1. Dudley Vanguard MCP Development Steph Cartwright - Director of Organisational Development & HR Dr Steve Mann – Clinical Executive for MCP Development Neill Bucktin – Director of Commissioning

2. The journey so far...

4. Teams without walls
Maximising their potential to work efficiently and effectively together
– to take a shared responsibility for achieving shared outcomes

6. Reflections
Biggest transformational change (particularly for primary care) the NHS has seen
OD approach before a contracting approach
Using the contract as an enabler
Be prepared for organisational and leadership conflict
Staff engagement and workforce development is inherent in developing the model
Development of new workforce solutions has been a success
All organisations are committed to joint messages and engagement
Never underestimate the level of drive, motivation and commitment needed to make this happen
Consideration needs to be given to what a future CCG will look like once the MCP exists
Excitement and trepidation of going first

7. Describing Success – What Staff are saying
It’s more holistic and person centred. A good idea that could get much better.
The new integrated way of working has helped me: better integrate with teams, understand what services can offer... pulling this all together in a regular meeting has given me greater autonomy this has directly improved patient pathways of care and reduced unplanned admissions to hospital.
It is rewarding seeing how integration has re-energised team members and the enthusiasm of key professionals in the service has encouraged more staff to want to become involved...
In the past … it was often hard to access the services and the help you felt your patient would benefit from. It could be very time consuming finding out the appropriate service and then the appropriate person to refer to, however with the MDT meetings this has improved considerably. I now have a network of colleagues to whom I can refer or simply ask for advice. This has improved my efficiency greatly and lead to a service improvement for patients and their carers.
The response to this new way of working, through our patients has been that of thanks, praise and relief due to the easier access to a variety of professionals

8. Describing Success – What People are saying
“I could have just stayed at home and given up. I wished I would have known about this five years ago. I’ve got what I really want, it’s lifted me and I have a laugh. I can feel a change in myself – I feel more alive to be honest.”.
“Due to this disability I have had to give up work and I am now virtually housebound. …[this] has opened up a lot of possibilities for me by encouraging me to become involved with a number of activities which has been a massive help to me… it has made a huge difference to my life.”
“… this has helped me a lot, … given me my confidence back. I am getting on well with people and beating everyone at pool. My life is getting better and I feel I will get back into work.”
“I feel safer now, really secure. The service is fantastic – although my GP had tried to help I was getting nowhere. ... Since [the link worker] came on the scene it’s all gone one way, and that’s up. He made me aware of places I didn’t even know existed and I dread to think what my situation would be if he hadn’t helped me”.

9. The GP Perspective

10. Primary Care in Dudley Long history of strong GP engagement in Dudley
Practice based commissioning clusters transformed into CCG localities
Historic Dudley Commissioning Forum (now CCG Clinical Forum) established for over ten years
GP Engagement Lead who works with every GP practice in Dudley to aid their practice and commissioning development
Monthly locality meetings chaired by elected CCG Board GPs
6 weekly CCG wide GP membership meetings attended by 100% of practices
Primary Care and Membership Development team in place since the establishment of the CCG

11. Development of Primary Care
GP Collaborative:
36 Practices have joined the GP collaborative
£1million funding through the Value Proposition to support primary care
Primary Care Development Group with GP and PM leadership established to deliver projects such as combining back office functions, paramedic home visiting service, education for HCAs, records storage, digital dictation etc.
Dudley Outcomes for Health Framework:
Replacement of QoF framework for 40 out of 46 practices
Outcomes based
Focussed on providing optimum care for long term conditions patients
Development of EMIS templates

12. New Primary Care Outcomes Framework

13. Development of Primary Care
MCP Development:
Dedicated team to develop the primary care element of the new model of care
Substantial negotiations need to take place to prepare for procurement process:
Between steering group and GP membership / collaborative
Between steering group and potential partners
Primary Care Team are:
Engaging the collaborative practices on what they want from the MCP (hosted contract or joint venture)
Developing the integration agreement between each GP practice and the MCP
Preparing the case to respond to both providers and the procurement process

14. Next Steps

15. What might the future look like?
Commissioning organisation
Provider 1 – hospital services – planned and urgent care.
Provider 2 – all community health services – physical health; mental health; children’s health; learning disability services; primary medical services and social care.

