Caroline Taylor Programme Director June 2015
• Change to structure of CLGs: now working groups looking at specific interventions / ideas; drawing in new specialists • Implementation of work that does not require consultation – e.g. Local Care Networks • Options appraisal work starting – moving towards possible consultation if needed • Continuing financial modelling and testing of CLG key interventions • Publication of consolidated strategy June 2015 • Engagement with partners – providers, mental health • Change to programme team: new Director/ structure
• Are the foundation of the Whole System Model, offering person centred services to local populations • Local Care Networks: going in to mobilisation phase, with structure and details developed locally but working to an agreed set of criteria • Each CCG is progressing with its own plans to progress the target model through the 24 LCNs now established across SE London in line with the agreed characteristics of Community Based Care. Examples of ‘big hitter’ or high impact initiatives being or already implemented by individual CCGs have been collected and are being shared with their SE London colleagues to help expedite progress and achieve equitable and high quality services and outcomes across the whole population.
Characteristics of Community Based Care Delivery of community based care will be achieved through the platform of Local Care Networks (LCNs) in line with seven confirmed Characteristics of Care and an agreed Target Model: 1. More accessible primary and community care 2. Timely and prompt assessment 3. Enhanced health promotion and disease prevention 4. Proactive and empowering care 5. Seamless co-ordinated care 6. Multidisciplinary holistic care 7. Continuity of care professional 4
The Community Based Care Target Model Integrated Single System Leadership and Management ‘The Core’ (as a minimum all LCNs Working with… Big hitters should encompass) • • Strong and confident communities Asset mapping supporting enhanced • Leadership team • Accessible HOT clinics and acute self management/care e.g. social Serving geographically • All general practices working at coherent populations oncology (urgent and emergency and prescribing scale (federated with single IT between 50,000 – 150,000 • system and leadership) cancer care) Prevention – Obesity, Alcohol and • All community pharmacy • Specialist opinion (not face to face) Smoking • Voluntary and community sector • and clear specialist service pathways Improved Core general practice Southwark • Community nursing for adults and • Pathways to MDTs access plus 8-8, 365 Greenwich children • • Integrated 111, LAS and OOH system Enhanced call and recall – improves • Social care Bexley Lambeth (interface with UCCs co-located with screening and early identification and • Community Mental Health Teams • ED model) Community therapy management of LTCs Lewisham • • Community based diagnostics • Housing, education and other council Reduction in gap between recorded • Patient and carer engagement services and expected prevalence in LTC groups • • Community based midwifery teams Supporting vulnerable people in the • Private and voluntary sector e.g. care community including those in care Bromley homes and domiciliary care homes and domiciliary care • • Cancer services Reduction in variation (level up) • Children’s integrated community team primary care management of LTCs • and short stay units Reablement – Admissions avoidance • Rapid response services and effective discharge • • Carers MDT configuration – main LTC groups • And there will be others.. (incl. MH) and Frail elderly • End of Life Care Integrated Pathways of care 5
The transformation we are undertaking Primary and community care (defined in its broadest sense) will be provided at scale by 24 local care networks supporting whole populations across south east London. This will be a universal service covering the whole population ‘cradle to grave’. A local care network will involve primary, community and social care colleagues working together and drawing on others from across the health, social care and the voluntary sector to provide proactive patient centered care. Services will be delivered in ways that respond to the varied needs and characteristics of our communities. GP Units & GP Networks Community services Primary care working within LCN’s Enablers supporting the transformation The Local Care Networks are the super enabler for integration of services IM&T, Commissioning Framework, Workforce, Estates 6
8. The Local Care Network Proposition (1/2) Local Care Networks are the foundation of the whole system model providing person centred services to populations. Community Based Care will be delivered through the platform of Local Care Networks. Enablers supporting the transformation The Local Care Networks are the super enabler for integration of services IM&T, Commissioning Framework, Workforce, Estates Core elements of the current LCN proposition: Transformational - The integration of care across the full range of provision focused upon local populations and the outcomes they achieve – Asking everyone to change - Multi-agency LCN leadership teams with autonomy to act together for that population according to the outcomes they have been collectively commissioned for. Population focused - Geographically coherent, serving natural communities, planned against a deep understanding of that population’s need, focused on prevention and inequalities Integrated – Networks will include ALL general practices in the locality, working ‘at scale’, providing the basis for integration between wider primary, social, community and mental health services (utilising the registered lists of that locality’s practices) Placed based – Effective LCNs will focus on individual patients and the populations they make up; they will utilise community assets, harness the capacity of the non-registered workforce and include community groups and local people General practice - working together at scale and with greater resilience to reduce variation and improve quality, with an enhanced ability to work with others to provide a wider range of community based services Scale – LCNs provide the ‘building blocks’ for integrated delivery with the ability to be considered separately or together at the ‘right’ scale to make best use of specialist expertise 7
June July August September October November December Impact analysis Consolidated strategy Develop evaluation criteria Option development and appraisal Key Activities Supporting Strategies Business case development Business case Assurance CLG implementation plans Ongoing engagement 8
Spring/ Summer 2015: • Further work on the whole system model and the models of care • Modelling expected impacts for providers and commissioners • Further development of the supporting strategies • Testing refreshed CCG Operating Plans against the strategy to ensure that there is consistency between the short and longer term plans • Engaging with Health and Wellbeing Boards and other key meetings for review and input • Further wide engagement through pop ups and other events. These will be borough based and use the Issues Paper and specifically developed materials such as case studies which are being tested with Engagement leads and PPAG. Summer 2015 – mid 2016 • Development of options and criteria to assess options for implementation • Modelling to support option appraisal • Business case development • Consultation, if required • Continuing implementation of elements not requiring consultation, such as the development of the local care networks, community based care and improved clinical pathways 9
Caroline Taylor Programme Director June 2015
Main focus of engagement between May – July is around the Issues Paper • Engagement materials developed for CCGs to use locally – at ‘pop ups’ and other events • Individual CCG engagement plans developed – associated gap analysis under constant review • Six deliberative events to be held, focussing on the questions within the Issues Paper • Equality - Going out to tender to deliver an equalities analysis summer 2015 • Further work to develop mechanisms for engagement on the options evaluation criteria
• Working closely in partnership with CCG communications and engagement leads and the programme’s Patient and Public Advisory Group to develop plans and materials. • Please see flipchart paper for programme timeline and associated communications and engagement milestones • CCG Engagement plans – Phase 2 Issues Paper engagement as Appendix
• Currently there is inconsistency in targeting staff and GP members • Gaps in information giving and engagement groups representing: - Mental Health Groups (in outer London boroughs) - Substance misuse (plans in development – not confirmed) - Gypsy/ traveller communities (plans in development – not confirmed) - LGBT and transgender groups (plans in development – not confirmed) 14
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