Building Healthy Communities 2 nd Provider Event 9 June 2016
Building Healthy Communities Brainstorming Session 1
Q1a: Is the future model realistic? Are there any changes you would like to suggest? • The model is a holistic and realistic model and forms part of the 5 year forward view, however huge transformation required within such short timeframe • Fairly standard and deliverable but requires a level of GP development • IT Challenge • Issues of mobilisation • 2022 sounds more realistic as a timeframe • Ambitious • Lot of communication to handle • Risky for a single provider • Bringing different big services together
Q1a: Is the future model realistic? Are there any changes you would like to suggest? • Responsibility where does the buck stop? • Need to define role of SPA – i.e. more details and accessibility • Model will rely on buy-in from primary care • Baseline activity required • Adult social care engagement is key in their delivery role, not just as commissioners especially for re-ablement services • Must define integration/alignment of the health and social care including TUPE arrangements
Q1b: Are there any core functions not included in the draft scope that are essential to deliver integrated care? • Define the expectations around management of the interface between the GP federation and the providers • Mental Health should be integrated as part of the model this would significantly reduce cost and enable people to mange anxieties • IAPT should also feed into Primary Care • Ensure the risk stratification includes screening and referral process into Health & well- being services • Must have a lead navigator plus social workers to prioritise navigation • Maturity of organisations is key • Be clear about boundaries e.g. what is in or out & definition of IAPT, LD scope • Expectations around care navigations roles and also extended primary care
Q1b: Are there any core functions not included in the draft scope that are essential to deliver integrated care? • ASC is a core part of elements delivery – pressures in that area • DoS • Demand management element • IT systems element • Future proofing • More flexibility to enable innovation from providers especially after ‘go live’ • Linking in with services commissioned by Local Authority • Impact of TST contracts across the borough
Q1c: What would providers expect the CCG to facilitate in order to make this future model achievable? • Ring fence spend with provider for provision of prevention and well-being • Capitated budget model could allow lead provider to sub contract health and well being to voluntary organisations • The CCG should ensure that Prevention/Health- wellbeing includes outreach in the community • Voluntary sector access – need to engage • Provide portfolio of other organisations • Assist with engagement with GPs and voluntary organisations • Define how smaller providers connect with more than one provider • Be helpful in opening up the process of dialogue • Assist with GP integration as there maybe challenges. What is their readiness?
Q1c: What would providers expect the CCG to facilitate in order to make this future model achievable? • Obtain acute trusts ‘buy in’ • Management of possible conflicts of interests • During mobilisation the CCG should retain capacity to link the providers • Social care framework and NHS outcomes framework defined • Assist with the negotiations for newer/different contracts and also allow innovation • To positively market the change to the existing workforce as a joint/CCG provider model • Engagement and links with the GP federation is key at a sessions with providers and the federation may be required as the outcome may influence the final specification • Pleased with 80k hub population size feels about right but more efficiencies possible if some services can be centralised • Electronic care navigation and SPA are people really needed and if so their role needs clarification
Q1c: What would providers expect the CCG to facilitate in order to make this future model achievable? • Ensure opportunities to meet with LBN, GP federation, MH • Partnership working post contract award is essential throughout the whole contract length. Needs to be developed as part of the negotiation workshop • A few realistic KPIs are preferable compared to many • Need to discuss how services can evolve within a longer contract • Longer contract length welcomed because these contract are loss making initially, service users don’t like change and embedding change takes time • Consideration of wider context i.e. TST and other procurements to be communicated • Joint learning and development with provider initiative • Lead on a wider community & family approach to encourage third party/voluntary organisations
Q1c: What would providers expect the CCG to facilitate in order to make this future model achievable? • IT recording and access • Specialist services e.g. COPD • Exclusivity contract will be a barrier for other interested providers and can the CCG facilitate this as a fair process • Provide clarity around what is in scope • Facilitating discussions on integration and support across whole health economy • Share client/patient record across all stakeholders, including voluntary and charity sectors
Building Healthy Communities Brainstorming Session 2
Q2a: How can CCG best support providers in ensuring the estates strategy is fit for purpose and can support the delivery of the future care model? • Share the estates strategy in its entirety although weird that its fixed • What are the hubs: who, what, where, where e.g. disposal, numbers etc • Provide information on total costs of running the buildings and facilities e.g. cost of cleaning, catering, service charges etc.- specifically East Ham Care Centre • What is planned with the LBN? Are there any joint ventures, any shared buildings • What are risks to the current providers and need to have an impact assessment • Estates vital and essential to succeed • Some see LIFT as an opportunity because it will be readily available and well maintained • Condition of GP premises would be useful to foster joint working • Facilitation required re shared premises
Q2a: How can CCG best support providers in ensuring the estates strategy is fit for purpose and can support the delivery of the future care model? • Contract needs to be flexible enough to allow for radical new innovation or change over a 7 year period • CCG needs go online to support interoperability, reasonable data sharing and mobile working • Create a formal use of technology such as use of apps, alarms etc • CCG’s role should support providers to negotiate leasers/rent/service charge • Logging and capturing equipment maintenance • Ensure combined package (60:40) consideration of innovation • How can innovation be encouraged given the long contract length • Provide further information on the details of GP Hubs v/s community hubs
Q2a: How can CCG best support providers in ensuring the estates strategy is fit for purpose and can support the delivery of the future care model? • Ensure the infrastructure supports the facility • Site visits welcomed • Hub model is key – need to be combine adminstrative and clinical hub • Premises must be right • Lift building, size, functionality, capacity • Ensure that contract allows flexibility and innovation • No restriction and tie-in • Allow co-location of services • Information current state, future state • Provide clarity on current plans for the future
Q2b: What technology enabled services should be in scope of a transformation programme given the timelines of 5-7 years? • Near patient testing • Virtual consultations – protocols for confidentiality etc such as skype consultations • This cannot be absorbed by efficiency savings because of level change & growth which may require pump priming • Facilitation of translation services via apps/technology • Algorithms – symptom trackers • Population training in use of technology to access modern community health services • CCG’s role must include support to consent to interface • CCG’s role should include buying in new innovation • Data collection and ability to capture information across providers
Q2b: What technology enabled services should be in scope of a transformation programme given the timelines of 5-7 years? • Training of new staff using new IT services • Standardisation is essential for all information • Use of apps, telemedicine • Define the outcomes and providers to explain how they will use technology to achieve these outcomes through innovative working practices e.g. via SPA • Providers to define interoperability and CCG not to prescribe • Blocks from GP practices could hinder delivery Free flow of internet provision across the hubs/GP practice s • • Consistent IT infrastructure across all services and supportive • Provider allowed to be innovative
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