Westminster Partnership Board for Health and Care. 17 January pm pm Room 5.3 at 15 Marylebone Road

Transcription

1 Westminster Partnership Board for Health and Care 17 January pm pm Room 5.3 at 15 Marylebone Road

2 Agenda Item # Item and discussion points Lead Papers Timing 1 Preliminary business Welcome and introductions Apologies for absence Approval of minutes Dr Neville Purssell (meeting chair) Additional Paper A Partnership Board minutes from 22 November pm 2 A Multispeciality Community Provider for Westminster The rationale Outcomes Scope Comments on the outcomes framework and proposed scope Chris Neill Dylan Champion Pages 3 to 8 of this pack Additional Paper B a draft outcomes framework for accountable care in Westminster 4.10pm 3 The provider perspective on delivering an MCP Table discussions on developing the provider capabilities for an MCP Chris Neill Pages 10 to 12 of this pack 4.40pm 4 Any other business Dr Neville Purssell (meeting chair) None 5.25pm 2

3 Item 2 A Multispeciality Community Provider for Westminster the rationale The CCG has described its intention radically to transform how care services in the community are experienced by local people, through a major change in how they are commissioned and provided. The future system will be based on the accountable care principle of One system, One budget, Better outcomes. The commissioners focus is on care provided in the community. This is because: this is where care is most fragmented and the benefits of integration for local people are greatest; this is where many types of care can be wrapped around primary care and tailored to each community s specific needs; this is where holistic care can focus on the long-term support of people in their own surroundings; this is where care can best encourage prevention, self-care, and the wider wellbeing agenda; and the flow of local people into hospital care involves a much wider area and must therefore be brought into an integrated system with a larger group of partners. The NHS s Five Year Forward View describes a range of new care models. Of these, the Multispeciality Community Provider (MCP) model is the form most suited to Westminster because: it focuses on the care delivered outside of hospitals, supporting the agenda set out in the previous box; an MCP is built around GPs registered lists and therefore reflects the role of primary care as the best integrator of the wide range of services that local people need; the prominence of general practice in the model means that GPs are in the driving seat of leading local change; and implementing an MCP reflects the principles of the CCG s approach to date, which has been to focus on the development of primary care at scale and its integration with other care services. The CCG has described the scope of healthcare services that it intends to be provided by the MCP. Additionally, it is working with Westminster City Council to plan what social care and public health services and functions might be brought within the scope of the MCP. 3

4 Item 2 A Multispeciality Community Provider for Westminster the rationale (continued) The objectives of commissioning an MCP are to: drive the improvement of health and wellbeing outcomes through better integration of services and co-ordination of care; allow for greater flexibility and personalisation of care, over the service specifications used in the current payment model; support the flow of funds to where they are needed in the care system, across current contractual and organisational barriers; develop greater incentives to keep people well through more preventative care; overcome current issues that inhibit shared provider investments; and incentivise the management of overall system costs. In practice, the commissioning of an MCP means that the CCG and potentially Westminster City Council will: be serving notice on a wide range of contracts currently held across out-of-hospital health services* in order to bring them and their associated budgets into a single long-term contract held by a Multispeciality Community Provider; in future be paying primarily through a block or capitated budget rather than by activity; in future be paying partly based on how care supports local people to improve their health and wellbeing outcomes; and in future be sharing financial risk with the Multispeciality Community Provider. 4

5 Item 2 A Multispeciality Community Provider for Westminster outcomes The current draft of the outcomes framework is enclosed with this pack as paper B. It is: based on the outcomes framework developed through Hillingdon s accountable care programme, which in turn built on the extensive engagement undertaken as part of the pan-nwl whole systems integrated care programme from 2013; and being developed jointly with West London CCG. This approach is in response to requests made at earlier Partnership Board meetings that commissioners align their work across borough boundaries. The commissioners are engaging local residents on this outcomes framework as it develops. The domains are designed to provide a comprehensive view of what local residents wish to be able to say about what care supports them to achieve, as well as how care looks and feels. The original indicators and metrics related largely to people over 65 and a more defined scope of services than envisaged for the Westminster MCP. The commissioners have therefore thought about what further indicators and metrics should be used. These are highlighted in blue on the spreadsheet. see the draft outcomes framework paper B 5

6 Item 2 A Multispeciality Community Provider for Westminster scope The accountable care commissioning plan sets out a high-level scope for the local MCP. This has been shared with the partnership board and is copied below. The broad scope arises from the MCP s need to be large enough to improve local health and wellbeing outcomes by developing a truly integrated out-of-hospital service. The CCG is currently building the additional detail that sits beneath the high-level categories below. This is a work in progress and the results to date are shown on the following two pages. Similarly, Westminster City Council is working with both Central London CCG and West London CCG to identify services and functions from social care and public health that could sit within an MCP. Source: Central London CCG accountable care commissioning plan, November 2017, p.38 6

