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
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…
• 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
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