Health & Care Partnership for Cheshire & Merseyside PRIMARY CARE NETWORK DEVELOPMENT FUND APPLICATION PACK

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1 Health & Care Partnership for Cheshire & Merseyside PRIMARY CARE NETWORK DEVELOPMENT FUND APPLICATION PACK Electronic copies of this application form are available from: For any queries, advise or support regarding the application process, please contact: Applications to be submitted by to: Closing date for applications: 9 July 2018 at 12 noon 1

2 1. How to apply PRIMARY CARE NETWORK DEVELOPMENT FUND APPLICATION FORM Primary Care Networks / Federations are asked to complete this form on behalf of their Network/Federation in order to enter the funding application process approved by the Cheshire and Merseyside (C&M) System Management Board. The purpose of this funding is to hasten the development of Primary Care Networks/Federations and increase the pace of real transformational change to deliver the Partnership s business plan to close the three gaps: quality, outcomes and affordability. The table below explains how applications meeting the entry requirements (A1-A4) will be judged against the criteria for assessment (B1-B2) and any allocations made available through this process will be subject to ongoing conditions (C1-C2) being met. # Entry Requirements Assurances A1 Confirmed commitment of constituent GP Confirmation from NHSE C&M Director of practices named in the application to work Commissioning together on a Network / Federation level. A2 A3 A4 A5 A clear and credible primary care at scale model is either already in place or there are robust plans to develop one. Realistic yet challenging programme plans in place or commitment to development including timescales and clear outcomes. Engagement of all GP Practices within the Primary Care Network footprint. Confirmed commitment of PC Network and constituent practices to work in full partnership and cooperate with local CCG and place-based systems to transform local care. Evidence provided to NHSE C&M Director of Commissioning Agreed with NHSE C&M Director of Commissioning Evidence provided to NHSE C&M Director of Commissioning of engagement activity. Confirmation of commitment in Application # Criteria Assurances B1 Evidence that allocated funding will Evidence provided to NHSE C&M Director of expedite the development of the Primary Commissioning Care Network and increase the pace of change and delivery of the primary care at scale model as a fundamental part of place-based integrated service delivery which aligns with the objectives of the C&M Health & Care Partnership, including initiatives funded by the Transformation Fund B2 Evidence of the clear, measurable outcomes of the initiative(s), including timescales and the return on investment. Evidence provided to NHSE C&M Director of Commissioning # Conditions Assurances C1 Network / Federation Leaders must be able to provide regular updates on the progress of their programme s delivery and be willing Regular status updates to GPFV Programme Director. to present status updates evaluating success to-date and any measurable outcomes. 2

3 C2 Network / Federation Leaders to share lessons learnt from their programme at organised learning events. Attendance. 2. Timeframes for applications The application process is now open with the purpose of assessing submissions and proposing allocations in time for the System Management Board meeting taking place w/c 16 July 2018 at which it is planned to confirm successful applicants. The full timetable is as follows: Date w/c 21 May 2018 W/c 28 May and W/c 4 June 2018 Action Communications issued to all GP practices and GP Federations. Place SROs, CCGs and LMCs copied in. Start of three briefing events held across Cheshire and Merseyside. 9 July 2018 at 12 noon Deadline for submitting applications to NHS England. 11 July 2018 Applications reviewed and collated W/c 16 July 2018 Panel convenes, assesses applications and shortlists bids for recommendation to C&M HCP 31 July 2018 C&M Health and Care Partnership Board approval. By 3 August 2018 All bidders notified of outcome with successful bidders being informed of: the sum available, any conditions applied to the offer, their buddy the memorandum of Understanding summary of next steps 3

4 Health & Care Partnership for Cheshire & Merseyside APPLICATION FOR PRIMARY CARE NETWORK DEVELOPMENT FUND Network / Federation Name: Widnes Highfield Health GP Federation General Practices signed up to the Network / Federation Proposal: How many GP practices are part of this Network proposal? : 8 What is the Network population coverage for this proposal? : 66,227 Please list below all of the practices that are part of this application Practice Name Practice List Size Lead Practice GP Name Appleton Village Surgery 10,020 Dr M Brindle Bevan Group Practice 14,593 Dr S Veedu The Beeches Medical Centre 8,272 Dr S Baker Hough Green Health Park 4,699 Dr S Koya Newtown Health Care Centre 7,234 Dr A Arain Oaks Place Surgery 3,377 Dr L Meda Peelhouse Medical Plaza 14,415 Dr P Hurst Upton Rocks Primary Care 3,617 Dr S Pitalia Total Please confirm that all of the above practices have committed to the contents of this Network proposal? Network/Federation Lead name and contact details (including address and telephone): Dr Paul Hurst Managing Director Transformation lead Widnes Highfield Health GP Federation on behalf of Widnes Community Hub 1 and Widnes Community Hub 2 Please supply details here of the individual who has been identified from the Network to act as lead for this application Network Finance : Please supply details here of the individual who has been identified from the Network to act as finance lead for this application. Dr Paul Hurst Managing Director Transformation lead Widnes Highfield Health GP Federation on behalf of Widnes Community Hub 1 and Widnes Community Hub 2 Brief Description of Scheme: Widnes is a town of 66,227 residents. It has eight GP practices who all work for their patient population in different ways. We recognise the value that this approach brings but also appreciate the variation and inefficiency that exists. We also recognise the increasing pressure and demand that is being placed on General Practice and its 4

5 staff, along with the increasing physical and psycho-social complexity of a lot of our patients. We want to create a primary care network that increases the capacity that is available to meet the increasing demand and need of our residents, that improves outcomes, that gives us more time with patients, to support patients to care for themselves, that reduces unwarranted variation, that maximises the skills and efficiency of our workforce, that improves the morale and job satisfaction of general practice staff, that reduces competition between practices and increases appropriate and timely access to the correct services. From experience we know that patients value the unique relationship with their GP and GP practice. We also know that continuity creates a safer, more efficient system with higher patient and staff satisfaction. But we need to think and act differently to enable us to create an approach where continuity can be offered when and where it s most important e.g. for those with long term conditions, complex comorbidity, frail elderly, or palliative care needs, whilst also working to meet the general rising demand. At the heart of our approach are the eight practices working in collaboration and as part of a network. General Practice in Widnes is a key member of the local Transformation programme, One Halton. Represented by our GP Federations, Widnes Highfield Health, we as local clinicians, in collaboration with our system partners, are embarking on an ambitious programme of work to transform the health and care system across Halton. We are fully committed to this programme of work and will play a leading role in delivering the vision of One Halton which is to work together to improve the health and wellbeing of the people of Halton so they live longer, healthier and happier lives To achieve this, we accept the challenge that everyone must change. The way services are commissioned and provided needs to be different. The four schemes set out in this proposal lay the foundations in General Practice in Widnes for how we will start to meet this challenge. This funding will be essential to accelerate the pace of change in general practice organising itself into a mature, robust, reliable, sustainable network capable of supporting system wide change. Halton has two federation who are committed to providing Borough wide solutions, 5 practices are members of Widnes Highfield Health, and 3 are members of GP Health Connect. All eight practice have in Widnes have agreed to work together to form a new town based Network, part of this bid is to fund forming, and agree a governance arrangement across the new Network. Our four schemes are: 1) A standardised approach to Chronic Disease Management across our eight practices 2) Working effectively as a primary care network to support continuity of care 3) Standardised care navigation 4) Realising efficiencies through standardising back office functions In this bid, we will describe each scheme in further detail, setting out the rationale, the approach, the timescales and the impact for each. By signing this bid, our eight practices have committed to support and deliver these four schemes for the residents of Halton. We are also delighted to have the support from our CCG, place-based SRO, David Parr, and One Halton Board. Evidence - B1 1. What level of financial resources you are seeking together with a breakdown, please indicate where current funding is already supported (clarifying total spend for each area) 5

6 In total, we are seeking * 228,100. Based on the funding approach being adopted with this transformation fund, we are therefore requesting an initial one-off award of 95,500. We will then use the 1 per head funding in 2018/19 and 2019/20 to fund the following as per table below. This bid is based a town based approach. However as this bid is aligned with the Borough vision for General Practice, across both Widnes and Runcorn. Opportunity if both Widnes and Runcorn bids are successful may present Borough wide economies of scale for the *Transformation & Change Specialist Support. The table below presents a breakdown of where this funding will be used: There are opportunities of economies of scale in relation to project managers support and Transformation change specialist support. Should both Widnes and Runcorn bids be successful we anticipate the project transformation support change costs will reduce by circa 14,000 and we would see the need for one project manager role and costs to support both Widnes and Runcorn networks. Number Sessions 18/19 Sessions 19/20 Rate GP Session ,200 Nurse session ,200 Administration session ,600 Practice Manager session ,200 GP Programme leadership ,400 Project manager and **37,500 **37,500 Transformation change specialist support **70,000 **70,000 Public engagement campaign support 18,000 18,000 Total 228,100 **Potential for the funding application of this bid amount to reduce to 176,600 would result in a revised on-off award of 44,000 or less Staffing input is critical to the success of this programme. As such, we have asked for each of the eight practices to commit to the contribution of one session a month from a GP, a nurse, a Practice Manager and administrative staff. The schemes they will develop and deliver are set out below. The time required from all staff to invest in these schemes will require remuneration. This will cover a combination of back fill or staff working additional hours to ensure that current services continue whilst this programme of work is undertaken. The GP Leadership approach is explained later in this proposal, as is the full time project manager (based on 18 months cost). The project manager will be fixed-term appointment, concluding in March Our preference is to appoint our own project manager. This will be a shared appointment between 6

7 this bid for Widnes and the bid for Runcorn. The project manager will support both programmes of work. The role and duties of the Transformation & Change specialist support and Public engagement campaign support are detailed in this proposal. Current funding At present (and as described in this proposal), the practices in Widnes receive 5/head as part of the Halton Enhanced Scheme (HES). This funding is split across 2 main schemes Quality referral initiative and Community Hub development. The proposal sets out how this funding is being used to support the Community Hub development and roll out and delivery of a series of Test Bed projects which fully align to the One Halton Transformation programme. The second element of funding being received in Widnes is a share of 25,000 (half of this) General Practice Resilience Funding which was won in 2017/18. This has been used to support a scheme called GP Staffing Pool which has been led by local GPs. This initiative is continuing and fully aligns to the schemes set out in this proposal. The funding we have requested will all be used exclusively to support the development and delivery of this proposal. It will not duplicate any existing funding contributions and will not be used to generate any profits for practices or provide overhead contributions to the GP Federations. How the Network s proposal will enable the delivery of primary care at scale and make a major contribution to/align with local place-based, integrated service delivery plans. The current approach to General Practice is unsustainable. We know there is variation is the services and outcomes across our practices. We are experiencing increasing demand from patients with ever increasing complexity and need. The increase in demand is from patients with both chronic and acute need, as well as mental health needs and social needs. We see a lot of people and we know we re not always the most appropriate place or people to provide the best or most effective support. Our partners in the local health and care system have skills, expertise and capacity that can better meet some of the demand we see. The overall system is too fragmented. It s often confusing for us to know how to best navigate it and we know it can be incredibly confusing and difficult for our patients too. We want and need to spend longer with our patients who need more support and intervention. All of these factors are contributing to reducing morale across our work force and as a result, it makes retention of our staff more challenging. We Want to change this We want to work together as practices to offer a standardised approach across Widnes. We want to work in a much more integrated way with our partners, including social care, mental health, community services, the third sector and our acute colleagues. We know we can do more to support prevention and self-care. We want to increase the capacity available using the same resources and assets but in a different, more efficient way. We want patients seeing the right professional and right service every time and that doesn t always mean General Practice or a GP. We want to invest in our staff and maximise the skills that we have available in Widnes. We want to make Widnes a great place to work in General Practice. What does this mean for patients? We want to improve the health of our population We want to improve the experience of our population accessing local services We want to spend more time with patients who need it and reduce the number of times a patient needs to tell their story 7

8 We want care continuity for patients who need it and to ensure that patients access the right services quickly What does this mean for our provider colleagues and workforce? We want to work as an integrated team with our statutory and non-statutory partners We want to maximise everyone s skills and increase morale We want to be co-located with partners (where it s appropriate) to offer one stop services We want to develop portfolio careers, offering choice and variety and opportunities to continue to learn and develop (where people want to) We want to make Widnes a great place to work We are a committed partner to the One Halton Transformation Programme and the vision it has for Halton. The four schemes included in this proposal and set out below describe how we plan to get General Practice in Widnes ready for operating in this future model, by working together and by working at scale. We have the commitment from all eight practices to embark on this ambitious change programme. Our four schemes: 1) A standardised approach to Chronic Disease Management across our eight practices Rationale Across our practices, we have variation in our outcomes for the different Chronic Disease Management groups, in our approach, in our pathways, in our training, in our communications and in our systems and information flows. Data showing variation in QOF prevalence rates across the eight Widnes practices (2016/17) CHD CVD Mental Health Hypertension Stroke / TIA Asthma COPD Diabetes Obesity AF Highest Lowest Our aim is to create a standardised town-based approach for each Chronic Disease Management group that will both reduce and remove elements of this variation and improve patient outcomes. By adopting this approach, we can start to share resources and skills across the town. We can support each other and ensure that every Widnes resident is receiving the same level of care. We will include prevention and self-care in the approach for each group to ensure we are not just focussing on treatment. We will do this by working with our local Public Health colleagues and the One Halton Population Health Framework. We will provide services and support through multi-disciplinary teams, working in an integrated way with 8

9 our partners across all sectors community staff, social care, third sector providers, acute and mental health colleagues whoever we needs to in order provide the very best care. The teams will provide care and support to patient groups, ensuring the most appropriate professional is providing the right support to patients at the right time. By improving Chronic Disease Management in General Practice, we will reduce demand on acute appointments. Approach We will create a rolling programme of rapid improvement cycles that focus on and standardise the approach to every Chronic Disease Management group. Led by our nursing workforce and working in partnership with local GPs with Special Interest, relevant local providers, Public Health colleagues, Practice Managers, the third sector administrative staff, commissioning colleagues and IT colleagues, we will review all aspects of our approach and delivery of care to these patient groups. We will engage with and co-produce these new ways of working with patients and their carers who live with these conditions. We will work in partnership with a Transformation and Change specialist, Integral Health Solutions, to diagnose, design, deliver and demonstrate solutions and changes. We believe that emerging solutions will involve multi-disciplinary team working in practices and in the communities, working in an integrated way with a range of partners. By working in this way, we believe we can standardise the approach, the templates, training and audit, skill mix, recall systems, exception reporting, patient information, patient education and information leaflets. We will focus on all aspects of care from prevention and self-care (supported by the One Halton Population Health Framework), through to treatment and palliative care. Our aim is to work with our commissioning colleagues and Public Health team to agree a prioritised order of which Disease Management Groups we will review based on a factors including unmet need, variation and levels of demand. Diagnose stage We will align our approach with what is recognised as best practice. We will do this by benchmarking and analysing our various approaches against NICE guidelines and quality standards, JSNA, patient feedback and experience, QOF data, exception reporting, prescribing data, medicines management intelligence, acute service demand and the local Primary Care dashboard. We will work closely with the Business Intelligence teams of the CCG and Public Health teams. We will focus on clinical pathways, infrastructure (governance, IT, estates, monitoring) and staffing. Design stage We will work with partners, patients and their carers to design and map the right services, pathways, approach, staffing, skill mix, communication and enabling infrastructure for each chronic disease group. This will be a true partnership approach. Deliver stage We will plan, implement, test and embed the agreed changes. We will do this with our partners and communicate effectively throughout the process. 9

10 Demonstrate stage We will capture both quantitative and qualitative data and evidence to demonstrate the effectiveness of the changes we make. This overall approach presents a new way of working for General Practice working at scale. We have engaged with a Transformation & Change specialist to support us with this. However, we want to invest in our staff and processes so we are not reliant on external support in perpetuity. As such, we are asking them to help us do three things: 1. Co-design and produce a framework and approach by which these rapid improvements cycles can be undertaken locally in Widnes 2. Train our staff our nurses, Practice Managers, administrative staff and GPs - in the skill of change management and rapid improvement cycles because we want the skills to do this moving forward. 3. Work with us closely and lead the first rapid improvement cycle, from beginning to end. Our aim is to complete the first rapid improvement cycle in six months. Thereafter, our aim is to undertake and complete each within 3-6 months. Timescales Our aim is to commence the first rapid improvement cycle in October Therefore, our aim is to complete the first rapid improvement cycle by March We would then undertake a further four rapid improvement cycles in 2019/20 and would have the skills to continue this process into 2020 and beyond. 2) Working effectively as a primary care network to support continuity of care Rationale General Practice is increasingly struggling to cope with the daily levels of demand placed upon it. Typical demand can be put into one of three categories: 1) Chronic Disease Management, planned care 2) Acute demand 3) Planned/pre-bookable The demand in each of these categories is increasing and as such, the time we have available to adequately meet this demand is reducing. It is not just about meeting the demand either, it s about providing the level of care that people need, at the right time, with the right person. We need to spend more time with some of our patients. Our aim is to adopt a new and integrated town-based approach with our urgent care centres to increase the capacity that is available. Approach We want to implement a new approach for how local residents access services in Widnes. We also want to maintain care continuity for those patients who need it the most, e.g. those with chronic conditions or the frail elderly (this is not an exhaustive list). We also want to be able to offer longer appointments and work in a more integrated and team-based way with our partners (mental health, social care, and third sector, acute, community) to better support these patients. By doing this, we can better manage and support patients and their conditions in the community, resulting in care closer to home and meaning patients only need to go to hospitals when specialist intervention is required. We can also work with 10

11 acute specialists in the community (e.g. geriatricians and paediatricians) as part of a wider, more integrated community based workforce. The way we believe this can happen is to integrate the urgent care centre provision with general practice in Widnes. This is a key reason for submitting this bid on behalf of our town-based population of 67,000. The rationale for this is further explained below. Where a patient wants to see a doctor or clinician and they don t have a chronic disease (or has a complex need that we believe should be managed in general practice), we will offer them a choice of where to access services locally. This could be an appointment in general practice or an appointment on the day at the urgent care centre, whether this be for acute on the day or planned or pre-bookable. The patient will be offered an on the day appointment in the urgent care centre where they will see a clinician appropriate for their need, but not likely to be their usual GP. By approaching the on the day demand in this way, it will create capacity in General Practice to provide care continuity for those patients where it s most important e.g. for those with long term conditions, complex co-morbidity, frail elderly, or palliative care needs We see opportunity to rotate practice staff through the urgent care centres, providing an integrated townbased service with other providers. This very much lends itself to the scope and requirements of the future Urgent Treatment Centres. Rotating some practice staff through the urgent care centres will also support staff retention and training as it will provide opportunities to experience new and different environments and services. We will work with our partners across Widnes as we believe having social workers, wellbeing officers, community staff, mental health professionals, our third sector partners (including organisations like Citizens Advice), acute professionals and our local housing experts will provide a more convenient service. We want to create a multi-disciplinary approach where physical, mental, social and domestic needs and issues can all be supported within a single visit. This is our ambition for our community hubs of the future but we believe this type of multi-disciplinary team can be established in the urgent care centres now. We believe that this approach of offering on the day access to appointments in a town-based service will be very attractive to a lot of our residents. We run the GP Extended Hours service in Widnes and have been since The feedback from a significant proportion of the service users is that they welcome the opportunity to have access to more convenient town-based service, where they don t see their own GP or clinician. It is the patient s choice to use the service. 98% of patients who use the GP Extended Hours service tell us they would use it again, and a lot do. For this new approach to work, we need to invest in our care navigation and IT systems. Whether a patients calls the practice, uses an IT solution to book an appointment or walk s in to the practice or urgent care centre for an appointment, we believe it is essential that a standardised approach to offering and accessing services is deployed across Widnes. The urgent care facilitates will have full visibility and access to the patient s primary care record, across all disciplines. As such, we need to develop a system that can be accessed and used by either the patient or staff members to ensure patients are accessing the right service. A critical first step in this scheme is to undertake detailed capacity and demand management modelling of general practice. We are delighted that NHS England are commissioning the APEX/Insight tool for local practices as we believe this will provide the data we need to start to plan the service configuration. This tool will extract detailed levels of staffing, services and productivity data from every practice system. 11

