Collaboration across sectorsChris Banks – Chief Executive & Tracy Cannell – Chief Operating OfficerTower Hamlets GP Care Group

www.towerhamletstogether.com #TH2GETHER

22 November 2017

Local Health Challenges

Third highest prevalence of first episode psychosis

in London

Who We Are

Our partnership has been built over the last few years and includes a number of local health, social care and voluntary organisations

Background• The development of Tower Hamlets Together and its Alliance Partnership is part of a much

broader history in the borough of commissioning services and providing care that is integrated around the patient and delivered across organisational boundaries.

Values, mission and aims

Our values: To make a positive difference for the people of Tower Hamlets we work passionately to be: Collaborative, Compassionate, Inclusive, Accountable.

Our mission

To improve outcomes and experience for adults with complex health and social care needs and their carers through delivering and building on the integrated care programme

To improve outcomes and experience for children and their parents/carers through developing and delivering new ways of working for children and young people and their carers

To improve the health and wellbeing of Tower Hamlets residents through promoting self-care and prevention and tackling health inequalities

Our aims:

For people feel in control of their health and well-being

For people have the best possible resolution to their priorities at any contact with services

To deliver a cultural change, such that the resident/service relationship is mutually supportive

• Universal

• A single point of access for all health and social care services

• IT that works, with mobile working fully rolled out

• Fully integrated with social care

• Developing a “five partners, one way of working” culture

• Supporting staff to develop quality improvement tools and techniques, with the freedom to test creative solutions to problems

• Promoting prevention and self-care, including through social prescribing and a wellbeing hub.

• Adults

• Extended “whole person care” primary care teams

• A new integrated community rehabilitation service

• A new rapid access integrated frailty assessment service

• Specialist services for adults working across acute and community

• Integrated EOLC Pathway

• Piloting new ways of working e.g. Buurtzorg approach to community nursing and home care

• Childrens

• A new model for complex services provided from one site, with the aim of developing a comprehensive integrated delivery model for children

What we’re doing: No single magic bullet

• Working hard at building relationships between providers, and building on our

strengths

• Integrated care local incentive scheme – testing how we work with shared risk and

opportunity

• Provider-led business intelligence

• New community health service model at the heart of our system approach,

secured via an outcomes based Alliance Contract

• Development of a systems outcomes framework articulating our collective

ambition to improve the health and wellbeing of the population

• Working together to understand the opportunities and risks of capitation

contracting through a two year shadow period

What we’re doing: underpinning foundations

Our Outcomes Framework

After using Tower Hamlets Together services we want

residents to be able to say…

Around me

I feel safe from harm in my community

I play an active part in my community

I am able to breathe cleaner air in the place where I live

I am able to support myself and my family financially

I am supported to make healthy choices

I am satisfied with my home and where I live

My children get the best possible start in life

My doctors,

nurses, social

workers and other

staff

I am confident that those providing my care are competent, happy and

kind

I am able to access the services I need, to a safe and high quality

I want to see money is being spent in the best way to deliver local

services

I feel like services work together to provide me with good care

Me

It is likely I will live a long, healthy life

I have a good level of happiness and wellbeing

Regardless of who I am, I am able to access care services for my physical

and mental health

I have a positive experience of the services I use, overall

I am supported to live the life I want

Metric

1a. Non-elective bed days per 1,000 for Very High Risk and High Risk population

1b. Non-elective admissions per 1,000 Very High Risk and High Risk population

1c. % 30 days readmissions for Very High Risk and High Risk population

1d. Avoidable admissions per 1,000 of the population

1e. Bed days for Barts Health patients who have dementia, depression or another MH problem

1f. Emergency admissions for patients with known dementia, depression or serious mental illness as per primary care register

2a. Delayed transfers of care per 100,000 (whole population)

2b. Permanent admissions to residential care per 100,000

2c. People still living at home 90 days after discharge

4a. Flu immunisation for whole population and at-risk cohorts

Integrated care incentive scheme

Benchmarked Performance

System Management Committee Dashboard

National Benchmarking

12 Months Ending Q4 2016-17

MCP 111.38 -33.20

Non-NCM 104.00 -25.82

- Tower Hamlets Together78.18 -

Bed Days - Indirectly Standardised

12 Months Ending Q4 2016-17 Tower Hamlets Variance

MCP 104.68 -2.18

Non-NCM 100.61 1.89

- Tower Hamlets Together102.50 -

Benchmark

Emergency Admissions - Indirectly StandardisedBenchmark Tower Hamlets Variance

NarrativeFor the 12 month period to the end of Q4 2016-17, Tower Hamlets indirectly standarsied ratio is lower (better) than MCPs and Non-NCMs.

