Ce diaporama a bien été signalé.
Le téléchargement de votre SlideShare est en cours. ×

PCN development event

Chargement dans…3

Consultez-les par la suite

1 sur 54 Publicité

Plus De Contenu Connexe

Diaporamas pour vous (20)

Similaire à PCN development event (20)


Plus par Helen Bevan (20)

Plus récents (20)


PCN development event

  1. 1. Accelerated Solution Event The PCN development support offer Supporting PCNs to #primarycarenetworks
  2. 2. MaryWardHouse 8d0da34dfe
  3. 3. 3 Our mission #primarycarenetworks • Hold an accelerated solutions event (with regions/ICS/STPs, key stakeholders, national teams) on 2nd April 2019 • Hold a Lead Provider Framework virtual engagement meeting on 10th April 2019 This accelerated solutions event will focus on: • Co-producing a specification that meets the needs of local systems (in preparation for the LPF engagement event) • Co-creating a ‘development community’ that connects those working in this area, builds relationships, shares learning and provides a platform for the future to work collectively on specific issues
  4. 4. 4 “They did not know it was impossible so they (just) did it” Mark Twain #primarycarenetworks
  5. 5. 10.00 Registration and coffee 10.30 Welcome and aims for the day 10.35 Who is in the room? 10.45 The story so far 11.15 What makes a healthy PCN? 12.30 Themes for the development specification 13.00 Lunch 13.45 An “unconference” to develop the key themes 15.30 Putting our plans in to action 16.00 Bringing the plans together 16.30 Close
  6. 6. Before lunch: Making this real Who can help us to achieve our purpose? How do we use all the resources and support systems that already exist in the system? Use the pink post-its to suggest groups within the system and the resources and support they bring What are the themes for the specification? What are the topics and themes that the specification of support needs to cover? #primarycarenetworks
  7. 7. Capturing our work today We are keeping a record of our discussions in “real time” We will use this to prepare a written report and pull together the specification ready for the virtual provider engagement event #primarycarenetworks
  8. 8. The Fundamental Law for today “Thesum of the expertise of the people in the audience is greater than the sumof expertise of the people on stage” DaveWiner Sourceof image:www.citynet.com
  9. 9. First conversations: what unites us •Introduce yourself to others on your table •Find five things that everyone on your table has in common and be prepared to share them with the wider group #primarycarenetworks
  10. 10. What unites us Table: 1 2 3 4 5
  11. 11. Our starting point • The PCN opportunity - Alex Morton • A primary care perspective - Peter Tinson
  12. 12. Primary Care Networks Development Support 2nd April 2019
  13. 13. 13 The changing health needs of the population are putting pressure on the health and social care system in England. Ageing population Between 2017 and 2027, there will be 2 million more people aged over 75. Chronic conditions The main task has changed from treating individual episodes of illness, to helping people manage long-term conditions. The steady expansion of new treatments gives rise to demand for an increasing range of services. New Treatments And our expectations are changing too. Things are changing…
  14. 14. General Practice Forward View lay foundations for change in general practice… GPFV published in 2016: • Represented a turning point in investment in general practice – committing an extra £2.4 billion a year to support general practice services by 2020/21 • Ambition to strengthen and redesign general practice • Vision built on the potential for transformation in general practice: • Enabling self care and direct access to other services • Better use of the talents of the wider workforce • Greater use of digital technology • Working at scale across practices to shape capacity • Extended access to general practice including evening and weekend appointments.
  15. 15. Now continuing support through the NHS Long Term Plan… 15 Aims: • Everyone gets the best start in life • World class care for major health problems • Supporting people to age well How: • Primary care networks as the foundation for Integrated Care Systems • Preventing ill health and tackling health inequalities • Supporting the workforce • Maximising opportunities presented by data and technology • Continued focus on efficiency
  16. 16. • Put in place seamless care (for both physical and mental health) across primary care and NHS community services, and remove the historic separation of these parts of the NHS. • Deliver care as close to home as possible, with networks and services based on natural geographies, population distribution and need rather than organisational boundaries. • Integrate across primary care networks and secondary care/place-based care with more clinically- appropriate secondary care in primary care settings. • Assess population health - focusing on prevention and anticipatory care - and maximise the difference we can make operating in partnership with other agencies • Promote and support people to care for themselves wherever appropriate • Build from what people know about their patients and their population • Because we want to make a tangible difference for patients and staff alike, with: • improved outcomes for patients and an integrated care experience for patients; • more sustainable & satisfying roles for staff, & development of multi-professional teams. • a more balanced workload PCNs - What are we trying to do?