7 IN PROGRESS; NOT EXHAUSTIVE Item 2 A Multispeciality Community Provider for Westminster scope (continued) High-level category Non-core primary care commissioning Additional detail, example services All services included in the new Partnership in Practice primary care contract: - From April 2018 respiratory (spirometry); cardiology (warfarin monitoring); cardiology (warfarin advanced monitoring); cardiology (ECG); cardiology (ABPM); diabetes level one; diabetes high-risk; management of Serious Mental Illness (SMI) and Complex Common Mental Health Problems (CCMI); wound care, phlebotomy, proactive care, self-care and prevention; referral management; extended hours; drug monitoring - near patient monitoring; patient experience - From April 2019: Respiratory (Asthma & COPD); Cardiology (Atrial Fibrillation); Access and Practice Demand Management Primary Care mental health services Urgent care and outof-hours primary care Planned care pathways Community physical health services NHS 111 Service Primary Care Out of Hours Services Community Cardiology and Respiratory Services Audiology Termination of pregnancy services Community diagnostic services Community dermatology services Care coordination services Specialist community nursing District nursing Occupational therapy (paediatric, general, specialist) Physiotherapy (paediatric, general, specialist) Haemoglobinopathy St Mary's Hospital Urgent Care Centre Extended and open access (e.g. walk in services) Community MSK services Community ophthalmology services Community gynaecology and continence services Diabetes Services Services to specialist groups (e.g. looked after children) Community matrons Night nursing Tissue viability services Dietetics and nutrition Podiatry Learning disabilities Learning disability services Learning disabilities assess & treat (healthcare) Learning disabilities placements LD Community Support Team Health LD S117 placements Placement and carer support Development services 7

8 IN PROGRESS; NOT EXHAUSTIVE Item 2 A Multispeciality Community Provider for Westminster scope (continued) High-level category Mental health services Intermediate care and CHC Additional detail, example services Inpatient mental health beds Community Mental Health Teams Home Treatment Early Intervention Psychotherapy Memory services Children's and Adolescents' Mental Health Psychology ECT OT Liaison Arts Community rehabilitation Wellbeing HIV Liaison Learning disabilities Nursing and residential home provision Continuing Home Dementia services Reablement Continuing Health Care Palliative care Rehabilitation and Interim Care (Elderly) Forensic Community Services Primary care mental health services Recovery services Forced migration Intermediate care service with additional mental health support Perinatal mental health IAPT Mental Health services to older people Independent Mental Health Advocacy Mental Health Social Inclusion Mental Health Supported Housing Personality Disorder Service User focussed Monitoring Mental Health Multi-systemic therapies for children Stroke Pathways Intermediate care services (e.g. Community Independence Services) Neuro-rehabilitation services Intermediate care beds Community Neuro-Rehab Continuing Care Therapies Specialist services (e.g. falls, Parkinson s) 8

9 IN PROGRESS; NOT EXHAUSTIVE Item 2 A Multispeciality Community Provider for Westminster scope (continued) High-level category Other patient support services Additional detail, example services Community transport Care services for homeless people: o health peer advocacy o intermediate care for homeless people o hostel beds for homeless people o Homeless Health Team Telephone-based interpreting service Wheelchair services Prevention services (e.g. volunteering) Support to carers Respite Dementia services not covered above Advocacy services Equipment services User involvement and outreach Note: some of these services listed here are funded through the Better Care Fund agreement with Westminster City Council and their inclusion is therefore subject to ongoing discussion. 9

10 Item 3 A Multispeciality Community Provider in Westminster the provider perspective This new approach to commissioning sets a major challenge to providers of care to work differently. An MCP in Westminster needs to be able to deliver a wide scope of care services whilst providing the leadership and co-ordination required to improve the outcomes achieved through community-based care. System leadership requirements Developing a compelling vision and clear strategy for how the MCP can support the achievement of better outcomes by local people, shared by all organisations and practitioners delivering care Leading and co-ordinating the organisations delivering care services behind this vision, with excellent clinical and executive leadership Over time, co-ordinating care with organisations whose services affect wider determinants of health (e.g. housing, employment) Building a culture of collaboration and mutual support across the system, supported by shared decision-making Making direct investments in the costs of co-ordination, such as network management, information systems, and activities like care planning Care requirements Delivering and co-ordinating care across the services in scope Working effectively with care professionals outside the MCP scope, including core primary care and secondary care Delivering more collaborative care through better multidisciplinary working across teams Driving a robust quality improvement methodology Providing care within the least intensive and most costeffective setting Ensuring effective clinical governance across the organisations providing care Building an integrated workforce with the roles, skills, and adaptability required to deliver the best care possible 10

11 Item 3 (continued) A Multispeciality Community Provider in Westminster the provider perspective Population health requirements Understanding local population health needs and risks, including through segmentation and stratification Designing local approaches to care that best meet these health needs and risks Managing the care of population groups based on the prioritisation of prevention and early intervention Engaging residents in the design and delivery of their individual care Engaging residents more broadly in how the local care system works Business requirements Holding and managing a large long-term contract with a capitated budget, some payment by outcomes, and some financial risk, through a structure that supports effective delivery and decision-making Tracking activity, cost, quality, performance, and outcomes across all services with analysis and reporting information driving service improvement Re-distributing system resources (money, workforce, estates) to improve outcomes Integrating data and IT solutions to support information sharing and collaborative care Constructing and managing a care supply chain based on robust agreements Developing clear processes that support co-ordinated delivery and alignment across multiple organisations, including to ensure public engagement, regulatory compliance, and risk management 11

12 Item 3 (continued) A Multispeciality Community Provider in Westminster the provider perspective Questions for discussion include: 1 How do providers need to start working together now to form an MCP that has these capabilities? 2 What is the role of our own organisations in developing these capabilities, given the ambitions of this programme (and parallel programmes in West London CCG and elsewhere)? 12