As can be seen from the run chart, this is consitent with Tower Hamlets' relative performance over the last three and a half years, which continues to improve.

NarrativeFor the 12 month period to the end of Q4 2016-17, Tower Hamlets indirectly standardised ratio is slightly higher than Non-NCMs but slightly lower than MCPs

However Tower Hamlets unstandardised bed day utilisation is lower than MPCs and slightly higher than Non-NCMs.

0

5

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Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

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Emergency Admissions Per 1,000 Quarterly Trend

MCP Non-NCM Tower Hamlets Together

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Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

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Bed Days Per 1,000 Quarterly Trend

MCP Non-NCM Tower Hamlets Together

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Emergency Admissions - Indirect Standardised Ratio Vanguard: Tower Hamlets Together - NCM: MCP (2016-17 Q1 -

2016-17 Q4)

Tower Hamlets Together MCP Vanguards Non-NCM

Dashboard Summary

System Management Committee Dashboard

In Month Performance SummaryMetric Id Metric Name Month Target Actual Variance % Variance RAG Status 12 Month Trend MoM Trajectory

1 Non Elective Admission - High Risk Patients Jun-17 62.94 53.02 per 1,000 -9.9 -16% -0.3

2 Non Elective Bed Days - High Risk Patients Jun-17 401.30 260.21 per 1,000 -141.1 -35% -66.0

3 Mental Health OBD - High Risk Patients Mar-17 7.60 7.02 -0.58 -8% 1.31

4 Mental Health Admissions - High Risk Patients Mar-17 6.3% 4.98% -1.3% -21% -0.6%

5 Under 5s A&E Attendances Per 1,000 Jun-17 59.36 41.12 -18.2 -31% -9

6 Under 5s Non Elective Admissions Per 1,000 Jun-17 8.89 5.25 -3.6 -41% -0.5

7 Under 5s Non Elective Bed Days Per 1,000 Jun-17 19.26 8.47 -10.8 -56% -1.9

8 LD Health Checks Jun-17 75% 6.37% -69% -92% - -

Summary View

Narrative

Data: Note, data for 2017/18 YTD is provisional

High Risk Patient Metrics- Following a spike in March, non elective admissions for high risk patients has been consistently within target levels throughout 2017/18. Following on from this, the number of Non Elective Bed days has also seen a continued reduction and has also been well within target levels throughout the first quarter of the financial year.

Mental Health Related Metrics - awaiting refreshed data for Q1 2017/18

Under 5s Metrics - The target has been achieved for all Under 5s metrics throughout Q1.

Uptake of NHS health checks for people aged 14+ with a learning disability - as of the end of Q1, only a relatively small number of eligible patients with learning disabilities had received a health check. There is some variation by network, and this metric will continue to be monitored for action by the SMC.

Page 1 of 1

Development of Primary Care Services

Tower Hamlet GP Care Groups JourneyApril 2009

Formation of 8 Primary Care networks

November 2013

Formation of the GP Care Group

September 2014

Incorporation as a Community Interest Company

November 2014

CEPN & Open Doors transferred to the GPCG (14/15 £300k)

April 2015

Vanguard and PMCF (15/16 £2.6m)

April 2016

Provider of Health Visiting services (16/17 £11.3m)

April 2017

Alliance Manager, Lead provider of NIS Contract (17/18 £23m)

Forming GP Networks 2009

65

1 23 4

56

89

10

7

1112

15

13

16

14

1718

19

242122

20

23

25

2627

2829

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Tower Hamlets before

networks

• 8 LAPs

• 36 practices

• Total population of ~245,000

• Practice list sizes of 3,000 to 11,000

65

1 23

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5

6

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15

13

16

14

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19

24

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20

23

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2829

30

31

32

Pop: 29,892

Pop: 18,027

Pop: 29,801

Pop: 35,720

Pop: 28,995

Pop: 33,186

Pop: 27,839

Pop: 31,975

8 Networks1 were formed in the borough during 2009

33

34

35

36

Why networks?• Focus on population health across a geography• Collaborative relationships with wide range of

partners (e.g. Borough, schools, charities)• Sufficient scale for specialisation of staff, ability to

access rare skills and ensure access, resources (e.g. equipment)

• Integration with estates plan

How did it work…

Organisational development •The capabilities and mindsets

Information and technology•The systems and processes to

underpin the new way of working

What supports it all?

