1. Healthier Together Joint Committee Wednesday 15th June 2016

2. Developing Integrated care in GM
Primary Care Update
Developing Integrated care in GM
Building on our Healthier Together Commitments
Rob Bellingham, Director of Commissioning

3. Context
The Healthier Together made a series of commitments relating to the development of primary and joined up care, (integrated care) across GM. This has given us a platform upon which significant aspects of our GM Strategic Plan, “Taking Charge” has been built. This presentation describes these next steps in the context of the wider GM transformation programme.
Members will recall the “venn diagram” depicting Primary, Integrated and Acute Care and our ambition to achieve a so called “total eclipse” of the Primary and Integrated Care circles. We believe that the work described in this presentation achieves this objective via the development of our GM Locality Plans and their vision for integrated care serving neighbourhoods of circa 30-50k populations.
Scaled, population health and wellbeing management is core to our strategy to transform community based care and support.
This part of our new models of care and support are central to our ability to maximise the demand reducing potential of those new models. An understanding of those characteristics of the new models essential to managing population health improvement and reducing demand on acute services is key to ensuring all parts of GM are developing models which will contribute to clinical and financial sustainability

4. Delivering our ambition: aligning reform across GM
H&SC TRANSFORMATION
WIDER REFORM ACROSS GM

5. Proposed method for a consistent approach to developing an LCO
DRAFT FOR DISCUSSION
Proposed method for a consistent approach to developing an LCO
The 10 stage approach to the left starts to illustrate an overall development approach to fully establishing an LCO.
GM colleagues consider the value of consistent approaches at key stages such as:
Risk stratification & population segmentation approaches
how we define an LCOs core characteristics at both a basic and advanced level to reach for the higher ambition on scope and development
A reliable costing methodology inform investment and implementation considerations and
a standard GM approach to Cost Benefit utilising the New Economy model, of interventions delivered by an LCO.
1. Identify target population
2. Assess potential impact by area of spend
3. Use ‘logic model’ to define reinvestment potential
4. Define core elements of delivery model
5. Translate the core elements to activity
6. Identify and model the workforce requirements
7. Model the financial requirement
8. Conduct segment level Cost Benefit Analysis comparing savings and investment
9. Translate into payment mechanisms
10. Identify performance “dashboard” and approach

6. Key Assumptions & principles
Assets & strengths of people & communities
Equally involved Carers & Family
Integrated Record & Care Plan for health & care needs
Involved in decisions on care & support
Key Assumptions & principles
Use of risk stratification & population segmentation
Well managed needs
2 or more health/complex needs
Mostly Healthy
3 or more health/complex needs
Increasing health and social care needs
Resources & approach reflective of intensity of support required
People & carers empowered to self care
Advice & support
Care & support co-ordination
Integrated team GP
Tailored increase in resources for self-care, carer involvement & primary & social care e.g. longer appointments, same day access, social prescribing, 24/7 cover
Home
pharmacy
GP Practice
Cluster/Group
Better connections of existing teams alongside development of new roles
Mental Health
Physio
Case management
Nurse practitioner
Pharmacist
Clinical lead
Physician associate
Existing services
Specialists
Care Co-ordination
VCSE
New/
emergent roles OT
Behavioural health
Social worker
Extra Care Housing
Diagnostics
JCP
Intermediate Care
Network enablers
Connecting all who contribute to health benefit
Voluntary & Community Sector
Wider Public services (housing, fire etc)
Diagnostics
Community Pharmacy
Primary & social care care at Scale
999,111, OOH
Acute & urgent care
Recognising organisational & cultural development
Cultural & people integration: Human to human, individual to team, team to team - local staff moving towards a single organisation
Financial Integration: Capitated budgets for a defined population with aligned incentives developed within longer term contracts
Systems and operational integration: shared IT & systems supported with robust governance arrangements

7. LCO’s are likely to be made up of interventions addressing these types of issues:1
Prevention and health improvement:
GM and locality programmes such as EY NDM, work and health schemes, dementia utd, Falls.
Improved community and social capital
Asset based care through culture and system change
Work place health programmes
Improved screening and early diagnosis
Use of practice registers and patient level data 2
Population level activity:
Identification (risk stratification and segmentation) and enrolment in programmes of risk individuals 3
Self care, Independence and well being:
Patient activation framework and measures
GM and local social marketing campaigns
Full use of digital technology for better self management and healthy lifestyles
Personal health budgets
Patient empowerment and self management programmes such as expert patient 4
Care planning and care coordination
Care navigation and communication systems across a range of health and care settings 5
Case management 6
Integrated hospital/care home diversion and discharge:
Integrated health and care teams
Access to specialist opinion
Rapid response teams
Virtual wards
Aligned intermediate/reablement 7
A health and care system aligned to wider public services:
Strong partnerships with: education, skills and work
Housing
Voluntary sector 8
New models of pricing and contracting:
Pricing & incentives to drive improvement in population health
Population outcome based contracts for community provision 9
Optimising elective care 10
Better integrated EOLC

