1. Trafford Integrated Care System:
How and Why?
Dr ND Guest
Dr P Jackson
Dr M Sangha
1 December 2016

2. Key Components? Primary Care Secondary Care Community Social
3rd Sector
Patients!

3. Questions? Does everything need integrating?
Who holds the ring…controls?
Who feels disenfranchised?
What is it we are trying to achieve?
Is integration the way?

4. What? Patient centric, sensitive and responsive
Locally delivered (where possible)
Highest possible standards
Highest quality outcomes
Economically sustainable

5. How? Big Bang? Incremental ? Financially driven
? Infrastructure driven

6. Trafford Experience ICO attempt 2010….not supported
Commissioned ‘Integrated Care’
Community / Primary Care Interface
Enhanced Community Support
Community Matrons
Domiciliary IV
Rapid Response
Community Nursing re-design

7. Trafford Experience Lacked Co-ordination
TCC…Co-ordination Centre Commissioned
£15m over 5 years
Directory of services
Risk stratification
Referral Management
Discharge Facilitation
Care Co-ordination

8. Trafford Experience Community + Social Care Integration Utilising TCC
Joint Management
Aligned/integrated teams
Aligned IT

9. Trafford Experience Primary Care investment TCC Nursing Homes LES
Extended Hours
7 Day access
ATT
Enhanced Screening ..Cx Cytology

10. Trafford Experience Issues Lots of components Partially successful
Dependent on Primary Care Engagement
Incentive?
Solution?

11. Primary Care Expanding demand Low morale Recruitment issues
Retention / retirement pressures
Low investment
Estate variance

12. Primary Care Solution Single System Common Ethos / Ownership
Single Leadership
Single Management Team
Common SOPs
Common Outcome Targets
New ‘QoF’
Performance Managed

13. Primary Care Solution Enablers TCC Workforce Development
Single Advanced IT system
VDI / Phones
TCC
Workforce Development
50/50 Nurse / Dr ratio
Expansion/Re-definition
Estates Rationalisation / Standardisation
Partnership Working
Community/MH/Secondary Care/3rd Sector/Patients

14. Primary Care Re-design
De-constructed into component parts
Prevention
‘Routine Care’
Delegation…DocMan/prescribing/paperwork
Urgent… neighbourhood provision
Domiciliary
Nursing home/residential/housebound/visits
Specialised
Intra and inter practice/system referral
Private

15. Form Follows Function! Single system 4 neighbourhood delivery
? Super partnership
? ‘John Lewis’ style
Common ownership
All salaried
Mutual benefit/gainshare

16. How does it work? Single System Ethos Common goal Common standards
Common outcome driven targets
Performance managed/supported
High quality efficient management
Happy and motivated workforce
Maximised local care
Integrated and co-ordinated services

17. How does it work? ‘Consume own smoke’ Reduced referral
Reduced unscheduled care
Reduced scheduled care
Increased quality
Increased range of services
Increased local access
Income generating

18. Economics Requires investment In Greater Manchester Devolution System
‘Bid’ for transformation funds
Circa £17m for £25m return over four years?

19. Summary Started with failure Slow build of supportive services
Recognition of Primary Care role
Radical solution required
Ready to go!?

20. Questions / discussion
Thank you for your time
Trafford New Models of Care Project Team administrator:
Rochelle Huddlestone,