Northumberland VanguardCreating an integrated ‘primary and

acute care system’ – moving towards and ACO

January 2016

Background

• Mix of large rural and urban areas covering 2,000sqm

• Challenges of providing local services to rural areas– Population of 320, 000

– 44 GP practices

– NHCFT main acute provider (11 sites), NUHT 3o

services, NTW

– NE area has 8 FTs

Background

• Good working relationships between Nland CCG , NHCFT, Nland county council – built over number of years

• 2002: Adult social care and community services under new management - Nland care Trust

• 2013 Nland CCG established• 2011:‘transforming community services’ transfer to NHCFT• 2011: Formal partnership agreement between NHCFT and

Nland CC – NHCFT receive delegated authority to manage adult social care

• Prime provider for end of life care established and subsequent joint venture partnership with Marie Curie.

Commissioning Integration

• 2013: CCG and Council co location

• 2013: CCG and adult social care s75: £35m

• 2015: total s75 agreement: £60m

• 2015: Development of PACS vanguard working and movement towards an ACO

At a glance…

PACS programme

• Stage 1: the opening of the Northumbria Specialist Emergency Care Hospital in June 2015.

• Development of primary care hubs, complex care team, workforce

• Stage 2: ‘primary care at scale’ supporting both in hours and extended hours periods including weekends, as well as reducing the duplication in provision

• Stage 3: complex care “enhanced care model” –movement of care outside of hospitals

• Stages 4 and 5: create the ACO in Northumberland first in shadow form (stage 4) and then as an organisational reality (stage 5)

Accountable Care Organisation

• The ACO is a consequence of the PACS• Depends on taking our integration further and turning a

hospital dependent system on its head• Removal of perverse incentives from the system• Maintain statutory functions of CCG – at min cost• Move to a capitated budget• Local GPs and Council included in the ACO model and its

development• Option already exists for GPs to remain independent or

salaried – no pressure !• Involvement of other providers – eg 3o FT, NTW • Re-set the system

Accountable Care organisation• Cultural shift started – vanguard status has supported this• Split CCG duties broadly into tactical and strategic

commissioning• ‘Strategic commissioning agreed to be ‘housed’ with council• Transfer strategic role early 16/17 with amends to

constitution• Need to keep minimal CCG infrastructure to ensure statutory

duties • Use of joint posts where possible – precedence already set

between NHCFT and council• Working with legal team to now finalise ACO construct by

April 16 –Due diligence and shadow running where possible from April 16

• Submission to relevant Boards /regulators through 16/17• Go Live April 17

Accountable Care Health Outcomes

• Long term and ambitious.

• Organisational health

• Improve healthy life expectancy

• Excellent patient care and experience.

• Ensure excellent clinical service delivery at the

most vulnerable times of people’s lives

Engaging patients, the public and staff

• Engagement and involvement with patients, the public and staff

• Northumberland vanguard co-design forum

• Building the future system together

• Widespread communications and engagement from February 2016

• Website live www.northumberland.nhs.uk

Engaging patients, the public and staff

• Engagement with patients, the public and GPs

THANK YOU

Any questions?