8. Summary and recommendations
The Healthier Together Joint Committee is asked to:
Note that the work which initially took place in line with the initial Healthier Together commitments has developed as described in this presentation
Note that this new phase of work directly connects to the GM Strategic Plan, “Taking Charge” and the development of the 10 Locality Plans
Note that each area of GM is developing Locality Care Organisations, in line with the models and characteristics set out in this presentation
Consider, in the light of the above, how the Joint Committee wishes to be appraised of progress on this agenda.

9. Sophie Hargreaves, Programme Director
Programme Update
Sophie Hargreaves, Programme Director

10. Purpose of meeting
Joint Committee’s role is to assess whether adequate progress is being made towards implementation of Healthier Together
This meeting is structured to provide an update on the GM and sector progress as well as key risks and dependencies
The Committee will be asked to comment on this at the end of the agenda

11. Highlights since March Joint Committee
11/6/2017
Highlights since March Joint Committee
Assurance:
3 of 4 sector stage 1 reviews completed
HR and workforce:
Recruitment principles agreed
Baseline taken
Finance:
Finance ongoing discussions regarding capital
Equalities:
Standards baseline taken
Access appraisal underway
Clinical:
Standards baseline taken Clarification of the general surgery model completed
Quick win recommendations identified (item 7)
NWAS audit underway
Evaluation:
Manchester University partnership established
Sophie

12. Programme Status Programme - AMBER 60% 90% 60% NWAS – AMBER / GREEN
11/6/2017
Programme Status
Programme - AMBER
Stage 1.
Establish Sector Programme 2.
Design of model of care and pathways
3. Completion of Business
4. Operational specification and detailed design
5. Preparation of Estate and facilities 6.
Planning for Implementation
IMPLEMENTATION 7.
Post Implementation review
MAT NE NW SE
60%
TBC
90%
Sophie
60%
NWAS – AMBER / GREEN

13. Programme Plan - Approach
11/6/2017
Programme Plan - Approach
Complex made up of many moving parts!
Many dependencies and interconnected activities
Risks and dependencies to be identified through Programme Board and managed through Risk/Dependency register
Therefore reviewed on a rolling basis – and updated quarterly for Joint Committee
Sophie

14. Healthier Together Implementation Plan
2016
2017
May
June
July
Aug
Sept
Oct - Dec
Jan - Mar
Apr – Jun
Aug - Sep
Sector Stage Milestones
Indicative – will vary by sector
Clinical
Pathfinder
Radiology &Paediatric Surgery
Finance
HR & Workforce
Equalities
Benefits Management and Evaluation
Stage 1
Stage 2
(Model of Care)
Stage 3 (Bus .Case)
Stage 4 (Operationalise)
Stage 6 (Transition Planning)
Stage 7 (Evaluate)
First Sector Goes Live
Stage 5 (Build)
NWAS Forwards Audit
NWAS backwards audit (depending on outcome of audit)
Scope
Plan
Quick Wins
Business Case content requirements
Capital agreed
Business Case assurance process
Assurance of business cases
Confirm required GM workforce
Develop GM principles
Confirm required GM workforce
Develop campaign
GM recruitment
Trainee changes notice given
Trainee changes enacted
Plan trainee doctor changes requirements
Analyse and Report baseline
Sector Action plans
National and automated benefit collection
Analyse and report baseline
Full benefits data collection
Develop automated / streamlined data collection processes
Scope
Grants application
Evaluation

15. Pan GM timeline (as of Wednesday 30th March 2016)
April to September 2016
Baseline audit returned and analysed
Recruitment Framework complete
Finance Framework complete
Source of capital and transition funding agreed
Paediatric surgery and radiology plans completed
NWAS Pathfinder audit completed
Doctors in Training - agreement of the impact
September 2016 to March 2017
1st wave of Recruitment to workforce
Business cases completed and assured
First clinical ‘quick wins’ delivered
Agreement on requirements for NWAS Pathfinder tool
Capital builds underway, where possible
March 2017
Radiology Hubs in place
First high risk general surgery patient movements (Sectors to have been through stages 1-6 of the Assurance Framework)
Beyond March 2017
Implementation of outstanding sectors following required capital build and assurance

