SYMPHONY Person-Centred, Co-ordinated The Symphony Programme 7 June 2016
Programme Structure: Overview Advisory Group Symphony Programme Board PMO Cross- Model Forum Identify themes and quick wins across new care models Small Action Team to implement quick win initiatives Core JV group A1 Complex Model A2 EPC Model A3 Elective A4 Urgent B1 IACO stand up & OBC OpCo/Integrat ed practices development Participating practices devel Vol sector/ Public health Paediatrics Develop detailed design, structure & governance Cross- Cutting Themes (feed in as required) IT and Technology Patient Safety & Quality Comms & Engagement Workforce 2
Complex : Extensivist care model The patient is assigned a care coordinator and offered more care, support and attention through a number of services Core Team Key Elements Expert Generalist Coordinator Comprehensive assessment of physical, mental health and social care needs GP Mental Health Complex, Polychronic Patients Extended Team Social Network of Services Therapies e.g. Physio Key Worker FOPAS (Crisis Support) Programmes Diabetes Respiratory CHF Dementia Other Support and coaching for patients and carers Co-ordination of integrated pathway Routine contact and monitoring of patient s health and care needs Proactive development of personalised health and social care escalation plans Acute Advanced Diagnostics Home Other services Rapid crisis response 3
Emergency Admissions per 1000 population 350 Impact of the Complex Hub on Emergency Admissions Pre Enrollment Post Enrollment 300 250 200 Pre enrollment trend Avoided admissions 150 100 12 month rolling trend 50 0 Actual number of admissions per month -24-23 -22-21 -20-19 -18-17 -16-15 -14-13 -12-11 -10-9 -8-7 -6-5 -4-3 -2-1 0 1 2 3 4 5 6 7 8 9 10 11 12 4
Enhanced primary care model The patient and key worker are supported by the wider care team and a number of care programmes and services Core Team GP Practice Nurse Interface Programmes and Specialists Diabetes Key Elements Team Working and Huddle Respiratory Triage Patient with Chronic Condition Key Worker / Health Coach CHF Stratification and Proactive Outreach Extended Team Mental Health Social Therapies e.g. Physio Dementia Other programmes Planning and Coordination Defined Workflows and Programme Integration Network of Services Aligned Resources and Incentives Acute Advanced Diagnostics Home Other services Shared Clinical Data and Population Health Analytics 5
Complex and EPC Rollout current status West Yeovil East Managed by Complex (model in use) Recruiting to West hub Current capacity for 200 patients Expanding to 500 patients Covered by Yeovil. May need own capacity later Managed by EPC with Complex support (model in development) Timing to be agreed (after Yeovil) Timing to be agreed Developing interface model to support EPC practices to manage these patients 1,500 patients Complexity and intensity Managed by EPC (model in use) 1 out of 5 practices 1 Wave one 0 Wave 2 (includes Langport) 5 out of 9 practices 2 Wave one 3 Wave two 6 out of 6 practices 2 Wave One 4 Wave Two = hub staff in place = hub staff in recruitment 6
Primary care principles Investment in primary care to facilitate delivery of higher quality and proactive care Enlarging the primary care team to allow GPs to focus on what they do best ( working at the top of your licence ) and increase the capacity of primary care to deliver services Shift focus to population-based health (preventative care) Using the greater resources of the JV to support practices to implement the new models Improving quality of care by linking elements of income to quality over time Ensuring sustainable and financially secure general practice Attracting new GPs and retaining existing GPs by providing an acceptable work-life balance and varied, fulfilling career choices Ensuring reversibility of any new contractual arrangements 7
Distribution of spending across South Somerset for a typical practice Total: 1.02m 0.93m 3.35m 1.02m 0.48m 0.58m 7.38m 8 7 m 6 5 4 3 2 1 Prescribing 2 Acute care Social care Mental health Community care Potential to be gainshared 0 Primary GP care Prescribing AC: A&E AC: O/P AC: I/P elect AC: I/P urgent SC:Home +Day SC: Resi SC: other MH: O/P MH: I/P CC: IP CC: other Gain share List size 6,380 4,340 660 1,990 630 490 70 30 130 120 10 30 1,010 Cost per patient 160 210 140 340 1,940 2,770 5,100 12,500 2,550 2,230 20,600 9,790 250 1. Mean figures averaging across 19 South Somerset GP practices. 2. Prescribing cost is extrapolated from Mar 2015 (HSCIC), with prescribing list for 2013 14 (Symphony data) 8
JV principles: balance, alignment and choice GMS/PMS Somerset CCG NHS South West Adult Social South Somerset Primary Healthcare Symphony IACO Yeovil Hospital Integrated Practices Complex Participating Practices Symphony Healthcare Services Yeovil Hospital Adult Social Community & Mental Health 9
GOVERNANCE PRIMARY CARE REPS NON-EXECUTIVE DIRECTORS? EXECUTIVE DIRECTORS BERGE STANDARDS C L I N I C A L S E R V I C E S NEW WAYS?? STEVE KAREN OPERATING COMPANY THE ENTITY ENABLERS PRACTICE HR & OD FINANCE QUALITY IT DATA FACILITIES LEGAL DAVID START UP IAN INTEGRATED SOLUTIONS MANDY DELIVERY C O M M U N I T Y