Samantha Jones visit 20 February 2017

Samantha JonesVisit
Monday 20 February 2017
Hosted by Greater Manchester
Academic Health Science Network

Itinerary
12:30 – 13:15
Update on New Care Models - Samantha Jones, New Care Models
Programme Director, NHS England
13:15 – 13:30
Update/Overview of GMAHSN and HInM – Plans for 2017 - Mike Burrows,
Managing Director, GM AHSN

Itinerary
13:30 – 13:35
Working lunch to be served in the Boardroom, 3rd floor
13:35 – 14:00
Health Programme – Updates and Links to New Care Models - Jane Macdonald
and Jenny Scott
14:00 – 14:25
Datawell – Gary Leeming and Stephen Dobson
14:25 – 14:50
Urgent Care – Dr Paula Bennett RN (Adult) RN (Child)
14:50 – 15:15
Update on the Industry andWealth Programme andVanguards – Linda Magee
and Robert Duncombe

Our values: clinical engagement, patient involvement, local ownership, national support
www.england.nhs.uk/vanguards #futureNHS
4
New care models
New care models programme
Samantha Jones
Director
New Care Models Programme
@SamanthaJNHS
February 2017

5
We are realising the NHS Five Year Forward View
through the new care models programme
Health and
wellbeing
gap
1
Care and
quality gap
2
Funding
gap
3
Clinical
engagement
Patient
involvement
Local
ownership
National
support

6
50 vanguards are developing new care models, and acting as
blueprints and inspiration for the rest of the health and care
system.
Integrated primary and
acute care systems
Multispecialty community
providers
Enhanced health in care
homes
Urgent and emergency care
Acute care collaboration
9
14
6
8
13

7
The national programme is supporting the vanguards
through the key enablers of their new care models
1.
Designing
new care
models 2.
Evaluation
and metrics
3.
Integrated
commissioning
and provision
4.
Governance,
accountability
and provider
regulation
5.
Empowering
patients and
communities
6.
Harnessing
technology
7.
Workforce
redesign
8.
Local
leadership
and delivery
9.
Communications
and
engagement

8
The last year has been about developing and delivering
new care models, and signs of impact are emerging

9
Vanguards are already improving the quality and sustainability of local
services, through new, flexible ways of working…
EMRAD (East Midlands
Radiology Consortium) ACC
shared radiology record and
workforce
Sharing cost, and expertise has saved
£3m in direct costs, and is expected to
save £30million across the life of the
contract.
Once fully implemented, the shared
record system will cover 6.5m patients,
10% of UK population. It will allow any
clinician (with relevant permissions) to
view, in real time, any image, anytime,
anywhere within the patch.
2016/17 has been about developing and delivering new care models

10
… providing proactive care to patients with higher needs…
Fylde Coast MCP: new community based 'extensive care' service
providing proactive support for people aged 60+, who have two or
more long-term conditions.
An integrated health and wellbeing team, including a senior doctor (GP or
geriatrician), community nurses, pharmacy and therapy input, provides patients with
the support they require to keep them out-of-hospital.
Eligible patients are referred by their GP, against set criteria. Vanguard funding
means the care model is being rolled across the entire Fylde Coast with every GP
practice able to refer eligible patients.
Early results show impressive reductions in demand for health services for these
patients, including:
• 16% reduction in A&E attendances,
• 16% reduction in first outpatient attendances and
• 19% reduction in non-elective admissions.

11
… keeping people well in their place of choice …
Connecting Care Wakefield Care Homes
A range of initiatives in Wakefield are helping keep care home residents well and out of
hospital, including:
• aligning 15 care homes to 25 GP practices through a locally enhanced service contract
• a multidisciplinary team, in these homes, providing proactive support, and improved
medicines management through regular pharmacy reviews, with mobile devices and
software to support
• Holistic health and social care assessment in care homes, video interviews to support
social needs and independence; and e-learning training tools for staff
• Community anchors in place – independent neighbourhood based organisations that
provide access to extended pathways of care and support, and tackle issues of social
isolation and loneliness
Against 15/16 baseline:
• Ambulance call outs reduced by 9%
• A&E attendances reduced by 12%
• Emergency Admissions reduced by 19%
• Bed days reduced by 26%

