www.england.nhs.uk

Five year

forward

view: the

North East at

the vanguard

Dr Craig Melrose

Medical Director

NHS England North: Cumbria & the North East

2 December 2015

www.england.nhs.uk

The Five Year Forward View

Set out the

challenges

& priorities

1. The health & wellbeing gap: getting serious

about prevention

2. The care & quality gap: driving down

variation, giving patients greater patient

control

3. The funding & efficiency gap: addressing

mismatch between resources and patient

needs of £30 billion a year by 2020/21

Set out

how to do

it

£200m investment in new care models

£250m investment in primary care

Success Regime for challenged areas

Focus on achievement of core standards

Testing and implementing new workforce roles

Mental health, cancer & maternity task forces

New urgent and specialised care models

Transforming care programme for LD

www.england.nhs.uk

NHS England’s 10 priorities

www.england.nhs.uk

50 Vanguard schemes nationally:

The New Care Models Programme

9 x integrated primary and acute care systems

14 x multi-speciality community service providers

6 x enhanced health in care homes

8 x urgent and emergency care

13 x acute care collaboration

5 in the

North East

www.england.nhs.uk

North East Vanguards

Northumberland

CCG

Cumbria CCG Durham, Dales,

Easington &

Sedgefield CCG

North

Durham

CCG

South Tees

CCG

Darlington

CCG

Hartlepool & Stockton

CCG

North Tyneside

CCG

Newcastle Gateshead

CCG

South Tyneside

CCG

Sunderland CCG

Northumberland

PACS/ACO

Gateshead

extended

care homes

Sunderland

Multi-

speciality

Community

Provider

Northumbria

acute care

collaboration

Urgent &

emergency

care

vanguard

www.england.nhs.uk

• Creation of a Primary Acute Care System (PACS) model – vertical integration

• Builds on Northumbria Healthcare NHS FT’s role as an integrated care provider

• Will bring together secondary care, ambulance, mental health, social care, specialist and primary care services

• One team, working across a single health & social care system – end-to-end pathway approach

• Responsible for all health needs of Northumberland population (322,000)

• Based on well-evaluated models in parts of America, Europe and Asia

• Incentivise outcome-focused care delivery

Northumberland Accountable care

Organisation (ACO) – clinical model

www.england.nhs.uk

• Partnership between Northumbria Healthcare NHS Foundation Trust, Northumberland CCG and Northumberland County Council

• ACO both tactical commissioner and provider of services using a capitated budget

• Residual strategic commissioning function (setting budget, health outcomes, incentives, quality & performance framework etc.) to be determined

• ACO to be operational in shadow form from 2016 and fully functional by April 2017.

• Governance, regulatory and assurance

functions to be addressed

Northumberland ACO –

organisational model

Proposed extension of ACO across North Tyneside

www.england.nhs.uk

• Builds on pre-existing work that led to a 9.3% reduction in emergency admissions for patients in long term care beds

• Will deliver a borough-wide integrated community-bed and home-based Care service

• Proactive work with care homes with the highest hospital admission rates

• Alignment of care homes to a GP practice and provision of weekly ‘ward rounds’

• Community geriatrician and weekly community MDTs introduced for case management and learning

• Interface geriatric model –frailty nurses and geriatrician working closely with community counterparts to discharge from A&E

• Use of mobile technology in out of hours service and MDTs for care home assessment and support to staff in homes

• Re-shaping community nursing to release resources to provide nurse specialists for residential care homes

Gateshead extended care homes –

the clinical model

www.england.nhs.uk

• Ambition to develop a Provider Alliance Network to support borough-wide service delivery

• A primary care led organisation with community and acute care alliances

• Will have 24/7 accountability, governance and contract responsibility for all healthcare provision within long & short term community-bed population of Gateshead and home-based rehabilitation and reablement

• Co-commissioning of all community-bed and home based care

• Capitation-based payment system based on need

• Outcome-based contract

Gateshead – the organisational model

www.england.nhs.uk

• Intended to deliver a more effective community beds function, enabling an overall reduction in community beds

• Provision of an enhanced level of response to complex patients both at home and in supported housing including care homes

• Patients to be identified using a risk stratification approach

• Planned integration of all core health and social care teams including the GP Out of Hours provider

