New Models of Care,

Vanguard sites and beyond

Jane Milligan

Chief Officer, NHS Tower Hamlets

8 February 2016

• In March 2015, the first 29 vanguard sites were chosen. There were three

vanguard types – integrated primary and acute care systems; enhanced health

in care homes; and, multispecialty community provider vanguards.

• In July 2015, 8 urgent and emergency vanguards were announced.

• In September 2015 a further 13 vanguards were announced – known as acute

care collaborations, they aim to link local hospitals together to improve their

clinical and financial viability.

Tower Hamlets Integrated Provider Partnership (THIPP)

THIPP was formed in December 2013

as part of the provider development

workstream of the WELC (Waltham

Forest, East London and City)

Integrated Care Programme and

incorporates the following partners:

• Tower Hamlets GP Care Group CIC

• Barts Health NHS Trust

• East London NHS Foundation Trust

• London Borough of Tower Hamlets

Built upon the network model

6 5

1 2 3 4

5 6

8 9

10

7

11 12

15

13

16

14

17 18

19

24

21 22

20

23

25

26 27

28 29

30

31

32

33

34

35

36

Tower Hamlets before networks

• 8 LAPs

• 36 practices

• Total population of ~245,000

• Practice list sizes of 3,000 to 11,000

6

5

1 2 3

4

5

6

8 9

10

7

11 12

15

13

16

14

17

18

19

24

21 22

20

23

25

26 27

28

29

30

31

32

Pop: 29,892

Pop: 18,027

Pop: 29,801

Pop: 35,720

Pop: 28,995

Pop: 33,186

Pop: 27,839

Pop: 31,975

8 Networks1 were formed in the borough during 2009

33

34

35

36

Why networks?

• Focus on population health across a geography

• Collaborative relationships with wide range of partners (e.g. Borough, schools, charities)

• Sufficient scale for specialisation of staff, ability to access rare skills and ensure access, resources (e.g. equipment)

• Integration with estates plan

Outcome based contracts linked

to improving population health

Key components of

the programme

• Using risk stratification to

proactively identify 20% of

population most at risk of a hospital

admission and commission

some/all of services below for this

group

• Commissioners moving to focus on

outcomes for population health,

new models of care (the integration

function/provider alliances) and

reforming financial incentives

(capitation and payment on

outcomes)

8

Diabetes Care Package Dashboard 2015-16

Multidisciplinary teams

QIPP 2015/16: Emergency Admissions (Integrated Care population)

QIPP 2015/16: Outpatients (Integrated Care population)

QIPP 2015/16: A&E (Integrated Care population)

Outcomes and incentives

Bro

ad

er

TS

T p

rog

ram

me

16

Specialist commissioning

• Planning guidance outlines need for sustainability and transformation plans (STPs) - specialist commissioning is integral to this and a step change in relationship between CCGs and NHSE signalled

• NHSE London commissions 3.6bn from 48 providers across acute and mental health

• 12 providers account for >80% of the spend

• Jonathan Fielding has been appointed as the new National Director for Specialist Commissioning reporting directly to Simon Stevens with John Stewart as Strategy and Policy Director.

• Current workstreams are Neuro rehabilitation, Tier 4 CAMHS and HIV

• Limited active QIPP in the past so opportunity for pathway redesign in some areas

• Shadow periods being proposed

Thank you

Questions?