Barnet Integrated Care Partnership (ICP) The journey so far

January 2020

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Objectives

The objectives for the session are to understand:

1. Different types of integrated care;

2. The NHS Long Term Plan ambitions;

3. NCL approach;

4. Progress of the Barnet Integrated Care Partnership

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1. Different types of integrated care

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• There is no single agreed definition, but a variety of perspectives,

concepts and models.

• At its core, integrated care is: joined up care, prevention and self-

care.

• Integrated care may be judged successful if it contributes to better

care experiences; improved care outcomes; delivered more cost

effectively.

Reference: World Health Organisation: Integrated Care Models: An Overview, 2016

Integrated Care

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Perspectives of Integrated Care

Reference: World Health Organisation: Integrated Care Models: An Overview, 2016

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The WHO distinguish four types of

integration:

• Organisational: organisations are brought

together formally by mergers or through

'collectives' and/or virtually through

coordinated provider networks or via

contracts between separate organisations

brokered by commissioner

• Functional: Integration of non-clinical

support and back-office functions, such as

electronic patient records

• Service: Integration of different clinical

services at an organisational level, such as

through teams of multidisciplinary

professionals

• Clinical: Integration of care delivered by

professional and providers to patients into

a single or coherent process within and/or

across professions, such as through use of

shared guidelines and protocols

Reference: World Health Organisation: Integrated Care Models: An

Overview, 2016

Types of integrated care

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1. Individual models of integrated care – focus on high-risk individuals and/or

multiple conditions, such as:

• Case Management

• Individual Care Plans

• Personal Health Budgets

2. Group and disease specific models – focus on specific groups and/or specific

conditions in populations, such as:

• Chronic Care Model

• Integrated Care Models for elderly and frail

3. Population based models - based on stratification of populations, supply

different services based on need, such as:

• Kaiser Permanente

Reference: World Health Organisation: Integrated Care Models: An Overview, 2016

Commonly known models of integrated care

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2. NHS Long Term Plan ambitions

NHS Long Term Plan

The NHS Long Term Plan was published in

January 2019, and sets out requirements for the

NHS to be:

• more joined-up and coordinated in its

care;

• more proactive in the services it provides;

• more differentiated in its support offer to

individuals.

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NHS Long Term Plan

It details five major changes to the NHS service model:

1. Boosting ‘out-of-hospital’ care and reducing the

primary and community health services divide

2. Redesigning and reducing pressure on

emergency hospital services

3. Individuals having more control over their own

health

4. Digitally-enabled primary and outpatient care will

go mainstream across the NHS

5. Local NHS organisations focusing on population

health and local partnerships with local authority-

funded services, through new Integrated Care

Systems (ICSs).

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• The NHS Long Term Plan outlined the ambition that every part of the

country should be a mature Integrated Care System (ICS) by April

2021.

• ICSs have evolved from Sustainability and Transformation Partnerships

(STPs), and take the lead in planning and commissioning across a

whole population.

• Every ICS will need streamlined commissioning arrangements to

enable a single set of commissioning decisions at system level. This will

typically involve a single CCG for each ICS area.

• The local Integrated Care System will cover North Central London

(NCL).

NHS Long Term Plan

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Integrated Care Partnerships

• An essential component of the ICS model is borough based

commissioner and provider partnerships, known as Integrated Care

Partnerships (ICPs).

• ICPs are alliances of NHS and Social Care commissioners and

providers that work together to deliver care by agreeing to

collaborate, rather than compete.

• Within NCL, ICPs are currently being developed in each of the

boroughs.

• ICPs are developing their own priorities, reflecting the different needs

of each local population.

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3. NCL approach

Proposed NCL ICS

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Neighbou

rhood

network

Neighbou

rhood

network

Neighbou

rhood

network

Neighbou

rhood

network

Borough-Based Integrated Care

Partnerships

NCL Strategic CommissionerPu

blic

en

ga

ge

me

nt a

nd

re

sid

en

t vo

ice

Borough

Council

Local authority

Health and

wellbeing

board

Multidisciplinary

teams serving 30

– 50k population

5 – 10 year

system

planning

Planning and

delivery for 3 – 5

year borough-

based strategies

The NCL ICS would see a single NCL wide strategic commissioner working with

borough based partnerships, supporting frontline integration of services at a

community level.

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4. Progress of the Barnet Integrated Care Partnership

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The Barnet ICP

• The Barnet ICP brings together Barnet CCG; Barnet Council; Royal Free

London NHS Foundation Trust; Central London Community Healthcare NHS

Trust; Barnet, Enfield and Haringey Mental Health Trust and the Barnet GP

Federation. With input from other key stakeholders from the voluntary sector.

• The ICP’s vision is to maximise health and wellbeing for all people of

Barnet by working together as an integrated care partnership.

• The main aims of the ICP are to:

• Keep people as independent as possible for as long as possible;

• Support residents in self-care and prevention;

• Reduce the number of avoidable unplanned hospital visits and admissions;

• Address wider determinants of health such as employment, housing and

education to improve outcomes; and

• Make the workforce fit for the future through joint workforce strategies.

