1. Working together to support patients with long-term conditions
Dr Nicky Williams
Deputy Clinical Chair
East and North Hertfordshire Clinical Commissioning Group
Working together to support patients with long-term conditions
Supporting Patients With Long Term Conditions & Key Enablers in The Primary Care Strategy

2. VISION Integrating care
User experience
Workforce experience
VISION
“everyone working as a coordinated team to achieve joined-up care through a shared single person-centred care plan.
" my care is planned with people who work together to understand me and my carers, put me in control, coordinate and deliver services to achieve my best outcomes “
National voices
Integrating care is a person centred - coordinated care management approach for the delivery of care using a single care plan
6/12 working with senior leaders of local providers to agree on a shared vision for integration and agree to some core principles which will inform future commissioning and the refinement of existing services so that we can see the benefits of integration
So what is integration ??? Vision from patient and staff/professional view point
So what would it mean for GPs? what would be different if we get this right? Less urgent care as planning and risk stratification will shift work to planned, with time to focus on areas of need as proactive planning undertaken within the MDT team wrapped around the patient. Rapid appropriate response to urgent need
GPs are currently clinically accountable but how in control do you feel? This will provide a trusted team approach and effort around the patient with clearly defined accountabilities.

4. Collaborative working: improving quality and access
The primary care strategy
Consolidating funding: bringing together funding for enhanced services to make care more resilient
Collaborative working:
improving quality and access
Improving IT: enhanced GP support, Stevenage project, info screens in practices, develop single IT platform
Primary care education, training and research: to attract, develop and retain high calibre staff