PRIMARY CARE COMMISSIONING COMMITTEE Meeting held in Public 3 rd July 2018 Title of report Purpose of the report and key highlights Resetting New Models of Care in Trafford This briefing paper sets out our commissioning direction for a new model of care in Trafford, working closely with all partners through a Local Care Alliance to deliver system change and improved outcomes for Trafford people. In particular the paper highlights the role of primary care within the commissioned model and as a delivery partner in the LCA. Actions requested Decision (Decision and discussion required) Discussion (No decision required. Discussion only which may lead to actions ) X Information (no discussion required) Strategic objectives supported by the report Continually improve engagement with member practices, patients, the public, carers, providers, our staff and other partners to effectively contribute to and influence the work of Trafford CCG. Working with health and social care partners deliver the transformation plan for Trafford including an increasing proportion of services from primary care and community services in an integrated way. Through effective integrated commissioning improve the quality of services and reduce the gap in health outcomes between the most and least deprived communities in Trafford. To be a sustainable economy both in terms of clinical services and finances. Recommendations Committee is asked to note the contents of the paper and provide comment on future oversight on primary care design and delivery. Trafford Coordination Centre implications Discussion history prior to the Clinical Committee N/A Paper was presented to Council of Members Meeting 13 th June 2018.
Financial implications Risk implications Equality Impact Assessment Communications Issues Public engagement summary Prepared by Responsible CLT Member Financial approval N/A The Board Assurance Framework will reflect any risks associated with change in strategic commissioning direction as identified. The outcome of any change in commissioning strategy and implications on commissioned services will be supported by a thorough equality impact assessment. Commissioning for Trafford people will form a key component of the Trafford communications and engagement strategy, plan and associated activity. None to date Rebecca Demaine, Interim Director of Commissioning Sara Radcliffe, Corporate Director of Commissioning Not applicable Priorities 2018-2019 1. Deliver implementation on New Models of Primary Care (Director of Commissioning, Medical Officer), the Local Care organisation (Interim Accountable Officer) and Care Complex (Director of Nursing) 2. Prepare commissioning plans for the new primary care organisation (PCO) and the local care organisation (LCO). (Director of Commissioning) 3. Maximise the Trafford Co-ordination Centre (TCC) and prepare stage 2 delivery planning and implementation. (Chief Finance Officer) 4. Attain delayed transfers of care targets (DTOCs). (Director of Commissioning, Director of Nursing) 5. Meeting waiting time standards in urgent care, cancer, mental health and planned care. (Director of Commissioning, Medical Officer) 6. Achieve financial plans. (Chief Finance Officer) 7. Implement primary care strategy and the new services from Altrincham. (Chief Finance Officer) 8. Enhance engagement with communities, providers and primary care (Director of Nursing, Medical Officer) 9. Progress organisational development throughout the health and social care sector. (Accountable Officer) 10. Progress commissioned service pathways e.g. end of life, diabetes. (Director of Commissioning, Medical Officer) 11. Manage the transition to the new integrated organisation. (Accountable Officer) 12. Design and implement the new strategic commissioning function. (Accountable Officer) 13. Support continuous quality improvement of Care Homes (Director of Nursing)
Resetting New Models of Care in Trafford Commissioning for the person and the place The Trafford transformation plan was developed in 2017 by Trafford CCG and Trafford Council. The plan describes how health and social care will be transformed in Trafford. We have two areas that we believe will drive forward the transformation of our system. A single commissioning team for health and social care in Trafford From April 2018 the Accountable Officer for the CCG is also the Chief Executive of the Council. This will enable an integrated commissioning function for health and social care to be brought together to commission for Trafford people. Trafford commissioning team will: Commission for the people we serve and the place where they live Commission strategically for outcome focused care models and systems Commission by co-designing place-based delivery models What and how we will commission is being driven through a Trafford approach to strategic commissioning underpinned by a set of commissioning outcomes, principles and behaviours which will facilitate the development of a commissioned model of care closer to home for Trafford residents across prevention, planned and urgent care. A Trafford delivery model for integrated care closer to home. Trafford has recently established a Local Care Alliance which brings together the main providers of health and social care to work on integrated care delivery. Primary Care is a major player in the LCA. Trafford commissioners see the LCA as an opportunity to begin to work differently with providers to transform services. We see this as a long-term plan to look at how services can be effectively delivered as close to a person s home as possible, be that at practice, community hub, locality or borough level. Services may be delivered most effectively outside of the borough itself and when this happens we need to ensure that there are integrated pathways back to home.
The transformed system will deliver the triple aim of improved patient health and wellbeing, improved quality of care for people in local communities and improved utilisation and sustainability of the health and care system. We will commission a health and social care system in Trafford that will: have a community focused integrated model of care around our four localities have joined up health and social care services whatever your age encourage independence and self-reliance through a new model of social care Trafford s key priorities within our locality plan We want to tackle health inequalities in Trafford to reduce the variation in health outcomes. Generally, residents in the north of the borough have lower life expectancy than in the south. In Trafford there are an estimated 1902 deaths per year. Almost a third of these are classed as premature which means people are dying before the age of 75 and two thirds of those deaths have preventable elements. We want to reduce preventable and early deaths and improve life expectancy, the three largest killers in Trafford are, cardio vascular disease, cancer and respiratory disease. We also want to improve the quality life for Trafford residents by improving the pathway of care in areas such as diabetes and frailty. A set of high level outcomes for Trafford have been developed: 1. A long healthy life - No matter where I live in Trafford I will live a long healthy life. 2. Support if I need it - I am able to deal with the challenges I may face in my life. When I cant I am able to ask for help. I am confident that the support I need will be there for me, from people around me and through services if I need them.
