Integrated Care Pioneers

Integrated Care Pioneers

In 2013, national partners asked local areas (NHS and local government together) to express an interest in becoming pioneers to act as exemplars, demonstrating the use of ambitious and innovative approaches to efficiently deliver integrated care. Following an independent selection process, 14 Pioneer sites across England were announced in November 2013. The selection process was then repeated in the autumn of 2014, and a further 11 Pioneer sites joined the programme in January 2015.

Integrated Care pioneers are local areas that:

  • Are covered by a clinical commissioning group or local authority, or larger area.
  • Work across the whole of their local health, public health and care and support systems and with other local authorities to achieve and demonstrate the scale of change needed.

The 25 Integrated Care Pioneers are acting as exemplars to address local barriers to delivering integrated care and support locally, and highlight national barriers that the national partners can work to address. They support the rapid dissemination, promotion and uptake of lessons across the country and receive support to breaking down these barriers from the national partners.

The four sites in the East Midlands and East of England are:

  • Nottingham City
  • Nottingham County
  • Southend
  • West Norfolk

The Pioneers programme is constantly evolving as Pioneers and national partners learn  and share innovative developments in integrated care.

West Norfolk Alliance Pioneer Programme – Profile

 

 

Southend on Sea Pioneer Programme - Profile

 

National Workstreams

The Pioneers programme is a collaboration of the 25 local Pioneers sites and the national health and care partners seeking to support the development and implementation of higher value integrated models.

As part of the programme, a number of national workstreams have been established on areas of high priority and interest for Pioneers. These workstreams bring together Pioneers and the relevant national leads from organisations such as NHS England, to help design solutions and make progress along common themes essential to better integrated health and care.

Developing patient centered care

It is important to ensure that the needs of patients are central to the development of new care models, embedding the National Voices ‘I statements’ in:

  • patient centred care planning’
  • implementing integrated personalised commissioning/personal health budgets, and
  • supporting patient choice.

 

Some pioneers have already made great progress in these areas. We are working with leading edge sites to:

  • develop and share good practice on patient centred care planning
  • ensure that patient choice is built into new models of care
  • integrate work on integrated personalised commissioning with new models of care

Increasing community involvement

The Forward View set out a commitment to create new relationships with communities and citizens, rethinking the boundaries between health professionals and patients, carers and the voluntary sector, involving them much more effectively in decisions about health and care services.

The Pioneers are working together to:

  • Identify and share good practice in identifying and supporting carers
  • Energise community volunteering and encourage new roles for volunteers and community groups
  • Find ways to simplify the means of the NHS grant funding charitable and voluntary sector partners

Workforce

The new models of care will only become a reality if we have enough staff with the right skills, values and behaviours to deliver them. We need to develop a workforce able to work across settings and traditional professional demarcations, with flexible skills.

The Pioneer Programme:

  • Works with Health Education England, the Royal Colleges and leading edge sites to develop a workforce modelling tool that provides a helpful starting point for future need modelling.
  • Is developing a library of clinical and non-clinical roles and responsibilities based on leading edge sites work to date and share these with Royal Colleges, HEE as appropriate
  • Facilitating international care model experts to visit / support England based sites working on workforce development to help identify recruiting, training and capacity requirements for new care models (from April 2015)

Technology

The Pioneer Informatics Network brings together informatics leads from across health and local government to remove barriers and share learning on integration. Work streams topics include information sharing, integrated care records, access to secure email systems, information governance framework and whole place analytics. 

Contractual models

The establishment of new care models requires new, simpler, more outcome focused contractual forms. There is currently no single form of contract which may be used to commission both general practice and other services. Other than core primary care services, all NHS-funded healthcare services must be commissioned using the NHS Standard Contract, irrespective of provider or service.

The Pioneer Programme is:

  • Engaging with pioneers to develop new simplified outcome focused standard contractual forms
  • Make these new contractual forms available to the rest of the county following testing

Procurement

The establishment of new models of care poses commissioners challenges in relation to procurement process. Issues can include both whether it is necessary to go through competitive tendering processes and challenges in relation to competition law and regulations regarding the need to ensure that monopolistic providers are not established against the interests of patients.

The Pioneer Programme

  • Work with pioneers to access consistent and clear legal and other advice to develop practical solutions to procurement and competition issues
  • Share practical advice/guidance with other parts of the country derived from the vanguard and pioneer sites to avoid the need for expensive legal fees at local level

Payment arrangements

The establishment of new models of care requires the development of new forms of pricing of services and probably some form of capitated budgets. Some good progress has already been made in a number of pioneer and other sites with input from Monitor on planning capitated budgets, but we now need to move to implementation of these approaches. This will need to include development of incentive payments/penalties and risk sharing between commissioner and provider.

The Pioneer Programme:

  • Is working with the local commissioners and providers in the new models of care test bed sites and in any of the other pioneers at an appropriate state of readiness to agree and implement new pricing and capitated budget approaches in shadow form.
  • Will develop practical toolkits for other parts of the country to use.

Infrastructure

Delivering services in more effective ways requires a much more effective use of infrastructure within local health economies. Partners working together on new models of care will need to work to develop a vision for strategic estates and efficiencies in procurement, IT systems and estate management.

Organisational forms

Pioneers seeking to establish new models of care are likely to require the development of different organisational forms requiring new governance, financial flows and risk sharing arrangements between existing organisations.

There are no existing, off the shelf solutions meeting the needs of these new organisational forms.

The Pioneer programmes is:

  • Working with advanced sites to develop what a successful joint venture between an acute and primary care provider(s) would look like in practice.
  • Working with advanced sites to provide an economic model that illustrates the impact of new models on a local health economy.
  • Providing similar support to advanced sites to generate lessons learned and toolkits which can be disseminated to others.
  • Developing a range standard templates which can be adopted/adapted in other parts of the country avoiding significant fees.