1. A Summary of our Sustainability and Transformation Partnership (STP)
April 30th 2018
Sally King and Julie Mackie
Service Development Managers, GCSNHST

2. Introduction to STP’s
National planning guidance from NHS England tasked local systems to develop a shared, system level, strategic plan to set out how we will deliver services over the next 5 years

3. One Gloucestershire
We are working to a local footprint for the STP, collaborating together in a joined up way as ‘One Gloucestershire’

4. The scale of the challenge

5. Top Line Messages
We will invest in keeping people healthier for longer by enabling communities to support each other, and support self care and prevention
We will reduce variation in prescribing and services, cut waste, and fund interventions that can deliver the greatest health benefit for our population
We will review the patients’ care journey, to ensure that care is delivered efficiently and effectively, and when appropriate, closer to home
We will join up care around communities, creating 16 GP practice clusters delivering integrated care with community services to support physical and mental health needs

6. Top Line Messages
We will have a clear joined up approach to urgent care provision, so that people will know when and where to access urgent care, when they need it
We will introduce urgent care centres and streamline assessment services when we are clear this will improve quality and safety, and reduce waiting times for our population
We will have a ‘one county’ approach to IT, Estates, and other system enablers
We will introduce countywide leadership, training, education and learning opportunities to support the shift to new roles and responsibilities for staff

7. Our Plan on a Page

8. Enabling Active Communities
Radical Self Care and Prevention Plan
Clinical Programme Approach
Reset Pathways for Dementia and Respiratory
Deliver the Mental Health FYFV
Reducing Clinical Variation
Choosing Wisely Medicines Optimisation
Diagnostics Review
One Place, One Budget, One System
Place Based Commissioning
Reset Urgent care and 30,000 community Model
System Enablers
Primary Care
Joint IT Strategy
Joint Estates Strategy
Workforce
Enabling Active Communities
Our approach will include:
Supporting people with non-medical needs through social prescribing i.e. GPs referring to sources of community support and community activities
Developing a county-wide programme to tackle obesity
Promoting healthy workplaces and schools, including improving employee health through the workplace well-being charter
Using innovative technologies to support self-care e.g. Diabetes
Strengthening support for Carers.

9. Clinical Programmes Approach
Enabling Active Communities
Radical Self Care and Prevention Plan
Clinical Programme Approach
Reset Pathways for Dementia and Respiratory
Deliver the Mental Health FYFV
Reducing Clinical Variation
Choosing Wisely Medicines Optimisation
Diagnostics Review
One Place, One Budget, One System
Place Based Commissioning
Reset Urgent care and 30,000 community Model
System Enablers
Primary Care
Joint IT Strategy
Joint Estates Strategy
Workforce
Clinical Programmes Approach
Our approach
Ensures care is safe, joined up and provides value for money
Places an emphasis on prevention and self- management advice at an early stage
Ensures people get the right treatment, in the right place, at the right time
Focuses on local priorities, including respiratory care (e.g. lung disease) and dementia.

10. One Place, One Budget, One System
Enabling Active Communities
Radical Self Care and Prevention Plan
Clinical Programme Approach
Reset Pathways for Dementia and Respiratory
Deliver the Mental Health FYFV
Reducing Clinical Variation
Choosing Wisely Medicines Optimisation
Diagnostics Review
One Place, One Budget, One System
Place Based Commissioning
Reset Urgent care and 30,000 community Model
System Enablers
Primary Care
Joint IT Strategy
Joint Estates Strategy
Workforce
One Place, One Budget, One System
The ‘People and Place’ community model
GP practices at the core, working with health, social care and the voluntary and community sector, covering populations of around 30,000
GP practices working together in closer partnership to provide a wider range of local services
Other health professionals working more closely with GP practices e.g. clinical pharmacists, paramedics and mental health staff to support local people
Joined up health and social care teams – more care in people’s own homes and in the community, supported by specialist staff if needed
Development of Centres of Excellence for rehabilitation at a number of community locations.

11. Improved access to GP services – including evenings and weekends
Enabling Active Communities
Radical Self Care and Prevention Plan
Clinical Programme Approach
Reset Pathways for Dementia and Respiratory
Deliver the Mental Health FYFV
Reducing Clinical Variation
Choosing Wisely Medicines Optimisation
Diagnostics Review
One Place, One Budget, One System
Place Based Commissioning
Reset Urgent care and 30,000 community Model
System Enablers
Primary Care
Joint IT Strategy
Joint Estates Strategy
Workforce
Development of a network of centres and services to meet people’s urgent care needs
Improved access to GP services – including evenings and weekends
Community based urgent care centres – bringing together increased access to GP care, out of hours services, diagnostic tests and minor injury and illness services
Increased support from hospital based specialists in the community
Continued development of high quality and joined up Mental Health Crisis services.