16. Provider 2 = MCP
Multi-Specialty – physical health, mental health, children, adults, social care, primary care……
Community – services delivered out of hospital
Provider

17. How do we commission?
Funded for a population – 315,000 people registered with Dudley GPs
We buy single events for patients – “procedures”, “admissions”, “attendances”, “contacts”
We have a statutory duty to reduce health inequalities but….
We only commission “outcomes” from primary care

18. How would it work?
Commission for better outcomes for the whole population – not single events
Start with a defined population – general practice
Build the “multi-specialties” at practice level – the MDT
Connect to the rest of the system outwards
Aggregate as the MCP

19. How it works cont’d No longer buy “events” Buy outcomes
Single capitated budget for a whole population
MDT has shared responsibility and is held to account for its defined (practice) population
MCP has responsibility for the whole population and is held to account by its commissioner

20. New System Commissioner – CCG + Dudley MBC
Two main contracts – MCP and Remaining Hospital Services, plus possibility of sub-contracting
MCP receives “capitated budget” (based on the population) to deliver a defined set of outcomes
Long term – 10 year - contract

21. Key MCP Features 1
the MCP is a single legal “entity” – one contract, not a series of contracts.
the model is based upon the GP registered list – requires primary care involvement.
the MCP will hold a whole population based budget for the services it provides including GP services.

22. Key Features cont’d
Changes the way care is delivered – risk stratification – pro-actively manages patients at risk of unplanned admission
Manages demand and increases efficiency through integration
Has the flexibility to decide how to allocate its budget

23. Timeline for MCP procurement
Public Consultation
GP development
Contract development
PIN
Market engagement
Gateway one Assurance
ITPD May
PQQ Feb
Bidder submission(s) followed by competitive dialogue process
July 16
Nov 16
Feb 17
Development of GP leadership capability to engage with potential partners and MoU with GP membership
CCG / NHSE continued development of contract, outcomes, scope. Secure external governance partner
PIN signals opportunity for market to engage with GP leadership in forming potential partnership(s); and for GP leadership to negotiate options with GP membership
CCG enters combined NHSE/NHSI/CQC gateway one assurance on procurement
Bidder submission(s) in response to PQQ requires GP participation
ITPD: bidder response to care model
Competitive dialogue affords the best mechanism for negotiating VFM and developing a new and complex contract

24. Timeline for MCP procurement
Preferred bid determined
Complete risk assessment
Gateway two assurance
Contract award
MCP infrastructure mobilised
Gateway three Assurance
MCP Mobilisation
Phased mobilisation of MCP begins
New partnership & commissioning arrangements
Aug 17
Dec 17
Apr 18
Risk assessment and assurance of MCP based on constituent parts (CCG, GP, partners)rather than MCP track record
Opportunity for Gateway two assurance measures to be built into CCG competitive dialogue
MCP legal entity, governance and leadership needs to be put in place (transition cost).
Gateway three includes CQC registration and NHSI regulatory requirements
MCP delivery phased in accordance with outcome of dialogue process (starts with Primary Care & community)
Some CCG functions contracted to MCP; new commissioning & system partnership arrangements commence

25. Potential Future Dudley System
Dudley Group FT
Best practice pathways
Incentives to repatriate population activity
Part of a Black Country acute alliance
Partnership Agreement
Risk / Gain share
MCP Commissioning
Acute / Specialised Commissioning
Dudley MBC
Adult & Children’s social care & public health
Local placed-based accountability
Dudley CCG
Black Country CCGs
Aligned with NHSE / CQC assurance
& NHSE specialised commissioning
MCP delivers population-based healthcare - integrated primary, community & social care
DGFT delivers local acute care and is part of a Black Country acute alliance
Partnership between two main providers in Dudley on shared protocols, resources, service interface
Risk / Gain share between CCG and MCP, with DGFT, on demand management of activity & allocative risk
Dudley CCG integrated with Black Country CCGs to undertake assurance and acute commissioning at scale
Dudley CCG integrated with Dudley MBC to undertake local MCP commissioning and accountability
Social Care resource limitations is a risk to financial viability

26. Questions and Discussion