  17. 17. • Practices continue to provide core services • Network Contract DES provides practices opportunity to work collaboratively with other practices health, social care and voluntary partners to deliver services • Practices and other health, social care and voluntary partners collaborate as primary care networks, providing additional services that can’t be delivered on a smaller scale Place c.250- 500k • Primary care interacts with hospitals, mental health trusts, local authorities and community providers to plan and deliver integrated care • In some systems, federations support efficiencies of scale and provide a voice for primary care • Primary care participates as an equal partner in decision making on strategy and resource allocation • Action is taken to ensure collaboration across hospitals, community services, social care and other partners, helping to join up and improve care • Data is used to deploy resources where they can have the maximum impact • Each person can access joined up, proactive and personalised care, based on ‘what matters’ to them and their individual strengths, needs and preferences Neighbour hood c.30k~50k System c.1+m Individual And primary care will play a key role in each level of the system
  18. 18. Anticipated benefits of integrated care systems and primary care networks For patients For general practice and other providers of care For the whole health and care system More coordinated services where they do not have to repeat their story multiple times Access to a wider range of services and professionals • in the community • In a single coordinated appointment Access to appointments that work around their life • shorter waiting times • different ways of accessing appointments using technology and face-to-face options More influence when they want it, giving more involvement and decision making opportunities over how their health and care are planned and managed Access to personalised care and with a focus on self care and prevention, living healthily, recognising what matters to the person and how their individual strengths, needs and preferences can support better outcomes Greater resilience across primary care by making the best use of shared staff, buildings and other resources, they can help to balance demand and capacity over time Better work/ life balance with more tasks routed directly to appropriate professionals, such as clinical pharmacists, social prescribers, physiotherapists More satisfying work with each professional able to focus on what they do best Improved care and treatment for patients, by expanding access to specialist and local support services including social care and the voluntary sector Greater influence on the wider health system, leading to more informed decisions about where resources are spent More coordinated care through collaboration and cooperation across organisational boundaries and teams Wider range of services in a community setting, so patients don’t have to default to the acute sector A more population-focused approach to systemwide decision-making and resource allocation, drawing on primary care expertise as central partners Greater resilience across the health and care system
  19. 19. DRAFT Plan: Plan in place articulating clear vision and steps to getting there, including actions at network, place and system level. Engagement: GPs, local primary care leaders, patients’ representatives, and other stakeholders believe in the vision and the plan to get there. Time: Primary care, in particular general practice, has the headroom to make change. Transformation resource: There are people available with the right skills to make change happen, and a clear financial commitment to primary care transformation. The network is taking the opportunities that GP network contract affords There is a clinical director for the network. The clinical director may serve multiple networks where that is agreed locally. Practices identify PCN partners and develop shared plan for realisation. There is joint planning underway to improve integration with community services as networks mature. There are arrangements for PCNs to collaborate for services delivered optimally above the 50k footprint Analysis on variation in outcomes and resource use between practices is readily available and acted upon. Basic population segmentation is in place, with understanding of needs of key groups, their needs and their resource use Integrated teams which may include social care are working in parts of the system. Plans are in place to develop MDT ways of working, including integrated rapid response community teams. Standardised end state models of care defined for all population groups, with clear gap analysis and workforce plan Steps taken to ensure operational efficiency of primary care delivery and support struggling practices. Primary care has a seat at the table for system strategic decision-making. PCNs are engaging directly with population groups, and with the wider community Providers within the PCN are embedding shared population health models identified at Step 1 that supports a significant maturity for integrated care. Functioning interoperability within networks, including read/write access to records, sharing of some staff and estate. All primary care clinicians can access information to guide decision making, including risk stratification to identify patients for proactive interventions, IT- enabled