1. BACKGROUND
What: Mapping the future, 5 Year Forward view all about moving services into the community , specifically services for frail people, office-ollogies, community services and health and social care co-ordination and integration.
Why- Patients like services close to home if possible, GPs and practices are the natural leaders of communities of care. Quality improves with integration. Continuity of care and clinical leadership “de-siloise” care. Hospital centric care puts tension in health economy.
But Practices can’t do this on their own and the CCG needs a consistent service

2. HOW
Provision;
Federations; a way of GP practices being able to provide more services across a wider area.
Three levels
Sharing of capacity and capability to deliver GMS
Clusters of practices to share more specialist services and staff (population 30000) and
Federation wide services (eg for urgent care)

3. authority
authority
Silos
Commissioners
authority
authority
authority
Business
risk
Community
Social care
Ambulance trust
GP surgery
Other trusts
accountability
information
authority
accountability
information
authority
accountability
information
authority
accountability
information
authority
accountability
information
authority
At the moment, practitioners have to be accountable to their boards in how they manage risk, and the boards risk intolerance affects practitioners’ behaviour in turn
Clinical
risk
Practitioners
Practitioners
Practitioners
Practitioners
Practitioners
Where is the patient? What are the quality and financial costs of silos?

4. ….Citizen centred care accountability Commissioners information
authority
authority
Commissioners
information
authority
authority
Business
risk
Community
Social care
Ambulance trust
GP surgery
Other trusts
Clinical
risk
Practitioners
Practitioners
Practitioners
Patient with care plan
If practitioners are to become more accountable to patients and to their Multi Disciplinary Teammates, we need to have a system that allows the patient and the care plan to hold the ring in terms of authority, information and accountability
Practitioners
Practitioners

5. Multisystem Community Provider
….Citizen centred care
With integrated provision
accountability
Commissioners
information
authority
authority
Clinical &
Business
risk
Multisystem Community Provider
Practitioners
Practitioners
Practitioners
Patient with care plan
If practitioners are to become more accountable to patients and to their Multi Disciplinary Teammates, we need to have a system that allows the patient and the care plan to hold the ring in terms of authority, information and accountability
Practitioners
Practitioners

6. HOW
Commissioning:
There is considerable uncertainty about how these new models of care will develop. It seems likely that the present clear boundaries between contracts and providers may need to change. Co-commissioning is one way to develop.
We need to get this right for our population, providers and commissioners.
Governing Body will learn more about co-commissioning with members and the LMC and produce proposal for members at the October AGM