12 It will enable us to accurately model the demand on services, how each practice manages this and for us to model alternative approaches to test the most efficient solutions and pathways. It will also enable us to consider alternative workforce models and to consider how we can maximise the efficiency and utilisation of both our current and future staff. Work is already being undertaken by Halton CCG to develop the local Urgent Treatment Centre and we will collaborate with them and other partners to develop the urgent care model, the service specifications, the future capacity requirements and the future care pathways to meet the levels of need and demand for a 24/7 solution in our community. This will consider all aspects of care in the community including services such as pharmacy and optometry. We also need to be mindful of potential future changes to services such as NHS 111. To do this, it is essential that General Practice is ready to work in this way and at scale. As such, we will establish a group to lead this piece of work on behalf of General Practice in Widnes. This group will consist of GPs, nurses, Practice Managers and administrative staff. It needs to be fully representative. This group will start in September 2018 and continue until March 2020 when we believe the new ways of working will be implemented. This group will use the same approach outlined above diagnose, design, deliver, demonstrate to develop a standardised General Practice service for urgent care. To underpin this and the scheme described above, we are engaging with a local Third Sector organisation, Halton Voluntary Community Action (Halton VCA), to work in partnership with us to support a public engagement and insight campaign. Halton VCA ran an excellent public engagement session for General Practice in which the question was asked Tell us what s wrong with General Practice. During and after the event, we received invaluable feedback including that 80% of attendees who responded to a survey said they felt more optimistic about the future of General Practice in Halton after attending the event. Therefore, we are confident that if we can effectively engage with the population, we can coproduce effective services and solutions that they will support. We want to work with, engage with and discuss the best ways of developing these standardised General Practice services with our residents from the outset, doing this in partnership with Halton VCA. Finally, we will engage with and align our IT requirements into the local IT Group to ensure that the technical solutions we require in General Practice are developed and implemented and integrate into the wider IT solutions across Widnes. Timescales We understand that the APEX/Insight tool will be deployed into Widnes soon and we will look to commence detailed capacity and demand management modelling in October We will start the General Practice project group in September 2018 and start to design the public engagement campaign with Halton VCA in September too. We anticipate the public engagement work will commence in November We anticipate 12 months of diagnosing and designing work so forecast that the deliver stage (service changes) will start to be made in September 2019, ahead of the winter period. The IT requirements will need to fit in line with the roll out of the new approach. 3) Standardised care navigation for every patient Rationale 12

13 The two schemes described above will change the way that services are offered and accessed. As a result, a town-based and consistent approach to Care Navigation across all practices is critical. We believe it is also essential to maximise the benefits of a new Care Navigation approach, a single approach is deployed across all eight practices at the same time. Without a robust, coherent and fully aligned/integrated approach, our view is that complaints could increase and patients may be left confused if practices are offering different advice. Approach NHS England have provided funding to support Care Navigation training and Halton CCG has already commenced a programme of work that has engaged with practices. The approach we want to take, working in partnership with the CCG is to lay the foundations to maximise the impact of care navigation. We want to line up all of the services and focus on implementing the optimum solution. Given the timescales set out above, we believe we have just over 12 months to develop a town-based approach to care navigation that will include the development of a common set of protocols and rules, a common script, common service list and access choices. We believe this offers a great opportunity to develop our staff, develop skills and potentially share our resources and skills across the town. There is concern that if practices launch Care Navigation at different times, it may confuse patients and as such, complaints may increase, patients may look to move practices and the variation of what services are offered may increase. As such, we want to establish a working group consisting of Practice Managers, administrative staff and our commissioning colleagues to oversee and develop this scheme in partnership. Staff involved in this will represent practices and lead the development, launch and implementation within their respective practices, to embed the training that is available from the GP Forward View, back into every practice in Widnes, across the whole workforce. Furthermore, we believe that the public engagement campaign that is to be run as part of the scheme above, the Care Navigation scheme and changes that will arise from this should be included to present a holistic and joined-up picture to the public. Timescales Our plan is to establish the working group described above in September 2018 and this will run for approximately 12 months. This working group will work in partnership with commissioning colleagues. The group will oversee the design of the approach, the training requirements, coordination with the public engagement campaign and the roll out at practice level. 4) Realising efficiencies through standardising back office functions Rationale There is an opportunity for General Practice to realise significant efficiencies in the way it coordinates and operates its back office functions. By back office functions we mean: Coding; Scanning; Summarising records; 13

14 Patient correspondence; Telephony Referral administration Hospital correspondence/communication National patient safety alerts Medicines management Audits Searches As well as efficiencies, we believe this will improve quality and patient safety as it will reduce potential delays in functions such as scanning and coding patient s records and discharge summaries. This will provide more timely information to our clinical staff. This scheme will not save the practices money but it will present the opportunity to increase productivity and efficiency of the funding that is currently spent. At present, the eight practices operate these functions largely independently of each other and there is a lot of scope and opportunity to standardise and centralise some of these functions, whilst creating and developing transferable skills and increasing the resilience of the respective services. Approach As above, we want to create a rolling programme of rapid improvement cycles that focus on and standardise the approach to each function. Lead by Practice Managers, working in partnership with administrative staff, we will review all aspects of our approach and delivery across each function. The diagnose, design, deliver, demonstrate approach outlined above will be adopted in the scheme too. As will the three aspects of the approach co-design the approach, train our staff, implement the first cycle with us. Our aim is to complete the first rapid improvement cycle in six months. Thereafter, our aim is to undertake and complete each within six months. We don t want our administrative staff to see this as a threat. We believe that this will result in changes within our administrative workforce however, we are not considering redundancies. There are significant opportunity to retrain staff, to support them develop new skills and to redeploy their skills elsewhere in new town-based general practice model. Timescales Our aim is to start this process in October Therefore, our aim is to complete the first rapid improvement cycle by March We would then undertake a further two rapid improvement cycles in 2019/20 and would have the skills to continue this process into 2020 and beyond. Programme leadership and resources This programme of work and the four schemes it details will be driven by the GP Federation, Widnes Highfield Health, supported by every practice. The Federation will monitor progress every month at its regular Board meeting. We will invite our NHS England buddy and a member of the CCG commissioning team to this session to provide complete transparency in our progress. The overall lead for the programme of work is Dr Paul Hurst, local GP and Clinical Transformation Lead for the GP Federation. He will dedicate 2 sessions a month to provide leadership across Widnes and 14

15 focus on the delivery of the schemes. He will be supported by the dedicated project manager. We are then asking each practice to commit to providing one session of input a month across the four schemes from a GP, a nurse, a Practice Manager and a member of administration staff. We believe that this whole approach underpins the principle of primary care at scale and fully aligns with the local place-based agenda. As a core and major member of the One Halton Board, we have signed a commitment to: Improve health and wellbeing outcomes for local people Collaborate between health and social care services, providing accessible high quality services to local people Develop new ways to prevent and better detect illness Reduce the levels of demand on hospital, acute care and healthcare services generally Deliver service closer to home and within local communities Again, we believe that the schemes we have set out above fully align to and start to deliver our commitment to the One Halton Board and the CCG Transformation agenda. How the Network s proposal is aligned to any current CCG transformation agenda As set out in the previous section, we believe that our proposed fully aligns to the CCG Transformation agenda, One Halton. The vision of One Halton is working together to improve the health and wellbeing of the people of Halton so they live longer, healthier and happier lives We believe that our proposal fully supports this vision. We want to work at scale and in partnership and develop services to fully meet the needs of our residents. All members of the One Halton Board have been asked to support 10 commitments. These are listed in the table below. We believe our proposal fully supports each commitment. Commitment We agree that an integrated system of health and social care is the best way to ensure optimum health, wellbeing and care outcomes for our population and to ensure collective financial sustainability. We agree that the Halton Health & Wellbeing Strategy provides the focus for our work together and sets out our vision to work together to reform health and social care services to improve the health outcomes of our residents and reduce health inequalities, as quickly as possible We agree the One Halton ACS Board will provide a focal point for prevention and early intervention, proactively identifying potential future demand and shifting the focus from unplanned and reactive services to planned and targeted interventions We agree to put patients and residents at the heart of what we do Does this proposal support the commitment? How? Our proposal fully focuses on integrated systems and providing optimum care and outcomes. As a partner, we support the drive for financial sustainability Our proposal is fully aligned to the One Halton vision and programme and we want to commit clinician time to the development to ensure this is a clinically-led redesign programme, in partnership with our colleagues from other organisations. We are an active member of the One Halton Board and fully support the approach and work streams. As such, we are targeted the Urgent Care & Complex Care needs work stream with this proposal Patient focus is at the heart of our proposal 15

16 We agree to put General Practice and other community practitioners at the centre of our care model We agree to design and plan services around functional geographical footprints with populations of 30,000 to 50,000 based on registered patient lists We agree to design services for users and not our organisational needs The Commissioners agree to deliver a single approach to commissioning health, wellbeing and care services in order to transform services and improve outcomes. This will enable collaboration integrated working and include the development of pooled budgets We agree that we will consider the options available to us, and select the best delivery model for the integrated care system in Halton, but not withstanding this, we will continue to integrate our services on the ground, at pace, using the existing options available to us to do so We acknowledge that creating a Locality Care Partnership will not resolve the significant budget challenges facing all organisations but it will go some way to reducing it and it will be necessary to continue to work closely together with all stakeholders to manage the deficit around health and social care We fully agree with this! We believe a town-based approach for this level of transformation will yield the greatest benefits. Geographically, it makes complete sense. We have built patient engagement and coproduction into this proposal We have very good and productive relationships with the commissioners and support the approach they are taking with One Halton. We want to work with partners to ensure that the very best models and solutions are designed and implemented. That may require us to change. We accept this challenge which is why this bid focusses on the eight practices working in close collaboration. We are committed to working with partners as we look at the development of a Local Care Partnership in Halton. How this will increase the pace of change from where the Network is now? Halton CCG have developed the Halton Enhanced Scheme (HES). This supports two programmes of work across General Practice in Halton with one specific component in 2018/19 to support the development of Test Bed projects. The Test Bed projects are part of the One Halton programme, meaning we have aligned General Practice focus with the One Halton ambitions. The projects are designed to support rapid improvement cycles by focussing on specific service areas and working in partnership with a key local provider. Each Test Bed project is being run by one of the local community hubs (or networks). Each community hub is made up of between 2 and 4 local practices working together in a geographical area. Each hub is a small operational unit, each sized between 28,000 and 37,000 population size, enabling operational, community focused multi-disciplinary teams to wrap around and focus on their specific population. The graphic below shows the four Test Bed projects, the respective providers and the population sizes. 16

17 All four Test Bed projects have commenced in the last two months and this approach demonstrates that the practices can work effectively in partnership. If a Test Bed project is successful, it will be rolled out across the other three community hubs. This is a fundamental ethos behind the Test Bed approach. To run project concurrently, to implement rapidly at a small/local level, to audit and evaluate quickly and at timely intervals, to share learning and if successful, to quickly roll out for all patients to benefit. Town-based approach For some services the hubs are too small and a town-based approach will be more appropriate and efficient. As such, services need to be designed and delivered at scale, including urgent care. As there is neither an acute trust nor A&E in Widnes, we are integrating our urgent care approach and provision with the urgent care centre facilities and capacity, services and staffing these provide. We believe that our town is of a suitable size to create a town-based urgent care model. This is the same situation in Runcorn, our bordering town. They don t have an acute trust or A&E in the town but they also have an urgent care centre within their boundaries. As such, a standardised urgent care model that integrated General Practice with the urgent care facilities already in situ is integral to each town and across Halton. Furthermore, we believe this new approach will have a significant and positive impact on the wider urgent care system across Widnes and Halton. If this bid were to be successful, it would rapidly increase the pace of change as it would enable us invest in more staff time to focus on developing and delivering the schemes set out in this proposal. With this same ethos being adopted, we would look to run projects concurrently. By signing up to this proposal, each practice has committed to providing additional sessions into these initiatives. This will include GP time, nurse time, administrative time and Practice Manager time. All of this time is in addition to existing commitments and in addition to the day job. As such, all time invested in this will be paid for. How you have and will be engaging with the Network s constituent practices to ensure there is full, collective commitment to delivery of this initiative? In September 2017 Widnes Highfield Health carried out an anonymous questionnaire of staff groups throughout Practice s who wished to take part. Feedback and results from this questionnaire influence and form part of the Widnes Strategy. Over the last year, the Federation (who support practices and community hubs) has developed a strategy that sets out three headline components: Practice collaboration Service delivery and development System transformation As such, the initiatives we are proposing here underpin and support the delivery of the strategy. They also align with the CCG s Primary care Strategy. In April 2018, we restructured our Federation Board to appoint a GP Hub Lead for each Community hub. One of these Community Hub Leads is also the Federation Clinical Director 17

18 We undertook this change at our own financial risk to ensure our engagement with practices was enhanced as we entered this exciting period of our development. The duties of the GP Hub Leads are: To provide clinical leadership to the emerging hubs; To encourage the sharing of best practice across the hub(s); To build relationships with clinical staff within and between the hubs; To develop and deliver specific pieces of work (practice collaboration); To develop and deliver the wider primary care and out of hospital model Furthermore, in April 2018, we created a new Board position, Managing Director Transformation lead, again at a financial risk. The duties of this post is: To lead the development and delivery of the primary care and out of hospital model with the board, practices and partners To build relationships with key stakeholders To support the clinical hub leads and other Board members, To support the development and delivery of work across the practices To research new and innovative care and workforce models As such, we have an infrastructure already in place and operational in Widnes to immediately launch a new set of projects. With the additional funding this bid provides and with the commitment from the practices to invest in this approach (with the funding to provide back-fill), we are in a good position to expand the existing approach with very little lead in period. All practices have been given the opportunity to contribute to this bid and the initiatives it proposes. This includes the aims of the bid as well as the commitment from individual practices. As such, we believe we have the collective commitment, infrastructure and vision to deliver this proposal. How you are, or plan to engage with other Networks, GP Provider Organisations, Community Providers, Local Authority and the 3rd and Voluntary Sectors? All four Community hubs (or networks) in Halton interact on a daily basis through the two GP Federations. Widnes Highfield Health and GP Health Connect. Over the last six months, strong relationships have been developed between the two local Federations and in April 2018, a Strategic Development Group (SDG) was launched. The roles and responsibilities of the SDG have been agreed for the first 12 months as being: Hub (or Network) development and associated MDT community developments; Collaborative delivery of primary care services; The primary care workforce model; Planned care and unplanned care pathways across Halton; Out of hours service provision; Primary Care home; and Accountable Care Systems or Place-based care We also attend the newly formed Merseyside & Cheshire Federation meeting. This provides an opportunity to share best practice, ideas and initiatives. Over the last 12 months, we (the two GP Federations in Halton, representing our four community hubs) have worked very closely with Bridgewater Community Healthcare NHS Foundation Trust and have provided clinical and managerial leadership in the development of the Out of Hospital programme for the One Halton Transformation Programme. This has included working in partnership with Halton Borough Council colleagues too to develop the One Halton programme approach. 18

19 We have engaged with a number of Third Sector organisations over the last 12 months as part of the One Halton programme but also to discuss and start to share the future community hub model in Halton. We have also engaged with a local Third Sector organisation who ran an excellent public engagement session for General Practice in which the question was asked Tell us what s wrong with General Practice. We plan to undertake more of this engagement work with the Third Sector through this proposal. Our vision for the primary care at scale involves all local partners. This isn t just those mentioned above. It also involved Halton Housing, Halton Chamber of Commerce, local colleges and schools, the local faith sector and positive and progressive discussions have been made with all of these organisations. Furthermore, the clinically-led and service-led approach of the One Halton programme means that we will be engaging with, planning, designing and delivering the new services of Halton in partnership with all local providers and partners. Using the descriptors in sections of the Primary Care Network Development plan document, please describe which of these categories your Network aligns to and why. Given this proposal is written on a town-based approach, it sees the two Widnes Hubs community hubs working together. We are therefore creating a new network. Given the relative maturity of the two community hubs, we believe that the new Widnes network should be aligned to In development. Our rationale is that the practices are committed to the vision and ambition of this plan, we have a clear work plan and stated delivery expectations and if successful, we will have the funds to deliver the plan that will yield sustainable benefits. Our plan will see us working in partnership with social care, mental health, community services, the third sector, acute providers and our commissioning colleagues. All of whom are working towards the same vision. As such, we believe that within 18 months, the Widnes network will move to the next level of Progressing well Evidence - B2 What are the clear, measurable outcomes of the proposal, including timescales? There are a range of measureable outcomes that will be delivered by the successful delivery of this proposal. 1) A standardised approach to Chronic Disease Management across our eight practices A reduction in disease prevalence variation across the eight Widnes practices (as per QOF). This will be seen on a disease area basis and be seen within 12 months of the completion of each rapid improvement cycle A reduction in exception reporting variation across the eight Widnes practices (as per QOF). This will be seen on a disease area basis and be seen within 12 months of the completion of each rapid improvement cycle Reduced referrals into secondary care across the eight Widnes practices. This will be seen within 6 months of the completion of each rapid improvement cycle. Positive impact on the mortality and morbidity of the population of Widnes. We anticipate this will be seen within 5 years. 19

20 Reduced prescribing variation across the eight Widnes practices. This will be seen on a disease area basis and be seen within 6 months of the completion of each rapid improvement cycle Improved quality of patient s life (for those with specific chronic diseases). We will undertake surveys to monitor this and forecast this will be seen within 12 months of the completion of each rapid improvement cycle Increased quality of management of Chronic Disease Management. We will undertake audits against recognised standards. This will be seen on a disease area basis and be seen within 12 months of the completion of each rapid improvement cycle 2) Working effectively as a primary care network to support continuity of care A reduction in A&E activity from the eight Widnes practices. This will be a phased impact, commencing initially with a reduction in the current rate of growth. This will be achieved within 6 months of the new service model being implemented. Thereafter, there will be a reduction in A&E activity from the eight Widnes practices. A reduction in Out of Hours GP services from the eight Widnes practices. This will be a phased impact, commencing initially with a reduction in the current rate of growth. This will be achieved within 6 months of the new service model being implemented. Thereafter, there will be a reduction in A&E activity from the eight Widnes practices. A reduction in zero-day length of stay admissions into hospital from the eight Widnes practices, with a reduction in readmissions and delayed transfers of urgent care. This will be a phased impact, commencing initially with a reduction in the current rate of growth. This will be achieved within 6 months of the new service model being implemented. Thereafter, there will be a reduction in A&E activity from the eight Widnes practices. Improved utilisation of the Urgent Care Centre from the eight Widnes practices. This will include both an increase in volume of activity and a reduction in waiting times at the centre. This will be seen within 3 months of the new service model being implemented. Creation of variable appointment duration to match patient needs across the eight Widnes practices. This will be seen within 3 months of the completion of each rapid improvement cycle AND the implementation of the new urgent care service model. Improved staff morale across the eight Widnes practices. This will be realised within 6 months of the new service model being implemented. 3) Standardised care navigation Increase in access to General Practice services via electronic means (e.g. web solutions). This will be seen within 6 months of launching the new care navigation approach. Increase appropriate attendance in primary care services. This will be seen within 6 months of launching the new approach. We will undertake surveys to monitor this. Increase in patient satisfaction across the following survey questions: o Ease of getting through to appropriate services o Helpfulness of Care Navigators o Overall, how would you describe your experience This will be seen within 6 months of launching the new care navigation approach. We will undertake patient surveys to monitor patient satisfaction. 4) Realising efficiencies through standardising back office functions Increase in time efficiency for all eight Widnes practices. This will be realised immediately after each rapid improvement cycle. Increase in financial efficiency for all eight Widnes practices. This will be realised gradually after each rapid improvement cycle Reduction in delays in functions such as scanning and coding. This will be realised within 3 months after each rapid improvement cycle. Standardise the quality of scanning and coding. This will be realised within 6 months after each rapid improvement cycle. We will undertake audits to monitor this measure. 20

