Draft Briefing Document Procurement of a Partial Multi-specialty Community Provider Contract What does it mean for GPs and Practices? April 2017
Contents 1. Procuring a provider for community services across Scarborough and Ryedale CCG area: How we got to where we are... 2 1.1 In summary... 2 1.2 More detail... 2 1.3 The new model... 4 2. What is a Multi-specialty Community Provider?... 5 2.1 In summary... 5 2.2 More detail... 5 2.2.1 The Partial MCP... 7 3. What are the integration agreements?... 8 3.1 In summary... 8 3.2 More detail... 9 4. Questions and Answers... 10 4.1 Who will the new provider be?... 10 4.1.1 Application of procurement rules... 10 4.2 Where will the new provider be based?... 11 4.3 What will the impact be on GMS?... 11 4.4 Questions regarding integration agreements:... 12 4.5 Please share more details on the model... 14 4.6 How will we recruit staff to these new teams... 14 4.7 Will this be dumping more work on GPs?... 15 4.8 What will the MCP look like on Day 1... 15 4.9 What happens to our Practice Nurses on day 1... 15 4.10 What will happen with DNs on day 1?... 15 4.11 We like the current service in Ryedale will the MCP spoil this?... 15 Appendix 1. Notes on the new service model... 17 1
1. Procuring a provider for community services across Scarborough and Ryedale CCG area: How we got to where we are 1.1 In summary Previous engagement over 15/16 gave clear message re need for better integration of community services CCG has listened to GPs talking about wanting a closer more consistent relationship with community nursing and therapy teams, and value placed on specialist nurse input Pause for reflection and discussion with Local Authority about what we could do better together in the community setting Commissioner workshop in September 2016 developing model Emerging model based on 4 components (single access point/customer service centre, prevention and health promotion, planned care, and fast response) and underpinned by pooled budget Council of Clinical Representatives (CoCR) workshop October 2016 supported need for change with broad support for emerging model Formal soft engagement between 21st November 2016 16 th February 2017 gave support for overall model and principle of integrated care (engagement report on CCG Website) Governing Body decision in January 2017 to procure Partial Multispecialty Community Provider (MCP) 1.2 More detail The current arrangements for the delivery of NHS and Local Authority out of hospital care is via a number of isolated and somewhat fragmented contractual agreements with providers. This approach has limitations and provides boundaries that make it harder to provide joined up care that is preventative, high quality and efficient. In order to facilitate true integration and offer improved, joined up, services for our population, the CCG and North Yorkshire County Council (NYCC) needs to radically change the way care is commissioned to develop a one system approach. There are a number of emerging models and contracting frameworks 2
that support the integration agenda. The NHS Five Year Forward View proposed two models for bringing together health services in local areas; the Primary and Acute Care System (PACS) and the Multi-Specialty Community Provider (MCP), these are briefly described in the next section. Both the PACs and the MCP approaches have three emerging contracting options: virtual, partially-integrated and integrated. Since August 2015, the CCG has been exploring how services provided outside of hospital, known as community services, can work better to improve patient s experience and respond to a growing demand for care. Staff and patients have had the opportunity to share their feedback and experience. The original planned procurement process was paused in 2016 following the first engagement events in order to take stock, with all the views and feedback helping to inform a new integrated prevention, community care and support draft service specification. A commissioner workshop was held in September 2016 following which NYCC and SRCCG officers started to develop a proposed model for an integrated community service. This would involve staff working across organisational boundaries to provide joined up and seamless care. This was followed up with a workshop at the Council of Clinical Representatives (CoCR) in October 2016 to explore the emerging model further. A series of events were held between 21/11/2016 and 16/02/2017 to present and test out the CCG s proposal for a new Integrated Prevention, Community Care and Support service. A report based on those activities can be found on the CCG website. Throughout the engagement the CCG talked about their desire to utilise one of the nationally developed new care models such as a Multi-specialty Community Provider (MCP) to ensure that as far as possible the attention is focused on care in the community setting with people and their GPs at the core. This approach will form the basis of the procurement and contracting model, subject to some adaptation to encompass integration with the NYCC services as well as General Practice, and also to set out the longer term intention and vision. The new service will bring together health and social care in a way that has not been seen before locally and will put General Practice at the heart of the delivery model so that care is organised around the places where people live and the GPs they see. The commissioning model and service specification has been developed in conjunction with North Yorkshire County Council (NYCC) and over time, we plan 3
that resources in the region of 60 million will be brought together under joint management to fundamentally change the way care outside of a hospital is organised and delivered in Scarborough and Ryedale. 1.3 The new model Customer service centre/single point of access Single health and social care hub, for public and professionals supporting the integrated multi-disciplinary teams, helping people to navigate care and support services Prevention, health promotion and wellbeing Planned care and intervention Fast response, intermediate care and reablement A philosophical underpinning of; promoting self-care and health promotion across the whole service, and Access to / provision of specific interventions targeted at prevention and living well Integrated multidisciplinary teams providing planned care and intervention Assessment in response to crisis; fast turnaround and coordination of a package of care as close to the home as possible. Access to staffed beds in the community setting and community reablement PRIMARY CARE LEADERSHIP 4