16. Progress to date - assessment
3 / 4 Stage 1 reviews complete
Good progress in areas, common themes of areas to work on
Agreement of model of care key on critical path
Stage 1 themes paper sets out actions for sectors on these themes
GM levers can also be used to support implementation

17. Recommendations for sectors
11/6/2017
Recommendations for sectors
Understand current performance issues relevant to HT and develop action plans to address identified risks
Develop plans to support relationship building across clinical teams and to address the cultural changes
Review and share outputs from the Clinical Alliance in sectors
Development of ‘quick win’ plans for each specialty, supported by HT Clinical Champions
Identification of resource to commence modelling work and standardisation of baseline data
Sectors to establish Patient Participation Groups and integrate patient participation into their plans
Joint Committee asked to support this and ensure actions are completed in sectors

18. 11/6/2017
Commissioning Levers
Demonstrate commitment to change through commissioning intentions:
Specifying single teams for general surgery in commissioning intentions from a set date – for example January 2017
Specifying movement of high risk elective patients (~100 per site per year) in commissioning intentions from a set date – the date will need exploration but could be for example April 2017
Action: Joint Committee are asked to endorse this approach and reflect in local commissioning intentions.
Action: CCGs to report proposed commissioning intentions for Healthier Together to September Joint Committee.
Action: Sector to identify Head of Commissioning Lead to work with CFO lead on this
The rationale for proposing this is that the movement of elective patients will require single team working to be embedded and effective so that all surgeons continue to undertake high risk elective work and maintain skills. Therefore plans should be in place in advance to support this. These are elective patients and as such plans can be made in advance to ensure appropriate resourcing and theatre/bed capacity. Each site treats ~100 high risk elective patients per year and so this would represent ~2 patients per week per sector.
From April we could include, insertion of the model of care to contracts with KPIs/CQINNS within the contract, improvement goals and implementation timescales over the 1718 period.

19. Other GM Levers Supporting model of care agreement:
11/6/2017
Other GM Levers
Supporting model of care agreement:
Stage 2 review meeting dates set
GM event is planned for sectors to share this in August
Support in finalising data
Clinical Effectiveness:
Sharing of national data and the baseline
identifying leads for best practice from across GM
‘Theme of the month’
Cultural challenges:
Engagement with GM Organisational Development Group to discuss the implementation challenge Healthier Together poses and draw on existing experience in managing change in GM
Collation of key clinical concerns and mitigations across sectors

20. Healthier Together HR & Workforce Update – Katy Coope, Assistant Director HR & Workforce

21. Recruitment Framework Approach
Key Principles:
Current Recruitment: What can and should be actioned immediately
Future Recruitment: The proposed way we will manage recruitment to ‘new’ vacancies as a direct result of the Healthier Together changes.

22. Follow Recruitment Process
Recruitment Approach
Work as a sector
Inform Candidates
Job Role Information
Follow Recruitment Process
Current Recruitment:

23. Future Recruitment (Recruitment Plan):
Recruitment Approach
Develop an attractive offer
Use new recruits flexibly
GM Recruitment Campaign for some roles
International Recruitment
Future Recruitment (Recruitment Plan):

24. Work Areas for Recruitment Plan1.
Understanding the
Gap
The gap between the current workforce and required workforce to deliver the standards needs to be fully understood 2.
Agreement of Greater Manchester Principles
A consistent approach to avoid competition between sectors will be developed including Consultant Contract, Recruitment Premia etc 3.
Development of a Greater Manchester Recruitment Campaign
To attract candidates outside Greater Manchester materials and communications will be developed centrally to support sector recruitment

25. Suggested Timeframe for Recruitment Plan
Central Team
Provider
May - June
Analysis of the baseline
Comparison to April 15 and confirmation of required consultant workforce for GM
Clarification of the baseline
Provide details to central team around current Consultant Contract, Recruitment & Retention premia etc
July - August
Development of Greater Manchester Principles
Development of a Greater Manchester Recruitment campaign
Sector workforce modelling to deliver model of care and understand recruitment locally
Share rota design
August – November
Share materials and comms with sectors
Commence GM Recruitment for specific roles
Commence Recruitment