Sara Shaw: The Trafford integration story

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  • 1. THE TRAFFORD INTEGRATION STORY Progress to date and  future challenges g SARA SHAW Senior Fellow, Nuffield Trust t: 0207 631 8450 e: info@nuffieldtrust.org.uk www.nuffieldtrust.org.uk
  • 2. OVERVIEW • Nuffield work with Trafford – 15 months – In‐depth case study – ‘Critical friend’ • Tracking and telling ‘the story’ – Work in progress – Three phases – Key challenges for Trafford to respond tot: 020 7631 8450e: info@nuffieldtrust.org.ukwww.nuffieldtrust.org.uk
  • 3. DRIVERS FOR INTEGRATION  • History of financial  problems • Rise in acute admissions  and GP  workload  and GP workload • Managing long term  conditions • 2008: new PCT strategy • Integration = way forward = way forward • End of ‘invest to save’t: 020 7631 8450e: info@nuffieldtrust.org.ukwww.nuffieldtrust.org.uk
  • 4. PHASE ONE: PLANNINGPHASE ONE: PLANNINGJanuary 2008 to March 2010
  • 5. SHAPING INTEGRATED CARE • September 2008  – First (of five) Clinical Congress events First (of five) Clinical Congress events – Mandate for developing new integrated approach – Development of ‘office medicine’ Development of  office medicine • Evidence + international models of care – Kaiser, Inter Mountain, Geisinger Kaiser, Inter Mountain, Geisinger • Strategic context (SHA, DH, TCS) • Communication and engagement (ongoing) Communication and engagement (ongoing)t: 020 7631 8450e: info@nuffieldtrust.org.ukwww.nuffieldtrust.org.uk
  • 6. SIX FOUNDING PRINCIPLES 1. ‘Nothing about me, without me’ 2. 2 General practice should be  locus of integrated  General practice should be ‘locus of integrated services’ 3. Consultant opinion is an essential component of  Consultant opinion is an essential component of effective integrated services 4. The delivery of integrated services will primarily rest  on extended roles for nurses and AHPs 5. Integrated services must incorporate social care 6. Future integrated services should bring together the  full range of primary caret: 020 7631 8450e: info@nuffieldtrust.org.ukwww.nuffieldtrust.org.uk
  • 7. MEDICINE AND SURGERY ARE DIFFERENT HORIZONTAL HORIZONTAL INTEGRATION ACUTE  ACUTE INTEGRATION SURGERY Increased use of TGH site for NHS activity presently done at high  l d hi h Enabled through  Enabled throughcost in the private sector  ACUTE  the creation of a and  potentially  MEDICINE new organisation through service‐level  g and  full mergers engagement with  OFFICE  primary care  MEDICINE  producing a shift  in activity in activity VERTICAL VERTICAL FAMILY  INTEGRATION INTEGRATION MEDICINE  MEDICINE
  • 8. • February 2009  – PCT B d i PCT Board sign‐off integrated care strategy  ff i t t d t t – Funding for development of a business case – Agreement to deliver ‘whole economy’ CIPs d l ‘ h l ’ • November 2009 – SHA supports the concept of ‘integrated care’ – Rethink required in terms of funding and pace of  implementationt: 020 7631 8450e: info@nuffieldtrust.org.ukwww.nuffieldtrust.org.uk
  • 9. • April 2010 – ‘Proof of concept’ year begins p y g – Reworked plans, guided by founding principles – Supporting eight work streams pp g g – Over one year (and beyond?) – £2m funding from PCT  • Shifting language/approach – Integrated Care Organisation g g – Integrated Care Systemt: 020 7631 8450e: info@nuffieldtrust.org.ukwww.nuffieldtrust.org.uk
  • 10. 1. Data sharing, population risk Integrated CareIntegrated Care  management System 2. Clinical panels and compacts g 3. Medical services redesign 4. Surgical Redesign 5. Patient experience and  coordination 6. Leadership and quality  Improvement Integrated  7. Programme support and  Care  Care e a uat o evaluation Organisation PLUS 8. Vertical integration
  • 11. PHASE TWO: IMPLEMENTATIONApril 2010 to March 2011
  • 12. PROGRESSING INTEGRATION PROGRESSING INTEGRATION • April 2010 onwards – Continue to develop ICO and supporting systems – Develop governance structures – Engage stakeholders, in Trafford and on the  borders – Develop ICO business plan • for submission to NHS North West under Transforming  Community Services C it S i • for NHS Competition and Cooperation Panelt: 020 7631 8450e: info@nuffieldtrust.org.ukwww.nuffieldtrust.org.uk
  • 13. OVERVIEW
  • 14. GOVERNANCE ICS MANAGEMENT BOARD Chair, Chief Executive NHS Trafford Formal decision‐making groupREDESIGN GROUP CLINICAL BOARD Chair, GP/PBC Lead Chair, PCT Medical Director Focused on detailed  Focused on detailed Overseeing clinical panels,  Overseeing clinical panelslocal system development  Advisory clinical governance,  and the disposition  education & training, quality  of surgical services  g improvement and patient  p p across Trusts empowerment STAKEHOLDER BOARD STAKEHOLDER BOARD Chaired by PCT Chair Underpinning partnership forum
