84,000 people (3% of population) £300 million (Better care fund+) For a Practice this means… 5,000 patients on average Avoid 2-3 admissions per month Avoid 4-5 A&E attendances per month Avoid 3-4 first outpatient attendances per month Avoid 14-15 follow up outpatient attendances per month GM Population size (registered) Current coverage of new models of care Care planning by GPs (2% high risk) Population targeted by Integrated Neighbourhood Teams Scale of pooled budgets

7. Joined up Care & Support – Wider Public Service Context 7 Integrated Neighbourhood Health & Social Care Teams Effective joint working across primary care, community services, social care and public health To be operational in every neighbourhood in GM To drive proactive care for patients most at risk of illness and admission Based on rigorous risk stratification and population segmentation GM wide action on demand and diversion through support for people with long term conditions to promote self management and healthy living. Enhanced Community Hubs Larger scale integrated community provision Serving populations of between 30k & 75K Potential to provide enhance and specialist primary, community & social care, Intermediate Care, community mental health provision etc Significant development of both step up and step down capacity Linked to district level care co-ordination developments Primary Care Transformation By the end of 2015 all Greater Manchester residents… Same day access to Primary Care services, seven days a week With long term or complex conditions will be cared for in the community where possible Will have access to their own records, helping to join up their care By the end of 2016 all Greater Manchester residents… Will be able to see how the GP practices perform against local and national measures Mental Health Transformation Better identification, treatment and early deflection of delirium, depression and dementia Grow capacity in intermediate care to manage delirium, depression and dementia Standardise RAID across GM In reach RAID into nursing and residential homes to prevent ambulance calls and A&E presentations Build psychological packages of care into long term condition management alongside a standardised physical health check for all people with severe & enduring mental illness Self care, self management adopted at scale as a first line intervention Action on social isolation, for example promoting independent people (PIP) workers Wider Public Service Reform Alignment of whole public resource blending, health, housing, debt advice, family support, skills and employment support. Roll out of GM Early Years New Delivery Model improve school readiness and increase parental employment Action to help 50,000 GM residents into work reducing drug dependency, alcohol dependency and mental ill health Integration and collaboration across Blue Light Responses e.g. GM’s Community Risk Intervention Teams - Greater Manchester Fire and Rescue Service (GMFRS) working with North West Ambulance Service (NWAS) and Greater Manchester Police (GMP) to form a new team to help drive further reductions in risk to our most vulnerable communities through a wider approach to prevention activities and projected to save £3.2m per year. We will develop an out of hospital framework for health and social care that follows the best available evidence, to deliver alternatives to hospital care and to reduce the reliance on and cost of statutory services. This framework would act as a ‘menu’ or guide for care closer to home to inform commissioning intent and provider strategy.

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9. Delivering the Primary Care Access Standard Recognition that this is and will continue to be a headline measure by which progress on primary care transformation will be gauged We equally wish to ensure that we present our progress in the context of the wider programme of health and social care reform. We anticipate publication of the independent evaluation of our Primary Care Demonstrator programme in June The fourth Greater Manchester Primary Care summit is to be held on 10 June, where each of our demonstrators and Prime Minister’s Challenge Fund sites will be present to share progress and learning We anticipate Primary Care Access and the wider transformation programme being identified as an Early Implementation Priority for the Greater Manchester Devolution programme, reconfirming our previous statements of intent in this regard and providing new opportunities for closer integration and accelerated delivery of our ambition 9

10. Some specifics on Primary Care Access We have the following schemes already in place or in implementation – 2013 – 4 demonstrator sites delivering 7 day access to some 300,000 GM residents – 2014 – Bury Prime Minister’s Challenge Fund Programme, including 7 day access to 195,000 Bury residents – 2015 - Wave 2 Prime Minister’s Challenge Fund programmes launched in the City of Manchester and Wigan, which together will deliver 7 day access to some 900,000 citizens These schemes will deliver 7 day access to over 1.1m GM citizens In addition, additional funding identified in 2015/16 to support the delivery of the Healthier Together access standard in the remaining 7 CCG areas. We are clear that an accelerated in-year roll out of this nature will provide challenges in terms of mobilisation, deployment and programme management but we remain confident that this objective can be successfully delivered A clinically led sub-group of the Association of CCGs is undertaking a piece of work to describe and confirm that all programmes are working to an agreed core standard for delivery. This does not impose set models on localities but will ensure the CiC and others are able to assess delivery in a consistent way across GM. 10