access to shared protocols, and real-time information on patient interactions with the system. Early elements of new models of care in place for most population segments, with integrated teams throughout system, including social care, mental health, the voluntary sector and ready access to secondary care expertise. Routine peer review. Networks have sight of resource use and impact on system performance, and can pilot new incentive schemes. Primary care plays an active role in system tactical and operational decision-making, for example on Urgent and Emergency Care Networks are developing an extensive culture of authentic patient partnerships PCN population health model fully functioning for all patient cohorts, working with other PCNs and local agencies in a provider alliance or similar collaborative working approaches. Fully interoperable IT, workforce and estates across networks, with sharing between networks as needed. Systematic population health analysis allowing PCNs to understand in depth their populations’ needs and design interventions to meet them, acting as early as possible to keep people well. Fully integrated teams throughout the system, comprising of the appropriate clinical and non- clinical skill mix. MDT working is high functioning and supported by technology. The MDT holds a single view of the patient. Care plans and coordination in place for all high risk patients. New models of care in place for all population segments, across system. Evaluation of impact of early-implementers used to guide roll out. PCNs take collective responsibility for available funding. Data is used in clinical interactions to make best use of resources. Primary care providers full decision making member of ICS leadership, working in tandem with other partners to allocate resources and deliver care. The PCN has built on existing community assets to connect with the whole community. Foundation Step 1 Step 2 Step 3 The journey of development for primary care networks in a health system – maturity matrix Primary care networks 08 Our learning to date tells us that primary care networks will develop and mature at different rates. Laying the foundations for transformation is crucial before taking the steps towards a fully functioning primary care network. This journey might follow the maturity matrix below. The Network Contract DES, when published, will provide important support for this new way of working
  20. 20.  We are looking to all those in local systems and beyond, CCGs, ICS and NHS England, NHS Improvement, HEE, other ALBs, professional representatives and other stakeholders, to fully support the development of primary care networks – your role is crucial  This work will be key to local systems as they develop plans to deliver better care for patients and communities  How we support development will be key - supporting the development of PCNs isn’t about mechanics, we need to keep the vision in mind and focus on fostering a different type of culture in organisations and relationships between people  Responsibility for this ultimately resides locally, but we need to do all we can together to support it – tell us what you need to make it work 20 Our roles in supporting PCNs
  21. 21. Getting this right together • Likely to be a marathon not a sprint – an evolution • Owned and led by primary care • Needs to be meaningful to local communities and partners • Should be the platform to build wider integration • Must dock into the wider ICS to get system benefits • We must ensure we remain focused on the end point and the spirit of intent
  22. 22. We need to remember We know what we’re aiming to achieve We have a shared endeavour The spirit of intent is crucial
  23. 23. Primary Care Network and Neighbourhood Development Support experience, learning and future work
  24. 24. • 5 Integrated Care Partnerships • 2 former Vanguards (Fylde Coast and Morecambe Bay) • 41 Primary Care Networks/Neighbourhoods (but reducing) • Different development journeys and maturity Lancashire and South Cumbria Integrated Care System Primary Care Network and Neighbourhood ‘Organisations’ • Locally some are… o less than 6 months old and others over 4 years old o ‘provider’ driven and others ‘commissioner’ driven o focused on building relationships between practices and others on their broader local authority and voluntary sector partnerships o focused on developing their ‘organisational’ governance arrangements and others on developing their integrated care teams • …and consequently some similar but some differing development support requirements and lots of learning to share
  25. 25. Primary Care Network and Neighbourhood Leaders • A Primary Care Network must appoint a Clinical Director as its named, accountable leader, responsible for delivery • Clinical Directors will play a critical role in shaping and supporting their Integrated Care System to implement the NHS Long Term Plan • They will provide strategic and clinical leadership to help support change across primary and community health services • A new and challenging leadership role • Locally some have… o existing ‘commissioning’ leadership experience from CCG roles o existing ‘provision’ leadership experience from federation or similar roles o existing ‘provision’ leadership experience from practice roles o no previous leadership experience • …and consequently some similar but some differing development support requirements • Plus clarity of where they fit in the broader ICS and ICP clinical leadership arrangements