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… and improving outcomes across a range of measures
Reduced Outpatient Attendance
Outpatient attendances at University Hospitals Morecambe
Bay FT reduced by the equivalent of 17 clinics per week
(10,500 annualised attendances) compared with doing
nothing in first 6 months of 16/17.
Fewer Beds
In the first 6 months of 2016/17, the equivalent of 30 adult
inpatient medical beds were closed. Plans are in place to
close a further 20 bed by the end of 2016/17.
Better Discharge
Medically fit to discharge patient numbers have reduced by
15% since April 2016.
Reduced travel time to care
In 2016/17 video consultations lead to: 1281.6 road miles
saved and 37 hours, 12 minutes travel time saved.
Fewer referrals
Of 1869 patients who would have referred by their GP, only
603 were referred after using the advice & guidance system.
Better Care Together
(Morecambe Bay Health
Community) PACS
Care is delivered through an
out of hospital model of 12
place-based integrated teams
in 12 communities, supporting
those with higher needs or risk
of admission.
Integrated teams are supported
by urgent rapid response
teams, care co-ordination, and
integrated pathways.
An online advice and guidance
system allows GPs to contact
hospital consultants for advice.
It now links 300 GPs with 16
specialties, and has enabled
over 3000 A&G conversations.

13
The golden thread that ties the new care models together is a focus on
more person-centred and sustainable population health care.
Population health models deliver much greater integration between primary and
acute care; physical and mental health, and health and social care; delivering
tangible and quantifiable results, while maintaining or improving patient experience
They take responsibility for the health and care outcomes of the population they
serve, and develop services accordingly.
This is achieved through closer working between NHS providers, commissioners
and other partners, in particular local government.
PACS and MCPs may take on
contractual accountability for
population health. This means that
many activities that were carried out
by commissioners eg resource
allocation, pathway design, could be
carried out by the MCP or PACS.
PACS and MCPs are responsible for
the health and care needs of the GP
registered list of patients within a
population budget plus an estimated
population for those in the
PACS/MCP locality not registered
with GPs.

14
Our challenge for the year ahead will be to cement the
improvements, and spread successful new care models

15
The new care models programme is also supporting the development of
further new care models
Primary care home
The key features of the Primary Care Home are:
• provision of care to a defined, registered population of
between 30,000 and 50,000;
• aligned clinical financial drivers through a unified, capitated
budget with appropriate shared risks and rewards
• an integrated workforce, with a strong focus on partnerships
spanning primary, secondary and social care; and
• a combined focus on personalisation of care with
improvements in population health outcomes
Initial development and testing of the PCH model is underway
with the National Association for Primary Care (NAPC) across
15 Rapid Test Sites
The PCH model has spread to 92 sites in total, with a
registered list population circa 4 million. NAPC expect this to
grow to around 200 sites in the PCH Community of Practice
by April 2017.
Acute medical model
The Acute Medical
Model Programme is a
cohort of 22 small
district general
hospitals who are
trialling, or plan to trial,
new workforce models
and new ways of
organising clinical
resources to
sustainably deliver their
acute medical
pathways.
2017/18 will increasingly be about spread

16
Sustainability and Transformation Plans (STPs) will be key to the future
delivery of health and care services
The 44 STP areas are strategic partnerships that bring together all health and care
partners to develop place-based plans over a five year period.
Their focus should be on confronting the big challenges and taking the critical
decisions that have previously been set aside. They are also about building the
leadership coalition necessary to implement these decisions.
The strongest STPs will be a blueprint
for how areas expect to develop and
spread new care models, making the
greatest possible use of technology
and a reshaped workforce.
STPs will consider how to implement (or
scale up) new care models, drawing on
the lessons from the vanguards. The
specifics of the care models, and the mix
between them, will be for the STP areas
to determine.
Nearly all of the STPs involve creating
new population health models. Some are
planning MCPs, others PACS, or PCHs
STPs will help make sure we make the
best decisions on the allocation of
sustainability and transformation
funding from 2017/18.

