Sussex Integrated Urgent Care Transformation Soft Market Testing Wednesday 26 th July 2017
Welcome
Agenda Welcome Purpose and programme for the day Sussex NHS 111Transformation The Context, Scope and Vision; Proposed procurement model and timeline Panel Session Q&A Lunch Workshops Final Q&A and wrap-up
Purpose To share our current thinking for the future commissioning of Integrated Urgent Care, the Sussex NHS111 Service and Consult and Complete activity To identify and engage with potential Service Providers To consider potential procurement and contracting models To collect Service Provider feedback to refine our proposed models and plans To understand any concerns or queries Service Providers might have
Context
Consultation Complete Model for Urgent Care Transitioning 111 from the Access Model to Consultation Complete Dr Peter Stott https://www.youtube.com/watch?v=fizzu4r6yeu&feature=youtu.be
CAS Development Currently 23 percent of callers to 111 speak to a clinician in the service Target for April 2017 is 50 percent (then 60%) To do this we are to develop CAS lead by GPs Needs an appropriate skill mix ~ 2/3 of clinicians needed are already in post but in the wrong place (alliance working) Links can be real or virtual
The 9 Key Elements of IUC Integration Level 2016/17 Threshold 2020 Threshold 1. A single call to get an appointment Out of Hours 70% 95% 2. Appointments can be made to in-hours GPs 5%* 50%* 3. Data can be sent between providers 50% 80% 4. The Summary Care Record (SCR) is available in the hub and elsewhere 100% 100% 5. Care plans and patient notes are shared 50% 90% 6. There is a Clinical Hub containing GPs and other health care professionals, 24 hours, 7 days a week; transferring more than 30% of all calls answered to a healthcare professional in the hub. 30% 50% 7. The capacity for NHS111 and OOHs is jointly planned 100% 100% 8. There is joint governance across Urgent and Emergency Care providers 100% 100% 9. Implementation of the IUC Workforce Blueprint Flexible Flexible
So What is the New Model STEP ONE National Telephony system and safeguards (111) IVR extractions 15-20% Dental dental nurse Repeat Medications - pharmacist Medication enquiries - pharmacist Call-backs - administrator STEP TWO Call handling Demographics & Risk stratification Default for HCP calls including Care Homes (also bypass line to CAS) clinical navigator
So What is the New Model (cont.) STEP TWO STEP THREE STEP FIVE NHS Pathways Module 0 NHSP Module 1 Early and Safe Exit 15% NHSP Modules 1 & 2 Closed with Self Care 5 % STEP FOUR 60% Red ambulance calls - Auto dispatch CLINICAL ASSESSMENT CENTRE (Senior Clinician Module of NHSP) Calls from clinical navigator Green ambulance calls ED dispositions Mental Health Care Homes Children under 1 year Palliative Care Complex calls (elderly) Refused dispositions Face to face services (ITK)
Unified IT Platform Able to AutoDispatch and Manage Access via Digital Platforms STEP TWO STEP THREE STEP FIVE NHS Pathways Module 0 NHSP Module 1 Early and Safe Exit 15% NHSP Modules 1 & 2 Closed with Self Care 5 % STEP FOUR 60% Red ambulance calls - Auto dispatch CLINICAL ASSESSMENT CENTRE (Senior Clinician Module of NHSP) Calls from clinical navigator Green ambulance calls ED dispositions Mental Health Care Homes Children under 1 year Palliative Care Complex calls (elderly) Refused dispositions Face to face services (ITK)
IUC Future Skill-mix GPs lead to give clinical confidence available 24/7 Plus ANP, Paramedic, Social Care, Community Care, Mental Health, Pharmacist, dental nurse, et al
