1. The Suffolk Four – Working Together for the Many Jon Green Dermot O’Riordan Dr Rakesh Raja Dr Andrew Yager

2. THE CURRENT SITUATION…….. HOW TO REFLOAT A GROUNDING

3. THE PROBLEM COMMISSIONERS AND PROVIDERS ARE FAILING TO DELIVER SUSTAINABLE SERVICES ACROSS THE WEST SUFFOLK HEALTH SYSTEM

4. THE OBJECTIVE BY THE END OF 2015/16 TO HAVE COMMISSIONERS AND PROVIDERS WORKING TOGETHER TO DEVELOP SUSTAINABLE SERVICES ACROSS THE WEST SUFFOLK HEALTH SYSTEM

5. Fishbone Analysis Diagram V2 No time (to stop and think) No time (to stop and think) PEOPLE ENVIRONMENT POLICY POLITICS Denial Hamster wheel Internal market Repeated reorgs/ Rules keep changing Repeated reorgs/ Rules keep changing Annual contract (e.g. penalties etc) Annual contract (e.g. penalties etc) General election “NIMBY” It will never happen (not in Suffolk!) It will never happen (not in Suffolk!) “Pass the patient” Do not think (as system) Do not think (as system) Work in silos/self survival Work in silos/self survival THIS WAY TO A SHARED VISION THIS WAY TO A SHARED VISION ECONOMICS Transitional funding (lack of) Transitional funding (lack of) No Money OTHER HEALTH What is the system? DGH only 40% of Total CCG budget DGH only 40% of Total CCG budget What is primary care? Self interest Collective ownership (lack of) Collective ownership (lack of) Regulatory framework No clear or common understanding of what integration is No clear or common understanding of what integration is Trust and relationships Information/shared Health record (lack of) Information/shared Health record (lack of) No shared incentives Staff Morale Workforce crisis Duplication No Money Soft factors Hard factors

6. SHARED INCENTIVES

7. GRAND STRATEGY THE HEALTH AND CARE SYSTEM IS CO-ORDINATED UNDER ONE STRUCTURE WITH SHARED INCENTIVES

8. PATIENT/CARE PATHWAYS DATA SHARING WORKFORCE ORGANISATIONAL FORM GRAND STRATEGY

9. ORGANISATIONAL SUB-STRATEGY Priority root cause to build ‘trust and relationships’ Collaborative working to create oversight model (shadow board) Board to Board joint sessions Supported work on governance Shared incentives developed via financial and contract models

10. IMPLEMENTATION PLAN – ORGANISATIONAL FORM Wide stakeholder engagement plan Joint Executive working plus board to board workshops Contract and finance model developed alongside “offerings” for stakeholders Working with regulators to approve changes Set up of Governance/Shadow board to develop legal model and transition plan

11. PATIENT/CARE PATHWAYS SUB- STRATEGY Stakeholder workshops Clinical forums Collaborative pathways with shared incentives Board to Board coaching

12. IMPLEMENTATION PLAN – PATIENT/CARE PATHWAYS Proof of principle needed Target area of concern – ophthalmology Joint pathway design Approval by both organisations Jointly commissioned service Shared learning across organisations Shared risk and reward

13. DATA SHARING SUB-STRATEGY Agreement of system leaders to facilitate the sharing of information when it is in the interests of patient care Create “West Suffolk Shared Record”

14. IMPLEMENTATION PLAN – DATA SHARING Sell the vision Personal meetings with key opinion influencers Joint Working Openness and transparency Understand legitimate concerns of others Data sharing agreement Secure funding Deliver the technology Not screw up

15. WORKFORCE INTEGRATION SUB- STRATEGY Forum examining future workforce – NHS 5 year plan Collaboration workforce leadership/training Implement change in workforce skill mix, barriers and working practices Collaborative strategy to address workforce recruitment and retention harnessing “shared incentive”

16. IMPLEMENTATION PLAN – WORKFORCE Vacancies in Primary and Secondary care Key stakeholders – ‘burning platform’ Identify struggling specialties prepared to work collaboratively Targeted job enhancement – with portfolios, fellowships etc Collaborative branding and marketing

17. EVALUATION PROCESS 1 GP Mandate and functioning shadow board Increased trust and reduced contractual queries Co-production of clinical pathways Collaborative working between HR departments Shared risks and rewards….contractually Signed up data sharing agreement Functioning health information exchange Actual numbers – pathways/jobs/fellowships Benchmarking against Vanguard sites

18. WHAT DID WE LEARN 1 The power of four working together with different starting points The benefits and challenges of group dynamics in problem solving The importance of sub strategies, change both top down and bottom up Lots of learning from having to develop sub strategies once main strategy and shared incentives settled on The importance of creating Trust and understanding to move to change

19. WHAT DID WE LEARN 2 Academic rigour stopped us jumping to “solution”…a framework essential Get the environment right and trust and ideas will flourish Talking doesn’t mean communicating…. “GPs are from Mars, Surgeons are from Venus??” As we got closer the system got further apart! Different levels of “distress” and “stakes in game” means one size will never fit all but principles can be agreed

20. The Suffolk Four – Working Together for the Many Jon Green Dermot O’Riordan Dr Rakesh Raja Dr Andrew Yager