Bay Health and Care Partners Update

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Dwain Walters
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1 Meeting Title/Date: Governing Body: 18 th September 2018 AGENDA ITEM NO: 6.0. Report Title: Paper Prepared By: Executive Sponsor: Committees where Paper Previously Presented: Background Paper(s): Bay Health and Care Partners Update Karen Kyle Hilary Fordham n/a n/a Date of Paper: Responsible Manager: 11 th September 2018 Karen Kyle Summary of Report: Recommendation(s): Identified Risks: This paper has been written to confirm the latest information about the work of the Bay Health and Care Partners. It provides the Governing Body with a continued report about the implementation of the Better Care Together strategy and is also made available for consideration by the Boards of other partner organisations and the Health and Wellbeing Board The Governing Body is asked to note the current update of the Bay Health and Care Partners. Please Select Y/N Impact Assessment: n/a (Including Health, Equality, Diversity and Human Rights) Strategic Objective(s) Supported by this Paper: Better Health - improve population health and wellbeing and reduce health inequalities Better Care - improve individual outcomes, quality and experience of care Delivered Sustainably - create an environment for motivated, happy staff and achieve our control total Please Contact: Karen Kyle Please Select (X) x x x

2 BAY HEALTH & CARE PARTNERS UPDATE REPORT September 2018 Introduction 1. This paper presents an update on key activities for Bay Health and Care Partners workstreams with a focus on: a) Developing & Strategic Workforce Plan b) ICP Leadership Team Development c) Integration of Services d) Primary Care Development e) Clinical Workstream updates Accelerator pathways f) Digital workstream g) Bay Health and Care Partner Delivery Plan Development BHCP WORKSTREAM DEVELOPMENT A. DEVELOPING A STRATEGIC BHCP WORKFORCE PLAN 2. Following the completion of the baseline workforce analysis for Bay Health & Care Partners, two workshop sessions have been held to engage partners across the Bay in understanding the workforce challenges and collaboration opportunities. These workshops were designed to empower discussion across partners; sharing challenges and opportunities from an individual organisation perspective before commencing discussion about the wider system challenges. 3. Outputs from both workshops have identified the key workforce challenges (with known/estimated vacancy factors) as follows: GPs (10% vacancy factor) Consultants (11% vacancy factor) Nurses & Midwives (12% vacancy factor) Social Care workforce vacancies to be confirmed 4. The identified priority areas are all areas where significant work is being done at individual organisation (or confederation) level, but presented opportunities for the development of collaborative approaches through the workforce strategy. These were identified as follows: Supply Upskilling Grow Our Own Strategy (Apprentices, Cadets, Traineeships) International Recruitment Careers Engagement & Schools Liaison Return to Practice Flexible employment package GPs with Special Interests (joint appointments) Advanced Practice (Therapists & Nurses) GP Practice Nurses

3 New Roles Cross-functional Support Workers Career Framework Physicians Associates GP Associates Nurse Associates New Ways of Working Leadership GP Practice skill-mix review(s) Rotational opportunities (cross-sector) Accessing the economically inactive Talent Management & Succession Planning 5. The workshops identified that there was already positive examples of innovation and best practice, but that this was happening sporadically across the BH&CP patch, or developed in silos. Examples included the development of the Better With You recruitment brand and portal, Apprenticeships, international recruitment, and new roles within the accelerator programmes. There was a clear need to identify opportunities for sharing, collaborating and spreading good practice. The areas identified for immediate action were as follows: Maximising International Recruitment opportunities (supply) Integrated Apprenticeship Strategy (supply) Skills development (upskilling) Targeted development/introduction of new roles (new roles/new ways of working) 6. The priority areas identified above will be the primary focus of the activity for the coming months. Each will require a detailed programme of activity under them that will allow partners to share accountability and derive benefits from collaborative approaches. 7. The next workshop (to be held 20 th September) will focus on drawing together a detailed action plan across all partners to identify specific deliverables, clarify leads and accountability and develop these programmes of work. B. ICP LEADERSHIP TEAM DEVELOPMENT 8. The future vision for the local health and social care system is ambitious, radical and transformational. In order to achieve the aspirations, it will require members of the ICP Leadership Team to work very differently to how they have previously individually and collectively, albeit building on the extremely solid relationships and foundations that have been developed to date. It will require a shift in effective joint working under a true system first philosophy.