21 Evidence - B3 Funding to support Primary Care Network Development is time-limited. Please indicate here how you will sustain the impact of the project after the funding ceases. We have structured our approach within this proposal to ensure a sustainable and long-term impact. We will achieve this by: Investing skills and expertise in our staff Developing local change processes (and skills) that we can and will run and deliver ourselves moving forward without the need for external support Fully designing the new model for urgent care in General Practice Commencing the implementation of the new model for urgent care in General Practice Using the efficiencies in time and money we generate to re-invest in more transformation and joint working Investing in the infrastructure (IT systems) that will yield long-term benefits Investing in our relationships with key partners that will yield on-going benefits. Increasing staff morale and staff retention. Please confirm that all constituent GP practices which are identified above are aware of the Development Fund requirements and are collectively signed up to delivery of the milestones identified in B2 above. Please submit a scanned copy of a simple agreement which confirms the above. (Please see template below) Network / Federation Leader Signature (permitted to act on behalf of constituent GP practices): Dr Paul Hurst Managing Director Transformation Lead Widnes Highfield Health GP federation Date: Primary Care Networks form an important part of integrated place-based delivery systems and proposals must align to the local place vision and strategy. The Place Senior Responsible Officer must therefore support this application. Application supported? or NO Please provide brief details to support your response: Effective General Practice is a fundamental component of One Halton and the whole system transformation we are seeking to deliver. The two GP Federations in Halton, representing all 14 local practices, have offered innovation,insight,commitment and leadership to the One Halton programme over the last 6 months. This bid represents the ambition and the enthusiasm they have demonstrated to improve services for local people. 21

22 As the place-based SRO for Halton, I fully endorse the proposals, the approach and outcomes described in this submission and will provide support and challenge to our General Practice colleagues and the whole system to ensure the impact and opportunity of this funding is maximised. Place SRO Signature: Date:

23 PRIMARY CARE NETWORK DEVELOPMENT FUND AGREEMENT OF THE CONSTITUENT MEMBERS OF THE NETWORK FOR THE SUBMISSION OF AN APPLICATION TO THE FUND We are the constituent GP Practice members of the Network named below and confirm that we are aware of the contents of this application for financial resources to support the development of Primary Care Networks and that we accept that we accept the conditions of the scheme. Primary Care Network/Federation Name: Widnes Highfield Health GP Federation on behalf of Widnes Community Hub 1 and Widnes Community Hub two. Name of Primary Care Network Lead: Dr Paul Hurst, Managing/Transformation Director, Widnes Highfield Health GP Federation, Highfield Road Widnes WA8 7DJ On behalf of Widnes Community Hub 1 and 2 Contact Details (inc telephone and address): Please supply details of the lead individual and lead practice which have been identified for this project and who will assume leadership and financial responsibility for delivery of this project. GP Practice Name Lead GP Partner Name GP Partner s Signature Appleton Bevan Group Practice The Beeches Medical Centre Hough Green Health Park Newtown Health Care Centre Oaks Place Surgery Peelhouse Medical Plaza Upton Rocks Dr M Brindle Dr S Veedu Dr S Baker Dr S Koya Dr A Arain Dr L Meda Dr P Hurst Dr S Patalia Name of Lead Practice for Memorandum of Understanding and Finance process: Widnes Highfield Health GP Federation. GP Partner s Practice Lead GP Partner Name GP Partner s Signature Peel House Medical Plaza N81045 DR PAUL HURST 23

24 24

25 Health & Care Partnership for Cheshire & Merseyside PRIMARY CARE NETWORK DEVELOPMENT FUND APPLICATION PACK Electronic copies of this application form are available from: For any queries, advise or support regarding the application process, please contact: Applications to be submitted by to: Closing date for applications: 9 July 2018 at 12 noon 1

26 1. How to apply PRIMARY CARE NETWORK DEVELOPMENT FUND APPLICATION FORM Primary Care Networks / Federations are asked to complete this form on behalf of their Network/Federation in order to enter the funding application process approved by the Cheshire and Merseyside (C&M) System Management Board. The purpose of this funding is to hasten the development of Primary Care Networks/Federations and increase the pace of real transformational change to deliver the Partnership s business plan to close the three gaps: quality, outcomes and affordability. The table below explains how applications meeting the entry requirements (A1-A4) will be judged against the criteria for assessment (B1-B2) and any allocations made available through this process will be subject to ongoing conditions (C1-C2) being met. # Entry Requirements Assurances A1 Confirmed commitment of constituent GP Confirmation from NHSE C&M Director of practices named in the application to work Commissioning together on a Network / Federation level. A2 A3 A4 A5 A clear and credible primary care at scale model is either already in place or there are robust plans to develop one. Realistic yet challenging programme plans in place or commitment to development including timescales and clear outcomes. Engagement of all GP Practices within the Primary Care Network footprint. Confirmed commitment of PC Network and constituent practices to work in full partnership and cooperate with local CCG and place-based systems to transform local care. Evidence provided to NHSE C&M Director of Commissioning Agreed with NHSE C&M Director of Commissioning Evidence provided to NHSE C&M Director of Commissioning of engagement activity. Confirmation of commitment in Application # Criteria Assurances B1 Evidence that allocated funding will Evidence provided to NHSE C&M Director of expedite the development of the Primary Commissioning Care Network and increase the pace of change and delivery of the primary care at scale model as a fundamental part of place-based integrated service delivery which aligns with the objectives of the C&M Health & Care Partnership, including initiatives funded by the Transformation Fund B2 Evidence of the clear, measurable outcomes of the initiative(s), including timescales and the return on investment. Evidence provided to NHSE C&M Director of Commissioning # Conditions Assurances C1 Network / Federation Leaders must be able to provide regular updates on the progress of their programme s delivery and be willing Regular status updates to GPFV Programme Director. to present status updates evaluating success to-date and any measurable outcomes. 2

27 C2 Network / Federation Leaders to share lessons learnt from their programme at organised learning events. Attendance. 2. Timeframes for applications The application process is now open with the purpose of assessing submissions and proposing allocations in time for the System Management Board meeting taking place w/c 16 July 2018 at which it is planned to confirm successful applicants. The full timetable is as follows: Date w/c 21 May 2018 W/c 28 May and W/c 4 June 2018 Action Communications issued to all GP practices and GP Federations. Place SROs, CCGs and LMCs copied in. Start of three briefing events held across Cheshire and Merseyside. 9 July 2018 at 12 noon Deadline for submitting applications to NHS England. 11 July 2018 Applications reviewed and collated W/c 16 July 2018 Panel convenes, assesses applications and shortlists bids for recommendation to C&M HCP 31 July 2018 C&M Health and Care Partnership Board approval. By 3 August 2018 All bidders notified of outcome with successful bidders being informed of: the sum available, any conditions applied to the offer, their buddy the memorandum of Understanding summary of next steps 3

28 Health & Care Partnership for Cheshire & Merseyside APPLICATION FOR PRIMARY CARE NETWORK DEVELOPMENT FUND Network / Federation Name: GP Health Connect, on behalf of St Pauls Community hub and Runcorn New Town Community hub General Practices signed up to the Network / Federation Proposal: How many GP practices are part of this Network proposal? : 6 What is the Network population coverage for this proposal? : 64,977 Please list below all of the practices that are part of this application Practice Name Practice List Size Lead Practice GP Name Brookvale Practice 8,393 Dr Patricia Abbott Castlefields Health Centre 12,664 Dr Zoe Rog Grove House Partnership 13,753 Dr Claire Forde Murdishaw Health Centre 7,821 Dr Rhian Thomas Tower House Practice 13,204 Dr Helen Bartlett Weavervale Practice 9,142 Dr Fenella Cottier Total Population 64,977 Please confirm that all of the above practices have committed to the contents of this Network proposal? Network/Federation Lead name and contact details (including address and telephone): Please supply details here of the individual who has been identified from the Network to act as lead for this application. Dr Gary O Hare, Murdishaw Health Centre, N81072, Network Finance Lead name and contact details if different to above (including address and telephone): Please supply details here of the individual who has been identified from the Network to act as finance lead for this application. Dr David Wilson, Grove House Partnership, N81066, Brief Description of Scheme: Runcorn is a town of 65,000 residents. It has six GP practices who all work for their patient population in different ways. We recognise the value that this approach brings but also appreciate the variation and inefficiency that exists. We also recognise the increasing pressure and demand that is being placed on General Practice and its staff, along with the increasing physical and psycho-social complexity of a lot of our patients. 4

29 We want to create a primary care network that increases the capacity that is available to meet the increasing demand and need of our residents, that improves outcomes, that gives us more time with patients, to support patients to care for themselves, that reduces unwarranted variation, that maximises the skills and efficiency of our workforce, that improves the morale and job satisfaction of general practice staff, that reduces competition between practices and increases appropriate and timely access to the correct services. From experience we know that patients value the unique relationship with their GP and GP practice. We also know that continuity creates a safer, more efficient system with higher patient and staff satisfaction. But we need to think and act differently to enable us to create an approach where continuity can be offered when and where it s most important e.g. for those with long term conditions, complex comorbidity, frail elderly, or palliative care needs, whilst also working to meet the general rising demand. At the heart of our approach is the six practices working in collaboration and as part of a network. General Practice in Runcorn is a key member of the local Transformation programme, One Halton. Represented by our GP Federation, GP Health Connect, we as local clinicians, in collaboration with our system partners, are embarking on an ambitious programme of work to transform the health and care system across Halton. We are fully committed to this programme of work and will play a leading role in delivering the vision of One Halton which is to work together to improve the health and wellbeing of the people of Halton so they live longer, healthier and happier lives To achieve this, we accept the challenge that everyone must change. The way services are commissioned and provided needs to be different. The four schemes set out in this proposal lay the foundations in General Practice in Runcorn for how we will start to meet this challenge. This funding will be essential to accelerate the pace of change in general practice organising itself into a mature, robust, reliable, sustainable network capable of supporting system wide change. Our four schemes are: 1) A standardised approach to Chronic Disease Management across our six practices 2) Working effectively as a primary care network to support continuity of care 3) Standardised care navigation 4) Realising efficiencies through standardising back office functions In this bid, we will describe each scheme in further detail, setting out the rationale, the approach, the timescales and the impact for each. By signing this bid, our six practices have committed to support and deliver these four schemes for the residents of Halton. We are also delighted to have the support from our CCG, place-based SRO, David Parr, and One Halton Board. Evidence - B1 1. What level of financial resources you are seeking together with a breakdown, please indicate where current funding is already supported (clarifying total spend for each area) In total, we are seeking 205,300. Based on the funding approach being adopted with this transformation fund, we are requesting a one-off award of 75,000. The table below present a breakdown of where this funding will be used: 5

30 The 75,000 will be used to fund the majority of the Transformation & Change specialist support, the commencement of the public engagement campaign and a small number of staff sessions in 2018/19. The 1/head contribution will then be used to fund the remaining staff sessions and project management support, the remaining Transformation & Change specialist support and the majority of the public engagement campaign. The staffing input is critical to the success of this programme. As such, we have asked for each practice to commit to the contribution of one session a month from a GP, a nurse, a Practice Manager and a member of administrative staff. The schemes they will develop and deliver are set out below. The time required from all staff to invest in these schemes will require remuneration. This will cover a combination of back fill or staff working additional hours to ensure that current services continue whilst this programme of work is undertaken. The GP Leadership approach is explained later in this proposal, as is the full time project manager (based on 18 months cost). The project manager will be fixed-term appointment, concluding in March Our preference is to appoint our own project manager. This will be a shared appointment between this bid for Runcorn and the bid for Widnes. The project manager will support both programmes of work. The role and input of the Transformation & Change specialist support and Public engagement campaign support are detailed in this proposal. Current funding At present (and as described in this proposal), the practices in Runcorn receive 5/head as part of the Halton Enhanced Scheme (HES). This funding is split across 2 main schemes Quality referral initiative and Community Hub development. The proposal sets out how this funding is being used to support the Community Hub development and roll out and delivery of a series of Test Bed projects which fully align to the One Halton Transformation programme. The second element of funding being received in Runcorn is a share of 25,000 (half of this) General Practice Resilience Funding which was won in 2017/18. This has been used to support a scheme called GP Staffing Pool which has been led by two local GPs. This initiative is continuing and fully aligns to the schemes set out in this proposal. 6

31 The funding we have requested will all be used exclusively to support the development and delivery of this proposal. It will not duplicate any existing funding contributions and will not be used to generate any profits for practices or provide overhead contributions to the GP Federations. How the Network s proposal will enable the delivery of primary care at scale and make a major contribution to/align with local place-based, integrated service delivery plans. The current approach to General Practice is unsustainable. We know there is variation is the services and outcomes across our practices. We are experiencing increasing demand from patients with ever increasing complexity and need. The increase in demand is from patients with both chronic and acute need, as well as mental health needs and social needs. We see a lot of people and we know we re not always the most appropriate place or people to provide the best or most effective support. Our partners in the local health and care system have skills, expertise and capacity that can better meet some of the demand we see. The overall system is too fragmented. It s often confusing for us to know how to best navigate it and we know it can be incredibly confusing and difficult for our patients too. We want and need to spend longer with our patients who need more support and intervention. All of these factors are contributing to reducing morale across our work force and as a result, it makes retention of our staff more challenging. Want to change this We want to work together as practices to offer a standardised approach across Runcorn. We want to work in a much more integrated way with our partners, including social care, mental health, community services, the third sector and our acute colleagues. We know we can do more to support prevention and self-care. We want to increase the capacity available using the same resources and assets but in a different, more efficient way. We want patients seeing the right professional and right service every time and that doesn t always mean General Practice or a GP. We want to invest in our staff and maximise the skills that we have available in Runcorn. We want to make Runcorn a great place to work in General Practice. What does this mean for patients? We want to improve the health of our population We want to improve the experience of our population accessing local services We want to spend more time with patients who need it and reduce the number of times a patient needs to tell their story We want care continuity for patients who need it and to ensure that patients access the right services quickly What does this mean for our provider colleagues and workforce? We want to work as an integrated team with our statutory and non-statutory partners We want to maximise everyone s skills and increase morale We want to be co-located with partners (where it s appropriate) to offer one stop services We want to develop portfolio careers, offering choice and variety and opportunities to continue to learn and develop (where people want to) We want to make Runcorn a great place to work We are a committed partner to the One Halton Transformation Programme and the vision it has for Halton. The four schemes included in this proposal and set out below describe how we plan to get General Practice in Runcorn ready for operating in this future model, by working together and by working at scale. We have the commitment from all six practices to embark on this ambitious change programme. Our four schemes: 7

32 1) A standardised approach to Chronic Disease Management across our six practices Rationale Whilst all practices already follow QOF guidelines and NICE, across our practices there still remains variation in our outcomes for the different Chronic Disease Management groups, in our approach, in our pathways, in our training, in our communications and in our systems and information flows. Data showing variation in QOF prevalence rates across the six Runcorn practices (2016/17) Data showing variation in specific QOF indicators across the six Runcorn practices (2016/17) Our aim is to create a standardised town-based approach for each Chronic Disease Management group that will both reduce and remove elements of this variation and improve patient outcomes. By adopting this approach, we can start to share resources and skills across the town. We can support each other and ensure that every Runcorn resident is receiving the same level of care. We will include prevention and self-care in the approach for each group to ensure we are not just focussing on treatment. We will do this by working with our local Public Health colleagues and the One Halton Population Health Framework. We will provide services and support through multi-disciplinary teams, working in an integrated way with our partners across all sectors community staff, social care, third sector providers, acute and mental health colleagues whoever we need to in order to provide the very best care. The teams will provide care and support to patient groups, ensuring the most appropriate professional is providing the right support to patients at the right time. By improving Chronic Disease Management in General Practice, we will reduce demand on acute services. Approach We will create a rolling programme of rapid improvement cycles that focus on and standardise the approach to every Chronic Disease Management group. Led by our nursing workforce and working in partnership with local GPs (including those with Special Interests), relevant local providers, Public Health colleagues, Practice Managers, the third sector, administrative staff, commissioning colleagues and IT colleagues, we will review all aspects of our approach and delivery of care to these patient groups. We will engage with and co-produce these new ways of working with patients and their carers who live with these conditions. 8

33 We will work in partnership with a Transformation and Change specialist, Integral Health Solutions, to diagnose, design, deliver and demonstrate solutions and changes. We believe that emerging solutions will involve multi-disciplinary team working in practices and in the communities, working in an integrated way with a range of partners. By working in this way, we believe we can standardise the approach, the templates, training and audit, skill mix, recall systems, patient access, exception reporting, patient information, patient education and information leaflets. We will focus on all aspects of care from prevention and self-care (supported by the One Halton Population Health Framework), through to treatment and palliative care. Our aim is to work with our commissioning colleagues and Public Health team to agree a prioritised order of which Disease Management Groups we will review based on a factors including unmet need, variation and levels of demand. Diagnose stage We will align our approach with what is recognised as best practice. We will do this by benchmarking and analysing our various approaches against NICE guidelines and quality standards, JSNA, patient feedback and experience, QOF data, exception reporting, prescribing data, medicines management intelligence, acute service demand, risk stratification and the local Primary Care dashboard. We will work closely with the Business Intelligence teams of the CCG and Public Health teams. We will focus on clinical pathways, infrastructure (governance, IT, estates, monitoring) and staffing. Design stage We will work with partners, patients and their carers to design and map the right services, pathways, approach, staffing, skill mix, communication and enabling infrastructure for each chronic disease group. This will be a true partnership approach. Deliver stage We will plan, implement, test and embed the agreed changes. We will do this with our partners and communicate effectively throughout the process. Demonstrate stage We will capture both quantitative and qualitative data and evidence to demonstrate the effectiveness of the changes we make. This overall approach presents a new way of working for General Practice working at scale. We have engaged with a Transformation & Change specialist to support us with this. However, we want to invest in our staff and processes so we are not reliant on external support in perpetuity. As such, we are asking them to help us do three things: 1. Co-design and produce a framework and approach by which these rapid improvements cycles can be undertaken locally in Runcorn 2. Train our staff our nurses, Practice Managers, administrative staff and GPs - in the skill of change management and rapid improvement cycles because we want the skills to do this moving forward. 3. Work with us closely and lead the first rapid improvement cycle, from beginning to end. Our aim is to complete the first rapid improvement cycle in six months. Thereafter, our aim is to undertake and complete each within 3-6 months. 9