  26. 26. Learning 1 (chronologically) Leadership • Provided funding for Neighbourhood Chair and other leadership roles, standard role outline, payment, process to secure and service contract – offer to develop support products and don’t wait to be asked Priority • Asked each Neighbourhood to identify a local priority, develop a ‘light’ business case, provided funding , secured evaluation support, agree to implement learning, chose care home, house bound and same day access priorities – rapid development of new care models and crucially built relationships/trust between practices Places • Local GP Quality contract included funding and ask for Neighbourhoods to meet monthly individually and also all together quarterly – share learning and co- produce support products Support • Aligned an executive and commissioner to each Neighbourhood to provide support, ‘system navigation’, occasionally remind of governance and leverage support from elsewhere – now ‘leaning in’ more commissioning staff
  27. 27. Learning 2 (chronologically) Community • Provided small amount of funding for Neighbourhoods to invest in community owned and driven self care and wellbeing initiatives – see Healthier Fleetwood Innovation test beds • Encouraged and supported Neighbourhoods to develop and test new care models, pathways and technologies - see innovation map plus CCG risk appetite issue Incentive scheme • Responded to Neighbourhood request to design gain share scheme – more challenging with new payment approaches based on cost reduction Leadership peer support • Neighbourhood chairs meet every 6 weeks – their agenda with CCG attendance System leadership • Neighbourhood chairs participating in Healthier Fylde Coast 100 System Leaders and Systems Integrators programme - work across the partnership effectively, connect people to each other and create communities for action
  28. 28. • Statistics showed residents in Fleetwood could expect to live shorter lives and experience more life-changing illnesses than people elsewhere • Healthier Fleetwood began as an idea in the Spring of 2016. Perhaps it wasn’t even an idea then, just a question: Is there a better way to improve the health and wellbeing of people living and working in the Town than just prescribing more medicines and making appointments to see the GP? • Residents, voluntary, faith and community groups, health professionals, the emergency services, local authority representatives and businesses leaders met and found there was a shared desire that something should be and could be done • Into 2017 and Heathier Fleetwood launched its own projects such Garden Buddies, volunteers helping isolated residents with some TLC for their gardens and the Young Chef of the Year Challenge which supported the benefits of nutrition and learning to cook among Year 5 pupils
  29. 29. Innovation map
  30. 30. • Initially Vanguards started using matrix over 12 months ago • Provided a valuable framework to engage Networks about future direction of travel and assess their maturity • Through engagement began to explore and expand maturity steps and theme • Began in Fylde Coast Vanguard and then expanded across Lancashire and South Cumbria ICS • Over a period of 3 months co-produced development and support tool and supporting annual plan template • Involved clinical and managerial colleagues from primary, community, LMC, NHSE and local authority partners (plus subject matter experts) Maturity matrix to development and support tool
  31. 31. • Six themes… Planning and support tool Leadership and corporate governance Population health management and care models Care team and clinical governance Resource management Empowering people and communities Provider collaboration
  32. 32. • Each theme based on practical steps up a ladder (may jump some) • Aligned with NHSE maturity matrix and NAPC grid • Launched before five year framework for GP contract reform • Tried to keep it simple! • Also identifies support products (about which more later) • Consistently assess maturity • But more importantly develop a plan for 2019/20 Planning and support tool
  33. 33. • Builds on tool themes, not prescriptive and live! • Which steps aiming to deliver by when and what support required • Expect initial focus on leadership and corporate governance and care team and clinical governance themes (setting up) Annual plans by 31 March 2019
  34. 34. • When developing tool identified what support products made sense to develop at ICP/ICS place involving Networks (overleaf) • Task and finish groups established, led by ICP colleagues (bottom up approach) • In response to five year framework reviewing what… o Not expected nationally and continue to develop locally o Expected nationally and not continue to develop locally o Expected nationally but continue to develop locally (timing) • Notably Networks also receiving multiple support product offers Support products
  35. 35. Support products for each theme A. Chair/lead recruitment package B. Terms of reference for leadership groups C. MoU between practices D. Annual plan template A. Population health profiles B. Real time patient tracking tool C. Risk stratification & segmentation tool D. Care model effectiveness report A. Stakeholder mapping tool A. Care team operating model B. Care package co- ordination tool A. Resource utilisation report B. Workforce Tool C. Incentive framework D. KPI & Outcome framework A. Business continuity plan template B. Data sharing agreements