• Reducing variability through the use of evidence based pathways

• Ensuring the right people to do the right tasks at the right time

• Enabling transparency of data at individual patient, clinician, practice, and network level

• Facilitating an integrated and coherent approach

• Focus on population health across a defined area

• Have collaborative relationships with a wide range of partners (e.g. Borough, Schools, Charities)

• Provide sufficient scale for:

– Specialisation of staff

– Ability to access rare skills

– Resources (e.g. equipment)

– Ability to ensure access

• Integrate with estates plan

Care packages are: Networks:

• Purpose

• to be the voice of primary care working at scale

• to ensure sustainability of primary care

• Community Interest Company limited by shares

• Shares owned by

• 36 general practices

• 1 homeless access centre

• Annual Turnover: budget y/e 31 March 2018 >£23m (2017 £11.3m)

• Employees: c360

Portfolio of services

• Surgical aftercare

• Pathology transport

• Websites

• CEPN

• Open Doors

• Extended access hubs

• Social prescribing pilots

• Health visiting

• System leadership – MCP Vanguard

• eConsult web-based consultation

• Network incentive scheme

• Out of Hours/Urgent Care

• Single Point of Access

• Health advocacy and interpreting

• Alliance Manager

• Medical indemnity

• Business Intelligence

• QI/ Primary Care resilience

• Substance misuse

Community Services Alliance

www.towerhamletstogether.com #TH2GETHER

The delivery model

• A single point of access for all health and social care services

• Extended “whole person care” primary care teams

• A new integrated community rehabilitation service

• A new rapid access integrated frailty assessment service

• A new model for complex children’s services, provided from one site, with the aim of developing a comprehensive integrated delivery model for children

• Specialist services for adults working across acute and community

• IT that works, with mobile working fully rolled out

• Promoting prevention and self-care, including through social prescribing and a wellbeing hub.

Responsibilities

Impact

• Greater support for self management

• Improved links with community services and more patients managed in the community with responsive support to avoid admission

• Colocation of staff, rationalisation of desks/offices, mobile working

• Patients have greater influence in service design and delivery

• Identified care co-ordinator, joint MDTs, shared care planning

• Increased role of Locality Boards to plan & manage local population health

Alliance Arrangements

Alliance Contract Structure and Payment• The contract is for 5 + 2 years.

• GPCG, Barts Health and ELFT all have contracts directly with the CCG for the elements they deliver.

• There is an Alliance Agreement and an Alliance Board comprising of the three providers and the CCG.

• GPCG is the Alliance Manager and has a co-ordinating role to support the delivery of the model and the associated outcomes.

• The contract is outcomes based with 5% increasing to 25% of the contract value dependent on the achievement of a range of PROMs, PREMs and process based proxies for outcomes

Our emerging plans to expand the Alliance• The alliance has overarching contract/MOU that sets

expectations and rules as to how the GP Care Group, Barts and ELFT, and the CCG, work together to deliver the CHS contract

• The alliance can be flexed in terms of scope and scale with agreement of all parties.

• Provides the basis upon which an accountable care system of provision could be based

Future System Changes

National Region

26

Target Operating Model - bridging strategy and implementation

Clinical and non clinical leaders from partner organisations coming together to lead the system towards a shared vision to deliver a agreed set of outcomes.

System Leadership

Partners & Alliances

Identity key partners and alliances to develop the system model. These will be internal to the borough as well as external.

Organisational Development

-Integrating front line services i.e. community health and social care teams, community equipment services etc

-Consolidation of support functions e.g. HR, Finance, Commissioning

-culture

-Workforce

Payment & Contracting

Data & Analytics

A shared and transparent dataset across the system used to analyse need, monitor performance and plan services.

Governance & Control

-Roles and responsibilities

-Structures

-Span of control

A new payment and contracting model fit for the transitional and end state of the health and care system

Partners & Alliances

Organisational Development

System Leadership

Data & Analytics

Governance & Control

Payment & Contracting

Improved Outcomes

HEALTH & WELL-BEING BOARD

Joint Commissioning Exec Provider Alliance Board Tower Hamlets Together

Partnership BoardAlliance associates

CCGLBTH

GPCG

ELFTBarts

Health

LBTH

Emerging Governance

Structure

Stakeholder Council

CICsVol

sector

System Management

Committee

Quality Committee

Practices

Complex Adults

Adults

Mostly healthy

Children & young people

STRATEGY & TRANSFORMATION PROGRAMME BOARDS

Service user & carer group

Business intelligence

EstatesPayment & contracting

ENABLER PROGRAMME BOARDS

TOWER HAMLETS TOGETHER PROGRAMMEUrgent Care

Board

OPERATIONAL COMMITTEES

NW Health & Wellbeing Committee

NE Health & Wellbeing Committee

SW Health & Wellbeing Committee

SE Health & Wellbeing Committee

LOCALITIES