34 Timescales Our aim is to commence the first rapid improvement cycle in October Therefore, our aim is to complete the first rapid improvement cycle by March We would then aim to undertake a further four rapid improvement cycles in 2019/20 and would have the skills to continue this process into 2020 and beyond. 2) Working effectively as a primary care network to support continuity of care Rationale General Practice is increasingly struggling to cope with the daily levels of demand placed upon it. Typical demand can be put into one of three categories: 1) Chronic Disease Management, planned care 2) Acute demand 3) Planned/pre-bookable The demand in each of these categories is increasing and as such, the time we have available to adequately meet this demand is reducing. It is not just about meeting the demand either, it s about providing the level of care that people need, at the right time with the right person. We need to spend more time with some of our patients. Our aim is to adopt a new and integrated town-based approach with our urgent care centres to increase the capacity that is available. Approach We want to implement a new approach for how local residents access services in Runcorn. We also want to maintain care continuity for those patients who need it the most, e.g. those with chronic conditions or the frail elderly (this is not an exhaustive list). We also want to be able to offer longer appointments and work in a more integrated and team-based way with our partners (mental health, social care, third sector, acute, community) to better support these patients. By doing this, we can better manage and support patients and their conditions in the community, resulting in care closer to home and meaning patients only need to go to hospitals when specialist intervention is required. We can also work with acute specialists in the community (e.g. geriatricians and paediatricians) as part of a wider, more integrated community based workforce. The way we believe this can happen is to integrate the urgent care centre provision with general practice in Runcorn. This is a key reason for submitting this bid on behalf of our town-based population of 65,000. The rationale for this is further explained below. Where a patient wants to see a doctor or clinician and they don t have a chronic disease (or has a complex need that we believe should be managed in general practice), we will offer them a choice of where to access services locally. This could be an appointment in general practice or an appointment on the day at the urgent care centre, whether this be for acute on the day or planned or pre-bookable. The patient will be offered an on the day appointment in the urgent care centre where they will see a clinician appropriate for their need, but not likely to be their usual GP. By approaching the on the day demand in this way, it will create capacity in General Practice to provide care continuity for those patients where it s most important e.g. for those with long term conditions, complex co-morbidity, frail elderly, or palliative care needs 10

35 We see opportunity to rotate practice staff through the urgent care centres, providing an integrated town-based service with other providers. This very much lends itself to the scope and requirements of the future Urgent Treatment Centre model. Rotating some practice staff through the urgent care centres will also support staff retention and training as it will provide opportunities to experience new and different environments and services. We will work with our partners across Runcorn as we believe having social workers, wellbeing officers, community staff, mental health professionals, our third sector partners (including organisations like Citizens Advice), acute professionals and our local housing experts will provide a more convenient service. We want to create a multi-disciplinary approach where physical, mental, social and domestic needs and issues can all be supported within a single visit. This is our ambition for our community hubs of the future but we believe this type of multi-disciplinary team can be established in the urgent care centres now. We believe that this approach of offering on the day access to appointments in a town-based service will be very attractive to a lot of our residents. We run the GP Extended Hours service in Runcorn and have been since April The feedback from a significant proportion of the service users is that they welcome the opportunity to have access to a convenient town-based service, where they don t see their own GP or clinician. It is the patient s choice to use the service. 98% of patients who use the GP Extended Hours service tell us they would use it again, and a lot do. For this new approach to work, we need to invest in our care navigation and IT systems. The urgent care facilitates will have full visibility and access to the patient s primary care record, across all disciplines. Whether a patients calls the practice, uses an IT solution to book an appointment or walk s in to the practice or urgent care centre for an appointment, we believe it is essential that a standardised approach to offering and accessing services is deployed across Runcorn. As such, we need to develop a system that can be accessed and used by both the patient or staff members to ensure patients are accessing the right service. A critical first step in this scheme is to undertake detailed capacity and demand management modelling of general practice. We are delighted that NHS England are commissioning the APEX/Insight tool for local practices as we believe this will provide the data and intelligence we need to start to plan the service configuration. This tool will extract detailed levels of staffing, services and productivity data from every practice system. It will enable us to accurately model the demand on services, how each practice manages this and for us to model alternative approaches to test the most efficient solutions and pathways. It will also enable us to consider alternative workforce models and to consider how we can maximise the efficiency and utilisation of both our current and future staff. Work is already being undertaken by Halton CCG to develop the local Urgent Treatment Centre and we are collaborating with them and other partners to develop the urgent care model, the service specifications, the future capacity requirements and the future care pathways to meet the levels of need and demand for a 24/7 solution in our community. This will consider all aspects of care in the community including services such as pharmacy and optometry. We also mindful of potential future changes to services such as NHS 111. To do this, it is essential that General Practice is ready to work in this way and at scale. As such, we will establish a group to lead this piece of work on behalf of General Practice in Runcorn. This group will consist of GPs, nurses, Practice Managers and administrative staff. It need to be fully representative. This group will start in September 2018 and continue until March 2020 when we believe the new ways of working will be implemented. 11

36 This group will use the same approach outlined above diagnose, design, deliver, demonstrate to develop a standardised General Practice service for urgent care. To underpin this and the scheme described above, we are engaging with a local Third Sector organisation, Halton Voluntary Community Action (Halton VCA), to work in partnership with us to support a public engagement and insight campaign. Halton VCA ran an excellent public engagement session for General Practice in 2017 in which the question was asked Tell us what s wrong with General Practice. During and after the event, we received invaluable feedback including that 80% of attendees who responded to a survey said they felt more optimistic about the future of General Practice in Halton after attending the event. Therefore, we are confident that if we can effectively engage with the population, we can co-produce effective services and solutions that they will support. We want to work with, engage with and discuss the best ways of developing these standardised General Practice services with our residents from the outset, doing this in partnership with Halton VCA. Finally, we will engage with and align our IT requirements into the local IT Group to ensure that the technical solutions we require in General Practice are developed and implemented and integrate into the wider IT solutions across Runcorn. Timescales We understand that the APEX/Insight tool will be deployed into Runcorn soon and we will look to commence detailed capacity and demand management modelling in October We will start the General Practice project group in September 2018 and start to design the public engagement campaign with Halton VCA in September too. We anticipate the public engagement work will commence in November We anticipate 12 months of diagnosing and designing work so forecast that the deliver stage (service changes) will start to be made in September 2019, ahead of the winter period. The IT requirements will need to fit in line with the roll out of the new approach. 3) Standardised care navigation for every patient Rationale The two schemes described above will change the way that services are offered and accessed. As a result, a town-based and consistent approach to Care Navigation across all practices is critical. We believe it is also essential to maximise the benefits of a new Care Navigation approach, a single approach is deployed across all six practices at the same time. Without a robust, coherent and fully aligned/integrated approach, our view is that complaints could increase and patients may be left confused if practices are offering different advice. Approach NHS England have provided funding to support Care Navigation training and Halton CCG has already commenced a programme of work that has engaged with practices. 12

37 The approach we want to take, working in partnership with the CCG, is to lay the foundations to maximise the impact of care navigation. We want to line up all of the services and focus on implementing the optimum solution. Given the timescales set out above, we believe we have just over 12 months to develop a town-based approach to care navigation that will include the development of a common set of protocols and rules, a common script, common service list and access choices. We believe this offers a great opportunity to develop our staff, develop skills and potentially share our resources and skills across the town. There is concern that if practices launch Care Navigation at different times, it may confuse patients and as such, complaints may increase, patients may look to move practices and the variation of what services are offered may increase. As such, we want to establish a working group consisting of Practice Managers, administrative staff and our commissioning colleagues to oversee and develop this scheme in partnership. Staff involved in this will represent practices and lead the development, launch and implementation within their respective practices and to embed the training that is available from the GP Forward View back into every practice in Runcorn across the whole workforce. Furthermore, we will incorporate the Care Navigation scheme and changes that will arise from it into the public engagement campaign that we described above. We want to present a holistic and joinedup picture to the public. Timescales Our plan is to establish the working group described above in September 2018 and this will run for approximately 12 months. This working group will work in partnership with commissioning colleagues. The group will oversee the design of the approach, the training requirements, coordination with the public engagement campaign and the roll out at practice level. 4) Realising efficiencies through standardising back office functions Rationale There is an opportunity for General Practice to realise significant efficiencies in the way it coordinates and operates its back office functions. By back office functions we mean: Coding; Scanning; Summarising records; Patient correspondence; Telephony; Referral administration; Hospital correspondence/communication; National patient safety alerts; Medicines management; Audits; Searches As well as efficiencies, we believe this will improve patient safety and quality of services as it will reduce potential delays in functions such as scanning and coding of patient s records and discharge summaries. This will provide more timely information to our staff. This scheme will not save the practices money but it will present the opportunity to increase productivity and efficiency of the funding that is currently spent. 13

38 At present, the six practices operate these functions largely independently of each other and there is a lot of scope and opportunity to standardise and centralise this, whilst creating and developing transferable skills and increasing the resilience of the respective services. Approach As described in scheme 1 above, we want to create a rolling programme of rapid improvement cycles that focus on and standardise the approach to each function. Lead by Practice Managers, working in partnership with administrative staff, we will review all aspects of our approach and delivery across each function. The diagnose, design, deliver, demonstrate approach outlined above will be adopted in this scheme too. As will the three aspects of the approach co-design the approach, train our staff, implement the first cycle with us. Our aim is to complete the first rapid improvement cycle in six months. Thereafter, our aim is to undertake and complete each within six months. We don t want our administrative staff to see this as a threat. We believe that this will result in changes within our administrative workforce however, we are not considering redundancies. There are significant opportunity to retrain staff, to support them develop new skills and to redeploy their skills within the new town-based general practice model. Timescales Our aim is to start this process in October Therefore, our aim is to complete the first rapid improvement cycle by March We would then undertake a further two rapid improvement cycles in 2019/20 and would have the skills to continue this process into 2020 and beyond. Programme leadership and resources This programme of work and the four schemes it details will be driven by the GP Federation, GP Health Connect, supported by every practice. The Federation will monitor progress every month at its regular Board meeting. We will invite our NHS England buddy and a member of the CCG commissioning team to this session to provide complete transparency in our progress. The overall lead for the programme of work is Dr Gary O Hare, local GP and Clinical Transformation Lead for the GP Federation. He will dedicate 2 sessions a month to provide leadership across Runcorn and focus on the delivery of the schemes. He will be supported by the dedicated project manager. We are then asking each practice to commit to providing one session of input a month across the four schemes from a GP, a nurse, a Practice Manager and a member of administration staff. We believe that this whole approach underpins the principle of primary care at scale and fully aligns with the local place-based agenda. As a core and major member of the One Halton Board, we have signed a commitment to: Improve health and wellbeing outcomes for local people; 14

39 Collaborate between health and social care services, providing accessible high quality services to local people; Develop new ways to prevent and better detect illness; Reduce the levels of demand on hospital, acute care and healthcare services generally; Deliver service closer to home and within local communities We believe that the schemes we have set out above fully align to and start to deliver our commitment to the One Halton Board and the CCG Transformation agenda. How the Network s proposal is aligned to any current CCG transformation agenda As set out in the previous section, we believe that our proposed fully aligns to the CCG Transformation agenda, One Halton. The vision of One Halton is working together to improve the health and wellbeing of the people of Halton so they live longer, healthier and happier lives We believe that our proposal fully supports this vision. We want to work at scale and in partnership and develop services to fully meet the needs of our residents. All members of the One Halton Board have been asked to support 10 commitments. These are listed in the table below. We believe our proposal fully supports each commitment. Commitment We agree that an integrated system of health and social care is the best way to ensure optimum health, wellbeing and care outcomes for our population and to ensure collective financial sustainability. We agree that the Halton Health & Wellbeing Strategy provides the focus for our work together and sets out our vision to work together to reform health and social care services to improve the health outcomes of our residents and reduce health inequalities, as quickly as possible We agree the One Halton ACS Board will provide a focal point for prevention and early intervention, proactively identifying potential future demand and shifting the focus from unplanned and reactive services to planned and targeted interventions We agree to put patients and residents at the heart of what we do We agree to put General Practice and other community practitioners at the centre of our care model We agree to design and plan services around functional geographical footprints with populations of 30,000 to 50,000 based on registered patient lists We agree to design services for users and not our organisational needs The Commissioners agree to deliver a single approach to commissioning health, wellbeing and care services in order to transform services and improve outcomes. This will enable collaboration integrated working and include the development of pooled budgets We agree that we will consider the options available to us, and select the best delivery model for the Does this proposal support the commitment? How? Our proposal fully focuses on integrated systems and providing optimum care and outcomes. As a partner, we support the drive for financial sustainability Our proposal is fully aligned to the One Halton vision and programme and we want to commit clinician time to the development to ensure this is a clinically-led redesign programme, in partnership with our colleagues from other organisations. We are an active member of the One Halton Board and fully support the approach and work streams. As such, we are targeted the Urgent Care & Complex Care needs work stream with this proposal Patient focus is at the heart of our proposal We fully agree with this! We believe a town-based approach for this level of transformation will yield the greatest benefits. Geographically, it makes complete sense. We have built patient engagement and coproduction into this proposal We have very good and productive relationships with the commissioners and support the approach they are taking with One Halton. We want to work with partners to ensure that the very best models and solutions are designed and 15

40 integrated care system in Halton, but not withstanding this, we will continue to integrate our services on the ground, at pace, using the existing options available to us to do so We acknowledge that creating a Locality Care Partnership will not resolve the significant budget challenges facing all organisations but it will go some way to reducing it and it will be necessary to continue to work closely together with all stakeholders to manage the deficit around health and social care implemented. That may require us to change. We accept this challenge which is why this bid focusses on the six practices working in close collaboration. We are committed to working with partners as we look at the development of a Local Care Partnership in Halton. How this will increase the pace of change from where the Network is now? Halton CCG have developed the Halton Enhanced Scheme (HES). This supports two programmes of work across General Practice in Halton, with one specific component in 2018/19 to support the development of Test Bed projects. The Test Bed projects are part of the One Halton programme, meaning we have aligned General Practice schemes with the One Halton ambition. The projects are designed to support rapid improvement cycles by focussing on specific service areas and working in partnership with a key local provider. Each Test Bed project is being run by one of the local community hubs. Each community hub is made up of between 2 and 4 local practices working together in a geographical area. Each hub is a small operational unit, sized between 28,000 and 37,000 population size, enabling operational, community focused multi-disciplinary teams to wrap around and focus on a specific population. The graphic below shows the four Test Bed projects, the respective providers and the population sizes. All four Test Bed projects have commenced in the last two months and this approach demonstrates that the practices can work effectively in partnership. If a Test Bed project is successful, it will be rolled out across the other three community hubs. This is a fundamental ethos behind the Test Bed approach. To run projects concurrently, to implement rapidly at a small/local level, to audit and evaluate quickly and at timely intervals, to share learning and if successful, to quickly roll out for all patients to benefit. 16

41 Town-based approach For some services, the hubs are too small and a town-based approach will be more appropriate and efficient. As such, services need to be designed and delivered at scale, including urgent care. As there is neither an acute trust nor A&E in Runcorn, we are integrating our urgent care approach and provision with the urgent care centre facilities and capacity, services and staffing these provide. We believe that our town is of a suitable size to create a town-based urgent care model. This is the same situation in Widnes, our bordering town. They don t have an acute trust or A&E in the town but they also have an urgent care centre within their boundaries. As such, a standardised urgent care model that integrated General Practice with the urgent care facilities already in situ is integral to each town and across Halton. Furthermore, we believe this new approach will have a significant and positive impact on the wider urgent care system across Runcorn and Halton. If this bid were to be successful, it would rapidly increase the pace of change as it would enable us invest in more staff time to focus on developing and delivering the schemes set out in this proposal. With this same ethos being adopted, we would look to run projects concurrently. By signing up to this proposal, each practice has committed to providing additional sessions into these initiatives. This will include GP time, nurse time, administrative time and Practice Manager time. All of this time is in addition to existing commitments and in addition to the day job. As such, all time invested in this will be remunerated. How you have and will be engaging with the Network s constituent practices to ensure there is full, collective commitment to delivery of this initiative? Over the last year, the GP Health Connect Federation (who support all Runcorn practices) has developed a strategy that sets out three headline components: Practice collaboration Service delivery and development System transformation As such, the initiatives we are proposing here underpin and support the delivery of the strategy. They also align with the CCGs Primary Care strategy. In April 2018, we restructured our Federation Board to appoint a GP Hub Lead for each Community hub. We undertook this change at our own financial risk to ensure our engagement with practices was enhanced as we entered this exciting period of our development. The duties of the GP Hub Leads are: To provide clinical leadership to the emerging hubs; To encourage the sharing of best practice across the hub(s); To build relationships with clinical staff within and between the hubs; To develop and deliver specific pieces of work (practice collaboration); To develop and deliver the wider primary care and out of hospital model Furthermore, in April 2018, we created a new Board position, Clinical Transformation Lead, again at a financial risk. The duties of this post are: To lead the development and delivery of the primary care and out of hospital model with the board, practices and partners; 17

42 To build relationships with key stakeholders; To support the GP hub leads and other Board members; To support the development and delivery of work across the practices As such, we have an infrastructure already in place and operational in Runcorn to immediately launch a new set of projects. With the additional funding this bid provides and with the commitment from the practices to invest in this approach (with the funding to provide back-fill), we are in a good position to expand the existing approach with very little lead in period. All practices have been given the opportunity to contribute to this bid and the initiatives it proposes. This includes the aims of the bid as well as the commitment from individual practices. As such, we believe we have the collective commitment, infrastructure and vision to deliver this proposal. How you are, or plan to engage with other Networks, GP Provider Organisations, Community Providers, Local Authority and the 3rd and Voluntary Sectors? All four Community hubs in Halton interact on a daily basis through two GP Federations. GP Health Connect and Widnes Highfield Health. Over the last six months, strong relationships have been developed between the two local Federations and in April 2018, a Strategic Development Group (SDG) was launched. The roles and responsibilities of the SDG have been agreed for the first 12 months as being: Hub development and associated MDT community developments; Collaborative delivery of primary care services; The primary care workforce model; Planned care and unplanned care pathways across Halton; Out of hours service provision; Primary Care home; and Accountable Care Systems or Place-based care The Federations also attend the newly formed Merseyside & Cheshire Federation meeting. This provides an opportunity to share best practice, ideas and initiatives. Over the last 12 months, we have worked very closely with Bridgewater Community Healthcare NHS Foundation Trust and have provided clinical and managerial leadership in the development of the Out of Hospital programme for the One Halton programme. This has included working in partnership with Halton Borough Council colleagues too to develop the One Halton programme approach. We have engaged with a number of Third Sector organisations over the last 12 months as part of One Halton programme and to discuss and share our vision for General Practice and our integrated approach. The local Third Sector are critical partners. We have also engaged with a local Third Sector organisation (Halton VCA) who ran an excellent public engagement session for General Practice in which the question was asked Tell us what s wrong with General Practice. We plan to undertake more of this engagement work with the Third Sector through this proposal. Our vision for the primary care at scale involves all local partners. This isn t just those mentioned above. It also involved Halton Housing, Well Being Enterprises, Halton Chamber of Commerce, local colleges and schools, the local faith sector and positive and progressive discussions have been made with all of these organisations. 18

43 Furthermore, the clinically-led and service-led approach of the One Halton programme means that we will be engaging with, planning, designing and delivering the new services of Halton in partnership with all local providers and partners. Using the descriptors in sections of the Primary Care Network Development plan document, please describe which of these categories your Network aligns to and why. Given this proposal is written on a town-based approach, it sees the two Runcorn community hubs working together. We are therefore creating a new network. Given the relative maturity of the two community hubs, we believe that the new Runcorn network should be aligned to In development. Our rationale is that the practices are committed to the vision and ambition of this plan, we have a clear work plan and stated delivery expectations and if successful, we will have the funds to deliver the plan that will yield sustainable benefits. Our plan will see us working in partnership with social care, mental health, community services, the third sector, acute providers and our commissioning colleagues. All of whom are working towards the same vision. As such, we believe that within 18 months, the Runcorn network will move to the next level of Progressing well Evidence - B2 What are the clear, measurable outcomes of the proposal, including timescales? There are a range of measureable outcomes that will be delivered by the successful delivery of this proposal. 1) A standardised approach to Chronic Disease Management across our six practices A reduction in disease prevalence variation across the six Runcorn practices (as per QOF). This will be seen on a disease area basis and be seen within 12 months of the completion of each rapid improvement cycle. A reduction in exception reporting variation across the six Runcorn practices (as per QOF). This will be seen on a disease area basis and be seen within 12 months of the completion of each rapid improvement cycle. Reduced referrals into secondary care across the six Runcorn practices. This will be seen within 6 months of the completion of each rapid improvement cycle. Positive impact on the mortality and morbidity of the population of Runcorn. We anticipate this will be seen within 5 years. Reduced prescribing variation across the six Runcorn practices. This will be seen on a disease area basis and be seen within 6 months of the completion of each rapid improvement cycle. Improved quality of patient s life (for those with specific chronic diseases). We will undertake surveys to monitor this and forecast this will be seen within 12 months of the completion of each rapid improvement cycle. Increased quality of management of Chronic Disease Management. We will undertake audits against recognised standards. This will be seen on a disease area basis and be seen within 12 months of the completion of each rapid improvement cycle. 19