2. What is a Multi-specialty Community Provider? 2.1 In summary An MCP is a new care model for provision of out-of-hospital care with a clear and robust governance structure, and its own organisational capability Built around the registered list, with primary care at the heart, focused on population health and self care, to enable greater scale and scope of services that dissolve traditional boundaries between different care sectors Making the most of digital technologies, with potentially joined-up electronic health records for its registered population, risk stratification and patient population segmentation, and targeted services for different groups of patients New skills and roles for expanded multi-disciplinary community-based teams, including for example pharmacists, social workers, cross organizational roles in health and social care, nurse leaders Based on population sizes of at least 30,000-50,000 Responsibility for managing new capitated contracts for population health and care 3 different model options of Virtually, Partially or fully integrated Governing Body decision in January 2017 to procure Partial Multispecialty Community Provider (MCP) 2.2 More detail An MCP is a new provider that integrates existing or new providers in a new and more innovative way. The scope of an MCP can vary but general practice has to be central to the leadership, management and delivery of care. A lead provider approach is expected, with a single provider entity (that could be formed through a corporate joint venture between several existing providers, for example) taking full contractual responsibility for the delivery of a range of integrated services for a specific population. The MCP can take on different organizational forms depending on the how the provider constructs itself for 5
example in the NHS England document Multispecialty community provider (MCP) draft MCP Contract package: questions and answers, available here: https://www.england.nhs.uk/wp-content/uploads/2017/01/draft-mcp-contractpack-q-and-a-1.pdf it states There will be no formal restrictions on who can hold an MCP Contract. Both NHS bodies (e.g. a foundation trust) and non-nhs bodies (e.g. a GP Limited Liability Partnership) can bid for the MCP. Through the procurement process and the integrated support and assurance process, providers will need to demonstrate to commissioners and to NHS England and NHS Improvement that they are capable of holding, and delivering, the contract. The CCG has made clear through engagement events, and in the market engagement event, that the model is based on letting a contract to a single legal entity, but this does not preclude innovative or multi-party bidding models and potential providers can consider a range of models which will meet the CCG s requirements. The MCP may provide all or some of the services, and all or some of the services may be sub-contracted. More information can be found in the CCGs MCP Prospectus document available on the CCGs website. MCPs are focused on care in the out of hospital setting (though strong relationships are needed with secondary care to ensure smooth transitions), and can include social care, public health, hospice, voluntary sector, and services that are more traditionally provided within a hospital setting. The following definitions are based upon the NHS England document GP participation in a multispecialty community provider available in full here: https://www.england.nhs.uk/wp-content/uploads/2016/12/gp-participation-mcpcontract-5.pdf The virtual MCP In this model core general practice remains commissioned under GMS, PMS or APMS contracts. Practices would sign an alliance agreement with commissioners and other providers to facilitate joint working, which sits over the top of (but does not supersede) traditional contracts. This builds on the growth of GP federations, which represents a stepping stone to this model. In this model a new MCP Contract is not awarded. The partially-integrated MCP The commissioner awards an MCP Contract for the services within scope of the model except core general practice. GPs / practices would remain on GMS, PMS 6
or APMS contracts. The crucial primary care contribution to the care model will be described via an Integration Agreement, which practices would sign with the MCP provider. The fully-integrated MCP In this model the commissioner awards a contract for a full range of services in scope, including core general practice. GPs would be able to suspend their GMS or PMS contracts (with right to reactivate) and move into the MCP as owners and /or employees. 2.2.1 The Partial MCP The CCGs governing body agreed in January 2017 that we would be pursue the procurement of a Partial MCP. The use of a partial MCP contract structure enables the CCG and NYCC as commissioners to build the blocks for a fully integrated commissioning approach to services out of the acute hospital setting in a phased way. The use of an MCP will strengthen the community and encourage a focus on what can be delivered safely and effectively in the community / home setting. Building on the principles of Home First the provider will be under a contractual obligation to make sure primary care is at the centre of a delivery model and the structure of the MCP contract will ensure the preferred provider is mandated to agree integration principles and process with NYCC and with General Practice. The structure of the MCP will make sure that service delivery works to provide services around the patient without significant constraints of organisational and service boundaries Where possible the MCP contract will be sufficiently flexible to bring new services on stream over the term of the contract, such as more health services that can be safely delivered in community setting and social care services. Where possible the MCP contact will also allow for more practices who wish to do so, to join the MCP, who may not be part of SRCCG. 7
