Care Closer to Home Integrated Networks (CHINS) Frequently Asked Questions Following on from the CEPN led Multi-Collaborative Learning Groups (MCLG) where the CCG and GP Federation engaged with practices on the Barnet Care Closer to Home Programme, we are pleased to inform you that we have had a further two CHINs come forward following the engagement process which will potentially provide 68% Barnet population coverage, when combined with the existing three CHINs. A number of questions were raised and these have been captured and addressed in this Frequent Asked Questions (FAQ) document. What is a CHIN? A population based approach to healthcare with the aim of improving how care is delivered closer to home for patients in an integrated way. Our vision within Barnet is to group (I say this as we are not intending new services) services around the GP to and to use data to drive how services are developed. How do we become part of a CHIN? As part of the engagement process, the CCG and GP Federation had been seeking the views of practices on the best way to take this agenda forward. However, we received mixed feedback on the original expressions of interest process that was undertaken to form the first three CHINs within Barnet. The potential options for becoming part of a CHIN are shown in the diagram below: The initial feedback suggested that practices were not keen on a top down approach, therefore a Locally Commissioned Service (LCS) option, which would provide funding and an easier entry process has been proposed by the CCG (option 3).
The high-level principles for becoming a CHIN are: Geographical Alignment Patient population size of between 30,000 50,000 patients Commitment to working with the Quality Improvement Support Team (QIST) Have an IT, Estates and Workforce baseline assessment and development plan Commitment to developing data sharing and information governance agreements, where not already in place We will be developing an Infrastructure LCS, which will make it much clearer what a CHIN is and how to become one. Data will be made available to suggest an area of focus and then the CHIN can begin working on their ideas. Whilst the LCS is being developed, please continue with the conversations that you may be having regarding forming a CHIN as the infrastructure LCS will reimburse you retrospectively for your time. Practices would like to have confirmation of what funding is available? What does back fill mean and how much will be funded? The funding for the programme is in addition to the core primary care budget and is new investment for sustainable transformation. The funding streams have been broken down into two areas and these are shown below: Formation of CHINs The CCG is currently developing an Infrastructure Locally Commissioned Service (LCS) that will provide funding for practices to meet and decide how they are going to work collaboratively and in an integrated manner as part of a network. We understand the need to release capacity for these important conversations take place. The expected outputs from this LCS would be: A Memorandum of Understanding (MoU) signed by all practices within the Network the CCG can support you with the development of this document A proposed governance structure the LCS will give guidance on what this means and how to produce it. A named lead for the Network A named Quality Improvement lead for the network This will need to go through the usual governance routes within the CCG and we are engaging with the Local Medical Committee (LMC) throughout the process so that we can launch the LCS in the coming weeks. CHIN Development and Service/Pathway Implementation Funding and physical resources are available to support CHINs with: 1. Generation of pipeline ideas, 2. Evidence based audits 3. Business case development for new models of care in the populations they serve.
The funding requirements for the scoping of pipeline ideas will need to be defined at the start of each project; however, you will be supported by CCG managers and the QIST team to help facilitate this process. Investment for service redesign and new models of care can be secured when the business cases have been approved. When will practices get data from CCG/CSU to help the decision making into what the CHIN could focus on? The CCG is currently working very closely with NELCSU on the business intelligence requirements for the CHINs and have already undertaken data analysis on avoidable admissions and unwarranted variation that can be shared with the CHINs and the GP Federation in the first instance. The CCG are also redesigning our monthly acute data reports to be produced at a CHIN level, rather than at individual practices. This data includes: A&E attendances, Elective admissions, Non-Elective Admissions, Outpatient attendances at a speciality level across your network. These reporting packs will be made available on a monthly basis to each of the CHINS within Barnet. The CCG is also undertaking a discovery project to support the Care Closer to Home transformation programme that will bring together data from hospitals, UCC, primary care, NHS 111, walk-in centre, extended Access and GP Out of-hours data. This is designed with the aim of providing insights into a local population. This will be provided at a CCG, CHIN and General Practice level through the North East London Information Exchange (NELIE) and will be available to all CHINS and practices. This project is currently being scoped and resources allocated to deliver this business intelligence product. What help and resources are available for the development of the CHIN business cases? The CCG will provide resources for the development of the CHIN business cases and this will primarily be the Care Closer to Home Locality Development Managers from the primary care team, who can call upon additional CCG resources as and when required. The Care Closer to Home Locality Development Managers who will be working with you are: Cassy Bygrave (cassy.bygrave@nhs.net) Conan Cowley (conan.cowley1@nhs.net) Nicholas Ince (Nicholas.ince@nhs.net) Once you have expressed an interest to become a CHIN and signed up to the Infrastructure LCS, you will have one of the team assigned to work with you as your embedded resource. The Barnet Federation will work in collaboration with the CCG and other provider organisations to provide support in areas such as governance and workforce issues that arise in the development of projects.