  • 15. CLINICAL BOARD the most powerful body in the ICS... linking the panels directly  the most powerful body in the ICS linking the panels directly with the whole group incentive scheme, or professional dividend Orthopedics Multi‐disciplinary  team panels  General surgery with resource  with resource Urology Diabetes allocation powers  ENT and standards  Gynecology End of Life Care End of Life Care authority – Colorectal overseeing the  Mental Health Cardiology move from  Unscheduled  Care ‘outpatients’ to   Cancer Care office medicine,  Pediatrics Respiratory and offering  collegiate process  Ophthalmology control t l RheumatologySix panels in ‘proof of concept’ year ....... another 18 to follow
  • 16. Example – End of Life Care • Four work streams centred on lung cancer and COPD  • Aim: to reduce deaths in hospital by 10% by April 2012  – Develop operating manual for appropriate delivery of EoL care  assessment and intervention across Trafford.   – Provide clear guidance on content of intervention, training  requirements for staff, patient and family information, documentation  and information sharing • Identified cohorts via vanguard practices  • Testing with patients (home, hospital, care homes) from  January 2011 • Mix of qual/quant measures: admissions/cost, shared  Mix of qual/quant measures: admissions/cost, shared information, administrative timet: 020 7631 8450e: info@nuffieldtrust.org.ukwww.nuffieldtrust.org.uk
  • 17. VANGUARD PRACTICES • 9 practices • 90,000 population • Laboratory for ‘testing’  integrated approach • Wrap around  community‐based  community based teams • Identifying cohorts  Identifying cohorts of ‘high risk’ patients
  • 18. SUPPORTING OFFICE MEDICINE • 4 neighbourhood teams • 4 4 community hospitals i h i l • 10 community physician  sessions  sessions • 7 days p.w. telephone advice • 5 Community matrons • 2 Advanced Nurse  Practitioners • 1 practice / 60 telehealth  1 ti / 60 t l h lth unitst: 020 7631 8450e: info@nuffieldtrust.org.ukwww.nuffieldtrust.org.uk
  • 19. • May 2010 – First cohort: Advanced Training Programme First cohort: Advanced Training Programme  focused on leadership and quality improvement  – Set up ‘patient experience’ monitoring  Set up  patient experience monitoring • October 2010 – Second ATP cohort Second ATP cohort • January 2011 – Begin reviewing outcomest: 020 7631 8450e: info@nuffieldtrust.org.ukwww.nuffieldtrust.org.uk
  • 20. FUTURE CHALLENGES 
  • 21. CONCLUSIONS SO FAR • A great deal has been achieved through strong clinical  engagement and leadership development • ICS provides robust foundations that appear to  ICS id b tf d ti th t t accommodate changes • Reinforced through a programme of quality improvement  and service redesign d d • Significant issues persist around QIPP/financial balance • Progress with  proof of concept has been slower than Progress with ‘proof of concept’ has been slower than  anticipated but is speeding up. • Plans for ICO ‘on hold’, awaiting SHA decision • To deliver transformation, a more consistent policy  T d li t f ti i t t li framework is needed to encourage integration and  provide clarity and directiont: 020 7631 8450e: info@nuffieldtrust.org.ukwww.nuffieldtrust.org.uk
  • 22. 5 PRACTICAL CHALLENGES 5 PRACTICAL CHALLENGES 1. What goes in shapes what comes out: how can Trafford  ensure good data quality / pop’n management?  g q y/p p g 2. What shifts in utilisation and finances are expected in  Trafford as a direct result of integration? Will  integration deliver QIPP agenda? 3. How/when will the system roll out across Trafford? (e.g.  all practices; all generalists and specialists) ll ti ll li t d i li t ) 4. What are the opportunities and threats to integrated  care from the emerging GP Consortium? care from the emerging GP Consortium? 5. Is there a Plan B?t: 020 7631 8450e: info@nuffieldtrust.org.ukwww.nuffieldtrust.org.uk
  • 23. 5 POLICY CHALLENGES 1. How is it possible to deliver a new relationship between  GPs and physicians in the present  choice environment? GPs and physicians in the present ‘choice’ environment? 2. What is the ‘best’ means of delivering population‐based  services? (PbR vs capitated budgets) i ? (PbR it t d b d t ) 3. What are the implications of a new GP contract? 4. Accountability vs Authority – what is going on? 4 A t bilit A th it h ti i ? 5. What is the impact of: – New role for local authorities New role for local authorities – Coalition government/politicst: 020 7631 8450e: info@nuffieldtrust.org.ukwww.nuffieldtrust.org.uk
  • 24. www.nuffieldtrust.org.ukwww nuffieldtrust org uk t: 0207 631 8450 e: info@nuffieldtrust.org.uk