3. What are the integration agreements? 3.1 In summary The integration agreement is at its most simple a signed agreement clarifying the basis on which the GPs will work closely with the new provider of community services and vice versa The MCP Contract will set out requirements on the MCP provider to integrate services with general practice in order to deliver the whole care model with sufficient involvement of primary care For the purposes of the local MCP, the CCG is also including the requirement for local authority services to work in an integrated way with the new MCP provider, and have agreed with NYCC that a further integration agreement be developed to reflect this. This briefing document however focuses only on the Primary care integration agreement. The Integration Agreement will ensure that GPs involved have the necessary commitment to integration for the MCP to succeed, effectively mirroring the MCP contract The Integration Agreement will perform two main functions: o o create a framework for shared governance and decision making between practices and the MCP; and set out how the integration of services will be affected, setting out the primary care contribution to the MCP care model The second function will evolve as local circumstances change, but will always need to mirror the MCP s obligations to integrate with primary care, as laid out in the MCP Contract There is a template integration agreement provided by NHS England however local areas are permitted to amend and adapt to suit local agreements It is essentially the role of the preferred MCP provider to secure the signed integration agreements with GP practices, however the CCG is planning to facilitate this through a model agreement that GPs are collectively happy with, as the basis for the agreement. This approach should minimize the potentially disruptive effects of multiple providers trying to talk to the practices separately where this is not welcomed 8
3.2 More detail The MCP model is built on the basis of integration with primary care it is integral to this delivery model and, unless we were to implement a virtual MCP, it must be secured either through integration agreements for partial MCPs, or by commissioning a fully integrated MCP in which PMS/GMS/APMS services are delivered through the MCP. We have committed to a partial MCP model. Our partially integrated model, therefore, needs each of our 15 General Practices to sign up to an integration agreement with the preferred MCP Provider. We also require the same on the social care side with NYCC. If General Practices will not sign integration agreements then there is a risk that the model won t be regarded as an MCP. If only a single practice will not participate, then although not fatal to the notion of an MCP, the CCG will need to make arrangements for the delivery of community services for the population of that practice. If the CCG could not secure sign up for the majority of the GPs, the validity of the model may be questioned. The CCG will set out how we are going to evaluate a bidder s ability to get the General Practices (and NYCC) to commit to integration agreements, and also our approach to best facilitate the understanding and sign up to the integration agreements, while minimising the disruption to practices through multiple bidders trying to talk to each practice separately. Further information can be found in the NHS England document The multispecialty community provider (MCP) template Integration Agreement overview, available in full here: https://www.england.nhs.uk/wp-content/uploads/2016/12/tia-agreement-mcpcontract-2a.pdf and also in the NHS England document GP participation in a multispecialty community provider available in full here: https://www.england.nhs.uk/wp-content/uploads/2016/12/gp-participation-mcpcontract-5.pdf 9
4. Questions and Answers 4.1 Who will the new provider be? Put simply, we do not and cannot know who the provider will be or what type of organisation it will be until we have worked through the procurement process. As part of our presentations to date and as part of our documentation on the CCG website, we have been clear that we want to see the development of innovative partnerships that put the patient and primary care in central roles, and welcome bids from organisations that can provide that. Because integration with primary care is central to the MCP, the need for a bidding organization, whether it be a public, private, or independent sector body, to be able to demonstrate the support of a critical mass of local GPs is of utmost importance, and the CCG is working through how we evaluate this as part of the process. 4.1.1 Application of procurement rules The procurement of health and social care contracts comes under the European Light Touch Regime (LTR) which is set out in Regulations 74-76 of the Public Contract Regulations 2015. From April 2016, the LTR also regulates the procurement by CCGs and NHS England of health services for the purposes of the NHS. Therefore both NYCC and the CCG are subject to the same European procurement rules under the LTR. The CCG is also bound by NHS Procurement, Patient Choice and Competition Regulation s 2013, and since well publicised problems in letting contracts to support new models of care elsewhere in the country, the CCG is also subject to the NHS England Integrated Support and Assurance Process (ISAP) which sets out key checkpoints for agreement throughout the procurement process. The LTR provides that for contracts over circa 590k there is a flexible approach to procurement. The LTR allows free choice of procurement procedure as long as the principles of equal treatment and transparency are not compromised. Once the procurement process is agreed and published it must be followed. The commissioner s will treat all current and potentially interested providers equally, in a non-discriminatory and transparent way, before during and following the procurement process. The following steps will ensure that this process is compliant and that the process is consistent with the principles of transparency and equal treatment. Engagement and Consultation if required as per legal obligations Determine the scope of the service model to procure 10
