1. SW HFMA conference 27th September 2019
Integrating care
Dominic Hardy
Director of Primary Care Delivery and System Transformation
NHS England and Improvement
SW HFMA conference 27th September 2019
NHS Improvement

2. Health and Care challenges in England…
Longest sustained funding pressure in NHS history
Significant social care funding shortfall in local government
Sustainable funding
(Significant) shortages in key groups – GPs, nurses
Rising numbers on waiting lists, with waiting times challenges
Capacity
Increasing frailty as population ages
Greater burden of disease
Widening inequalities
Outcomes

3. … have lead to fragmentation
People experience dislocated services
No one team/organisation can solve that
The way we work has to address this

4. What might the future look like?
Dennis’s story

5. The NHS Long Term Plan addresses this
“We will continue to develop ICSs, building on the progress the NHS has already made. By April 2021, ICSs will cover the whole country” +
“£4.5bn of new investment will fund expanded community multidisciplinary teams aligned with new Primary Care Networks based on neighbouring GP practices that work together, typically covering 30-50,000 people”

6. ICSs PCNs …with clear aims: Bring together local organisations
Focus on redesigning care and improving population health
Deliver triple integration
PCNs
Support sustainable general practice
Create capacity to integrate at local level
Enable voice of general practice to be heard in systems

7. Integrating systems Focus on very local need PCNs have a key role
Neighbourhood
(30-50k)
Decision-making/care delivery
Key link with local government
Place
( k)
Enabling delivery
Address issues once
System
(c1m)

8. ICSs and PCNs build on past work…
Long history of GP collaboration
90%+ practices self-identified as ‘networks’ last year
Neighbourhood focus – right size team

9. Progress so far: 1250 99% 1250 40k 14 ICSs covering 21 million people
Primary Care Networks established
Practices taking up PCN DES
PCN Clinical Directors identified
Average size of a PCN
1250
99%
1250
40k

10. Form? It’s about integrating care
“Now this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning.”
Success consists of going from failure to failure without loss of enthusiasm.
You have enemies? Good. That means you have stood for something sometime in your life.
A pessimist sees the difficulty in every opportunity; an optimist sees the opportunity in every difficulty.

11. Holding back expectations
5 new groups of staff to deploy
MDTs to form with community services providers
Relationships to build – internal and external
7 new service specifications to deliver
‘sort out’ access
Deliver integrated care

12. How it feels now?

13. What needs to be different?
What will be different and how will you make it happen?
How will you build collaborative relationships?
What are the population’s health and care needs?
What is the inspiring plan?
Vision
Data
Impact
Leadership and behaviours

14. What will you do differently today to deliver integrated care?