  36. 36. Future work Development Support Offer – accelerated solutions Additional Roles – fit and options to secure from 2019/20 onwards People Support – including CCG in kind ICS and ICP – engagement Local Supplementary Network Services – integration into DES from April 2020 Personalised Care – leadership arrangements Network Service Specifications – fit and options to deliver from 2020/21 onwards Network Agreement – sign up of other community partners Network Delivery Model – options Combined Access Offer – fit and options to deliver from April 2021Extended Access DES – options to deliver from July 2019 NHSE development and testing programme – volunteer for test bed sites
  37. 37. 38 ‘En este muno traidor No hay verdad ni mentira, Que todo esta en el color Del cristal con que se mira.’ (In this world of many mazes There is nothing false or true: All depends upon the hue Of the glass through which one gazes.) (Sixteenth-century Spanish quatrain) #primarycarenetworks
  38. 38. Seeing PCN development within the wider system Complex systems are driven by the quality of the interactions between the parts, not the quality of the parts. Working on discrete parts or processes can properly bugger up the performance at a system level. Never fiddle with a part unless it also improves the system @ComplexWales #primarycarenetworks
  39. 39. Anatomy of change Physiology of change Definition The shape and processes of the system; detailed analysis; how the functional components fit together. The vitality and life-giving forces that enable the system and its people to develop, grow and change. Focus Processes, systems and structures to deliver population health and healthcare Energy/fuel for change Leadership activities  defining functionality  measurement and evidence  governance systems  reducing unwaranted variation in the system  redesigning pathways  creating a higher purpose and deeper meaning  creating organisational health  building community  connecting with values  creating hope and optimism about the future  calling to action Source: Crump and Bevan
  40. 40. Anatomy of change Physiology of change Definition The shape and processes of the system; detailed analysis; how the functional components fit together. The vitality and life-giving forces that enable the system and its people to develop, grow and change. Focus Processes and structures to deliver population health and healthcare Energy/fuel for change Leadership activities  defining functionality  measurement and evidence  governance systems  reducing waste and variation in health and care processes  redesigning pathways  creating a higher purpose and deeper meaning  creating organisational health  building community  connecting with values  creating hope and optimism about the future  calling to action Source: Crump and Bevan
  41. 41. Healthy PCNs as well as high-performing PCNs “Organisational health is a state of being whole and sound. Healthy organisations use the talents of everyone in the organisation. They function effectively, continuously improve and grow from within.” from the NHS Leadership Forum, 18 December 2018 #primarycarenetworks
  42. 42. Inter-dependence Who are the key people and groups that the PCN needs to build relationships with in order to flourish and achieve its goals? How do we build strong trusting relationships, both within the PCN and for the PCN in its wider context? Shared purpose Why does the PCN exist? What unites the PCN with the wider health system? How do we build a profound sense of shared purpose, anchored in values? Autonomy How do we build the adaptability, innovativeness and problem solving capability of the PCN; the ability to respond to change without compromising core values? Resilience What capacity does the PCN need to impact upon its environment and make a difference? What structures and systems does it need to enable effective action? Table:
  43. 43. Plot the dots • Put a green dot on attributes you need that you have in place or are confident you know how to fix • Put a red dot on attributes you need that you are certain you don’t know how to fix • Put a yellow dot on attributes that need more discussion to be clear about next steps #primarycarenetworks
  44. 44. Making this real Who can help us to achieve this purpose? How do we use all the resources and support systems that already exist in the system? Use the pink post-its to suggest groups within the system and the resources and support they bring What are the themes for the specification? What are the topics and themes that the specification of support needs to cover (enabling PCNs to work inter-dependently)?
  45. 45. Who can help us to achieve this purpose? What are the themes for the specification?
  46. 46. 50 Specification themes Creating the environment and relationships 2 poster types depending on your challenge
  47. 47. Review the gallery of outputs • One person from each group to stay with their poster • Everyone else has the opportunity to review three other posters; add additional ideas in a different colour pen • Three rounds, ten minutes each #primarycarenetworks
  48. 48. Review the gallery of outputs • Pull out three headlines from your poster on how to bring the ideas to action and write them on a sheet of flipchart paper • Be ready to share this with the wider group #primarycarenetworks
  49. 49. Reflection time Think about the implications of today for your own system/area of work Plan what you might do as a result of today #primarycarenetworks

