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This document provides an update on the work of the MCP and progress and impact since September 2016. Since our last update, the MCP has:

Held its first showcase event with 90 delegates including representation from vanguards and partnerships in Blackpool, Erewash, Bristol, Cambridgeshire, Worcestershire, Dudley, Hammersmith and Fullam.

Received data from East Midlands Ambulance Service for w/c 24 October showing an improved Rushcliffe non-conveyance to hospital rate of 50% - the best performing of all 22 CCGs in the East Midlands region.

Seen 17 referrals to the new Primary Care Psychological Medicine service (month one) - appendix 1.

Seen a secondary care saving of £171,680 from referrals to the Trauma and Orthopaedics community service (as at month four) based on the cost of an average referral.

Received early data showing a reduction in secondary care referrals since the mobilisation of the Community Gynaecology Service.

Seen 80 IV Zolendrate infusions delivered in the community by the Fracture Liaison Service in year one, 48 above target.

Predicted an increase on return on investment through the piloting of the Fracture Liaison Service in Nottingham North and East and Nottingham West CCGs - from 12% to 41%.

Seen 55 patients in primary care during September following the recommencement of GP extended hours / weekend working.

Signed off business cases and investment at the MCP Governance Group for workstreams 3-4, 5, 6-7, 8, 9 and 10.

Agreed a contract variation with Rushcliffe Community and Voluntary Services for delivery of self-care services, self-care assessment tool, volunteer development and customer ownership approach.

Taken part in a STP-wide Clinical Leaders Event to ensure wider engagement on the New System of Care and identified six workstreams to progress phase two of work with Centene due for completion 21 November.

Provided support in the completion of Project Initiation Documents for five high impact areas, three workstreams and three enablers included in the 21 October submission of the STP.

Worked with patient representatives to develop resources to promote Self Care week (14-20 November).

Agreed a re-fresh of the Principia brand following engagement with clinicians, staff and patients.

Hosted a visit from Ian Dodge, NHS England Director for Commissioning Strategy.

Monthly update October 2016

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Contributed to a Nursing Standard profile of Sister Donna Rowe of the Fracture Liaison Service for publication.

Welcomed Sharon Creber from Nottinghamshire Healthcare NHS Trust as MCP Programme Lead.

Principia MCP key facts:

1) Awarded £3.53m in June 2016 to support the development of its Multi-specialty Community Provider (MCP) model of care during 2016/17.

2) The MCP Vision is: “To provide a better quality of care for the people of Rushcliffe through an innovative, patient-centred, coordinated care delivery system, which is designed to improve our communities’ health outcomes, increase our clinician and staff satisfaction and at the same time moderate the cost of delivering that care.”

3) Our ambition is to create a care system which is re-organised and out of hospital, founded on best in class with increased capability and capacity, working in partnership with other providers in a culture of mutual accountability and commitment and bringing benefits to all. The MCP will be accountable for the health care provision for the local population. Risk will be mitigated through the empowerment and involvement of primary care, patients and local providers.

4) Delivery through 10 workstreams - each with clinical leadership and aligned to five overarching goals and triple aims:

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Progress and Impact

1. Sharing Success and Innovation – Principia showcase

In order to share learnings and most efficiently meet a high number of external requests for fact-finding visits and information, Principia held its first showcase event on 13 October 2016 at Nottingham Forest Football Club. Titled Sharing Success and Innovation, Principia MCP used the event as a vehicle for sharing achievements and progress since becoming a vanguard, including areas of service redesign and impact. The ‘essential ingredients’ of new service specifications were provided within the delegate packs for attendees to take away.

A total of 90 delegates attended including local MCP partners, colleagues from NHS England and vanguard peers from across the country. In the post-event survey circulated to all attendees, 95% of respondents rated the both the event and the information in the delegate packs as excellent or very good overall, with delegates confirming that the material shared “will be of use for colleagues,” “has already been shared,” and the “level of detail contained within was very helpful.” 100% of respondents fed back that the event was well or extremely well organised, with one of the delegates commenting, “The day was really positive, ran smoothly and had a really good feel to it,” and another adding, “The sessions were excellent and well-structured, with engaging and informative presenters.” The full event evaluation is attached as appendix 2 and presentations from the event can be found here: bit.ly/PrincipiaMCP.

2. Community Gynaecology

The Community Gynaecology Service launched at Keyworth Medical Practice in May 2016. The potential gross savings identified were just over £150,000 through a reduction in outpatient first attendances, follow ups and procedures. At month five (August 2016) GP referred outpatient first attendances were 164 referrals below plan, representing a 15.2% reduction. This equates to a secondary care saving of £55,432 based on the cost of an average referral (includes first/ follow up and procedures). Given that the service started in May, the projection is to meet the modelled savings. The latest data (graph below) shows a steady decline in acute first patient activity since the launch of the service. To month 6 there have been 138 fewer patients seen in secondary care which is being attributed to the introduction of the new community service.

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3. Highest regional performer in reducing ambulance

conveyances to hospital

The MCP has developed an approach to improve ambulance attendance and conveyance across Rushcliffe. The aim of this work is to:

To support the 999 EMAS Rushcliffe community car project.