• Each of five Sunderland localities will have teams of district nursing; community matrons, social workers, GP Practices working within single-management structure

• Teams will be wrapped around groups of 10-15 GP practices

• Co-located with appropriate technological facilities

• Employing a coordinated, preventative and case managed basis

• Teams will include Community Connectors who will be familiar with the local

voluntary and community resources

Sunderland – multi-speciality community

service provider - the clinical model

www.england.nhs.uk

• A multi-speciality community service provider

approach – moving specialist care out of hospital into

the community

• A lead provider will be identified within Sunderland

partnership

• Outcome based contract with shadow capitated and

delegated budget

• Single management arrangement

Sunderland – the organisational model

www.england.nhs.uk

• Northumbria Healthcare NHS Foundation Trust Vanguard

• Development of a multi-speciality chain

• Intended to enable support and service provision to other organisations

• Could include acquiring and/or merging other hospital trusts, providing corporate services to other NHS organisations, creating a standard operating model built on providing excellent clinical outcomes

Northumbria – acute care

collaboration

www.england.nhs.uk

North East Urgent & Emergency Care

Vanguard

Partners signed up to deliver Vanguard:

All 10 North East CCGs

Both Mental Health & LD NHS Foundation Trusts

All acute NHS Foundation Trusts

North East Ambulance Service NHS FT (111 & 999 provider)

Nine system resilience groups

North East local authorities

Clinical Health Information Network

Regional Out of Hours Providers

Royal College of Psychiatry

Academic Health Science Network

Health Education North East

Voluntary Organisations Network North East

• North East-wide Vanguard

• Delivery through North East Urgent Care Operational Group

• Led by Dr Stewart Findlay, Chief Clinical Officer, NHS Durham Dales,

Easington & Sedgefield CCG, chair of above group

www.england.nhs.uk

Urgent Care Vanguard aims…

www.england.nhs.uk

Urgent Care Vanguard aims…

• Implementation of Keogh Urgent & Emergency Care Review across the

North East

• Address service fragmentation

www.england.nhs.uk

Urgent Care Vanguard aims… Out of hospital

• Increase direct booking into GP appointments and other urgent care services

• Greater integration between 111 and out of hours services

• Expand the Directory of Services (DoS) to include social care

• Use of ambulance trauma consultants to enhance treatment in the community

• Mobile access to DoS for all services

• Early clinical assessment of green ambulance and ED dispositions

Enablers and system leadership

• Standardise system metrics

• Consistent delivery of High Impact Interventions by System Resilience Groups.

• Improved intelligence and modelling

• Payment reform

• Enhance Summary Care Records

• Implement information sharing between providers

www.england.nhs.uk

Urgent Care Vanguard aims… Integration

• Greater integration between 111 and range of providers

• Implementation of revised NHS 111 Commissioning Standards

• Implement 24/7 senior clinical decision support through an enhanced clinical

hub, accessible by 111/999 and external clinicians, including GPs,

pharmacists, mental health, dental and social care professionals

• Improve See & Treat and Hear & Treat

• Enhance mental health integration through rollout of 24/7 triage services,

psychiatric liaison, 7 day MH consultant working and 7 day street triage

Primary care

• Standardise minor ailments schemes in pharmacy

• Increase direct booking into GP appointments and other urgent

care services

www.england.nhs.uk

• Additional investment

• National director sponsor

support

• Access to practical support and

expertise through New Models

of Care Team

• Potential freedoms and

flexibilities to support testing at

pace

The Vanguard deal

• System-wide learning

• Blueprints for future care

models to support NHS

sustainability

• Testing of new technology,

workforce, contracting,

payment models

The ‘Gets’ The ‘Gives’

www.england.nhs.uk

Other ‘Vanguard-esque’ vehicles • Prime Minister’s Challenge Fund schemes: two Wave 2 in the

North East

• Long-term commissioning plans

www.england.nhs.uk

New planning localities

North of

Tyne

Cumbria

Newcastle Gateshead

South Tyneside

& Wearside

Co Durham &

Darlington

Tees

• Focus on acute care sustainability

with aligned out of hospital and

primary care service development

• Plans will focus on Vanguard

delivery where schemes exist

• New forms of acute care

collaboration elsewhere