I attended the Buckinghamshire Health and Social
Care Integration Summit in November 2017 when the new Integrated Care System was discussed by representatives from the local authorities, health care system, local charities & the voluntary sector and some members of the public (me included).
Sadly the presentations went over time so there was no time for questions (not good!) but I did send my questions into the organisers. I have now received the response to those questions.
Of course the name of the new system has been changed in the meantime. However the purpose of the new system remains the same. So for Accountable Care System (ACS) please read Integrated Care System (ICS).
Q1. Is there any extra
funding for Buckinghamshire ACS to invest in Public Health & community services?
Answer: NHS England is offering Accountable Care System (ACS) transformation
money to support us to meet our priorities and go further, faster.
Opportunities to bid for further funds do often arise.
In addition
to monies that may be made available through the ACS, we are investing £1
million in community services, bringing together nurses, therapists, social
workers, GPs and other relevant organisations to provide 24/7 cover for people
who need the greatest health and care support and give them better, more
coordinated care in their homes.
Q2. ‘Accountable’ to whom?
How can the public hold this new organisation, which most know nothing &
were not consulted on, to account?
Answer: The ACS is not a new organisation, it’s about further
developing our system way of working, which supports:
• Joined
up working between health
and social care services to provide better care and help people to stay healthier
• Staff
to work together easier across
our provider and commissioner organisations
• More
local control and freedom to make decisions
• Extra
support to go further and faster in improving services
It will allow us to have stronger local relationships and
partnership work based on common
understanding of local priorities, challenges and next steps.
Q3. How will the public
know that the ACS has achieved its purpose, indeed what is its purpose? What baseline measures do you have for
outcomes, organisational, financial and patient outcomes, so we can compare the
improved public health & other outcomes in the future?
Answer: The purpose of our system working is to achieve our vision
for “One Buckinghamshire, one integrated health and care system”, by further
developing our community-focused approach to integrating services and
collaborative working across the county.
We have a track record of success on working collaboratively
to improve quality, transform service models and build financial
sustainability. Some of our successful working to date includes:
A system wide Primary Care Strategy, agreed in 2015 and with strong clinical
leadership across primary care that has seen the development of a nationally
recognised innovative alternative, the Quality and Outcomes Framework, with
outcomes that build a ‘fit for purpose’ future primary care service. This has
established a care and support planning approach in primary care resulting in
Buckinghamshire being the best for diabetic glucose control in the country.
A Buckinghamshire Provider Alliance agreed between FedBucks,
Oxford Health NHS Foundation Trust and Buckinghamshire Healthcare NHS Trust,
with a commitment to integrate seamless services for patients;
Care Closer to Home – Integrated Adult Community Healthcare
teams have provided 24/7 services since 2012. Locality led initiatives include
the introduction of the Airedale model remotely supporting care homes and
enhanced primary care teams supporting frail elderly people developed from our system
work on Multi Agency Groups;
We are piloting the development of Community Hubs including
increased community based services, short term packages and a new frailty
assessment service, reducing the use of overnight community beds;
A collective approach to engagement – with a single
communications and engagement team across Buckinghamshire County Council and
the Clinical Commissioning Groups working closely with colleagues in provider
trusts.
Q4. One example of an ACS
in Canterbury in New Zealand. This has taken ten years to achieve its aims and required
extra funding for public health, community services & social care. We do not have the luxury of time not it
seems any investment. We need
improvements now to maintain the quality of care services & to improve outcomes.
Can this ACS do in a short time what took Canterbury 10 years to achieve &
without extra funding?
Answer: We do recognise that like Canterbury, we are not going to be
able to achieve what we want overnight. Some work streams will take longer than
others. However in the meantime we are equipping ourselves with the lessons
learnt from the Canterbury project, as we have been able to meet with them and
apply this where appropriate to our work. We have also set ourselves some priorities to
deliver for 2017/18, which include:
• Providing
more joined-up care closer to home, through community hubs and
integrated teams working with groups of GPs, tailoring care to the needs of
their local communities.
• Making
it easier for people to get urgent care when they need it, including out
of hours.
• Improving
and simplifying care for diabetes and musculoskeletal problems.
• Improving
and increasing access to mental health services, including for children
and young people.
• Improving
the prevention, diagnosis and treatment of cancer.
Q5. How will the Bucks
ACS improve retention and recruitment of staff? What is the effect of the ACS
on the working conditions of staff, on their Terms and Conditions, GP surgery
& Pharmacy contracts etc.?
Answer: Staff will continue to be employed by the organisation they
currently work for and as such there will be no changes to their terms and
conditions or contracts as a result of Buckinghamshire becoming an ACS.