44 2) Working effectively as a primary care network to support continuity of care A reduction in A&E activity from the six Runcorn practices. This will be a phased impact, commencing initially with a reduction in the current rate of growth. This will be achieved within 6 months of the new service model being implemented. Thereafter, there will be a reduction in A&E activity from the six Runcorn practices. A reduction in Out of Hours GP services from the six Runcorn practices. This will be a phased impact, commencing initially with a reduction in the current rate of growth. This will be achieved within 6 months of the new service model being implemented. Thereafter, there will be a reduction in A&E activity from the six Runcorn practices. A reduction in zero-day length of stay admissions into hospital from the six Runcorn practices, with a reduction in readmissions and delayed transfers of care. This will be a phased impact, commencing initially with a reduction in the current rate of growth. This will be achieved within 6 months of the new service model being implemented. Thereafter, there will be a reduction in A&E activity from the six Runcorn practices. Improved utilisation of the Urgent Care Centre from the six Runcorn practices. This will include both an increase in volume of activity and a reduction in waiting times at the centre. This will be seen within 3 months of the new service model being implemented. Creation of variable appointment duration to match patient needs across the six Runcorn practices. This will be seen within 3 months of the completion of each rapid improvement cycle AND the implementation of the new urgent care service model. Improved staff morale across the six Runcorn practices. This will be realised within 6 months of the new service model being implemented. 3) Standardised care navigation Increase in access to General Practice services via electronic means (e.g. web solutions). This will be seen within 6 months of launching the new care navigation approach. Increased appropriate attendance in primary care services. This will be seen within 6 months of launching the new approach. We will undertake surveys to monitor this. Increase in patient satisfaction across the following survey questions: o Ease of getting through to appropriate services o Helpfulness of Care Navigators o Overall, how would you describe your experience This will be seen within 6 months of launching the new care navigation approach. We will undertake patient surveys to monitor patient satisfaction. 4) Realising efficiencies through standardising back office functions Increase in time efficiency for all six Runcorn practices. This will be realised immediately after each rapid improvement cycle. Increase in financial efficiency for all six Runcorn practices. This will be realised gradually after each rapid improvement cycle. Reduction in delays in functions such as scanning and coding. This will be realised within 3 months after each rapid improvement cycle. Standardise the quality of scanning and coding. This will be realised within 6 months after each rapid improvement cycle. We will undertake audits to monitor this measure. Evidence - B3 Funding to support Primary Care Network Development is time-limited. Please indicate here how you will sustain the impact of the project after the funding ceases. We have structured our approach within this proposal to ensure a sustainable and long-term impact. We will achieve this by: Investing skills and expertise in our staff; 20

45 Developing local change processes and skills that means we can and will run and deliver ourselves moving forward without the need for external support; Fully designing the new model for urgent care in General Practice; Commencing the implementation of the new model for urgent care in General Practice; Using the efficiencies in time and money we generate to re-invest in more transformation and joint working; Investing in the infrastructure (IT systems) that will yield long-term benefits; Investing in our relationships with key partners that will yield on-going benefits; Increasing staff morale and staff retention. Please confirm that all constituent GP practices which are identified above are aware of the Development Fund requirements and are collectively signed up to delivery of the milestones identified in B2 above. Network / Federation Leader Signature (permitted to act on behalf of constituent GP practices): Date: 06/07/2018 Primary Care Networks form an important part of integrated place-based delivery systems and proposals must align to the local place vision and strategy. The Place Senior Responsible Officer must therefore support this application. Application supported? Please provide brief details to support your response: Effective General Practice is a fundamental component of One Halton and the whole system transformation we are seeking to deliver. The two GP Federations in Halton, representing all 14 local practices, have offered innovation, insight, commitment and leadership to the One Halton programme over the last 6 months. This bid represents the ambition and the enthusiasm they have demonstrated to improve services for local people. As the place-based SRO for Halton, I fully endorse the proposals, the approach and outcomes described in this submission and will provide support and challenge to our General Practice colleagues and the whole system to ensure the impact and opportunity of this funding is maximised. Place SRO Signature: Date: 06/07/18 21

46 PRIMARY CARE NETWORK DEVELOPMENT FUND AGREEMENT OF THE CONSTITUENT MEMBERS OF THE NETWORK FOR THE SUBMISSION OF AN APPLICATION TO THE FUND We are the constituent GP Practice members of the Network named below and confirm that we are aware of the contents of this application for financial resources to support the development of Primary Care Networks and that we accept that we accept the conditions of the scheme. Primary Care Network/Federation Name: GP Health Connect, on behalf of St Pauls Community hub and Runcorn New Town Community hub Name of Primary Care Network Lead: Dr Gary O Hare Contact Details (inc telephone and address): GP Practice Name Lead GP Partner Name GP Partner s Signature Brookvale Practice Castlefields Health Centre Grove House Partnership Murdishaw Health Centre Tower House Practice Weavervale Practice Dr Patricia Abbott Dr Zoe Rog Dr Claire Forde Dr Rhian Thomas Dr Helen Bartlett Dr Fenella Cottier Name of Lead Practice for Memorandum of Understanding and Finance process: GP Practice Name Lead GP Partner Name GP Partner s Signature Grove House Partnership Murdishaw Health Centre Dr David Wilson Dr Gary O Hare 22

47 Health & Care Partnership for Cheshire & Merseyside PRIMARY CARE NETWORK DEVELOPMENT FUND APPLICATION PACK Electronic copies of this application form are available from: For any queries, advise or support regarding the application process, please contact: Applications to be submitted by to: Closing date for applications: 9 July 2018 at 12 noon 1

48 1. How to apply PRIMARY CARE NETWORK DEVELOPMENT FUND APPLICATION FORM Primary Care Networks / Federations are asked to complete this form on behalf of their Network/Federation in order to enter the funding application process approved by the Cheshire and Merseyside (C&M) System Management Board. The purpose of this funding is to hasten the development of Primary Care Networks/Federations and increase the pace of real transformational change to deliver the Partnership s business plan to close the three gaps: quality, outcomes and affordability. The table below explains how applications meeting the entry requirements (A1-A4) will be judged against the criteria for assessment (B1-B2) and any allocations made available through this process will be subject to ongoing conditions (C1-C2) being met. # Entry Requirements Assurances A1 Confirmed commitment of constituent GP Confirmation from NHSE C&M Director of practices named in the application to work Commissioning together on a Network / Federation level. A2 A3 A4 A5 A clear and credible primary care at scale model is either already in place or there are robust plans to develop one. Realistic yet challenging programme plans in place or commitment to development including timescales and clear outcomes. Engagement of all GP Practices within the Primary Care Network footprint. Confirmed commitment of PC Network and constituent practices to work in full partnership and cooperate with local CCG and place-based systems to transform local care. Evidence provided to NHSE C&M Director of Commissioning Agreed with NHSE C&M Director of Commissioning Evidence provided to NHSE C&M Director of Commissioning of engagement activity. Confirmation of commitment in Application # Criteria Assurances B1 Evidence that allocated funding will Evidence provided to NHSE C&M Director of expedite the development of the Primary Commissioning Care Network and increase the pace of change and delivery of the primary care at scale model as a fundamental part of place-based integrated service delivery which aligns with the objectives of the C&M Health & Care Partnership, including initiatives funded by the Transformation Fund B2 Evidence of the clear, measurable outcomes of the initiative(s), including timescales and the return on investment. Evidence provided to NHSE C&M Director of Commissioning # Conditions Assurances C1 Network / Federation Leaders must be able to provide regular updates on the progress of their programme s delivery and be willing Regular status updates to GPFV Programme Director. to present status updates evaluating success to-date and any measurable outcomes. 2

49 C2 Network / Federation Leaders to share lessons learnt from their programme at organised learning events. Attendance. 2. Timeframes for applications The application process is now open with the purpose of assessing submissions and proposing allocations in time for the System Management Board meeting taking place w/c 16 July 2018 at which it is planned to confirm successful applicants. The full timetable is as follows: Date w/c 21 May 2018 W/c 28 May and W/c 4 June 2018 Action Communications issued to all GP practices and GP Federations. Place SROs, CCGs and LMCs copied in. Start of three briefing events held across Cheshire and Merseyside. 9 July 2018 at 12 noon Deadline for submitting applications to NHS England. 11 July 2018 Applications reviewed and collated W/c 16 July 2018 Panel convenes, assesses applications and shortlists bids for recommendation to C&M HCP 31 July 2018 C&M Health and Care Partnership Board approval. By 3 August 2018 All bidders notified of outcome with successful bidders being informed of: the sum available, any conditions applied to the offer, their buddy the memorandum of Understanding summary of next steps 3

50 Health & Care Partnership for Cheshire & Merseyside APPLICATION FOR PRIMARY CARE NETWORK DEVELOPMENT FUND Network / Federation Name: Widnes Highfield Health GP Federation General Practices signed up to the Network / Federation Proposal: How many GP practices are part of this Network proposal? : 8 What is the Network population coverage for this proposal? : 66,227 Please list below all of the practices that are part of this application Practice Name Practice List Size Lead Practice GP Name Appleton Village Surgery 10,020 Dr M Brindle Bevan Group Practice 14,593 Dr S Veedu The Beeches Medical Centre 8,272 Dr S Baker Hough Green Health Park 4,699 Dr S Koya Newtown Health Care Centre 7,234 Dr A Arain Oaks Place Surgery 3,377 Dr L Meda Peelhouse Medical Plaza 14,415 Dr P Hurst Upton Rocks Primary Care 3,617 Dr S Pitalia Total Please confirm that all of the above practices have committed to the contents of this Network proposal? Network/Federation Lead name and contact details (including address and telephone): Dr Paul Hurst Managing Director Transformation lead Widnes Highfield Health GP Federation on behalf of Widnes Community Hub 1 and Widnes Community Hub 2 Please supply details here of the individual who has been identified from the Network to act as lead for this application Network Finance : Please supply details here of the individual who has been identified from the Network to act as finance lead for this application. Dr Paul Hurst Managing Director Transformation lead Widnes Highfield Health GP Federation on behalf of Widnes Community Hub 1 and Widnes Community Hub 2 Brief Description of Scheme: Widnes is a town of 66,227 residents. It has eight GP practices who all work for their patient population in different ways. We recognise the value that this approach brings but also appreciate the variation and inefficiency that exists. We also recognise the increasing pressure and demand that is being placed on General Practice and its 4

51 staff, along with the increasing physical and psycho-social complexity of a lot of our patients. We want to create a primary care network that increases the capacity that is available to meet the increasing demand and need of our residents, that improves outcomes, that gives us more time with patients, to support patients to care for themselves, that reduces unwarranted variation, that maximises the skills and efficiency of our workforce, that improves the morale and job satisfaction of general practice staff, that reduces competition between practices and increases appropriate and timely access to the correct services. From experience we know that patients value the unique relationship with their GP and GP practice. We also know that continuity creates a safer, more efficient system with higher patient and staff satisfaction. But we need to think and act differently to enable us to create an approach where continuity can be offered when and where it s most important e.g. for those with long term conditions, complex comorbidity, frail elderly, or palliative care needs, whilst also working to meet the general rising demand. At the heart of our approach are the eight practices working in collaboration and as part of a network. General Practice in Widnes is a key member of the local Transformation programme, One Halton. Represented by our GP Federations, Widnes Highfield Health, we as local clinicians, in collaboration with our system partners, are embarking on an ambitious programme of work to transform the health and care system across Halton. We are fully committed to this programme of work and will play a leading role in delivering the vision of One Halton which is to work together to improve the health and wellbeing of the people of Halton so they live longer, healthier and happier lives To achieve this, we accept the challenge that everyone must change. The way services are commissioned and provided needs to be different. The four schemes set out in this proposal lay the foundations in General Practice in Widnes for how we will start to meet this challenge. This funding will be essential to accelerate the pace of change in general practice organising itself into a mature, robust, reliable, sustainable network capable of supporting system wide change. Halton has two federation who are committed to providing Borough wide solutions, 5 practices are members of Widnes Highfield Health, and 3 are members of GP Health Connect. All eight practice have in Widnes have agreed to work together to form a new town based Network, part of this bid is to fund forming, and agree a governance arrangement across the new Network. Our four schemes are: 1) A standardised approach to Chronic Disease Management across our eight practices 2) Working effectively as a primary care network to support continuity of care 3) Standardised care navigation 4) Realising efficiencies through standardising back office functions In this bid, we will describe each scheme in further detail, setting out the rationale, the approach, the timescales and the impact for each. By signing this bid, our eight practices have committed to support and deliver these four schemes for the residents of Halton. We are also delighted to have the support from our CCG, place-based SRO, David Parr, and One Halton Board. Evidence - B1 1. What level of financial resources you are seeking together with a breakdown, please indicate where current funding is already supported (clarifying total spend for each area) 5

52 In total, we are seeking * 228,100. Based on the funding approach being adopted with this transformation fund, we are therefore requesting an initial one-off award of 95,500. We will then use the 1 per head funding in 2018/19 and 2019/20 to fund the following as per table below. This bid is based a town based approach. However as this bid is aligned with the Borough vision for General Practice, across both Widnes and Runcorn. Opportunity if both Widnes and Runcorn bids are successful may present Borough wide economies of scale for the *Transformation & Change Specialist Support. The table below presents a breakdown of where this funding will be used: There are opportunities of economies of scale in relation to project managers support and Transformation change specialist support. Should both Widnes and Runcorn bids be successful we anticipate the project transformation support change costs will reduce by circa 14,000 and we would see the need for one project manager role and costs to support both Widnes and Runcorn networks. Number Sessions 18/19 Sessions 19/20 Rate GP Session ,200 Nurse session ,200 Administration session ,600 Practice Manager session ,200 GP Programme leadership ,400 Project manager and **37,500 **37,500 Transformation change specialist support **70,000 **70,000 Public engagement campaign support 18,000 18,000 Total 228,100 **Potential for the funding application of this bid amount to reduce to 176,600 would result in a revised on-off award of 44,000 or less Staffing input is critical to the success of this programme. As such, we have asked for each of the eight practices to commit to the contribution of one session a month from a GP, a nurse, a Practice Manager and administrative staff. The schemes they will develop and deliver are set out below. The time required from all staff to invest in these schemes will require remuneration. This will cover a combination of back fill or staff working additional hours to ensure that current services continue whilst this programme of work is undertaken. The GP Leadership approach is explained later in this proposal, as is the full time project manager (based on 18 months cost). The project manager will be fixed-term appointment, concluding in March Our preference is to appoint our own project manager. This will be a shared appointment between 6

53 this bid for Widnes and the bid for Runcorn. The project manager will support both programmes of work. The role and duties of the Transformation & Change specialist support and Public engagement campaign support are detailed in this proposal. Current funding At present (and as described in this proposal), the practices in Widnes receive 5/head as part of the Halton Enhanced Scheme (HES). This funding is split across 2 main schemes Quality referral initiative and Community Hub development. The proposal sets out how this funding is being used to support the Community Hub development and roll out and delivery of a series of Test Bed projects which fully align to the One Halton Transformation programme. The second element of funding being received in Widnes is a share of 25,000 (half of this) General Practice Resilience Funding which was won in 2017/18. This has been used to support a scheme called GP Staffing Pool which has been led by local GPs. This initiative is continuing and fully aligns to the schemes set out in this proposal. The funding we have requested will all be used exclusively to support the development and delivery of this proposal. It will not duplicate any existing funding contributions and will not be used to generate any profits for practices or provide overhead contributions to the GP Federations. How the Network s proposal will enable the delivery of primary care at scale and make a major contribution to/align with local place-based, integrated service delivery plans. The current approach to General Practice is unsustainable. We know there is variation is the services and outcomes across our practices. We are experiencing increasing demand from patients with ever increasing complexity and need. The increase in demand is from patients with both chronic and acute need, as well as mental health needs and social needs. We see a lot of people and we know we re not always the most appropriate place or people to provide the best or most effective support. Our partners in the local health and care system have skills, expertise and capacity that can better meet some of the demand we see. The overall system is too fragmented. It s often confusing for us to know how to best navigate it and we know it can be incredibly confusing and difficult for our patients too. We want and need to spend longer with our patients who need more support and intervention. All of these factors are contributing to reducing morale across our work force and as a result, it makes retention of our staff more challenging. We Want to change this We want to work together as practices to offer a standardised approach across Widnes. We want to work in a much more integrated way with our partners, including social care, mental health, community services, the third sector and our acute colleagues. We know we can do more to support prevention and self-care. We want to increase the capacity available using the same resources and assets but in a different, more efficient way. We want patients seeing the right professional and right service every time and that doesn t always mean General Practice or a GP. We want to invest in our staff and maximise the skills that we have available in Widnes. We want to make Widnes a great place to work in General Practice. What does this mean for patients? We want to improve the health of our population We want to improve the experience of our population accessing local services We want to spend more time with patients who need it and reduce the number of times a patient needs to tell their story 7

54 We want care continuity for patients who need it and to ensure that patients access the right services quickly What does this mean for our provider colleagues and workforce? We want to work as an integrated team with our statutory and non-statutory partners We want to maximise everyone s skills and increase morale We want to be co-located with partners (where it s appropriate) to offer one stop services We want to develop portfolio careers, offering choice and variety and opportunities to continue to learn and develop (where people want to) We want to make Widnes a great place to work We are a committed partner to the One Halton Transformation Programme and the vision it has for Halton. The four schemes included in this proposal and set out below describe how we plan to get General Practice in Widnes ready for operating in this future model, by working together and by working at scale. We have the commitment from all eight practices to embark on this ambitious change programme. Our four schemes: 1) A standardised approach to Chronic Disease Management across our eight practices Rationale Across our practices, we have variation in our outcomes for the different Chronic Disease Management groups, in our approach, in our pathways, in our training, in our communications and in our systems and information flows. Data showing variation in QOF prevalence rates across the eight Widnes practices (2016/17) CHD CVD Mental Health Hypertension Stroke / TIA Asthma COPD Diabetes Obesity AF Highest Lowest Our aim is to create a standardised town-based approach for each Chronic Disease Management group that will both reduce and remove elements of this variation and improve patient outcomes. By adopting this approach, we can start to share resources and skills across the town. We can support each other and ensure that every Widnes resident is receiving the same level of care. We will include prevention and self-care in the approach for each group to ensure we are not just focussing on treatment. We will do this by working with our local Public Health colleagues and the One Halton Population Health Framework. We will provide services and support through multi-disciplinary teams, working in an integrated way with 8