Notes de l'éditeur

  • A vision for primary care networks

    The case for primary care networks is that by working together, GP practices and other care providers can deliver better care for their patients, and better lives for their staff, than they can by working in isolation. Patients and professionals working primary care networks have outlined the following benefits:

    We know that primary care networks can deliver clear, tangible benefits for both people who use our services and those who work in them.

    We will be discussing these in more detail later on, but the main benefits are:

    delivering improved outcomes and an integrated care experience for patients
    Taking pressure off GPs by drawing on the skills of the wider team where these are the best fit
    more sustainable and satisfying roles for staff
    Helping systems to plan and discharge resources more effectively, also giving primary care providers a pivotal role in the groupings that are leading this (STPs and ICSs)

    Networks will work collectively to change the way in which services are delivered to their patients. They will be focused on the care of their population, working together collectively to design and deliver services that respond to patient need and improve outcomes and quality in primary and community care.

    Great networks will be based on population health, focussed on prevention and anticipatory care, with networks operating in partnership with other agencies, both health and non health, statutory and voluntary, to deliver new, expanded and improved services and address the wider determinants of health.
  • Joined up care planning, coordination and delivery between primary care, community care, voluntary sector, social care, and other parts of local government, including public health, with NHS and social care teams working together in multidisciplinary teams (MDTs) and hubs.
    Services will respond to the needs of the communities they serve.
    Harnessing the opportunities available from technology, including digital provision of care for patients (e.g. a digital front end), real time shared care records and business intelligence systems.
    Staff will have a more sustainable workload and more attractive, structured career pathways, that enable multidisciplinary working, portfolio careers and the ability to move between care sectors.
    Integration and partnership working with wider partners, in local government public health, fire, housing, police and education will help to address wider determinants of health.
    A business model to incentivise networks, with a contract for outcomes based commissioning, appropriate payment models and removal of potential barriers to integration, including estates and indemnity.
    Developed clinical and business leadership within and between networks and the wider health and care system with a strong provider voice of general practice.
  • We can add to this that today aims to help them think about what they are going to need and provide some input on what they can expect to help them – but it is their day so just as important will be their input on what they need. Not just for today but in weeks and months to come.
  • Local rules