How do we approach Quality Improvement and how will the CHINS be supported with this? The CCG are working with the GP Federation to develop a specification for the Quality Improvement Support Team (QIST) and contractualise arrangements to support the CHINs. The QIST will operate as a cohesive team, led by a senior clinician and the team will have access to and draw on a range of local knowledge, clinical expertise, and information systems expertise. The GP federation has a Quality Improvement lead, Dr Thivyan Thiruudaian, and the CCG, with the Federation will be inviting expressions of interest for a Clinical Quality Improvement lead to work with the QIST. It is anticipated that the QIST will use a Multi-Disciplinary approach with the right skills to deliver the quality improvement agenda for Care Closer to Home. It is expected the team will carry out but not be limited to: Harness analytics and business intelligence Work with any existing systems and processes to ensure that rich and accurate data is collected and well-used to inform continual service improvement. As a part of this, assurance will be provided to the commissioner that practices are willing to participate in the sharing of practice-level data from systems such as e-referrals and EMIS. Co-designing quality based work in primary care Aim to triangulate inputs from primary care, commissioning and public health data to target unwarranted variations in standards. This work not only intends to reduce variation but also to raised standards of health care delivery. Generate and Develop Ideas for CHIN pipeline work The QIST team will aim to work with each CHIN to help identify areas for pipeline work, sharing knowledge gained from NCL activity as well as across Barnet practices. The team will also carry out and embed peer review and training by working collaboratively with clinicians. How will the CCG / Federation / Locality / CHIN / GP surgery relationship will work, making specific reference to who is responsible for what area of work? We are all learning from the creation of new healthcare forms in primary care and need to be aware that much of what is created will be based as well as improved on from experiences from practices. For this reason, relationships will be defined as part of the outputs from the infrastructure LCS in the form of the CHIN governance structure, this will be iterative as the CHINs, the GP Federation infrastructure and wider system partner engagement develops. There is also the distinct possibility that the roles and relationships may be different within each CHIN, depending on the nature of the project and the skills contained within the network. There is an established governance structure for the overall Care Closer to Home programme that is jointly led by the Barnet Local Authority and the CCG and this will be shared with the CHINs so that the high-level structure of the programme can be understood and taken into account when developing local structures and defining the roles of delivery partners. What is the role of the Federation in this programme?
Barnet GP Federation is an vital component of every CHINs delivery and will play an important role as a delivery partner in the Care Closer to Home programme and the CCG, along with the Local Authority, are all working together to provide sustainable clinical transformation, bridging the gap between health and social care, releasing capacity in general practice and primary care resilience. Barnet Federation, in conjunction with the CCG, have developed plans to form a CHIN steering group. This steering group is designed with the aim of providing the link from the Federation and CCG to CHINs. Development plans, operational delivery and support for practices will all flow through this group to ensure clarity to practices on how to manage this new approach to healthcare delivery. The Federation has advertised for a position of a clinical lead for CHINs to support practices through this process and aim to appoint in due course. Can I join an existing CHIN? If you are geographically aligned to an existing CHIN, we would encourage practices to make contact with the CHIN leads and discuss how you could become part of the network. The CHIN leads for the existing three networks are: Dr Aash Bansal (CHIN 1) Everglade Practice Dr Anita Patel (CHIN 2) St Andrews Medical Centre Dr Alexis Ingram (CHIN 3) Woodlands Medical Practice