55 our partners across all sectors community staff, social care, third sector providers, acute and mental health colleagues whoever we needs to in order provide the very best care. The teams will provide care and support to patient groups, ensuring the most appropriate professional is providing the right support to patients at the right time. By improving Chronic Disease Management in General Practice, we will reduce demand on acute appointments. Approach We will create a rolling programme of rapid improvement cycles that focus on and standardise the approach to every Chronic Disease Management group. Led by our nursing workforce and working in partnership with local GPs with Special Interest, relevant local providers, Public Health colleagues, Practice Managers, the third sector administrative staff, commissioning colleagues and IT colleagues, we will review all aspects of our approach and delivery of care to these patient groups. We will engage with and co-produce these new ways of working with patients and their carers who live with these conditions. We will work in partnership with a Transformation and Change specialist, Integral Health Solutions, to diagnose, design, deliver and demonstrate solutions and changes. We believe that emerging solutions will involve multi-disciplinary team working in practices and in the communities, working in an integrated way with a range of partners. By working in this way, we believe we can standardise the approach, the templates, training and audit, skill mix, recall systems, exception reporting, patient information, patient education and information leaflets. We will focus on all aspects of care from prevention and self-care (supported by the One Halton Population Health Framework), through to treatment and palliative care. Our aim is to work with our commissioning colleagues and Public Health team to agree a prioritised order of which Disease Management Groups we will review based on a factors including unmet need, variation and levels of demand. Diagnose stage We will align our approach with what is recognised as best practice. We will do this by benchmarking and analysing our various approaches against NICE guidelines and quality standards, JSNA, patient feedback and experience, QOF data, exception reporting, prescribing data, medicines management intelligence, acute service demand and the local Primary Care dashboard. We will work closely with the Business Intelligence teams of the CCG and Public Health teams. We will focus on clinical pathways, infrastructure (governance, IT, estates, monitoring) and staffing. Design stage We will work with partners, patients and their carers to design and map the right services, pathways, approach, staffing, skill mix, communication and enabling infrastructure for each chronic disease group. This will be a true partnership approach. Deliver stage We will plan, implement, test and embed the agreed changes. We will do this with our partners and communicate effectively throughout the process. 9

56 Demonstrate stage We will capture both quantitative and qualitative data and evidence to demonstrate the effectiveness of the changes we make. This overall approach presents a new way of working for General Practice working at scale. We have engaged with a Transformation & Change specialist to support us with this. However, we want to invest in our staff and processes so we are not reliant on external support in perpetuity. As such, we are asking them to help us do three things: 1. Co-design and produce a framework and approach by which these rapid improvements cycles can be undertaken locally in Widnes 2. Train our staff our nurses, Practice Managers, administrative staff and GPs - in the skill of change management and rapid improvement cycles because we want the skills to do this moving forward. 3. Work with us closely and lead the first rapid improvement cycle, from beginning to end. Our aim is to complete the first rapid improvement cycle in six months. Thereafter, our aim is to undertake and complete each within 3-6 months. Timescales Our aim is to commence the first rapid improvement cycle in October Therefore, our aim is to complete the first rapid improvement cycle by March We would then undertake a further four rapid improvement cycles in 2019/20 and would have the skills to continue this process into 2020 and beyond. 2) Working effectively as a primary care network to support continuity of care Rationale General Practice is increasingly struggling to cope with the daily levels of demand placed upon it. Typical demand can be put into one of three categories: 1) Chronic Disease Management, planned care 2) Acute demand 3) Planned/pre-bookable The demand in each of these categories is increasing and as such, the time we have available to adequately meet this demand is reducing. It is not just about meeting the demand either, it s about providing the level of care that people need, at the right time, with the right person. We need to spend more time with some of our patients. Our aim is to adopt a new and integrated town-based approach with our urgent care centres to increase the capacity that is available. Approach We want to implement a new approach for how local residents access services in Widnes. We also want to maintain care continuity for those patients who need it the most, e.g. those with chronic conditions or the frail elderly (this is not an exhaustive list). We also want to be able to offer longer appointments and work in a more integrated and team-based way with our partners (mental health, social care, and third sector, acute, community) to better support these patients. By doing this, we can better manage and support patients and their conditions in the community, resulting in care closer to home and meaning patients only need to go to hospitals when specialist intervention is required. We can also work with 10

57 acute specialists in the community (e.g. geriatricians and paediatricians) as part of a wider, more integrated community based workforce. The way we believe this can happen is to integrate the urgent care centre provision with general practice in Widnes. This is a key reason for submitting this bid on behalf of our town-based population of 67,000. The rationale for this is further explained below. Where a patient wants to see a doctor or clinician and they don t have a chronic disease (or has a complex need that we believe should be managed in general practice), we will offer them a choice of where to access services locally. This could be an appointment in general practice or an appointment on the day at the urgent care centre, whether this be for acute on the day or planned or pre-bookable. The patient will be offered an on the day appointment in the urgent care centre where they will see a clinician appropriate for their need, but not likely to be their usual GP. By approaching the on the day demand in this way, it will create capacity in General Practice to provide care continuity for those patients where it s most important e.g. for those with long term conditions, complex co-morbidity, frail elderly, or palliative care needs We see opportunity to rotate practice staff through the urgent care centres, providing an integrated townbased service with other providers. This very much lends itself to the scope and requirements of the future Urgent Treatment Centres. Rotating some practice staff through the urgent care centres will also support staff retention and training as it will provide opportunities to experience new and different environments and services. We will work with our partners across Widnes as we believe having social workers, wellbeing officers, community staff, mental health professionals, our third sector partners (including organisations like Citizens Advice), acute professionals and our local housing experts will provide a more convenient service. We want to create a multi-disciplinary approach where physical, mental, social and domestic needs and issues can all be supported within a single visit. This is our ambition for our community hubs of the future but we believe this type of multi-disciplinary team can be established in the urgent care centres now. We believe that this approach of offering on the day access to appointments in a town-based service will be very attractive to a lot of our residents. We run the GP Extended Hours service in Widnes and have been since The feedback from a significant proportion of the service users is that they welcome the opportunity to have access to more convenient town-based service, where they don t see their own GP or clinician. It is the patient s choice to use the service. 98% of patients who use the GP Extended Hours service tell us they would use it again, and a lot do. For this new approach to work, we need to invest in our care navigation and IT systems. Whether a patients calls the practice, uses an IT solution to book an appointment or walk s in to the practice or urgent care centre for an appointment, we believe it is essential that a standardised approach to offering and accessing services is deployed across Widnes. The urgent care facilitates will have full visibility and access to the patient s primary care record, across all disciplines. As such, we need to develop a system that can be accessed and used by either the patient or staff members to ensure patients are accessing the right service. A critical first step in this scheme is to undertake detailed capacity and demand management modelling of general practice. We are delighted that NHS England are commissioning the APEX/Insight tool for local practices as we believe this will provide the data we need to start to plan the service configuration. This tool will extract detailed levels of staffing, services and productivity data from every practice system. 11

58 It will enable us to accurately model the demand on services, how each practice manages this and for us to model alternative approaches to test the most efficient solutions and pathways. It will also enable us to consider alternative workforce models and to consider how we can maximise the efficiency and utilisation of both our current and future staff. Work is already being undertaken by Halton CCG to develop the local Urgent Treatment Centre and we will collaborate with them and other partners to develop the urgent care model, the service specifications, the future capacity requirements and the future care pathways to meet the levels of need and demand for a 24/7 solution in our community. This will consider all aspects of care in the community including services such as pharmacy and optometry. We also need to be mindful of potential future changes to services such as NHS 111. To do this, it is essential that General Practice is ready to work in this way and at scale. As such, we will establish a group to lead this piece of work on behalf of General Practice in Widnes. This group will consist of GPs, nurses, Practice Managers and administrative staff. It needs to be fully representative. This group will start in September 2018 and continue until March 2020 when we believe the new ways of working will be implemented. This group will use the same approach outlined above diagnose, design, deliver, demonstrate to develop a standardised General Practice service for urgent care. To underpin this and the scheme described above, we are engaging with a local Third Sector organisation, Halton Voluntary Community Action (Halton VCA), to work in partnership with us to support a public engagement and insight campaign. Halton VCA ran an excellent public engagement session for General Practice in which the question was asked Tell us what s wrong with General Practice. During and after the event, we received invaluable feedback including that 80% of attendees who responded to a survey said they felt more optimistic about the future of General Practice in Halton after attending the event. Therefore, we are confident that if we can effectively engage with the population, we can coproduce effective services and solutions that they will support. We want to work with, engage with and discuss the best ways of developing these standardised General Practice services with our residents from the outset, doing this in partnership with Halton VCA. Finally, we will engage with and align our IT requirements into the local IT Group to ensure that the technical solutions we require in General Practice are developed and implemented and integrate into the wider IT solutions across Widnes. Timescales We understand that the APEX/Insight tool will be deployed into Widnes soon and we will look to commence detailed capacity and demand management modelling in October We will start the General Practice project group in September 2018 and start to design the public engagement campaign with Halton VCA in September too. We anticipate the public engagement work will commence in November We anticipate 12 months of diagnosing and designing work so forecast that the deliver stage (service changes) will start to be made in September 2019, ahead of the winter period. The IT requirements will need to fit in line with the roll out of the new approach. 3) Standardised care navigation for every patient Rationale 12

59 The two schemes described above will change the way that services are offered and accessed. As a result, a town-based and consistent approach to Care Navigation across all practices is critical. We believe it is also essential to maximise the benefits of a new Care Navigation approach, a single approach is deployed across all eight practices at the same time. Without a robust, coherent and fully aligned/integrated approach, our view is that complaints could increase and patients may be left confused if practices are offering different advice. Approach NHS England have provided funding to support Care Navigation training and Halton CCG has already commenced a programme of work that has engaged with practices. The approach we want to take, working in partnership with the CCG is to lay the foundations to maximise the impact of care navigation. We want to line up all of the services and focus on implementing the optimum solution. Given the timescales set out above, we believe we have just over 12 months to develop a town-based approach to care navigation that will include the development of a common set of protocols and rules, a common script, common service list and access choices. We believe this offers a great opportunity to develop our staff, develop skills and potentially share our resources and skills across the town. There is concern that if practices launch Care Navigation at different times, it may confuse patients and as such, complaints may increase, patients may look to move practices and the variation of what services are offered may increase. As such, we want to establish a working group consisting of Practice Managers, administrative staff and our commissioning colleagues to oversee and develop this scheme in partnership. Staff involved in this will represent practices and lead the development, launch and implementation within their respective practices, to embed the training that is available from the GP Forward View, back into every practice in Widnes, across the whole workforce. Furthermore, we believe that the public engagement campaign that is to be run as part of the scheme above, the Care Navigation scheme and changes that will arise from this should be included to present a holistic and joined-up picture to the public. Timescales Our plan is to establish the working group described above in September 2018 and this will run for approximately 12 months. This working group will work in partnership with commissioning colleagues. The group will oversee the design of the approach, the training requirements, coordination with the public engagement campaign and the roll out at practice level. 4) Realising efficiencies through standardising back office functions Rationale There is an opportunity for General Practice to realise significant efficiencies in the way it coordinates and operates its back office functions. By back office functions we mean: Coding; Scanning; Summarising records; 13

60 Patient correspondence; Telephony Referral administration Hospital correspondence/communication National patient safety alerts Medicines management Audits Searches As well as efficiencies, we believe this will improve quality and patient safety as it will reduce potential delays in functions such as scanning and coding patient s records and discharge summaries. This will provide more timely information to our clinical staff. This scheme will not save the practices money but it will present the opportunity to increase productivity and efficiency of the funding that is currently spent. At present, the eight practices operate these functions largely independently of each other and there is a lot of scope and opportunity to standardise and centralise some of these functions, whilst creating and developing transferable skills and increasing the resilience of the respective services. Approach As above, we want to create a rolling programme of rapid improvement cycles that focus on and standardise the approach to each function. Lead by Practice Managers, working in partnership with administrative staff, we will review all aspects of our approach and delivery across each function. The diagnose, design, deliver, demonstrate approach outlined above will be adopted in the scheme too. As will the three aspects of the approach co-design the approach, train our staff, implement the first cycle with us. Our aim is to complete the first rapid improvement cycle in six months. Thereafter, our aim is to undertake and complete each within six months. We don t want our administrative staff to see this as a threat. We believe that this will result in changes within our administrative workforce however, we are not considering redundancies. There are significant opportunity to retrain staff, to support them develop new skills and to redeploy their skills elsewhere in new town-based general practice model. Timescales Our aim is to start this process in October Therefore, our aim is to complete the first rapid improvement cycle by March We would then undertake a further two rapid improvement cycles in 2019/20 and would have the skills to continue this process into 2020 and beyond. Programme leadership and resources This programme of work and the four schemes it details will be driven by the GP Federation, Widnes Highfield Health, supported by every practice. The Federation will monitor progress every month at its regular Board meeting. We will invite our NHS England buddy and a member of the CCG commissioning team to this session to provide complete transparency in our progress. The overall lead for the programme of work is Dr Paul Hurst, local GP and Clinical Transformation Lead for the GP Federation. He will dedicate 2 sessions a month to provide leadership across Widnes and 14

61 focus on the delivery of the schemes. He will be supported by the dedicated project manager. We are then asking each practice to commit to providing one session of input a month across the four schemes from a GP, a nurse, a Practice Manager and a member of administration staff. We believe that this whole approach underpins the principle of primary care at scale and fully aligns with the local place-based agenda. As a core and major member of the One Halton Board, we have signed a commitment to: Improve health and wellbeing outcomes for local people Collaborate between health and social care services, providing accessible high quality services to local people Develop new ways to prevent and better detect illness Reduce the levels of demand on hospital, acute care and healthcare services generally Deliver service closer to home and within local communities Again, we believe that the schemes we have set out above fully align to and start to deliver our commitment to the One Halton Board and the CCG Transformation agenda. How the Network s proposal is aligned to any current CCG transformation agenda As set out in the previous section, we believe that our proposed fully aligns to the CCG Transformation agenda, One Halton. The vision of One Halton is working together to improve the health and wellbeing of the people of Halton so they live longer, healthier and happier lives We believe that our proposal fully supports this vision. We want to work at scale and in partnership and develop services to fully meet the needs of our residents. All members of the One Halton Board have been asked to support 10 commitments. These are listed in the table below. We believe our proposal fully supports each commitment. Commitment We agree that an integrated system of health and social care is the best way to ensure optimum health, wellbeing and care outcomes for our population and to ensure collective financial sustainability. We agree that the Halton Health & Wellbeing Strategy provides the focus for our work together and sets out our vision to work together to reform health and social care services to improve the health outcomes of our residents and reduce health inequalities, as quickly as possible We agree the One Halton ACS Board will provide a focal point for prevention and early intervention, proactively identifying potential future demand and shifting the focus from unplanned and reactive services to planned and targeted interventions We agree to put patients and residents at the heart of what we do Does this proposal support the commitment? How? Our proposal fully focuses on integrated systems and providing optimum care and outcomes. As a partner, we support the drive for financial sustainability Our proposal is fully aligned to the One Halton vision and programme and we want to commit clinician time to the development to ensure this is a clinically-led redesign programme, in partnership with our colleagues from other organisations. We are an active member of the One Halton Board and fully support the approach and work streams. As such, we are targeted the Urgent Care & Complex Care needs work stream with this proposal Patient focus is at the heart of our proposal 15

62 We agree to put General Practice and other community practitioners at the centre of our care model We agree to design and plan services around functional geographical footprints with populations of 30,000 to 50,000 based on registered patient lists We agree to design services for users and not our organisational needs The Commissioners agree to deliver a single approach to commissioning health, wellbeing and care services in order to transform services and improve outcomes. This will enable collaboration integrated working and include the development of pooled budgets We agree that we will consider the options available to us, and select the best delivery model for the integrated care system in Halton, but not withstanding this, we will continue to integrate our services on the ground, at pace, using the existing options available to us to do so We acknowledge that creating a Locality Care Partnership will not resolve the significant budget challenges facing all organisations but it will go some way to reducing it and it will be necessary to continue to work closely together with all stakeholders to manage the deficit around health and social care We fully agree with this! We believe a town-based approach for this level of transformation will yield the greatest benefits. Geographically, it makes complete sense. We have built patient engagement and coproduction into this proposal We have very good and productive relationships with the commissioners and support the approach they are taking with One Halton. We want to work with partners to ensure that the very best models and solutions are designed and implemented. That may require us to change. We accept this challenge which is why this bid focusses on the eight practices working in close collaboration. We are committed to working with partners as we look at the development of a Local Care Partnership in Halton. How this will increase the pace of change from where the Network is now? Halton CCG have developed the Halton Enhanced Scheme (HES). This supports two programmes of work across General Practice in Halton with one specific component in 2018/19 to support the development of Test Bed projects. The Test Bed projects are part of the One Halton programme, meaning we have aligned General Practice focus with the One Halton ambitions. The projects are designed to support rapid improvement cycles by focussing on specific service areas and working in partnership with a key local provider. Each Test Bed project is being run by one of the local community hubs (or networks). Each community hub is made up of between 2 and 4 local practices working together in a geographical area. Each hub is a small operational unit, each sized between 28,000 and 37,000 population size, enabling operational, community focused multi-disciplinary teams to wrap around and focus on their specific population. The graphic below shows the four Test Bed projects, the respective providers and the population sizes. 16

63 All four Test Bed projects have commenced in the last two months and this approach demonstrates that the practices can work effectively in partnership. If a Test Bed project is successful, it will be rolled out across the other three community hubs. This is a fundamental ethos behind the Test Bed approach. To run project concurrently, to implement rapidly at a small/local level, to audit and evaluate quickly and at timely intervals, to share learning and if successful, to quickly roll out for all patients to benefit. Town-based approach For some services the hubs are too small and a town-based approach will be more appropriate and efficient. As such, services need to be designed and delivered at scale, including urgent care. As there is neither an acute trust nor A&E in Widnes, we are integrating our urgent care approach and provision with the urgent care centre facilities and capacity, services and staffing these provide. We believe that our town is of a suitable size to create a town-based urgent care model. This is the same situation in Runcorn, our bordering town. They don t have an acute trust or A&E in the town but they also have an urgent care centre within their boundaries. As such, a standardised urgent care model that integrated General Practice with the urgent care facilities already in situ is integral to each town and across Halton. Furthermore, we believe this new approach will have a significant and positive impact on the wider urgent care system across Widnes and Halton. If this bid were to be successful, it would rapidly increase the pace of change as it would enable us invest in more staff time to focus on developing and delivering the schemes set out in this proposal. With this same ethos being adopted, we would look to run projects concurrently. By signing up to this proposal, each practice has committed to providing additional sessions into these initiatives. This will include GP time, nurse time, administrative time and Practice Manager time. All of this time is in addition to existing commitments and in addition to the day job. As such, all time invested in this will be paid for. How you have and will be engaging with the Network s constituent practices to ensure there is full, collective commitment to delivery of this initiative? In September 2017 Widnes Highfield Health carried out an anonymous questionnaire of staff groups throughout Practice s who wished to take part. Feedback and results from this questionnaire influence and form part of the Widnes Strategy. Over the last year, the Federation (who support practices and community hubs) has developed a strategy that sets out three headline components: Practice collaboration Service delivery and development System transformation As such, the initiatives we are proposing here underpin and support the delivery of the strategy. They also align with the CCG s Primary care Strategy. In April 2018, we restructured our Federation Board to appoint a GP Hub Lead for each Community hub. One of these Community Hub Leads is also the Federation Clinical Director 17