17
We are learning about the key requirements for developing, delivering,
and spreading new care models
• Build collaborative system leadership and relationships
around a shared vision for the population.
• Develop a system-wide governance and programme
structure to drive the change.
• Undertake the detailed work to design the care model, the
financial model and the business model. This includes
clinical and business processes and protocols, team design
and job roles.
• Develop and implement the care model in a way that allows it
to adapt and scale.
• Implement the appropriate commissioning and contracting
changes that will support the delivery of the new care model.

18
Some amazing examples of spread are already happening
Partnerships and
providers outside the
vanguards are adopting
elements of the new
care models
Middlesbrough CCG have
adapted and adopted the
‘Early intervention vehicle’
from N&E Herts CCG care
home vanguard. They are
progressing quickly, have
started to clearly see
benefits, and now it is part of
their mainstream
commissioning. This is now
being rolled out to their
neighbouring CCGs.
Vanguards are sharing
successes and how to
achieve them
A wealth of resources are being
developed by vanguards like
Morecambe Bay PACS, who are
producing and sharing case
studies of their successes for
other vanguards to adapt and
adopt.
Others, like Connecting Care
Partnership MCP, are working
through issues as they develop
new governance and business
arrangements – solving
problems for themselves and
sites who will follow in their
footsteps.
Vanguards are spreading
their new care models
across wider areas
Some vanguards are already
looking to expand their initial
coverage. North East Hampshire
& Farnham PACS is considering
how their care model could
expand to cover the entire STP
footprint, bringing in all the
CCGs in the area.
Sunderland MCP is being
supported to spread the current
vanguard into a larger
population area - South
Tyneside; and to further develop
the enhanced care home and
enhanced primary care models in
both Sunderland and South
Tyneside

19
More details can be found on the
NHS England website:
www.england.nhs.uk/vanguards
You can email the programme at:
england.newcaremodels@nhs.net
Or join the conversation on Twitter
using the hashtag:
#futureNHS
For further information…

20
Itinerary
13:30 – 13:35
Working lunch to be served in the Boardroom, 3rd floor
13:35 – 14:00
Health Programme – Updates and Links to New Care Models - Jane Macdonald
and Jenny Scott
14:00 – 14:25
Datawell – Gary Leeming and Stephen Dobson
14:25 – 14:50
Urgent Care – Dr Paula Bennett RN (Adult) RN (Child)
14:50 – 15:15
Update on the Industry and Wealth Programme and Vanguards – Linda Magee
and Robert Duncombe

NW Utilisation Management Unit
Urgent & EmergencyCare
Dr Paula Bennett RN (Adult, Child)
Associate Director – Clinical Development
Utilisation Management Unit
GM - AHSN

Click to edit Master title styleNorth West Utilisation Management Unit
Analytics
Urgent Care
Pressures
Management
Clinical
Review and
Support
‘Triumvirate of
Expertise’

Click to edit Master title styleNorth West UM Unit ‘Products and Sub-Services’

Click to edit Master title styleNational drivers
• For adults and children with urgent care needs
– highly responsive service.
– care as close to home as possible.
– minimising disruption and inconvenience.
• For those people with more serious or life-threatening
emergency care needs
– treated in centres with the right expertise.
– processes and facilities to maximise the prospects of survival
and a good recovery.
Transforming urgent and emergency care service in England. Urgent and Emergency Care
Review. End of Phase 1 report (Keogh 2013)
24

Adapted from NHS England (2015) Transforming urgent and emergency care services in England.
Safer, faster, better: good practice in delivering urgent and emergency care.
A guide for local health and social care communities
Good patient
flow, demand
management
& escalation
System
partnership &
governance
Information
flows and IT
Ambulatory
Emergency
Care (AEC)
Acute Medical
Assessment &
Admission
Frailty,
Paediatrics,
Mental Health,
Surgery
Emergency
Departments
High Quality
Emergency &
Urgent Care
Primary Care
Commissioning
Ambulance
Services & NHS
111
Community
Services &
Urgent care
Centres
Social Care
25

Click to edit Master title stylePatient experience
• “I use the A&E because I can attend when I need to, they have immediate
access to diagnostic investigations and where needed I can see a consultant
or specialist in the department.”
• “When in doubt, frightened or worried, I’d use A&E.”
• “It was a weekend, no GP on duty, I was in acute pain, so I went straight to
A&E.”
• “Alternatives were not open at the time I needed it.”
• “I was very well attended to in A&E, staff were very helpful and informative,
and time was not a problem considering the volume of work at the time.
Very happy with my experience.”
RCEM (2015) McNulty (n.d.)
26

