Northumberland Primary and Acute Care

System (PACS)

Today…Northumberland PACS Vanguard • Joint bid with NHCFT & Northumberland CCG for a PACS• Impact of 7 day services – acute, primary care and

complex care team• Move of care out of hospital and into community• Null hypothesis approach to project, mostly based around

patient/citizen experience• Funding secured c£30m over 3 years

o year 1 funds £8.3mo Clear deliverables on the back of release of fundingo For every £1 spent need to save £3

Today…

Our Partners

• 2 CCGs – Northumberland and North Tynesideo PACS Northumberland only

• NTW – Mental Health• NEAS – ambulance service• Primary Care• Newcastle Acute Trust – Tertiary services• Local Authorities• Voluntary Sector• Health and Wellbeing Boards• Patient Engagement

Today…Northumberland PACS Vanguard

• Phase 1: Deliver 7 day working at NSECH and create base site hubs with access to GPs

• Phase 2: Deliver 7 day access in primary care through creation of ‘hubs’ in response to pt engagement

• Phase 3 : Develop health and care locality teams focussed on complex/high risk patients

• IT – shared access to patient records• Alternative workforce and national freedoms re medical

recruitment• Establish an ACO April 2017

Today…

Today…Phase 1• Phase 1 complete June 2015• 7 day consultant specialty working - acute services and

establishment of first 3 hubs• Model delivering reduction in admissions • Model delivering reduction in LOS• All on back of increasing A&E demand – acute and

urgent care / hub activity• Some further efficiencies of 3 hubs to be explored• IT MIG in place from November 2015 • Development of read / write capability or move to one

system still outstanding

Today…A&E AttendancesThe Northumbria, North Tyneside, Wansbeck and Hexham General Hospitals

- Base site attend followed by NSEC attend within 2 hours counted as 1 attendance

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 8,000

9,000

10,000

11,000

12,000

13,000

14,000

15,000

All ages2014/15 2015/16

Length of Emergency Spells Today…

*excluding deaths* spells starting at The Northumbria, Hexham, North Tyneside , Wansbeck general hospitals (ending at any Northumbria hospital)

Apr-14

May-14

Jun-1

4Ju

l-14

Aug-14

Sep-14

Oct-14

Nov-14

Dec-14

Jan-1

5

Feb-15

Mar-15

Apr-15

May-15

Jun-1

5Ju

l-15

Aug-15

Sep-15

Oct-15

Nov-15

Dec-15

Jan-1

6

Feb-16

Mar-16

-

1,000

2,000

3,000

4,000

5,000

6,000

0%

10%

20%

30%

40%

50%

60%

70%

80%

Emergency admissions % <3 daysAdmissions % <3 days

Today…Transforming primary and community based care

• Assess capacity/ demand in primary care services• Reshape primary care team (GP/ nurse practitioner/

pharmacist, NP)• Most appropriate person seeing the patient • Extend access to primary care services through locality

hubs• Increase capacity in the community (planned/ rapid

response)• Develop an integrated complex care team – accessed from

GP (if see deterioration and specialist post acute episode

Today…• Enable telephone, electronic, and telemedicine consultations in primary and secondary care

• Integrated patient record• Development of IT to introduce more efficiencies both in

primary and secondary care – for back office functions and patient care

• New roles and skill mixes to change our model of care• Development of nursing fast track scheme and use of

alternative graduate work force to support• Move to a change in payment mechanism

ACO Development Today…• Need to remove perverse incentives out of the system if

vanguards are to deliver• Firm commitment from Northumberland CCG and

Northumberland CC to develop an ACO type system• Working through how this can work with previously listed

partners3 stages and key deliverables• Release money from management and transaction processes• Improve patient pathways by developing new models of care• Real , whole population health

Today…Summary

• Delivery of phase 1 of vanguard demonstrates potential value in the approach, stimulating ACO development

• Need to remove perverse incentives from the system and ensure all parties work to one plan

• Clinical and citizen engagement will be key• Early gains from transaction costs and new models,

with real long term gains from Population Health

Any questions?