We hope that being an ACS will help to improve retention and
recruitment of staff in a number of ways.
By working closer together across the system it will make it easier to
make sure we’ve got the right people in the right place at the right time. Job
satisfaction will increase as together we will be able to provide better care
in the community, at home or in hospital, helping people to stay
healthier. There will also be greater
career development opportunities for our people, as they will have the
opportunity to work in integrated teams or rotate across different health and
care settings. As one of the first ACS we believe the opportunity to get
involved in something that is exciting and innovative will also be an
attractive prospect for some.
Q6. What will be done to
improve access to Primary Care Services & GP services, especially in places
like High Wycombe and the rural parts of Buckinghamshire?
Answer: Improving access to
primary care services and GP services is central to NHS England’s Five Year
Forward View (FYFV) and General Practice Forward View (GPFV) and so is a key
part of much of the work at Aylesbury Vale and Chiltern CCGs. We also have a number of work streams in
place specifically designed to ensure the population of Buckinghamshire have
timely access to appropriate primary medical services. This work is being done
in the context of the development of an ACS for Buckinghamshire which
encourages partnership working across the whole health and social care system
and whose benefits are already positively impacting on improved access for
primary care services.
NHS England
launched the General Practice Resilience Programme (GPRP) as part of the GPFV,
which is designed to secure sustainability of GP surgeries by tackling many of
the issues that are creating pressures on general practice and threatening the
viability of practices. A key part of the GPRP in Buckinghamshire is to
encourage practices to work together in clusters on a range of projects which
improve access to primary care services, for example, developing integrated
teams with a focus on integration with other primary care professionals
(nurses, pharmacists) or improved working with the voluntary sector, addressing
the needs of high intensity users of primary care, out of hours services and
A&E by better working with social services. We now have thirteen such
clusters beginning to form local plans across Bucks.
In addition, GPRP
funding is being used to train care navigators in general practice. Care
navigators provide front of house signposting of patients to ensure they
receive the right care from the right healthcare professional, or alternatively
are able to access social care or services from the voluntary sector.
Many practices are
also using or developing alternative methods for patients to access primary
medical services such as on-line booking of appointments, Skype and telephone
consultations.
So that access to
primary care services in and out of hours is seamless for patients, we are also
in the process of commissioning extended access into primary care services
whereby patients will be able to book an appointment with a healthcare professional
8am to 8pm Monday to Friday. We will
also be looking at whether we need to commission this type of service at the
weekend (although experience from elsewhere suggests that routine appointments
for primary care services at the weekend are poorly utilised). We anticipate that 100% of the
Buckinghamshire population will be covered by this new service by March 2019.
The extent of the
work means that all residents of Buckinghamshire should see an improvement in
access to primary care services whether they live in a town or rural area. A
key part of cluster working is for practices to understand and plan for the
needs of their local area, including how different groups access services. As
the CCGs develop working as part of the ACS this locality focus will widen out
to other health and social care providers to create an integrated care system
with timely and appropriate access at its heart.
Q7. Buckinghamshire has
already squeezed the local health economy and has, just about managed its
finances but there are now signs of stress in that a deficit is forecast for
this year. Is the ACS really just a
means to balance the books rather than improve quality of care? Buckinghamshire
has already made many changes to remain within the financial targets so what
other changes can be made in the way that hospitals deliver acute care more
efficiently?
Answer: Becoming an ACS is certainly not just a means to balance the
books although we are hoping that by working better together we can find ways
of delivering higher standards of care more cost efficiently. For Buckinghamshire Healthcare NHS Trust,
being part of an ACS is about how we can work with our partners in the system
to ensure the residents of Buckinghamshire stay healthier for longer - now and
in the future. Research shows that it is in the best interests of patients to
stay at home and receive treatment locally. We are working as a system to
achieve this, ensuring that acute care is there for those that really need it and
that all patients are seen at the right time, in the right place, first
time. We believe greater transparency
and openness between organisations – working towards a common goal – means that
we would reduce duplication and stop moving money around the system, instead
focussing on where the greatest support and investment is required.
Q8. There is a mismatch
between what senior managers/civil servants NHSE say and the views of those
providing and reviewing care on the wards, in outpatients & GP
surgeries! We need to bridge that gap –
what is being done to do so?
Answer: We take the views of our staff extremely seriously and hold
regular informal and formal feedback sessions to understand any issues or to
hear suggestions for how we can improve things.
We know that our staff have the solutions and so an
important principle for our ACS is for there to be strong clinical and staff
leadership, and that we actively involve and engage our patients and
communities to co-design future services.