Click to edit Master title styleWhat is quality in Urgent & Emergency Care ?
• Safe care
– when you need it,
– where you want it ?
• Without undue delay ?
• In a suitable environment
– Not crowded
– With enough time for every patient
• Consistent and reliable
• Right first time
• Where the sickest and most
vulnerable take priority ?
28

Click to edit Master title stylePrinciples
We injure more patients through
poor process than through poor
medicine…
….too much of our focus is on
population behaviours with insufficient
focus on systems behaviours.

Click to edit Master title style
Capacity is :
“The ability to meet a patients needs at the
point that those needs become apparent”
The last question is “ how many beds do
I need ?” not the first question…
The wrong question is “Am I busier than
last year?”
The right question is “ how busy do I
expect to be ?”

Click to edit Master title styleHigh performing Health & Social Care Systems
• Timely access to urgent care
• Low ED conversion rate
• High zero LOS
• Low re-admissions
• Moderate to low in-hospital LOS
• Early in the week discharges
• Everyday ward rounds
• Moderate to high short stay residential placements
31

Click to edit Master title style
Key Characteristics of a High Performing Trust
An ‘if it can’t be done in 4 hours, it can’t be done in ED!’ mentality
A significant and appropriate allocation of assessment capacity: a full diagnostic and clinical service over 18 hours/7 days per week
Assessment Units / ACUs have sufficient capacity for 1 day assessments
An expectation that at least 1 in 3 of all non-elective admissions will have a zero day length of stay
An ‘Assess to admit’ philosophy i.e. the assessment units are seen as short stay with a ‘rule out’ mandate

Click to edit Master title styleUse the available evidence…………………

Click to edit Master title styleAssessing the impact of the intervention…………………
4 hour 95% performance

Click to edit Master title styleSilo thinking “v” systems thinking

Click to edit Master title styleMaybe it’s helpful to think about it like this …
• Demand variation
– What will the population do : are our pressures demand induced ?
– What's the seasonal and trend impact ?
– What does our information tell us we need to do ?
• Supply side variation
– How do services (true capacity) respond ?
– Four questions
• What do the data suggest will happen?
• How far can I adjust the service ?
• What's the residual gap ?
• What would be the benefits and consequences of attendance, admission
and length of stay initiatives ?
– Planning
• Strategic plan
• Tactical adjustment
• Operational response

Support for Innovators and Industry
Engagement
Visit of Sam Jones, New Care Models Programme
Director, NHS England, 20 February 2017
Linda Magee, Executive Director, Industry &Wealth

Industry and Wealth programme
Aims
Increase the flow of good quality, and effective products and
services for the GM AHSN members
Help industry, SMEs in particular, overcome barriers to doing
business with the NHS: support regional economic growth
Facilitate the introduction of disruptive innovation into the
NHS: health benefit for local population
Support platform: Innovation Nexus (www.intohealth.org)

The Innovation Nexus
Mechanisms for delivery:
 Nexus - web portal containing
information and links to key
partners and associates for SMEs
wanting to engage with the NHS
 An advice service with regulatory,
evaluation, market access and
procurement expertise plus access
to wider NHS/GMAHSN network
 Business Support Programmes,
providing intensive support,
designed bespoke for companies

Innovative
product/service/technology
  Benefits the NHS
Location Type Clinical/TechnologyArea
GM AHSN footprint
(Greater Manchester, East
Lancashire, East Cheshire)
SME
Cardiovascular health
Patient safety (esp. medication error)
Digital health/informatics
North of England
Atrial Fibrillation
Chronic Kidney Disease
Familial Hypercholesterolaemia
EPaCCs (end of life care)
Mental Health
Dementia
Cancer prevention
Operational efficiency
Rest of UK
International
NHS/Academia
Large corporations
Any other clinically important area
Special focus on National Innovation
Programmes or referrals from other
AHSNs
GMAHSN Triage