12. Development of Centres of Excellence at our two general hospitals
Enabling Active Communities
Radical Self Care and Prevention Plan
Clinical Programme Approach
Reset Pathways for Dementia and Respiratory
Deliver the Mental Health FYFV
Reducing Clinical Variation
Choosing Wisely Medicines Optimisation
Diagnostics Review
One Place, One Budget, One System
Place Based Commissioning
Reset Urgent care and 30,000 community Model
System Enablers
Primary Care
Joint IT Strategy
Joint Estates Strategy
Workforce
Development of Centres of Excellence at our two general hospitals
When you need specialist hospital services, our plan is to:
Ensure specialist staff see enough patients to maintain their skills and the right number of staff are available 24/7
Speed up assessment and decision making about people’s treatment and onward hospital care
Improve the patient environment
Improve links between related services – making services more joined up.
To do this we believe we should continue to bring together some services to ensure quality and safety.

13. Reducing Clinical Variation
Enabling Active Communities
Radical Self Care and Prevention Plan
Clinical Programme Approach
Reset Pathways for Dementia and Respiratory
Deliver the Mental Health FYFV
Reducing Clinical Variation
Choosing Wisely Medicines Optimisation
Diagnostics Review
One Place, One Budget, One System
Place Based Commissioning
Reset Urgent care and 30,000 community Model
System Enablers
Primary Care
Joint IT Strategy
Joint Estates Strategy
Workforce
Reducing Clinical Variation
Our approach will include:
Developing a ‘Best use of medicines’ programme – helping people take the right medicines correctly to benefit their health, avoid taking unnecessary medicines and reduce waste
Priority funding the drugs and treatments that have the greatest health benefit for our population
Campaigns highlighting how the public can help – e.g. choosing alternatives to A&E when it’s not an emergency, cancelling appointments if we can’t make them or not stockpiling medicines
Reducing duplication and improving service efficiency e.g. looking at how we provide tests and follow up outpatient appointments.

14. System Enablers - Technology
Enabling Active Communities
Radical Self Care and Prevention Plan
Clinical Programme Approach
Reset Pathways for Dementia and Respiratory
Deliver the Mental Health FYFV
Reducing Clinical Variation
Choosing Wisely Medicines Optimisation
Diagnostics Review
One Place, One Budget, One System
Place Based Commissioning
Reset Urgent care and 30,000 community Model
System Enablers
Primary Care
Joint IT Strategy
Joint Estates Strategy
Workforce
System Enablers - Technology
Our approach will include:
Joining up your Information – secure access to patient records for clinicians and care workers, where and when they are needed
Providing access for patients and their carers to their digital health records
Helping people to take greater responsibility for their health through use of technology
Developing on-line resources to guide people through their care and treatment, including community support information
Extending the role of technology to support direct patient care e.g. e-consultations and video consultations.

15. System Enablers - Workforce
Enabling Active Communities
Radical Self Care and Prevention Plan
Clinical Programme Approach
Reset Pathways for Dementia and Respiratory
Deliver the Mental Health FYFV
Reducing Clinical Variation
Choosing Wisely Medicines Optimisation
Diagnostics Review
One Place, One Budget, One System
Place Based Commissioning
Reset Urgent care and 30,000 community Model
System Enablers
Primary Care
Joint IT Strategy
Joint Estates Strategy
Workforce
System Enablers - Workforce
Our approach will include:
Offering county-wide leadership, training, education and learning opportunities to support new ways of working and ensure staff have the right skills
Joining up teams and introducing new roles to improve continuity of care and support for people
Joining up our approach to recruitment: promoting Gloucestershire as a great place to live and work
Minimising the use of expensive agency and temporary staff.

16. Examples from ‘Place Based’ Clusters Community Dementia Project – Stroud ‘Rural’
To support GPs with dementia diagnosis and provide best care for people with dementia in partnership with GPs and Integrated Community Teams
Ensure that people with dementia access right care, right time, right place by the right health care professional
Improve service user and carer experience
Work closely with GPs / Practice Nurses and across organisations to reduce duplication
Work towards becoming a Dementia Friendly Town
Collaborate with other agencies (Age UK etc)

17. Examples from ‘Place Based’ Clusters First Contact Physiotherapy – Aspen and St Pauls
People with musculoskeletal problems are given an appointment with a physio working within the practice.
More appropriate care for patients, improving patient experience
Releasing GP time and skills for other appointments
Providing quicker access for patients to be seen by a physiotherapist
Reducing (appropriate) prescribing expenditure
Reducing unnecessary diagnostic tests
Supporting people to return to work

18. Next Steps – what can you do to be involved
Formal consultation will be announced – we would like to hear your views
In the mean time
You have kindly given a list of the WI groups and which of the 16 clusters they are most closely linked to
We would like to be able to contact those groups if we need help in developing projects and engaging with communities about them

19. Where to find out more

20. We would be pleased to answer any questions you may have, or hear any comments you wish to make.