The Commissioners NHS Coastal West Sussex CCG Lead commissioner for Sussex NHS111 Population: 482,100 GP Practices: 48 NHS Brighton and Hove CCG Population: 300,000 GP Practices: 37 NHS Crawley CCG Population: 120,000 GP Practices: 12 NHS Eastbourne, Hailsham and Seaford CCG Population: 192,400 GP Practices: 20 NHS Hastings and Rother CCG Population: 186,000 GP Practices: 25 NHS High Weald Lewes Havens CCG Population: 166,300 GP Practices: 20 NHS Horsham and Mid Sussex CCG Population: 225,000 GP Practices: 23 Total population across the Sussex NHS111 Footprint is 1.69m
Local Information
Local NHS Providers Acute Trusts Community Trusts Mental Health Trusts East Sussex Healthcare NHS Trust Queen Victoria Hospital NHS Trust Surrey and Sussex Healthcare NHS Trust Brighton and Sussex University Hospitals NHS Trust Western Sussex Hospital Foundation Trust Sussex Community Foundation Trust East Sussex Heathcare NHS Trust Sussex Partnership Foundation Trust Surrey and Borders NHS Foundation Trust Ambulance Trusts SECAmb 1 Local Authorities Brighton and Hove City Council East Sussex County Council West Sussex County Council 5 2 2 3
Sussex 111 and the Surrey and Sussex STP Footprint The Sussex 111 footprint sits within the Surrey and Sussex STP Footprint NHS East Surrey CCG are working with other Surrey CCGs to commission a 111 service The Surrey and Sussex STP footprint is seeking to develop a model of care that will be delivered through four place based localities Coastal, CSESA North, CSESA South and East Sussex Better Together
Demographics And Data
Age Population 90+ 85-89 80-84 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4 Sussex Footprint Population Estimate for 2017 Total population = 1.69m - 20,000 40,000 60,000 80,000 100,000 120,000 140,000
Local Information Brighton and Hove 130,000 Households 34,220 students in Brighton and Hove in 2014/15
Local Information East Sussex Caring Responsibilities Caring Responsibilities Very Good Health 44% 36% Good Health 245,000 Households Very Bad / Bad Health 5% 15% Fair Health
Local Information West Sussex
Sources of Information on Health Needs Brighton and Hove JSNA https://www.bhconnected.org.uk/content/needsassessments East Sussex JSNA http://www.eastsussexjsna.org.uk/ West Sussex JSNA http://jsna.westsussex.gov.uk/
Sussex NHS 111
Sussex Directory of Services (DoS) Sussex has a DoS Lead forming part of the NHS111 Transformation Team All CCGs have nominated DoS champions The current Sussex DoS has approx 1300 Services profiled across the region, including Dental, Community Nursing, Optician, Mental Health, Pharmacy, ED, GP OOHs, Walk In Centres and Minor Injury Units
Sussex NHS 111 Activity Summary - 2015 Answered Calls by CCGs 2015 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Total NHS Brighton and Hove CCG 5,496 5,099 5,612 5,610 6,156 4,840 4,821 5,035 4,360 4,956 4,628 5,660 62,273 NHS Coastal West Sussex CCG 9,594 8,547 9,448 8,856 10,389 8,230 8,505 8,959 7,679 8,129 8,093 10,089 106,518 NHS Crawley CCG 2,541 2,300 2,547 2,305 2,695 2,165 2,293 2,224 1,981 2,190 2,397 2,724 28,362 NHS Eastbourne Hailsham & Seaford CCG 3,400 3,097 3,364 3,166 3,588 2,968 3,047 3,258 2,859 2,969 2,942 3,635 38,293 NHS Hastings and Rother CCG 3,578 3,119 3,702 3,459 3,724 3,172 3,205 3,410 2,977 3,157 2,942 3,700 40,145 NHS High Weald Lewes Havens CCG 3,776 3,496 3,872 3,675 4,182 3,113 3,396 3,541 3,021 3,286 3,111 4,008 42,477 NHS Horsham & Mid Sussex CCG 4,088 3,727 4,186 3,774 4,306 3,365 3,515 3,776 3,143 3,498 3,476 4,203 45,057 Total 32,473 29,385 32,731 30,845 35,040 27,853 28,782 30,203 26,020 28,185 27,589 34,019 363,125 Disposition 2015/2016 % of calls Referred to GP (within 24 Hours) 58% Referred to 999 (red) 6% Referred to 999 (green) 6% Referred to ED (inc. Mental Health) 8%
Hourly Call Volumes - Weekdays
Hourly Call Volumes - Weekends
