Commissioning for Primary and Community Care Juliet

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Commissioning for Primary and Community Care
Juliet Warburton Head of Primary and Community
Care Wendy Young Strategic Commissioner for
Urgent Care Joanne Matthews Strategic
Commissioner for Long Term Conditions and
Promoting Independence
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One part of a whole system
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Primary and Community Care Commissioning Strategy

• High level document
• Drawing together previous work together with
  outlining the areas for transformational change
• Underpinned by 10 detailed commissioning plans
  and patient offers
• Reflective of current economic climate and
  Transforming Community Services (TCS)

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Vision Commissioning or Primary and Community
Care

• Commissioning
• Networks/Region
• For specialist commissioning before PCT e.g.
  Sussex wide
• PCT
• Population wide commissioning / strategic
• Locality / Poly-system
• Federated or networked clinical commissioning
  for locality practice population
• Practice
• Clinical commissioning for practice population
• Individual Patient
• Personalised health budgets

Central Neighbourhood System
Individual patient
Individual practice
West Neighbourhood System
PCT
East Neighbourhood System
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Commissioning Intentions

• The commissioning intentions are
• Disease Prevention and Health Promotion
• 2) Mental well-being
• 3) Oral health
• 4) Primary care quality, access and
  responsiveness
• 5) Maternity services
• 6) Long-term conditions and case management
• 7) Urgent Care
• 8) Promoting Independence
• 9) Planned Care

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Commissioning Intention Plans

• Informed by detailed diagnostic work that
  includes
• Needs assessment
• Patient feedback and previous consultation
  outcomes
• Quality outcomes
• Financial, activity, performance and productivity
  benchmarking
• Market analysis
• Outlines Patient Offers
• Describes current and future state
• Priorities and transformational change programme
• Details 3 year plan with costs, productivity
  and procurement intentions

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Progress so far
Strategy Board established Draft 10
Commissioning Intentions agreed Leads identified
and work progressing on diagnostic and
commissioning plans Timelines agreed to reflect
World Class Commissioning assurance and
Strategic Commissioning Plan (SCP) process whilst
enabling time for co-design Work progressing on
working up detail of transformation programmes
and frameworks
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Co-production
Identified leads are co-ordinating sessions with
clinicians and lead key managers to co-design
commissioning plans LTC commissioning plans
shared at local Primary Care Conference PCT
Clinical Executive providing leadership role
ensuring development of strategy shared with
Clinical Boards PBC leads members of Strategy
Board
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Commissioning Plans

• Primary Care
• Long Term Conditions and Case Management
• Urgent Care

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Key issues primary care

• Large number of small providers with wide
  variation in quality and access
• Historical investment patterns means that areas
  in most need tend to have less than there fair
  share of resource
• Overall primary care is insufficiently developed
  (particularly in terms of infrastructure such as
  premises) to support the delivery of more
  services in primary care

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Key issues

• Urgent care provision is complex, making it
  difficult for people to navigate, with the
  default position often being hospital/AE
• Some good pathways but a system with multiple
  access points which means that patients dont
  always follow the most appropriate one to meet
  their need
• Rates of emergency admissions are the highest in
  SHA and significantly above national average
• Support for people with long term conditions to
  live independently at home is complex and can be
  disjointed with many different teams from Acute,
  Primary, community care and 3rd Sector involved

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Summary
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Primary Care the vision

• Ensure high quality is a consistent part of
  everyones primary care experience

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Primary Care the plan

• All primary care contractors
• Develop quality and performance frameworks for
  all primary care contractors with the aim of
  improving the overall quality of service
  provision and addressing the variation at
  individual contractor level. The frameworks will
   
• benchmark quality and performance
• support provider development

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General Practice the plan

• Continue to invest in primary care premises and
  infrastructure 
• Improve access and responsiveness
• Improve patient choice, information and
  experience
• Target resources to areas in most need and reduce
  health inequalities
• Focus services on health promotion and healthy
  living

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Dentistry the plan

• Improve access especially in those areas with
  high need
• Provide greater information to patients
• Improve patient satisfaction, experience and
  choice
• Improve access to a local consultant restorative
  dental service
• Review the following services to improve local
  service provision.
• Orthodontics
• Special Care Community
• Emergency Dental Service
• Sedation services

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LTC the vision

• Systematic and integrated primary and community
  care for people with a LTC across all levels of
  care, from self care to end of life
• All people with a LTC and their carer will be
  offered information, support, education and
  training to help them better manage their own
  care
• All people with a LTC will be offered an
  individualised patient held care plan a named
  case manager who will undertake a coordination
  role

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LTC the plan

• Multi disciplinary LTC community teams will be
  developed through the transformation and
  reconfiguration of existing resources and teams
• LTC teams will be provided at a locality level
  with clear links to individual practices
• LTC team will work closely with primary care to
  ensure seamless care provision for patients and
  their carers

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Urgent Care the vision

• Clear and simple self-care opportunities that
  support people to manage their own care and make
  informed choices
• One local single point of access providing
  information and/or access to urgent care and
  community services
• Simple community based rapid access to assessment
  and urgent response services
• Rationalised bed based services targeted at
  supporting prevention of admission
• Fewer avoidable emergency admissions and
  attendances

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Urgent Care the plan

• Community based rapid assessment and response
  service through service reconfiguration
• Local single point of access for both patients
  and referrers.
• Social marketing to understand peoples reasons
  for using AE/Urgent care and develop targeted
  strategy
• Analysis of GP referral activity targeted
  strategy to address variations
• Integrated Urgent Care Centre and clear care
  pathways
• Acute hospital admission criteria

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Case Study

• 85 year old who lives alone in a flat
• Multiple co-morbidities
• Limited mobility so rarely goes out
• Carer once a day
• Develops infection and falls
• Carer finds her and dials 999

Before After

• Not known to community health teams
• Taken to A E where she is admitted to a ward
  due to confusion
• Discharge plan includes increased care package ?
  Delay in getting package in place.
• Discharged home
• No follow up review by community teams or GP
• Out patient appointment

• Managed by the locality LTC team and has in place
  a care plan and care co-ordinator
• Paramedic Practitioner attends assesses, calls
  SPA
• Transferred to community assessment facility
  ,admitted to a community bed
• SPA informs GP / care co-ordinator
• LTC teams in reach to support discharge planning
• LTC team restart community provision
• COE follow up review in community

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Benefits

• Improved information and self care opportunities
  to support patient choice and control
• Quality care and improved access and experience
  for patients across primary care
• Proactive and ongoing support from
  multi-disciplinary teams for people with a LTC
  and complex needs in community and when in
  hospital
• Joined up care between primary, community and
  hospital so experience is more seamless
• Appropriate and timely response taken when a
  person reaches crisis thus avoiding hospital
  admissions
• Care informed by individualised care plan held by
  patients

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Summary of plans

• Provide better information and self care
  opportunities for patients and carers
• Focus on prevention and admission avoidance
• Further develop primary care infrastructure and
  make improvements in access, responsiveness and
  experience
• Simplify the system through redesigning
  bringing together teams and services that are
  responsive to need
• Reconfigure services and workforce to support
  people with LTC and complex needs
• Develop services at a practice and locality
  level, working with PBC

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The time is right..
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Questions

• What do you think about the proposals?
• overall direction of proposals
• Weaknesses or anything missing
• areas for development
• potential benefits for patients
• 2. What further work do we need to do with
  clinicians, key stakeholders and the public to
  implement the plans?