3. A peaceful end to life - I will have dignity in the final stages of my life and choice over how and where I die. The people who support me to do this will be compassionate and listen to my wishes. 4. My independence - I am able to live my life independently. I have choice and control over how and where I live and support if I need it, for as long as I need it. 5. I take charge of my own life - I have the confidence and knowledge to make good choices. I take responsibility for myself and my actions. 6. I belong - I feel a part of Trafford and its communities, where I am welcomed and valued. I am able to take part in community life. 7. I feel safe - My community is a safe place to live, and we look out for each other. Services in Trafford will protect me from harm and reduce the risks I may face. 8. We are a family - Whatever family means to me (whether its friends, community or relatives), I will have my family around me. If things break down and we need help we will be supported. 9. Our children will have the best start in life - No matter where our children live in Trafford they will grow up to reach their full potential. A New Model of Care We will work with our partners in the LCA to provide care closer to home through the introduction of a new model of care covering areas such as: Respiratory (including COPD, asthma, flu and pneumonia) Diabetes Falls & Frailty Medicines optimisation Mental Health & Wellbeing Dedicated multi-disciplinary teams (MDT) for nursing home patients As commissioners we believe Trafford LCA is the fundamental building block for transforming the system that transformation will be translated and delivered through the LCA. Working with the LCA will help to create a sustainable system focussing integrated delivery on the key impact areas outlined above. Place based commissioning will ensure that there are opportunities for delivery at scale (borough wide where appropriate), at locality, neighbourhood and community level, working with our colleagues in partnerships to ensure an asset based approach. At a neighbourhood level, we will agree a risk stratification approach for the population to enable predictive modelling for current and future need and commission a care co-ordination model which is owned and delivered by all partners within the LCA. There will be a requirement for identified leadership in the neighbourhoods across all the partners to lead the design, development and delivery of the care model for that locality.
Primary care within the Local Care Alliance must be representative of the whole of primary care and this extends beyond General Practice to include: Out Of Hours provision Dental Services Community Pharmacy Optometry Decisions will need to be taken about the scope of primary care provision to be included in the delivery model such as core general medical services or enhanced provision and there are a number of contractual and regulatory frameworks to be considered. The model of care cannot be delivered through primary care alone and must be an alliance with LCA partners. The key enablers to successful delivery such as workforce, estates and technology must be owned by the partners who will work together to innovate and deliver a transformed model of provision, leadership and performance. We will commission; and partners will deliver a fully integrated, all age, neighbourhood based health and social care system which is flexible, responsive, and proactive with a redesigned primary care offer at the centre. It will be delivered across 4 neighbourhoods and will provide care to the highest common standards and outcomes. The model will serve the entire population of Trafford as it is an all age model and will be designed to prioritise particular population cohorts to deliver improved outcomes.
Our model will prevent unnecessary unscheduled hospital admissions but also facilitate timely discharge and appropriate aftercare, in order to prevent readmissions. To achieve the design of our new care system to address the issues within our target cohorts, we need to be ambitious. When designing a new care model for Trafford we will: Design for cohorts of our population Think about the functions that we are trying to provide (e.g. responding to crisis) and how this can be done in an integrated way to reduce duplication & handovers Think beyond the constraints of current services that we provide Think beyond organisational boundaries Consider the challenges we are trying to solve, particular to Trafford Consider how we can meet the requirements of 7 day access Design for improved outcomes including wider system benefits e.g. employment, skills, social prescribing, physical activity, housing etc. Within the delivery model, primary care needs to reform to meet current and future challenges but must do this in the context of the wider system change. The proposed transformation of primary care in Trafford aims to change the primary care day, freeing capacity for staff to focus on supporting patients with long term conditions and provide urgent access when appropriate. The model will have dedicated capacity to introduce a systematic approach to support for residential, nursing homes and housebound patients in partnership with a remodelled homecare, adult social care and proactive and reactive community service. It will provide specialist and urgent care skills & capacity within the workforce and will introduce streamlined administrative and back office functions. Primary Care must underpin the LCA delivery model, enhancing and reinforcing the integrated working with community, social, mental health, voluntary sector and secondary care providers and other partners. The transformation of primary care will: Current primary care provision in Trafford is variable and there is significant variation in quality, we will commission a set of standards based on the Greater Manchester primary care standards which will be owned and delivered though the Local Care Alliance. We will standardise performance through the introduction of a single quality contract to be based on the GM primary care standards: 1. Improving access to a GP; 2. Improving outcomes for patients with mental illness; 3. Improving cancer survival rates and earlier diagnosis; 4. Ensuring a proactive approach to health improvement and early detection; 5. Improving the health and wellbeing of carers; 6. Improving outcomes for people with long-term conditions; 7. Promoting medication checks; 8. Improving outcomes around childhood asthma; 9. Proactive disease management.
In conclusion, this briefing paper sets out our commissioning direction for a new model of care in Trafford, working closely with all partners through a Local Care Alliance to deliver system change and improved outcomes for Trafford people. The dialogue will continue over the coming months as our commission intentions are finalised and we look forward to your continued engagement in design and delivery oversight.