Develop the service specification and budget Advertise the opportunity through a Prior Information Notice (PIN) Develop the selection process using an agreed selection criteria and an open process 4.2 Where will the new provider be based? The service requirements document (specification) will make clear that the MCP is about the provision of local services, based around list based general practice, therefore it is anticipated that for day to day operations local bases will be part of the proposals that bidders submit. Many organizations have head quarters and back office buildings additional to local bases that may or may not be deemed local, however bidders will need to demonstrate how they will function on an operational, corporate and strategic basis; how they will develop and build local relations, harness the wider community, and how their emergency preparedness and business continuity plans will work in practice locally. 4.3 What will the impact be on GMS? In a partial MCP as is locally planned, GPs retain their existing GMS/PMS/APMS contracts. There is scope to include some or all of the locally enhanced services within the MCP from day 1 however the CCG has elected to include only specified schemes such as the Primary Care Frailty scheme) in the MCP in its second year. The contract will be structured to ensure that over the course of the contract (which could be 10 15 years) GPs who wish to do so, could move their services into the MCP. There are no plans currently to replace QOF however on a consensus basis this is something that the CCG would be amenable to in order to focus greater resource and attention on meeting the outcomes of the new service. The BMA offer the following advice: Our advice is that practices should avoid relinquishing their national GMS/PMS contract, and, together with their LMC, should put forward proposals for participation in MCPs under their current contract. We have consistently argued that participation in, and the success of MCPs does not logically depend on practices moving away from their standard contract, since the wider integrated delivery of services sits above the core contractual responsibility of practices. It is vital that NHS England has recognised this is one of three MCP type models. The BMA advice in full can be accessed here: https://www.bma.org.uk/advice/employment/contracts/gp-partner-contracts/mcpcontract-framework 11
4.4 Questions regarding integration agreements: We didn t know there would be a need to sign an integration agreement - what does that mean for us in practice? What if we do or don t? Are these legally binding? Integration agreements are a core part of the partial MCP contract. As mentioned earlier in this briefing document they set out the levels of integration that is expected between the MCP provider and the GPs/Practices. Without the primary care integration agreements the MCP model cannot be put be put in place. The CCG is using the MCP to strengthen community based services and see social care as a key part of this, hence, NYCC have also agreed that they work with any preferred provider and will enter into an integration agreement in order to support the integration of health and social care. The integration agreements are designed to help to be clear about how partners in the MCP will work together in a mutually supportive way to better care for the population they both serve; so how the GP Practice will work with the MCP and vice versa in the following ways (partly drawn from the NHS England guidance as linked below): Shared vision and delivery of system outcomes Commit to delivery of system outcomes in terms of clinical matters, patient experience and resource allocation Develop and participate in the risk reward scheme where all share in savings generated by reduction in acute activity Commit to delivering the best possible care for the whole population Adopt an uncompromising commitment to trust, honesty, collaboration, innovation and mutual support Working together Commit to work together and to make system decisions on a best for service basis Establish an integrated collaborative team environment to encourage open, honest and efficient sharing of information, subject to competition law compliance Adopt collective ownership of risk and reward, including identifying, managing and mitigating all risks in performing our respective obligations in this agreement 12
Co-produce with others, especially service users, families and carers, in designing and delivering the service Decision making Take responsibility to make unanimous decisions on a best for service basis Governance The GPs will work with the provider to establish an Integration Leadership Team which will not form a committee of any Participant (for example this will not be a committee of the CCG or of any body which is part of a provider vehicle) but it will hold the Integration Management Team to account. The purpose of this is to ensure that the joint objectives set out in the MCP contract and the Integration Agreements are abided by Ethical Walls The integration agreements anticipate that there may be future contracts and procurements opportunities involving the parties to the integration agreements. This therefore requires arrangements within these integration agreements to protect the parties whilst enabling the parties to continue to work together and share information in the spirit of the integration anticipated in these agreements. These provisions explain ethical walls and what these arrangements should look like Risk Share The agreements as drafted by NHS England anticipate the provision for GPs to benefit from risk share arrangements. This aligns with the MCP contract arrangements which allow financial reward as a result of a result of a number of things, such as a reduction in acute admissions. The CCG needs to seek some guidance from NHSE about how this might work in terms of the practicalities of it however it is clear that where an integration agreement provides for KPIs itself and these are successful, individual GP surgeries could also benefit from risk sharing processes While each GP Practice will need to sign an integration agreement in their own right with the new provider (an individual integration agreement) prior to the MCP contract being awarded by the CCG, they may agree that the GP Federation negotiate on their behalf, and the CCG will endeavor to develop a core integration agreement reflecting the service requirements document which could include all or some of the elements set out above with clear examples of what is meant by the terms used. 13