Top 20 Symptom Discriminator Groups Symptom Discriminator Total for 2015 & 2016 % of Top 20 Share N/A (no detail recorded) 170,487 34.11% NHS Pathways In House Clinician 84,319 16.87% Repeat Prescription 24,528 4.91% Breathing problems, Breathlessness or Wheeze 20,835 4.17% Pain and / or Frequency Passing Urine 19,116 3.82% Toothache Without Dental Injury 16,782 3.36% Vomiting 16,316 3.26% Chest and Upper Back Pain 15,917 3.18% Skin, Rash 14,315 2.86% Sore Throat 13,954 2.79% Unwell, Under 1 Year Old 13,661 2.73% Abdominal Pain 12,832 2.57% Cough 10,843 2.17% Earache 10,542 2.11% Lower Back Pain 10,376 2.08% Diarrhoea 9,875 1.98% Predetermined Management Plan 9,576 1.92% Diarrhoea and Vomiting 9,347 1.87% Fever 8,286 1.66% Wound Problems 7,877 1.58% Grand Total 499,784
STP 111 Overall Top 12 Disposition By Percentage 58% of total calls over both years for all CCG s was GP Practice 24 Hours and Less
Sussex NHS111 Patient Age Analysis NHS Horsham & Mid Sussex NHS High Weald Lewes Havens NHS Hastings & Rother NHS Eastbourne, Hailsham and Seaford NHS Crawley NHS Coastal West Sussex NHS Brighton & Hove 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% NHS Brighton & Hove NHS Coastal West Sussex NHS Crawley NHS Eastbourne, Hailsham and Seaford NHS Hastings & Rother NHS High Weald Lewes Havens NHS Horsham & Mid Sussex < 1 Year 2821 5186 1679 1944 2166 1511 2558 1-5 Years 13893 28553 8489 10031 10835 8634 14161 6-18 years 9660 18447 4386 6013 6691 6014 8743 19-59 Years 69903 88137 21435 29394 32348 23615 34327 60-79 Years 15959 36324 4425 13558 14320 10208 11177 80+ Years 12097 33642 3968 13836 12559 8986 10052 No Age Recorded 347 585 97 198 201 161 247
Model and Vision
NHS 111 Hear and Treat / See and Treat
The Options
Procurement Options
NHS111-IUC: The Strategic Business Case NHS111 : The IUC Offer for 2017-2018* describes: Fully integrated urgent care services Combining NHS111 & GP OoH NHS111 moving from assess and refer to consult and complete Options considered & Strategic recommendation for NHS111 Transformation and procurement service specification 1. Thin 111, Sussex hub linked to remote service 2. 111 / 3 hubs / linked to remote services 3. Integrated 111 / CAS linked to remote services STP Exec agreement to the approach and high level model (May 2017) (*UEC 5YFV Delivery Plan issued April 2017)
Financial Model Results
Option 1
Option 2
Option 3
Cost of the procurement Contract length standard 3 years with 1 plus 1 Contract value approx 17 to 19 million per annum (TBC) depends on split of phone triage and face to face OOH provision Capitation budget based on population size Outcome contract with gainshare agreement Need to be flexible and innovative
Digital Delivery of 111 core capability Design of mobility platform for remote workers (especially Clinicians in the CAS) Digital development in the wider Integrated Urgent Care system
Timescales for Procurement for 111 Specification and procurement approach approval September 2017 Procurement Readiness September 2017 December 2017 Procurement January 2018 September 2018 Deployment and Mobilisation - September 2018 April 2019 Transition and phasing of further pathways April 2019 - TBC 42
Q&A
Lunch 12-1
Workshops 45 minute information sessions: Digital (tables 1&2) Workforce (tables 3&4) Finance, Performance & Contracting (tables 5&6) Tea & Coffee break at 14:30-15:00pm
Q&A
Key Programme Contacts Colin Simmons, Programme Director Sussex 111 Transformation Programme Kerry Exley, Senior Project Manager Sussex 111 Transformation Programme Nicola Kemp, Senior Communications & Engagement Manager Sussex 111 Transformation Programme Dawn Fourniss, 111 Programme Support Officer Sussex 111 Transformation Programme Morven Banks, Senior Commissioning Manager Sussex 111 Contract Team Vinny Hanley, Directory of Services & Project Manager Sussex 111 Contract Team You can contact the team on: cwsccg.sussex111transformation@nhs.net