Integrating care Dominic Hardy Director of Primary Care

Integrating care Dominic Hardy Director of Primary Care Delivery and System Transformation NHS England Improvement SW HFMA conference 27 th September 2019

Health and Care challenges in England… Sustainable funding • Longest sustained funding pressure in NHS history • Significant social care funding shortfall in local government Capacity • (Significant) shortages in key groups – GPs, nurses • Rising numbers on waiting lists, with waiting times challenges Outcomes • Increasing frailty as population ages • Greater burden of disease • Widening inequalities

… have lead to fragmentation People experience dislocated services No one team/organisation can solve that The way we work has to address this

What might the future look like? • Dennis’s story

The NHS Long Term Plan addresses this “We will continue to develop ICSs, building on the progress the NHS has already made. By April 2021, ICSs will cover the whole country” + “£ 4. 5 bn of new investment will fund expanded community multidisciplinary teams aligned with new Primary Care Networks based on neighbouring GP practices that work together, typically covering 30 -50, 000 people”

…with clear aims: ICSs PCNs Bring together local organisations Support sustainable general practice Focus on redesigning care and improving population health Create capacity to integrate at local level Deliver triple integration Enable voice of general practice to be heard in systems

Integrating systems Neighbourhood (30 -50 k) Place (250 -500 k) System (c 1 m) • Focus on very local need • PCNs have a key role • Decision-making/care delivery • Key link with local government • Enabling delivery • Address issues once

ICSs and PCNs build on past work… Long history of GP collaboration 90%+ practices self-identified as ‘networks’ last year Neighbourhood focus – right size team

Progress so far: 1250 Primary Care Networks established 99% Practices taking up PCN DES 1250 PCN Clinical Directors identified 40 k Average size of a PCN 14 ICSs covering 21 million people

Form? It’s about integrating care “Now this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning. ”

Holding back expectations • 5 new groups of staff to deploy • MDTs to form with community services providers • Relationships to build – internal and external • 7 new service specifications to deliver • ‘sort out’ access • Deliver integrated care

How it feels now?

What needs to be different? • What is the inspiring plan? • How will you build collaborative relationships? Vision Data Leadership and behaviours Impact • What are the population’s health and care needs? • What will be different and how will you make it happen?

What will you do differently today to deliver integrated care?