NICE METAToolkit
• GAP analysis of company to meet NICE pre-requisites – 3 stage
 Online submission- company
 Facilitated face to face session- advisers
 Written report of recommendations – advisers
• Developed process/toolkit/training material
 Piloted with 10 SMEs (mostly GM)
 Due for launch in Spring
• GM AHSN will deliver META toolkit and support/make funding available
to plug gaps for eligible local SMEs to undertake evaluation identified as
gaps via toolkit

Innovation Funds
Aim:To promote the introduction and adoption of needs led, evidence-based
innovations into the health system in Greater Manchester and support business growth
Early stage development of innovative solutions.
Open to academics, NHS/Social Care and Industry Partners
Proof of concept/prototyping projects.
Open to academics, NHS/Social Care and Industry Partners
Support market ready innovative products and services.
Open to SMEs working with GM NHS/Social Care Organisations

Innovation Funds – previous awards
Contactless monitoring ICU, remote monitoring for rehab, bowel closure
device, aseptic skin prep, arterial plaque detector, falls detector, patient
identification system, hydration aids, inhaler device, medicines adherence
system , dementia device, peer support system, stroke monitoring device
Interstitial fluid extraction system, cancer testing device, colonoscopy
device, dialysis infection monitoring system
Fracture screening software, digital wound care management, blood cell
recovery system, breast cancer screening technology, patient monitoring
system , mental health app, district nurse scheduling software, draining
solution for dialysis patients

Support to the CancerVanguard
 Facilitation/support with pharma industry meetings (Pharma Challenge)
 Highlight cancer prevention as part of Innovation Nexus triage
 Identify cancer prevention specifically in current Innovation Fund
(IGNITE) call
 Support for Early Diagnosis Industry Challenge
– promote the EDIC details out to our networks of medtech/diagnostic
companies
– Identify technologies/service developments currently in Innovation
Nexus portfolio as possible contenders
– GMAHSN staff to support process and proposal review

Optimising the use of cancer
medicines.
The Pharma Challenge
Rob Duncombe
20th February 2017
Greater Manchester Cancer
Vanguard Innovation

What we have achieved in Year 1Vanguard Innovation
4th May 2016:
Chief pharmacists
meet to discuss
“Pharma Challenge”
May 16’
17th May 2016:
Engagement with
ABPI & EMIG
June 16’
24th June 2016:
39 responses received
from Industry
July 16’
5th July 2016:
Evaluation event undertaken
and a shortlist of projects
was compiled to be
developed further as part of
the Cancer Vanguard
24th July 2016:
Kick off meetings with
successful companies to
start drafting PID
Aug 16’
23rd August 2016:
Second evaluation event
and more projects
shortlisted
Sept 16’
21st September 2016:
First Joint MO Group
meeting and
ratification of 2 PID’s
Nov 16’
November 2016:
Signing Joint Working
Agreements - Sandoz
& 1st Amgen project
Dec 16’
December 2016:
Ratified PID with
QuintilesIMS
and Celgene.

What we will deliver Year 2 (5 Projects)
 Amgen (Denosumab) – Breast (GM Sharing insight)
 Contribute to and share evaluation of service modelling outcomes
 Taking delivery of care out of the hospital setting
 Sandoz – Bio-similars (GM supporting delivery)
 Co-production of bio-similars education materials
 Education of clinicians & patients
 Supporting transition to bio-similars in haematology / oncology
 QuintilesIMS – Metastatic Colorectal (GM Lead)
 Identify avoidable variation in m-Colorectal pathway
 Pilot and evaluate a patient App. (U-Motiff) PROMS and PREMS
 Model potential savings when variance is reduced
 Testing the model of combining macro – data sets from across multiple sites.
Vanguard Innovation

What we will deliver Year 2
Celgene – Myeloma (GM Lead)
 Develop an interactive optimisation and compliance dashboard &
service model evaluation framework
Amgen (IV Chemotherapy) – PID in development
Developing a set of principles to support out-of-hospital IV drug
administration.
PHARMA-CHALLENGE 2…………………….
Vanguard Innovation

What we have learnt
Vanguard Innovation
- Appetite from Pharma for Joint Working
- There is no such thing as a “free – lunch”
- But there are opportunities for deriving mutual
benefit
- Rate limiting step is often our resources
- Nothing ventured ……… nothing gained.

Samantha Jones visit 20 February 2017

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