To ensure capacity within the community teams is sufficient to provide a responsive community response.

To provide evidence of the service change and impact on outcomes.

The objectives:

Provide care closer to home for patients who could potentially have been conveyed to hospital.

Ensure the care delivery group, including health, social care and the voluntary sector are utilised to full potential to both support patients and the project in order to understand the needs of patients and the capacity required for future commissioning intentions.

Provide capacity to bridge any service gaps to ensure a timely community response, with an element of complex case & referral management, traditionally provided by community matrons, and therapy staff.

To ensure community capacity will meet the increased demand of supporting avoided admissions through the EMAS community care service.

Provide robust data to support ROI and service benefits to the patient and the wider integrated urgent and emergency care system.

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The approach is supported by the community health teams who provide support for patients who are not conveyed. The community teams provide the co-ordination between primary care, community, crisis response and other stakeholders.

The ambulance technicians document patient contacts on e-PRF (electronic patient report forms) and will also have access to systmOne and EMIS via the MIG. This ensures optimal information sharing between services to allow for better informed decision making.

The service commenced 3 October 2016, with the first 3 days as orientation. The service will be in place for 6 months, completing 31 March 2017. An evaluation will be undertaken December 2016/January 2017.

Initial Data from East Midlands Ambulance Service (EMAS) for w/c 24 October shows a Rushcliffe non-conveyance to hospital rate of 50% - making it the best performing of all 22 CCGs in the East Midlands region. Rushcliffe EMAS performance: Red 1 - 100% (7 calls) Red 2 - 59.6% (89 calls) Green 1 - 59.3% (27 calls) Green 2 - 58.7% (63 calls). Compared with neighbouring county CCGs, Rushcliffe had 100% response to Red 1s with other areas average around 40%.

4. Weekend GP Service improving access

The recommencement of the GP weekend working and extended hours across Rushcliffe benefitted 55 patients in September. The service is based on nationally agreed core components, and a phase two model is in development which will meet the full extended access requirements of the GP Forward View by 31 March 2017. Patient experience feedback received includes: “I have already had need of this service and saw a GP, on a Sunday morning in Gamston. I cannot praise the service highly enough. I was given the time, attention, and care I needed - 10 minutes away from home, rather than having to go to the very crowded city centre facility. This is a brilliant move, and I feel extremely lucky to have access to it”.

5. Business cases and delivery resource

The MCP Governance Group signed off business cases and investment for Principia workstreams 3-4, 5, 6-7, 8, 9 and 10. Business cases for workstream 1-2 is scheduled for a future meeting and scoping of a business case for workstream 11 is underway. The revised MCP delivery plan will be submitted to the Clinical Delivery Group at its November meeting shared in next month’s report to the NCM Team. The MCP also welcomes Sharon Creber who joins Principia two days a week from her substantive role of Deputy Director of Business Development & Marketing at MCP partner Nottinghamshire Healthcare NHS Foundation Trust. She will be

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supported in her role as MCP Programme Lead by the CCG lead and PartnersHealth Business Manager.

6. External support phase two

Phase two of the external support offer in place to support the development of Accountable Care in Greater Nottingham. The proposed solution will include the characteristics of an integrated accountable care solution and the optimal contractual framework for this system. This 3-5 month programme offer has received positive engagement across the Greater Nottingham Health and Care Partners. A Clinical Leaders event took place at the end of September to ensure wider engagement on the New System of Care and the six identified workstreams:

• Patient Pathways • Population Health Management • IM&T • Provider Payments • Social Care Integration • ACS Governance Design and Contractual Framework

This work will report on 21 November 2016 A scoping document has been drafted to enable the production of a Greater Nottingham New System of Care Value Proposition with support from NHSE. This has been approved, and procurement of an external partner to support this work is underway.

7. Workforce development and modelling

As part of the Nottinghamshire and Nottingham STP, the MCP is participating in a workforce modelling approach available through Health Education England using the Whole Systems Partnership (WSP) SWIPE systems dynamic modelling tool together with a range of supporting tools and resources. The MCP is part of pilot/project 2 using the Whole Systems Partnership (WSP) approach to Strategic Workforce Integrated Planning and Evaluation (SWIPE) that supports local partners to combine local data, analysis and systems dynamic modelling to develop a strategic tool to help answer questions for commissioners and their local providers in respect of system wide workforce planning. An initial planning event on proactive care was held on 11th October.

8. Supporting Self Care Week

The MCP has worked with patients through the Patient Active Group (Chairs of GP Practice Patient Participation Groups) and workstream one’s Self Care task and finish group to produce resources for practices to promote and support Self Care week (14-20 November) and winter health. As well as specific Self Care Week and Flu campaign resources, the initiative sees an extension of the localised One You campaign to focus on winter health, use of pharmacies and appropriate use of NHS services.

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9. Connected Notts Newsletter – Issue 3

Attached as appendix 3.

For more information please contact: Fiona Callaghan Head of Strategy and Service Development, NHS Rushcliffe Clinical Commissioning Group Tel: 0115 8837814. Mail: principia.MCP@rushcliffeccg.nhs.uk