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Barnet ICP Progress to date

• Identified system leaders across multi-organisations in Barnet

• Held ‘Integreat’ workshops and informal meetings over the summer to build relationships

• Held detailed discussions about vision, outcomes, governance and financial management of the Barnet ICP to develop shared understanding

Developed strong collaborative system leadership

• Developed interim governance arrangements

• Established the Barnet ICP Board and Barnet Integrated Care Delivery Board

• Agreed Terms of References and Memorandum of Understanding

• Established workstreams to progress ICP development

Developed joint governance

• Developed five high-level outcome domains around access, workforce, population health, wider determinants and community resilience

• Agreed an approach to develop detailed outcomes based on priority pathways

Developed high level outcome domains

• Identified areas to progress integration, informed by the emerging outcomes, existing schemes, and areas of existing priorities and pressures for the local health and social care economy

• The areas are Dementia and Urgent and Emergency Care pathways, under the framework of an ‘Ageing Well’ model.

Identified areas to progress local integration

Barnet ICP Interim Governance Structure

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Barnet Integrated

Care Partnership

Board

Strategy &

Scope

Population

Health

Management

Pathway

Development

/ Priorities

Barnet Integrated

Care Delivery

Board

Barnet Health

and Wellbeing

Board

Outcomes

Framework

Governance

& ODWorkforce

Comms

&

Engagement

Financial

Management

& Planning

Delivery

PMO

Barnet ICP development model

Barnet Health & Wellbeing

Board PrioritiesHow does the ICP link to the HWB

Strategy?

Ensuring coordinated and holistic care

ICP High Level Outcomes

What are the main outcomes we are

trying to achieve?

Embedding Population

Health approach into

care

Improving Access and

Quality of Care

Building Community

Resilience

Making our workforce

fit for the future

Improving wider

determinants of

Health

Population Segmentation

Which groups will we focus on?

Start well

Age: 0-19

Live well

Age: 20-64

Age well

Age: 65+

Workstreams interventions

Which areas will we focus on?

The “ICP Approach”

How will we link outcomes with the

delivery?

Pilot phase to April 2021

Urgent and Emergency Care

Dementia

Define

relevant

outcomes

Determine

model of

integration

Use data to

inform

approach

Co-design

pathways

with patients

Develop finance

and contracting

models

Develop

workforce

ICP VisionThe “Why”

We will work together as an Integrated Care Partnership to

maximise health and wellbeing for all people of Barnet

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Proposed Five year approach

ICP Pilot Phase ICP Mature State

October

2019October

2020

April

2021April

2022April

2023

April

2024

Age well pilots

Start well model

Live well model

Age well model

Clinical / Service integrationClinical / Service / functional /

organisational integration

Deadline to become

a mature Integrated

Care Partnership

Draft ICP High Level Programme Plan

Q1Q4Q3Q2Q1Q4Q3

2019 20212020

Agree core objectives

Agree core outcomes

Refine outcomes/ measures

Embed outcomes in pathway changes

Develop prioritisation framework

Identify pilot pathways to

test integration

Use PHM data to support pathway development

Determine integration

approach for pilot projects

Devise PHM risk stratification

approach

Develop and deliver pathway changes

Design / Implementation / Monitoring Evaluate impact

Develop financial principles for the ICP

Develop financial baselining for in-scope pathways

Work with outcomes to establish incentives

Establish interim governance

arrangements

Agree and sign MoU Develop governance strategy

Engage with NCL / NLP workforce

plans

Identify resource and gaps in workforce for in-scope

pathways

Implement and embed strategy

Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr

Outcomes

Framework

Strategy

and Scope

Population

Health

Management

Pathway /

Priorities

Workforce

Financial

Management

and Planning

Governance

Define relevant outcomes and measures

Embed processes and implement strategy

Imbed new workforce in pathway redesign for in-scope pathways

Use PHM data to review outcomes and

determine new opportunities

Monitor effectiveness of pathway / priorities implementation

Continuous review of data to determine new

areas of focus

Design and implement future state pathway and priorities

Identify workforce needs for new opportunities

Implement system wide plans for

workforce

Monitor and evaluate new

workforce models

Develop an estates strategy

Start monitoring outcomes

Embed refined outcomes linked to future state pathways

Develop a strategy for future scope and developing

priorities

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Moving towards ICP Mature State

• Barnet ICP will use the ICS Maturity Matrix, developed by NHS

England, to monitor development.

• The matrix outlines core characteristics of a mature integrated care

system.

Key areas that we aim to achieve by April 2021 include:

• Collaborative and inclusive system leadership;

• Dedicated capacity and infrastructure to enable change;

• Strong system architecture and financial management and

planning;

• Population Health Management capability;

• Strong integrated care teams, bringing together PCNs, mental

health, social care, community and hospital services; and

• Tangible progress towards delivering national and local priorities.