64 We undertook this change at our own financial risk to ensure our engagement with practices was enhanced as we entered this exciting period of our development. The duties of the GP Hub Leads are: To provide clinical leadership to the emerging hubs; To encourage the sharing of best practice across the hub(s); To build relationships with clinical staff within and between the hubs; To develop and deliver specific pieces of work (practice collaboration); To develop and deliver the wider primary care and out of hospital model Furthermore, in April 2018, we created a new Board position, Managing Director Transformation lead, again at a financial risk. The duties of this post is: To lead the development and delivery of the primary care and out of hospital model with the board, practices and partners To build relationships with key stakeholders To support the clinical hub leads and other Board members, To support the development and delivery of work across the practices To research new and innovative care and workforce models As such, we have an infrastructure already in place and operational in Widnes to immediately launch a new set of projects. With the additional funding this bid provides and with the commitment from the practices to invest in this approach (with the funding to provide back-fill), we are in a good position to expand the existing approach with very little lead in period. All practices have been given the opportunity to contribute to this bid and the initiatives it proposes. This includes the aims of the bid as well as the commitment from individual practices. As such, we believe we have the collective commitment, infrastructure and vision to deliver this proposal. How you are, or plan to engage with other Networks, GP Provider Organisations, Community Providers, Local Authority and the 3rd and Voluntary Sectors? All four Community hubs (or networks) in Halton interact on a daily basis through the two GP Federations. Widnes Highfield Health and GP Health Connect. Over the last six months, strong relationships have been developed between the two local Federations and in April 2018, a Strategic Development Group (SDG) was launched. The roles and responsibilities of the SDG have been agreed for the first 12 months as being: Hub (or Network) development and associated MDT community developments; Collaborative delivery of primary care services; The primary care workforce model; Planned care and unplanned care pathways across Halton; Out of hours service provision; Primary Care home; and Accountable Care Systems or Place-based care We also attend the newly formed Merseyside & Cheshire Federation meeting. This provides an opportunity to share best practice, ideas and initiatives. Over the last 12 months, we (the two GP Federations in Halton, representing our four community hubs) have worked very closely with Bridgewater Community Healthcare NHS Foundation Trust and have provided clinical and managerial leadership in the development of the Out of Hospital programme for the One Halton Transformation Programme. This has included working in partnership with Halton Borough Council colleagues too to develop the One Halton programme approach. 18

65 We have engaged with a number of Third Sector organisations over the last 12 months as part of the One Halton programme but also to discuss and start to share the future community hub model in Halton. We have also engaged with a local Third Sector organisation who ran an excellent public engagement session for General Practice in which the question was asked Tell us what s wrong with General Practice. We plan to undertake more of this engagement work with the Third Sector through this proposal. Our vision for the primary care at scale involves all local partners. This isn t just those mentioned above. It also involved Halton Housing, Halton Chamber of Commerce, local colleges and schools, the local faith sector and positive and progressive discussions have been made with all of these organisations. Furthermore, the clinically-led and service-led approach of the One Halton programme means that we will be engaging with, planning, designing and delivering the new services of Halton in partnership with all local providers and partners. Using the descriptors in sections of the Primary Care Network Development plan document, please describe which of these categories your Network aligns to and why. Given this proposal is written on a town-based approach, it sees the two Widnes Hubs community hubs working together. We are therefore creating a new network. Given the relative maturity of the two community hubs, we believe that the new Widnes network should be aligned to In development. Our rationale is that the practices are committed to the vision and ambition of this plan, we have a clear work plan and stated delivery expectations and if successful, we will have the funds to deliver the plan that will yield sustainable benefits. Our plan will see us working in partnership with social care, mental health, community services, the third sector, acute providers and our commissioning colleagues. All of whom are working towards the same vision. As such, we believe that within 18 months, the Widnes network will move to the next level of Progressing well Evidence - B2 What are the clear, measurable outcomes of the proposal, including timescales? There are a range of measureable outcomes that will be delivered by the successful delivery of this proposal. 1) A standardised approach to Chronic Disease Management across our eight practices A reduction in disease prevalence variation across the eight Widnes practices (as per QOF). This will be seen on a disease area basis and be seen within 12 months of the completion of each rapid improvement cycle A reduction in exception reporting variation across the eight Widnes practices (as per QOF). This will be seen on a disease area basis and be seen within 12 months of the completion of each rapid improvement cycle Reduced referrals into secondary care across the eight Widnes practices. This will be seen within 6 months of the completion of each rapid improvement cycle. Positive impact on the mortality and morbidity of the population of Widnes. We anticipate this will be seen within 5 years. 19

66 Reduced prescribing variation across the eight Widnes practices. This will be seen on a disease area basis and be seen within 6 months of the completion of each rapid improvement cycle Improved quality of patient s life (for those with specific chronic diseases). We will undertake surveys to monitor this and forecast this will be seen within 12 months of the completion of each rapid improvement cycle Increased quality of management of Chronic Disease Management. We will undertake audits against recognised standards. This will be seen on a disease area basis and be seen within 12 months of the completion of each rapid improvement cycle 2) Working effectively as a primary care network to support continuity of care A reduction in A&E activity from the eight Widnes practices. This will be a phased impact, commencing initially with a reduction in the current rate of growth. This will be achieved within 6 months of the new service model being implemented. Thereafter, there will be a reduction in A&E activity from the eight Widnes practices. A reduction in Out of Hours GP services from the eight Widnes practices. This will be a phased impact, commencing initially with a reduction in the current rate of growth. This will be achieved within 6 months of the new service model being implemented. Thereafter, there will be a reduction in A&E activity from the eight Widnes practices. A reduction in zero-day length of stay admissions into hospital from the eight Widnes practices, with a reduction in readmissions and delayed transfers of urgent care. This will be a phased impact, commencing initially with a reduction in the current rate of growth. This will be achieved within 6 months of the new service model being implemented. Thereafter, there will be a reduction in A&E activity from the eight Widnes practices. Improved utilisation of the Urgent Care Centre from the eight Widnes practices. This will include both an increase in volume of activity and a reduction in waiting times at the centre. This will be seen within 3 months of the new service model being implemented. Creation of variable appointment duration to match patient needs across the eight Widnes practices. This will be seen within 3 months of the completion of each rapid improvement cycle AND the implementation of the new urgent care service model. Improved staff morale across the eight Widnes practices. This will be realised within 6 months of the new service model being implemented. 3) Standardised care navigation Increase in access to General Practice services via electronic means (e.g. web solutions). This will be seen within 6 months of launching the new care navigation approach. Increase appropriate attendance in primary care services. This will be seen within 6 months of launching the new approach. We will undertake surveys to monitor this. Increase in patient satisfaction across the following survey questions: o Ease of getting through to appropriate services o Helpfulness of Care Navigators o Overall, how would you describe your experience This will be seen within 6 months of launching the new care navigation approach. We will undertake patient surveys to monitor patient satisfaction. 4) Realising efficiencies through standardising back office functions Increase in time efficiency for all eight Widnes practices. This will be realised immediately after each rapid improvement cycle. Increase in financial efficiency for all eight Widnes practices. This will be realised gradually after each rapid improvement cycle Reduction in delays in functions such as scanning and coding. This will be realised within 3 months after each rapid improvement cycle. Standardise the quality of scanning and coding. This will be realised within 6 months after each rapid improvement cycle. We will undertake audits to monitor this measure. 20

67 Evidence - B3 Funding to support Primary Care Network Development is time-limited. Please indicate here how you will sustain the impact of the project after the funding ceases. We have structured our approach within this proposal to ensure a sustainable and long-term impact. We will achieve this by: Investing skills and expertise in our staff Developing local change processes (and skills) that we can and will run and deliver ourselves moving forward without the need for external support Fully designing the new model for urgent care in General Practice Commencing the implementation of the new model for urgent care in General Practice Using the efficiencies in time and money we generate to re-invest in more transformation and joint working Investing in the infrastructure (IT systems) that will yield long-term benefits Investing in our relationships with key partners that will yield on-going benefits. Increasing staff morale and staff retention. Please confirm that all constituent GP practices which are identified above are aware of the Development Fund requirements and are collectively signed up to delivery of the milestones identified in B2 above. Please submit a scanned copy of a simple agreement which confirms the above. (Please see template below) Network / Federation Leader Signature (permitted to act on behalf of constituent GP practices): Dr Paul Hurst Managing Director Transformation Lead Widnes Highfield Health GP federation Date: Primary Care Networks form an important part of integrated place-based delivery systems and proposals must align to the local place vision and strategy. The Place Senior Responsible Officer must therefore support this application. Application supported? or NO Please provide brief details to support your response: Effective General Practice is a fundamental component of One Halton and the whole system transformation we are seeking to deliver. The two GP Federations in Halton, representing all 14 local practices, have offered innovation,insight,commitment and leadership to the One Halton programme over the last 6 months. This bid represents the ambition and the enthusiasm they have demonstrated to improve services for local people. 21

68 As the place-based SRO for Halton, I fully endorse the proposals, the approach and outcomes described in this submission and will provide support and challenge to our General Practice colleagues and the whole system to ensure the impact and opportunity of this funding is maximised. Place SRO Signature: Date:

69 PRIMARY CARE NETWORK DEVELOPMENT FUND AGREEMENT OF THE CONSTITUENT MEMBERS OF THE NETWORK FOR THE SUBMISSION OF AN APPLICATION TO THE FUND We are the constituent GP Practice members of the Network named below and confirm that we are aware of the contents of this application for financial resources to support the development of Primary Care Networks and that we accept that we accept the conditions of the scheme. Primary Care Network/Federation Name: Widnes Highfield Health GP Federation on behalf of Widnes Community Hub 1 and Widnes Community Hub two. Name of Primary Care Network Lead: Dr Paul Hurst, Managing/Transformation Director, Widnes Highfield Health GP Federation, Highfield Road Widnes WA8 7DJ On behalf of Widnes Community Hub 1 and 2 Contact Details (inc telephone and address): Please supply details of the lead individual and lead practice which have been identified for this project and who will assume leadership and financial responsibility for delivery of this project. GP Practice Name Lead GP Partner Name GP Partner s Signature Appleton Bevan Group Practice The Beeches Medical Centre Hough Green Health Park Newtown Health Care Centre Oaks Place Surgery Peelhouse Medical Plaza Upton Rocks Dr M Brindle Dr S Veedu Dr S Baker Dr S Koya Dr A Arain Dr L Meda Dr P Hurst Dr S Patalia Name of Lead Practice for Memorandum of Understanding and Finance process: Widnes Highfield Health GP Federation. GP Partner s Practice Lead GP Partner Name GP Partner s Signature Peel House Medical Plaza N81045 DR PAUL HURST 23

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71 Health & Care Partnership for Cheshire & Merseyside PRIMARY CARE NETWORK DEVELOPMENT FUND APPLICATION PACK Electronic copies of this application form are available from: For any queries, advise or support regarding the application process, please contact: Applications to be submitted by to: Closing date for applications: 9 July 2018 at 12 noon 1

72 1. How to apply PRIMARY CARE NETWORK DEVELOPMENT FUND APPLICATION FORM Primary Care Networks / Federations are asked to complete this form on behalf of their Network/Federation in order to enter the funding application process approved by the Cheshire and Merseyside (C&M) System Management Board. The purpose of this funding is to hasten the development of Primary Care Networks/Federations and increase the pace of real transformational change to deliver the Partnership s business plan to close the three gaps: quality, outcomes and affordability. The table below explains how applications meeting the entry requirements (A1-A4) will be judged against the criteria for assessment (B1-B2) and any allocations made available through this process will be subject to ongoing conditions (C1-C2) being met. # Entry Requirements Assurances A1 Confirmed commitment of constituent GP Confirmation from NHSE C&M Director of practices named in the application to work Commissioning together on a Network / Federation level. A2 A3 A4 A5 A clear and credible primary care at scale model is either already in place or there are robust plans to develop one. Realistic yet challenging programme plans in place or commitment to development including timescales and clear outcomes. Engagement of all GP Practices within the Primary Care Network footprint. Confirmed commitment of PC Network and constituent practices to work in full partnership and cooperate with local CCG and place-based systems to transform local care. Evidence provided to NHSE C&M Director of Commissioning Agreed with NHSE C&M Director of Commissioning Evidence provided to NHSE C&M Director of Commissioning of engagement activity. Confirmation of commitment in Application # Criteria Assurances B1 Evidence that allocated funding will Evidence provided to NHSE C&M Director of expedite the development of the Primary Commissioning Care Network and increase the pace of change and delivery of the primary care at scale model as a fundamental part of place-based integrated service delivery which aligns with the objectives of the C&M Health & Care Partnership, including initiatives funded by the Transformation Fund B2 Evidence of the clear, measurable outcomes of the initiative(s), including timescales and the return on investment. Evidence provided to NHSE C&M Director of Commissioning # Conditions Assurances C1 Network / Federation Leaders must be able to provide regular updates on the progress of their programme s delivery and be willing Regular status updates to GPFV Programme Director. to present status updates evaluating success to-date and any measurable outcomes. 2

73 C2 Network / Federation Leaders to share lessons learnt from their programme at organised learning events. Attendance. 2. Timeframes for applications The application process is now open with the purpose of assessing submissions and proposing allocations in time for the System Management Board meeting taking place w/c 16 July 2018 at which it is planned to confirm successful applicants. The full timetable is as follows: Date w/c 21 May 2018 W/c 28 May and W/c 4 June 2018 Action Communications issued to all GP practices and GP Federations. Place SROs, CCGs and LMCs copied in. Start of three briefing events held across Cheshire and Merseyside. 9 July 2018 at 12 noon Deadline for submitting applications to NHS England. 11 July 2018 Applications reviewed and collated W/c 16 July 2018 Panel convenes, assesses applications and shortlists bids for recommendation to C&M HCP 31 July 2018 C&M Health and Care Partnership Board approval. By 3 August 2018 All bidders notified of outcome with successful bidders being informed of: the sum available, any conditions applied to the offer, their buddy the memorandum of Understanding summary of next steps 3

74 Health & Care Partnership for Cheshire & Merseyside APPLICATION FOR PRIMARY CARE NETWORK DEVELOPMENT FUND Network / Federation Name: GP Health Connect, on behalf of St Pauls Community hub and Runcorn New Town Community hub General Practices signed up to the Network / Federation Proposal: How many GP practices are part of this Network proposal? : 6 What is the Network population coverage for this proposal? : 64,977 Please list below all of the practices that are part of this application Practice Name Practice List Size Lead Practice GP Name Brookvale Practice 8,393 Dr Patricia Abbott Castlefields Health Centre 12,664 Dr Zoe Rog Grove House Partnership 13,753 Dr Claire Forde Murdishaw Health Centre 7,821 Dr Rhian Thomas Tower House Practice 13,204 Dr Helen Bartlett Weavervale Practice 9,142 Dr Fenella Cottier Total Population 64,977 Please confirm that all of the above practices have committed to the contents of this Network proposal? Network/Federation Lead name and contact details (including address and telephone): Please supply details here of the individual who has been identified from the Network to act as lead for this application. Dr Gary O Hare, Murdishaw Health Centre, N81072, Network Finance Lead name and contact details if different to above (including address and telephone): Please supply details here of the individual who has been identified from the Network to act as finance lead for this application. Dr David Wilson, Grove House Partnership, N81066, Brief Description of Scheme: Runcorn is a town of 65,000 residents. It has six GP practices who all work for their patient population in different ways. We recognise the value that this approach brings but also appreciate the variation and inefficiency that exists. We also recognise the increasing pressure and demand that is being placed on General Practice and its staff, along with the increasing physical and psycho-social complexity of a lot of our patients. 4

75 We want to create a primary care network that increases the capacity that is available to meet the increasing demand and need of our residents, that improves outcomes, that gives us more time with patients, to support patients to care for themselves, that reduces unwarranted variation, that maximises the skills and efficiency of our workforce, that improves the morale and job satisfaction of general practice staff, that reduces competition between practices and increases appropriate and timely access to the correct services. From experience we know that patients value the unique relationship with their GP and GP practice. We also know that continuity creates a safer, more efficient system with higher patient and staff satisfaction. But we need to think and act differently to enable us to create an approach where continuity can be offered when and where it s most important e.g. for those with long term conditions, complex comorbidity, frail elderly, or palliative care needs, whilst also working to meet the general rising demand. At the heart of our approach is the six practices working in collaboration and as part of a network. General Practice in Runcorn is a key member of the local Transformation programme, One Halton. Represented by our GP Federation, GP Health Connect, we as local clinicians, in collaboration with our system partners, are embarking on an ambitious programme of work to transform the health and care system across Halton. We are fully committed to this programme of work and will play a leading role in delivering the vision of One Halton which is to work together to improve the health and wellbeing of the people of Halton so they live longer, healthier and happier lives To achieve this, we accept the challenge that everyone must change. The way services are commissioned and provided needs to be different. The four schemes set out in this proposal lay the foundations in General Practice in Runcorn for how we will start to meet this challenge. This funding will be essential to accelerate the pace of change in general practice organising itself into a mature, robust, reliable, sustainable network capable of supporting system wide change. Our four schemes are: 1) A standardised approach to Chronic Disease Management across our six practices 2) Working effectively as a primary care network to support continuity of care 3) Standardised care navigation 4) Realising efficiencies through standardising back office functions In this bid, we will describe each scheme in further detail, setting out the rationale, the approach, the timescales and the impact for each. By signing this bid, our six practices have committed to support and deliver these four schemes for the residents of Halton. We are also delighted to have the support from our CCG, place-based SRO, David Parr, and One Halton Board. Evidence - B1 1. What level of financial resources you are seeking together with a breakdown, please indicate where current funding is already supported (clarifying total spend for each area) In total, we are seeking 205,300. Based on the funding approach being adopted with this transformation fund, we are requesting a one-off award of 75,000. The table below present a breakdown of where this funding will be used: 5

76 The 75,000 will be used to fund the majority of the Transformation & Change specialist support, the commencement of the public engagement campaign and a small number of staff sessions in 2018/19. The 1/head contribution will then be used to fund the remaining staff sessions and project management support, the remaining Transformation & Change specialist support and the majority of the public engagement campaign. The staffing input is critical to the success of this programme. As such, we have asked for each practice to commit to the contribution of one session a month from a GP, a nurse, a Practice Manager and a member of administrative staff. The schemes they will develop and deliver are set out below. The time required from all staff to invest in these schemes will require remuneration. This will cover a combination of back fill or staff working additional hours to ensure that current services continue whilst this programme of work is undertaken. The GP Leadership approach is explained later in this proposal, as is the full time project manager (based on 18 months cost). The project manager will be fixed-term appointment, concluding in March Our preference is to appoint our own project manager. This will be a shared appointment between this bid for Runcorn and the bid for Widnes. The project manager will support both programmes of work. The role and input of the Transformation & Change specialist support and Public engagement campaign support are detailed in this proposal. Current funding At present (and as described in this proposal), the practices in Runcorn receive 5/head as part of the Halton Enhanced Scheme (HES). This funding is split across 2 main schemes Quality referral initiative and Community Hub development. The proposal sets out how this funding is being used to support the Community Hub development and roll out and delivery of a series of Test Bed projects which fully align to the One Halton Transformation programme. The second element of funding being received in Runcorn is a share of 25,000 (half of this) General Practice Resilience Funding which was won in 2017/18. This has been used to support a scheme called GP Staffing Pool which has been led by two local GPs. This initiative is continuing and fully aligns to the schemes set out in this proposal. 6

77 The funding we have requested will all be used exclusively to support the development and delivery of this proposal. It will not duplicate any existing funding contributions and will not be used to generate any profits for practices or provide overhead contributions to the GP Federations. How the Network s proposal will enable the delivery of primary care at scale and make a major contribution to/align with local place-based, integrated service delivery plans. The current approach to General Practice is unsustainable. We know there is variation is the services and outcomes across our practices. We are experiencing increasing demand from patients with ever increasing complexity and need. The increase in demand is from patients with both chronic and acute need, as well as mental health needs and social needs. We see a lot of people and we know we re not always the most appropriate place or people to provide the best or most effective support. Our partners in the local health and care system have skills, expertise and capacity that can better meet some of the demand we see. The overall system is too fragmented. It s often confusing for us to know how to best navigate it and we know it can be incredibly confusing and difficult for our patients too. We want and need to spend longer with our patients who need more support and intervention. All of these factors are contributing to reducing morale across our work force and as a result, it makes retention of our staff more challenging. Want to change this We want to work together as practices to offer a standardised approach across Runcorn. We want to work in a much more integrated way with our partners, including social care, mental health, community services, the third sector and our acute colleagues. We know we can do more to support prevention and self-care. We want to increase the capacity available using the same resources and assets but in a different, more efficient way. We want patients seeing the right professional and right service every time and that doesn t always mean General Practice or a GP. We want to invest in our staff and maximise the skills that we have available in Runcorn. We want to make Runcorn a great place to work in General Practice. What does this mean for patients? We want to improve the health of our population We want to improve the experience of our population accessing local services We want to spend more time with patients who need it and reduce the number of times a patient needs to tell their story We want care continuity for patients who need it and to ensure that patients access the right services quickly What does this mean for our provider colleagues and workforce? We want to work as an integrated team with our statutory and non-statutory partners We want to maximise everyone s skills and increase morale We want to be co-located with partners (where it s appropriate) to offer one stop services We want to develop portfolio careers, offering choice and variety and opportunities to continue to learn and develop (where people want to) We want to make Runcorn a great place to work We are a committed partner to the One Halton Transformation Programme and the vision it has for Halton. The four schemes included in this proposal and set out below describe how we plan to get General Practice in Runcorn ready for operating in this future model, by working together and by working at scale. We have the commitment from all six practices to embark on this ambitious change programme. Our four schemes: 7