4 9. As a new team, bound together by a common vision but separated by different cultures and operating styles, a leadership development programme has been put in place that will support the team through: Building clarity on individual roles and responsibilities Ensuring congruence of individual and team objectives Team members better understanding the styles and preferences of themselves and colleagues, in order to optimise contribution to the team goal Building a high-performing team 10. A two-phase OD intervention has been commissioned to deliver these goals. The first phase, held on 21 st June, utilised UHMB s in-house team to deliver an Insights Workshop, which gave members of the ICP Leadership Team insight into their own strengths, style and approach, and those of their colleagues. 11. The second phase is being delivered by Affina OD and is currently in the fieldwork stage, with 1:1 interviews and use of their Advanced Team Performance Inventory (ATPI) tool, prior to a follow-up workshop in October. This will build a map of team strengths and development needs and team goals over a 1, 3 and 5 year timeframe. C. INTEGRATION OF SERVICES 12. The Integrated Care Communities (ICCs) continue to work on a range of topics, in particular development of multi-disciplinary team meetings to review frail elderly patients and those at risk of being admitted. They are also continuing with a range of projects on population health topics related to the needs of their populations. 13. The transfer of adult community services from Blackpool Teaching hospitals to the Integrated Services Care Group is still on track for integration on 1 October. This will enable the Community Care group to commence work on bay wide models of care and efficiencies related to improve streamlining of process. 14. At the same time the Children s services will transfer to the Women and Children s Care group. The Women and Children s workstream continues to look at ways of integrating services in a way that better reflects children s needs. 15. The Integrated Services Management Board is working to support the integration of services which have been provided across a number of organisations previously including Musculo-Skeletal services and Therapy Services. Work is on-gong to understand where these are best managed to obtain the best services and outcomes for patients and staff, but also the most efficient care. D. PRIMARY CARE DEVELOPMENT BHCP Leadership team is currently working on the development of a Primary care strategy which will address short, medium and long term priorities for Primary Care. This primary care strategy will be co-designed with Primary care providers and will also contribute to the wider system workforce strategy that is being developed. Over the last few months the GP federations and LMC have formed a GP provider alliance leadership team who have been offered places at a number of key meetings in the newly created ICP governance structure. One of the GP Provider leadership attends the BHCPs Integrated Management Board and has recently presented there are the challenges being faced by General practice providers in Morecambe Bay.

5 E. CLINICAL WORKSTREAMS 16. In preparation for developing the BCT Delivery plan 2018, the Transformational PMO is supporting the clinical workstreams to review their individual delivery plans and define next steps. Progress to date for the accelerator pathways is summarised in the table below. ACCELERATOR PATHWAYS Service area Key activities Respiratory Development of a Respiratory service network model business case, the target to reduce Respiratory Outpatient attendance by 50%, Emergency admissions by 20% and Emergency bed days by 50% over two years. Recruitment planning for community based staff roles taking place MDTs have been held in the North Lancashire locality and in Barrow Town Integrated Care Community (ICC) since November 2017 which has recorded a 40% reduction in new GP referrals for period November 2017 to April MSK Six MSK pathways have been relaunched in Emergency Departments in both RLI and FGH with targets being achieved in the final quarter of 2017/18. Virtual Fracture Clinic in RLI which is focusing on stable ankle and wrist fractures and feeing up capacity. Extended imsk service for South Cumbria patients is fully implemented by 1 st October once staff have been recruited and trained. Pilot Direct access physiotherapy services available for local practices being established in Bay Medical Group, Carnforth and Ulverston and Millom aim at reducing the scale of hospital referrals for outpatients. A Pilot Chronic Pain PDSA starts in October with Psychological and Physiotherapists support to look at alternative methods of care for patients with Spinal, Joint and other forms of pain. Creation of Clinical Pathways for Hip and Knee focusing on developing a dedicated JSNA for MSK. Impact on the future capacity and cost release required in the system is being undertaken. Frailty Pathway improvement work is taking place on the fall and fracture neck of femur pathway across Morecambe Bay to reduce average hospital length of stay and release inpatient bed capacity Review of Care Home provision support to prevent admissions has commenced across the Bay. Improving the use of intermediate care beds in South Cumbria Community for admission prevention. A Bay wide PLT was held on the 18 th May to approximately 150 GPs and practice nurses on promoting the proposed pathway changes and Falls awareness and osteoporosis information,. Impact on future secondary activity and capacity is taking place. Diabetes Scoping work taking place around developing an overarching diabetes pathway for pre, Type 1 and Type 2 diabetes which will be implemented across Morecambe Bay.

