1. Better Together-Development Journey June 2017
Helping to shape future health and social care in Mid Nottinghamshire

2. COMMERCIAL IN CONFIDENCE
Helping to shape future health and social care in Mid Nottinghamshire
COMMERCIAL IN CONFIDENCE

3. COMMERCIAL IN CONFIDENCE
STP in place to achieve overall financial balance – work in progress
New care model in place – all component, but further evaluation, refinement and additions required in 2017/18 (extensivist, evaluation of PRISM business model, ambulatory care, self-care / community activation)
Newark Hospital Strategy refreshed and being implemented
Health and Wellbeing Centre at Ashfield Health Village
Mansfield Community Hospital model to be reviewed in 2017/18
Estates strategy as part of STP
Commissioning strategy determined – Alliance contract in place
Primary care strategy developed and plans in place for general practice to join the Alliance, with hubs
New care model, Primary and Acute Care System
Alliance PMO now being established with joint working across the system
Total savings £22,275m, gross savings £3.5m, ROI 122% in 2016/17
Mortality improved
Infections improved
CQC rating improved – no longer in special measures
Helping to shape future health and social care in Mid Nottinghamshire
COMMERCIAL IN CONFIDENCE

4. PACS New Care Model
Helping to shape future health and social care in Mid Nottinghamshire

6. New Care Models / Transformation
Vanguard Schemes
Explanation
Service System Impacts
Local Integrated Care Teams (LICTs)
These teams are based on the PRISM model (Profiling Risk, Integrated Care and Self-Management) . Using the Devon tool, those members of the local population most likely to be admitted to hospital as an emergency are identified (2%);
Those patients deemed suitable for the LICT undergo a case review following which they are considered to be on a ‘virtual ward’. At each monthly LICT meeting, following review of each patient’s GP and hospital notes, a decision to review, continue or enhance care may be agreed or the patient may be discharged from the virtual ward. LICTs work closely with community based clinics (CVD, COPD, diabetes) that have consultant specialist support, community nursing teams, and the voluntary sector. One key worker is assigned to coordinate the services around an individual patient.
Between April 2014 and March 2016, LICT teams delivered 11,743 proactive actions designed to reduce future risk of admission. An independent impact study concluded that there is some evidence from HES data that over the period that LICT teams have been operating, there has been a shift in the length of stay among people in the target age and morbidity groups of the PRISM teams (that is, frail older people). A recent independent review concluded that the LICT teams have the potential to reduce bed days by 28,122, ED attendances by 4,687 and ambulance conveyances by 4, 218 per year. LGA evaluation on impact on preventing or delaying need for social care to complete Sept 2017

7. New Care Models / Transformation
Vanguard Schemes
Explanation
Service System Impacts
Specialist Intermediate Care Team
The Intensive Home Support service is a specialist intermediate care team made up of therapy, nursing and social care staff. The introduction of ANPs ensures that a sub-acute case mix can now be managed to allow earlier discharge from hospital or step up care to avoid admission. This team also has access to step up and down beds as required. NCC have created a Short Term Independence Service (community & beds) aligning to this.
This team provides a community IV service reducing the activity seen in the AECU at KMH. The team is now responsible for providing the new D2A pathway which includes CHC patients, ensuring that assessments occur outside of the hospital. In 16/17 there were 719 referrals to intermediate care with an average LOS of 25 days.
Call for Care
Call for Care is a care navigation service for health and social care professionals. It is a call streaming service, providing clinical triage and a 2 hour response from community clinicians. The service can support patients for 48 hours until mainstream services are in place to prevent unnecessary hospital admission. Pathways are being linked with the NCC Customer Services Centre
In 2016/17 4,093 calls were received. 2,349 cases were deemed to require an urgent clinical response. 1,520 avoided ED attendances (£443,840 system saving), 613 avoided non elective admissions (£1,195,350 saving) and 216 patients had a reduced LOS (Minimum £46,440 system saving).

8. New Care Models / Transformation
Vanguard Schemes
Explanation
Service System Impacts
Primary Care Hubs
We have been working with our practices over the last twelve months to bring them together in a way that expands their focus from the traditional registered list size, circa 5-10K to locality areas covering circa 60-80K population.
Organising 41 practices into four localities is helping to set clinical priorities such as diabetes; it brings about collective action on common objectives that align to the Alliance.
Having a single provider infrastructure means general practice can speak confidently with one provider voice and allows other providers to work with general practice in new and emerging ways such as the MSK pathway.
The primary care hubs have allowed the CCG to test new ways of providing GPs with headroom to think and to co-design services that not only wrap around general practice to ease the burden of workload but also to align the focus to system objectives. For example – the acute home visiting service :
The likelihood of admission for a senior opinion increases as the day progresses; peaking at teatime
Home visits done early allow the system greater opportunity to respond to alternative hospital admission; aligning to system objectives such as Call for Care

9. New Care Models / Transformation
Vanguard Schemes
Explanation
Service System Impacts
Single front Door
The co-located A&E and Primary Care service (PC24) at KMH are now accessed via a single entrance and reception before clinical streaming to the most appropriate service takes place. This Includes 7/7 social care assessors.
A number of streaming models have been piloted. Currently the streaming is led by ED clinicians and this has resulted in a 2-3% increase in the number of patients streamed to PC24 and a reduction in time to triage. Currently 22% of all activity and 29% of all walk in activity is streamed to and treated by PC24 clinicians.
Self care hub
2 elements:
Self Care Advisors working within the LICT , supporting patients around self-care, understanding their condition more effectively and improving their outcomes.
Self Care Hub “one stop shop” for service users, public and professionals providing expert advice, signposting and information, and facilitating access to relevant self-care support.
The 2 year pilot period has seen the hub provider working collaboratively with specific disease specialists to enhance and encourage self-care in patients to improve outcomes. The service has helped to promote self-care to both the public and healthcare professionals across Mid-Nottinghamshire. Lessons learned from the 2 year period are being reviewed as part of a wider strategic review. This work will shape the Mid-Notts CCGs’ Self care strategy and associated work streams.
Currently undertaking proof of concept on Patient Activation Measures, supported by a health coach model for patients diagnosed with a long term condition.

10. New Care Models / Transformation
Vanguard Schemes
Explanation
Service System Impacts
Integrated Urgent Care
Mid Notts is working with Greater Notts colleagues to increase the % of patients who receive clinical assessment following a call to NHS 111. All ED illness dispositions are now streamed to NEMS reducing the number of inappropriate ED attendances.
Currently this pathway reduces ED attendances by 3 per day.
Proactive care homes service
Mid Notts have piloted a proactive care home service, utilising learning from other Vanguard sites. The 9 homes with the highest NEL admissions and Ambulance conveyances were targeted. This service will be rolled out in 17/18.
The pilot resulted in a 38% reduction in NELs from the care homes involved and a 30% reduction in EMAS conveyances from those homes.
Ambulatory Emergency Care
KMH has an AECU which currently manages up to 28% of the emergency medical take. SFHFT, NEMS, LP and CCG colleagues are working together to mobilise a number of pathways that can be managed by primary care and community services rather than the AECU service, further reducing NEL admission activity.
A number of pathways have been added to the streaming protocols including a low risk DVT pathway, IV cellulitis pathway and a gynae pathway. This is supporting the increase in % streaming to PC24. Further pathways are now being developed including a full DVT pathway, fluid challenge and renal colic.