The integration agreements are legally binding to the extent that the CCG will place a contract with the MCP and the MCP will, as an integral part of that contract have in place integration agreements with primary care. These would technically therefore be legally binding, with breach of contract being a possible cause of action for breach. It is not currently clear or certain however how successful that would be in reality (ie what detriment could be demonstrated from a breach). NHS England have produced a template integration agreement which will be amended for local purposes. The NHS England NHS Standard Contract Template Integration Agreement for Partially Integrated MCPs is available in full here: https://www.england.nhs.uk/wp-content/uploads/2016/12/tia-partially-integratedmcp-contract-2b.pdf along with The multispecialty community provider (MCP) template Integration Agreement overview, available in full here: https://www.england.nhs.uk/wp-content/uploads/2016/12/tia-agreement-mcpcontract-2a.pdf 4.5 Please share more details on the model The model the CCG wishes to commission is set out at its highest level in section 1.3 of this document. The requirements document (specification) will be published at the same time as the invitation to tender is published, and will set out in a much more detailed way the core requirements of the service. This document will detail the services to be provided on Day 1 and those that will come on stream the following year. Appendix 1 of this document contains information on the new service model which is extracted from the MCP Prospectus; available in full on the CCG website. 4.6 How will we recruit staff to these new teams If the provider of the MCP is not the current employer, employees in the current services will be protected, where applicable, under the Transfer of Undertakings (Protection of Employment) regulations (TUPE). As part of the procurement process it is likely that bidders will need to submit workforce plans and proposals for how they will develop staff to meet the requirement of the new services. The MCP will be free to recruit and develop staff as they see fit to meet the outcomes of the service. As has been clearly stated and set out as part of the procurement process the CCG is looking for innovative forward thinking approaches to staffing, including the development of integrated working across traditional organizational boundaries. The extent to which primary 14
care staffing will be effected by this is largely down to local discussion and agreement about what is possible by working together better. For example primary care and the new provider may work together to share teams and resources to provide a more comprehensive joined up service to care home residents. 4.7 Will this be dumping more work on GPs? The whole ethos of the MCP is about how we can better support and develop the ability and capacity of primary care to care for people at home, in the community and to support them living as independently as possible for as long as possible. There is no intention of dumping additional work on primary care and the CCG will be mindful of any unintended consequences of the new model of care, including the move of services traditionally provided in a hospital based setting, such as outpatients, into primary care. Over time the MCP will oversee a ship of resources from buildings based, secondary care into primary and community based care. 4.8 What will the MCP look like on Day 1 On day 1 GPs may not see much if any difference to the services they currently access for their patients such as District Nursing, specialist nursing and community therapy. Business continuity is the first priority to avoid any hiatus on handover. In the 3 months or more before day 1, the new provider will be mobilizing the teams in preparation for delivering the new model of care but change will not happen overnight. As a core part of the new model GPs and their practice teams will be fully involved in the roll out of the new services and will be kept informed by the new provider and CCG of referral processes, changes to services and new services. The CCG will be testing out communications and mobilization plans as the procurement progresses. 4.9 What happens to our Practice Nurses on day 1 There is no planned change to Practice Nursing. It is hoped that the new provider will be working closely with primary care and that over time new ways of shared working can be developed, however this would be by consensus and at a time when all parties feel comfortable. 4.10 What will happen with DNs on day 1? Refer to answer to Question 4.8 above. 4.11 We like the current service in Ryedale will the MCP spoil this? The community services provided in Ryedale (SRCCG area) are within the scope of the MCP. This includes the District Nursing services as well as what is 15