6 Re-imagine Outpatients Short term focus on reducing prescribing costs profiles associated with diabetes thorough an enhanced case management approach and reducing current duplications and variations in care. Pilot testing of a Diabetes MDT intervention within Ash Trees surgery practice. A package of interventions on targeted specialties to reduce the volume of outpatients This including; IRD Review, Patient Initiated Follow Up Advice and Guidance, E-RS/Paper Switch Off Programme and PaperLite Case for Change to streamline outpatient administration activity to a small number of Booking hubs is being prepared F. DIGITAL WORKSTREAM 18. The Digital Workstream outlines below further progress in the following areas: Integrated Care System Primary Care Exemplars Work continues with Bay Medical Group, Lancaster Medical Practice and East Integrated Care Community to implement iplato patient triage functionality with an objective to digitally signpost patients to appropriate services based on their presenting condition. Primary Care Record Data Sharing with North West Ambulance Service Testing is now been completed satisfactorily with the North West Ambulance Service( NWAS) and the teams are working with the remaining 5 GP Practices that have not yet signed off the data sharing agreement. NWAS is currently assessing how to effectively integrate access to these records into 999 and 111 services. Clinical System for Primary Care Assessment Service (PCAS) The UHMB team Is currently working with the PCAS team to replace the Adastra system with Lorenzo as the preferred system as agreed through the A&E Delivery Board. Citizen Engagement Platform the iplato product has been deployed to all but 2 small practices covering approximately 99% of the population of Morecambe Bay. See current utilisation metrics below which continue to improve month on month, however, there is significant opportunity to utilise this product further:

iplato Utilisation Future developments for the Digital Offer: The Digital Leads forum continues to progress the outlined workstreams: Digital Strategy work continues to develop a high level digital

7 iplato Utilisation Future developments for the Digital Offer: The Digital Leads forum continues to progress the outlined workstreams: Digital Strategy work continues to develop a high level digital strategy in-line with the national digital placemat format of Empower the Person, Support the Clinician, Integrate Services, Manage the System Effectively, Create the Future and Live Services & Infrastructure. Diabetes Dashboard Meeting has been held with Geographic Information System (GIS) expert to discuss potential opportunities for presenting Morecambe Bay Health Needs Assessment and Population Health data using maps. Discussions held to identify required data and analytic resource requirements to support Population Health Management. Visit from Chief Information Officer (CIO) Health and Care in England has been rearranged for 3 rd October from August 29 th which will focus on: 1. the increasing digital maturity of University Hospitals of Morecambe Bay in their use of Lorenzo and; 2. the use of technology that supports the delivery of care across pathways.

8 G. BH&CP DELIVERY PLAN 2018/19 DEVELOPMENT 17. Working with NHS Improvement and NHS England, a clearly defined approach has been agreed between MBCCG & UHMBFT for the production of the 5 year Delivery plan following a joint meeting on 20 th August. The plan will outline the continued delivery of the BCT Strategy with Executive Directors assigned to lead on each of the priority areas within the plan. A timetable and governance process is in development to support submission of the plan on October 31 st. RECOMMENDATION 18. The MBCCG Governing Body is asked to consider the information within the report and note the progress made.

Approve Ratify For Discussion For Information

Approve Ratify For Discussion For Information NHS North Cumbria CCG Governing Body Agenda Item 2 August 2017 10 Title: General Practice Update Report August 2017 Purpose of the Report This is the first report on General Practice since the CCG boundary