78 1) A standardised approach to Chronic Disease Management across our six practices Rationale Whilst all practices already follow QOF guidelines and NICE, across our practices there still remains variation in our outcomes for the different Chronic Disease Management groups, in our approach, in our pathways, in our training, in our communications and in our systems and information flows. Data showing variation in QOF prevalence rates across the six Runcorn practices (2016/17) Data showing variation in specific QOF indicators across the six Runcorn practices (2016/17) Our aim is to create a standardised town-based approach for each Chronic Disease Management group that will both reduce and remove elements of this variation and improve patient outcomes. By adopting this approach, we can start to share resources and skills across the town. We can support each other and ensure that every Runcorn resident is receiving the same level of care. We will include prevention and self-care in the approach for each group to ensure we are not just focussing on treatment. We will do this by working with our local Public Health colleagues and the One Halton Population Health Framework. We will provide services and support through multi-disciplinary teams, working in an integrated way with our partners across all sectors community staff, social care, third sector providers, acute and mental health colleagues whoever we need to in order to provide the very best care. The teams will provide care and support to patient groups, ensuring the most appropriate professional is providing the right support to patients at the right time. By improving Chronic Disease Management in General Practice, we will reduce demand on acute services. Approach We will create a rolling programme of rapid improvement cycles that focus on and standardise the approach to every Chronic Disease Management group. Led by our nursing workforce and working in partnership with local GPs (including those with Special Interests), relevant local providers, Public Health colleagues, Practice Managers, the third sector, administrative staff, commissioning colleagues and IT colleagues, we will review all aspects of our approach and delivery of care to these patient groups. We will engage with and co-produce these new ways of working with patients and their carers who live with these conditions. 8

79 We will work in partnership with a Transformation and Change specialist, Integral Health Solutions, to diagnose, design, deliver and demonstrate solutions and changes. We believe that emerging solutions will involve multi-disciplinary team working in practices and in the communities, working in an integrated way with a range of partners. By working in this way, we believe we can standardise the approach, the templates, training and audit, skill mix, recall systems, patient access, exception reporting, patient information, patient education and information leaflets. We will focus on all aspects of care from prevention and self-care (supported by the One Halton Population Health Framework), through to treatment and palliative care. Our aim is to work with our commissioning colleagues and Public Health team to agree a prioritised order of which Disease Management Groups we will review based on a factors including unmet need, variation and levels of demand. Diagnose stage We will align our approach with what is recognised as best practice. We will do this by benchmarking and analysing our various approaches against NICE guidelines and quality standards, JSNA, patient feedback and experience, QOF data, exception reporting, prescribing data, medicines management intelligence, acute service demand, risk stratification and the local Primary Care dashboard. We will work closely with the Business Intelligence teams of the CCG and Public Health teams. We will focus on clinical pathways, infrastructure (governance, IT, estates, monitoring) and staffing. Design stage We will work with partners, patients and their carers to design and map the right services, pathways, approach, staffing, skill mix, communication and enabling infrastructure for each chronic disease group. This will be a true partnership approach. Deliver stage We will plan, implement, test and embed the agreed changes. We will do this with our partners and communicate effectively throughout the process. Demonstrate stage We will capture both quantitative and qualitative data and evidence to demonstrate the effectiveness of the changes we make. This overall approach presents a new way of working for General Practice working at scale. We have engaged with a Transformation & Change specialist to support us with this. However, we want to invest in our staff and processes so we are not reliant on external support in perpetuity. As such, we are asking them to help us do three things: 1. Co-design and produce a framework and approach by which these rapid improvements cycles can be undertaken locally in Runcorn 2. Train our staff our nurses, Practice Managers, administrative staff and GPs - in the skill of change management and rapid improvement cycles because we want the skills to do this moving forward. 3. Work with us closely and lead the first rapid improvement cycle, from beginning to end. Our aim is to complete the first rapid improvement cycle in six months. Thereafter, our aim is to undertake and complete each within 3-6 months. 9

80 Timescales Our aim is to commence the first rapid improvement cycle in October Therefore, our aim is to complete the first rapid improvement cycle by March We would then aim to undertake a further four rapid improvement cycles in 2019/20 and would have the skills to continue this process into 2020 and beyond. 2) Working effectively as a primary care network to support continuity of care Rationale General Practice is increasingly struggling to cope with the daily levels of demand placed upon it. Typical demand can be put into one of three categories: 1) Chronic Disease Management, planned care 2) Acute demand 3) Planned/pre-bookable The demand in each of these categories is increasing and as such, the time we have available to adequately meet this demand is reducing. It is not just about meeting the demand either, it s about providing the level of care that people need, at the right time with the right person. We need to spend more time with some of our patients. Our aim is to adopt a new and integrated town-based approach with our urgent care centres to increase the capacity that is available. Approach We want to implement a new approach for how local residents access services in Runcorn. We also want to maintain care continuity for those patients who need it the most, e.g. those with chronic conditions or the frail elderly (this is not an exhaustive list). We also want to be able to offer longer appointments and work in a more integrated and team-based way with our partners (mental health, social care, third sector, acute, community) to better support these patients. By doing this, we can better manage and support patients and their conditions in the community, resulting in care closer to home and meaning patients only need to go to hospitals when specialist intervention is required. We can also work with acute specialists in the community (e.g. geriatricians and paediatricians) as part of a wider, more integrated community based workforce. The way we believe this can happen is to integrate the urgent care centre provision with general practice in Runcorn. This is a key reason for submitting this bid on behalf of our town-based population of 65,000. The rationale for this is further explained below. Where a patient wants to see a doctor or clinician and they don t have a chronic disease (or has a complex need that we believe should be managed in general practice), we will offer them a choice of where to access services locally. This could be an appointment in general practice or an appointment on the day at the urgent care centre, whether this be for acute on the day or planned or pre-bookable. The patient will be offered an on the day appointment in the urgent care centre where they will see a clinician appropriate for their need, but not likely to be their usual GP. By approaching the on the day demand in this way, it will create capacity in General Practice to provide care continuity for those patients where it s most important e.g. for those with long term conditions, complex co-morbidity, frail elderly, or palliative care needs 10

81 We see opportunity to rotate practice staff through the urgent care centres, providing an integrated town-based service with other providers. This very much lends itself to the scope and requirements of the future Urgent Treatment Centre model. Rotating some practice staff through the urgent care centres will also support staff retention and training as it will provide opportunities to experience new and different environments and services. We will work with our partners across Runcorn as we believe having social workers, wellbeing officers, community staff, mental health professionals, our third sector partners (including organisations like Citizens Advice), acute professionals and our local housing experts will provide a more convenient service. We want to create a multi-disciplinary approach where physical, mental, social and domestic needs and issues can all be supported within a single visit. This is our ambition for our community hubs of the future but we believe this type of multi-disciplinary team can be established in the urgent care centres now. We believe that this approach of offering on the day access to appointments in a town-based service will be very attractive to a lot of our residents. We run the GP Extended Hours service in Runcorn and have been since April The feedback from a significant proportion of the service users is that they welcome the opportunity to have access to a convenient town-based service, where they don t see their own GP or clinician. It is the patient s choice to use the service. 98% of patients who use the GP Extended Hours service tell us they would use it again, and a lot do. For this new approach to work, we need to invest in our care navigation and IT systems. The urgent care facilitates will have full visibility and access to the patient s primary care record, across all disciplines. Whether a patients calls the practice, uses an IT solution to book an appointment or walk s in to the practice or urgent care centre for an appointment, we believe it is essential that a standardised approach to offering and accessing services is deployed across Runcorn. As such, we need to develop a system that can be accessed and used by both the patient or staff members to ensure patients are accessing the right service. A critical first step in this scheme is to undertake detailed capacity and demand management modelling of general practice. We are delighted that NHS England are commissioning the APEX/Insight tool for local practices as we believe this will provide the data and intelligence we need to start to plan the service configuration. This tool will extract detailed levels of staffing, services and productivity data from every practice system. It will enable us to accurately model the demand on services, how each practice manages this and for us to model alternative approaches to test the most efficient solutions and pathways. It will also enable us to consider alternative workforce models and to consider how we can maximise the efficiency and utilisation of both our current and future staff. Work is already being undertaken by Halton CCG to develop the local Urgent Treatment Centre and we are collaborating with them and other partners to develop the urgent care model, the service specifications, the future capacity requirements and the future care pathways to meet the levels of need and demand for a 24/7 solution in our community. This will consider all aspects of care in the community including services such as pharmacy and optometry. We also mindful of potential future changes to services such as NHS 111. To do this, it is essential that General Practice is ready to work in this way and at scale. As such, we will establish a group to lead this piece of work on behalf of General Practice in Runcorn. This group will consist of GPs, nurses, Practice Managers and administrative staff. It need to be fully representative. This group will start in September 2018 and continue until March 2020 when we believe the new ways of working will be implemented. 11

82 This group will use the same approach outlined above diagnose, design, deliver, demonstrate to develop a standardised General Practice service for urgent care. To underpin this and the scheme described above, we are engaging with a local Third Sector organisation, Halton Voluntary Community Action (Halton VCA), to work in partnership with us to support a public engagement and insight campaign. Halton VCA ran an excellent public engagement session for General Practice in 2017 in which the question was asked Tell us what s wrong with General Practice. During and after the event, we received invaluable feedback including that 80% of attendees who responded to a survey said they felt more optimistic about the future of General Practice in Halton after attending the event. Therefore, we are confident that if we can effectively engage with the population, we can co-produce effective services and solutions that they will support. We want to work with, engage with and discuss the best ways of developing these standardised General Practice services with our residents from the outset, doing this in partnership with Halton VCA. Finally, we will engage with and align our IT requirements into the local IT Group to ensure that the technical solutions we require in General Practice are developed and implemented and integrate into the wider IT solutions across Runcorn. Timescales We understand that the APEX/Insight tool will be deployed into Runcorn soon and we will look to commence detailed capacity and demand management modelling in October We will start the General Practice project group in September 2018 and start to design the public engagement campaign with Halton VCA in September too. We anticipate the public engagement work will commence in November We anticipate 12 months of diagnosing and designing work so forecast that the deliver stage (service changes) will start to be made in September 2019, ahead of the winter period. The IT requirements will need to fit in line with the roll out of the new approach. 3) Standardised care navigation for every patient Rationale The two schemes described above will change the way that services are offered and accessed. As a result, a town-based and consistent approach to Care Navigation across all practices is critical. We believe it is also essential to maximise the benefits of a new Care Navigation approach, a single approach is deployed across all six practices at the same time. Without a robust, coherent and fully aligned/integrated approach, our view is that complaints could increase and patients may be left confused if practices are offering different advice. Approach NHS England have provided funding to support Care Navigation training and Halton CCG has already commenced a programme of work that has engaged with practices. 12

83 The approach we want to take, working in partnership with the CCG, is to lay the foundations to maximise the impact of care navigation. We want to line up all of the services and focus on implementing the optimum solution. Given the timescales set out above, we believe we have just over 12 months to develop a town-based approach to care navigation that will include the development of a common set of protocols and rules, a common script, common service list and access choices. We believe this offers a great opportunity to develop our staff, develop skills and potentially share our resources and skills across the town. There is concern that if practices launch Care Navigation at different times, it may confuse patients and as such, complaints may increase, patients may look to move practices and the variation of what services are offered may increase. As such, we want to establish a working group consisting of Practice Managers, administrative staff and our commissioning colleagues to oversee and develop this scheme in partnership. Staff involved in this will represent practices and lead the development, launch and implementation within their respective practices and to embed the training that is available from the GP Forward View back into every practice in Runcorn across the whole workforce. Furthermore, we will incorporate the Care Navigation scheme and changes that will arise from it into the public engagement campaign that we described above. We want to present a holistic and joinedup picture to the public. Timescales Our plan is to establish the working group described above in September 2018 and this will run for approximately 12 months. This working group will work in partnership with commissioning colleagues. The group will oversee the design of the approach, the training requirements, coordination with the public engagement campaign and the roll out at practice level. 4) Realising efficiencies through standardising back office functions Rationale There is an opportunity for General Practice to realise significant efficiencies in the way it coordinates and operates its back office functions. By back office functions we mean: Coding; Scanning; Summarising records; Patient correspondence; Telephony; Referral administration; Hospital correspondence/communication; National patient safety alerts; Medicines management; Audits; Searches As well as efficiencies, we believe this will improve patient safety and quality of services as it will reduce potential delays in functions such as scanning and coding of patient s records and discharge summaries. This will provide more timely information to our staff. This scheme will not save the practices money but it will present the opportunity to increase productivity and efficiency of the funding that is currently spent. 13

84 At present, the six practices operate these functions largely independently of each other and there is a lot of scope and opportunity to standardise and centralise this, whilst creating and developing transferable skills and increasing the resilience of the respective services. Approach As described in scheme 1 above, we want to create a rolling programme of rapid improvement cycles that focus on and standardise the approach to each function. Lead by Practice Managers, working in partnership with administrative staff, we will review all aspects of our approach and delivery across each function. The diagnose, design, deliver, demonstrate approach outlined above will be adopted in this scheme too. As will the three aspects of the approach co-design the approach, train our staff, implement the first cycle with us. Our aim is to complete the first rapid improvement cycle in six months. Thereafter, our aim is to undertake and complete each within six months. We don t want our administrative staff to see this as a threat. We believe that this will result in changes within our administrative workforce however, we are not considering redundancies. There are significant opportunity to retrain staff, to support them develop new skills and to redeploy their skills within the new town-based general practice model. Timescales Our aim is to start this process in October Therefore, our aim is to complete the first rapid improvement cycle by March We would then undertake a further two rapid improvement cycles in 2019/20 and would have the skills to continue this process into 2020 and beyond. Programme leadership and resources This programme of work and the four schemes it details will be driven by the GP Federation, GP Health Connect, supported by every practice. The Federation will monitor progress every month at its regular Board meeting. We will invite our NHS England buddy and a member of the CCG commissioning team to this session to provide complete transparency in our progress. The overall lead for the programme of work is Dr Gary O Hare, local GP and Clinical Transformation Lead for the GP Federation. He will dedicate 2 sessions a month to provide leadership across Runcorn and focus on the delivery of the schemes. He will be supported by the dedicated project manager. We are then asking each practice to commit to providing one session of input a month across the four schemes from a GP, a nurse, a Practice Manager and a member of administration staff. We believe that this whole approach underpins the principle of primary care at scale and fully aligns with the local place-based agenda. As a core and major member of the One Halton Board, we have signed a commitment to: Improve health and wellbeing outcomes for local people; 14

85 Collaborate between health and social care services, providing accessible high quality services to local people; Develop new ways to prevent and better detect illness; Reduce the levels of demand on hospital, acute care and healthcare services generally; Deliver service closer to home and within local communities We believe that the schemes we have set out above fully align to and start to deliver our commitment to the One Halton Board and the CCG Transformation agenda. How the Network s proposal is aligned to any current CCG transformation agenda As set out in the previous section, we believe that our proposed fully aligns to the CCG Transformation agenda, One Halton. The vision of One Halton is working together to improve the health and wellbeing of the people of Halton so they live longer, healthier and happier lives We believe that our proposal fully supports this vision. We want to work at scale and in partnership and develop services to fully meet the needs of our residents. All members of the One Halton Board have been asked to support 10 commitments. These are listed in the table below. We believe our proposal fully supports each commitment. Commitment We agree that an integrated system of health and social care is the best way to ensure optimum health, wellbeing and care outcomes for our population and to ensure collective financial sustainability. We agree that the Halton Health & Wellbeing Strategy provides the focus for our work together and sets out our vision to work together to reform health and social care services to improve the health outcomes of our residents and reduce health inequalities, as quickly as possible We agree the One Halton ACS Board will provide a focal point for prevention and early intervention, proactively identifying potential future demand and shifting the focus from unplanned and reactive services to planned and targeted interventions We agree to put patients and residents at the heart of what we do We agree to put General Practice and other community practitioners at the centre of our care model We agree to design and plan services around functional geographical footprints with populations of 30,000 to 50,000 based on registered patient lists We agree to design services for users and not our organisational needs The Commissioners agree to deliver a single approach to commissioning health, wellbeing and care services in order to transform services and improve outcomes. This will enable collaboration integrated working and include the development of pooled budgets We agree that we will consider the options available to us, and select the best delivery model for the Does this proposal support the commitment? How? Our proposal fully focuses on integrated systems and providing optimum care and outcomes. As a partner, we support the drive for financial sustainability Our proposal is fully aligned to the One Halton vision and programme and we want to commit clinician time to the development to ensure this is a clinically-led redesign programme, in partnership with our colleagues from other organisations. We are an active member of the One Halton Board and fully support the approach and work streams. As such, we are targeted the Urgent Care & Complex Care needs work stream with this proposal Patient focus is at the heart of our proposal We fully agree with this! We believe a town-based approach for this level of transformation will yield the greatest benefits. Geographically, it makes complete sense. We have built patient engagement and coproduction into this proposal We have very good and productive relationships with the commissioners and support the approach they are taking with One Halton. We want to work with partners to ensure that the very best models and solutions are designed and 15

86 integrated care system in Halton, but not withstanding this, we will continue to integrate our services on the ground, at pace, using the existing options available to us to do so We acknowledge that creating a Locality Care Partnership will not resolve the significant budget challenges facing all organisations but it will go some way to reducing it and it will be necessary to continue to work closely together with all stakeholders to manage the deficit around health and social care implemented. That may require us to change. We accept this challenge which is why this bid focusses on the six practices working in close collaboration. We are committed to working with partners as we look at the development of a Local Care Partnership in Halton. How this will increase the pace of change from where the Network is now? Halton CCG have developed the Halton Enhanced Scheme (HES). This supports two programmes of work across General Practice in Halton, with one specific component in 2018/19 to support the development of Test Bed projects. The Test Bed projects are part of the One Halton programme, meaning we have aligned General Practice schemes with the One Halton ambition. The projects are designed to support rapid improvement cycles by focussing on specific service areas and working in partnership with a key local provider. Each Test Bed project is being run by one of the local community hubs. Each community hub is made up of between 2 and 4 local practices working together in a geographical area. Each hub is a small operational unit, sized between 28,000 and 37,000 population size, enabling operational, community focused multi-disciplinary teams to wrap around and focus on a specific population. The graphic below shows the four Test Bed projects, the respective providers and the population sizes. All four Test Bed projects have commenced in the last two months and this approach demonstrates that the practices can work effectively in partnership. If a Test Bed project is successful, it will be rolled out across the other three community hubs. This is a fundamental ethos behind the Test Bed approach. To run projects concurrently, to implement rapidly at a small/local level, to audit and evaluate quickly and at timely intervals, to share learning and if successful, to quickly roll out for all patients to benefit. 16

General Practice 5 Year Forward View Operational Plan Leicester, Leicestershire and Rutland (LLR) STP

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