colloquially known as the Ryedale hub. The new service model is based upon integrated multi-disciplinary teams grouped around practices of 30,000 population, and it is likely that development and change to the current fragmented models will be needed. While it is not possible to preempt how a provider will deliver the new model and the requirements that will be clearly set out, the local GPs will be central to how the model will operate, and therefore influential in agreeing ways of working to suit their local practice populations. To that end the MCP is unlikely to spoil the current services in Ryedale, but it may change the make up and operation in order to meet the wider brief of new service model. 4.12 How will the MCP be funded? The MCP payment structure comprises three elements; Whole Population Budget (WPB), a single payment made to the MCP based on current commissioner spend for in scope services Improvement payment scheme (IPS) to incentivise improvements in care quality, outcomes and transformation. This is a top slice from the whole population budget and is similar to the current CQUIN scheme whereby a series of quality measures have to be delivered by the provider to secure this level of income. Gain/loss share agreement to align financial incentives across services represents a new way of managing risk across the system to ensure that costs are not just shifted into other parts of the health economy. 16
Appendix 1. Notes on the new service model Following periods of engagement with staff and the public we want to collectively focus and refocus the in-scope services to respond to three key strands, all supported by a customer service/ access centre, as will be more fully described in in due course. The four key strands are: A customer service access centre/single point of access Prevention and self-care, including strengthening wider community response and reducing social isolation Planned on going care and treatment, including continuing health care Intermediate and fast response, re-ablement including admission avoidance and discharge to assess Together these elements support improving the health of the population, improving the individual s knowledge, skills and confidence in their ability to understand their condition and self care, promote better coordination of care, and offer better access to the right care in the right place at the right time. The service will be based upon the highest level of commitment to service quality and patient safety, and will be population-based and founded upon list based general practice. The structure and accessibility of the service will support and strengthen general practice through integrated services which engender a strong can do attitude based on agreed risk thresholds and competency based protocols across partners. The service delivery model will be built upon the unique position of primary care starting with the individual patient registered with a practice and the role of the GP being fundamental. General practice takes overall responsibility for the care provided by other services. These services will include integrated multi-disciplinary teams (IMDTs), a wider network of community based and voluntary sector services organised around populations of approximately 30,000. The service specification will set out the full range of services to be provided by the MCP. Critical success factors include: The CCG consider the following to be the critical success factors for this new care model: 17
A connected system with a can do and it s my job approach A service that is integrated from the viewpoint of the people who access the service. Built around people in their community An emphasis on prevention rather than reaction A supported and enhanced primary and community care system led and delivered by primary and community care A career framework where people see their futures wherever they enter the caring professions. A system that wastes nobody s time and that includes not admitting to hospital or attending the emergency department when the right care and support is available closer to home Shared and trusted assessments Minimal transfers between teams and agencies Better use of resources across the economy Use of innovative IT systems that enable information sharing across health and social care and all partner sectors to help with service delivery Use of technology, such as tele-health and tele-care where appropriate, to support patient care People using health and social care services are safe from harm Health and social care services are centred on helping maintain or improve the quality of life of people who use those services Resources are used effectively and efficiently in the provision of health and social care People who provide unpaid care are supported to look after their own health and wellbeing People who work in health and social care feel engaged with the work they do, are supported to continually improve the information, support and care they provide. Health and social care services contribute to reducing health inequalities The Overall Integrated Health and Social Care Service Delivery Model The vision is for all teams looking after the adult population across health and social care to be integrated, sharing knowledge and skills, and having respect for 18
each other s strengths; one team delivering a service in equal partnership, based on the highest level of commitment to service quality and patient safety the adult population, and founded upon list based general practice in a structure that supports and strengthens the leadership and decision making of general practice. The vision includes developing 3 or 4 hubs grouped around primary care, and around which integrated multidisciplinary support teams will be built. We intend that the service moves away from a traditional model delivered to suit organisational boundaries, to a model that starts with the needs of the individual and builds arounds the functions that will mean care can be delivered as close to home as possible when it is needed. The service will work towards ultimately integrating health and social care delivery. This will mean considerable work to build new relationships, new role profiles that will develop over time, and a significant level of commitment to new ways of working. The overall model will not be achieved on day one of the new service, nor do we believe it can be delivered by a single agency without a significant commitment to partnership and integrated working. A phased approach will be needed to secure full integration and this will be subject to further development and discussion as the procurement progresses, and in later years of the contract term. 19
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