New Care Models: East Vanguards Supporting the transformation of NHS and care services

#futureNHS www..nhs.uk/futureNHS New Care Models – Contents Vanguards

New Care Models - What are vanguards? 3 This guide provides a summary of the new care model ‘vanguards’. Of the 50 vanguards around the country, nine East Midlands vanguards footprint 4 are in the East Midlands, more than anywhere else – reinforcing our region’s commitment to transformation, innovation and East Midlands – our nine vanguard partnerships 5 collaboration. Collectively the nine East Midlands sites are supporting service improvement for millions of people. Integrated Primary & Acute Care Systems • Mid- Better Together Programme 6 What are vanguards? Multispecialty Community Providers During 2015 the NHS invited individual organisations and • Erewash Multispecialty Community Provider 7 partnerships to apply to become vanguards as part of the new • Principia Partners 8 care models programme, which is a key part of the NHS Five • Lakeside Healthcare 9 Year Forward View (published in October 2014). The aim of each vanguard is to bring together a range of partners to support the Enhanced Health in Care Homes improvement and integration of services – providing patients with • City Clinical Commissioning Group 10 better, more accessible and joined-up support. During 2015, a total of 50 vanguards were chosen by NHS England, split into five types: Urgent & Emergency Care • Greater Nottingham System Resilience Group 11 • Acute Care Collaborations that aim to link local hospitals • , & System Resilience Group 12 together to improve their clinical and financial viability, reducing variation in care and efficiency Acute Care Collaboration • Enhanced Health in Care Homes that seek to offer older people • Working Together Partnership 13 better, joined up health, care and rehabilitation services • East Midlands Radiology Consortium (EMRAD) 14 • Integrated Primary and Acute Care Systems that seek to join up East Midlands Partner Organisations ‘EMPO’ 15 GP hospital, community and mental health services • Multispecialty Community Providers that seek to move specialist care out of hospitals into the community • Urgent and Emergency Care that seek to develop new approaches to improve the coordination of urgent and emergency care services and reduce pressure on A&E departments

2 3 East Midlands How will vanguards Vanguard make a difference Footprint to patients?

Each vanguard brings together a range of partners to support improvement and integration of health and care services – providing better and more accessible joined-up support to patients, their families and carers. For example this could include:

• Organising specialist clinics in local surgeries, Mid Nottinghamshire resulting in fewer trips to hospital Better Together • Providing more support and advice services within Led by Newark & Sherwood patients’ homes and & Ashfield CCGs Nottinghamshire • Giving patients a single point of call for family

Derbyshire doctors, community and social support services Erewash Multispecialty Greater Nottingham • Joining up the often confusing range of services – Community Provider: System Resilience Group such as A&E, GP out-of-hours, minor injury clinics, ‘Wellbeing Erewash: Partnership of Nottingham City CCG, ambulance services and 111 – so patients know Nottingham West CCG, Nottingham North Your life, your way’ and East CCG and CCG more easily how to access help seven-days-a-week Led by Erewash CCG • Improving IT systems and using technology to better share patient information between care Leicester, Leicestershire & Rutland providers, and also help people take more control Principia Partners in Health Leicestershire System Resilience Group over managing their own care. (Rushcliffe) Partnership of Leicester City CCG, East Leicestershire Led by Rushcliffe CCG and Rutland CCG and West Leicestershire CCG To find out more about NHS England’s new care models programme and the Five Year Forward View visit: Lakeside Healthcare Working Together Partnership www.england.nhs.uk/futureNHS () (South Yorkshire, Mid Led by Corby CCG Yorkshire, North ) Northamptonshire North Derbyshire CCG area Nottingham City Clinical Commissioning Group East Midlands Radiology (Nottingham City CCG area) Consortium (EMRAD) Led by Nottingham City CCG Collaboration across the whole region

4 5 Vanguard type: Integrated Primary & Acute Care Systems Vanguard type: Multispecialty Community Provider Mid Nottinghamshire ‘Wellbeing Erewash: Better Your life, your way’ Together

Aim Aim • A new care model for delivering Seven Day Services This vanguard will provide more joined-up hospital, community, social and GP / primary care – The vision is for thriving communities within Erewash, for local people including those with urgent care transforming services and bringing care closer to home for the 310,000 people who live in mid where people feel confident and supported to choose needs • Accessible primary care through appropriate GP Nottinghamshire (Newark & Sherwood and Mansfield & Ashfield). a healthier lifestyle, stay well, and know how to get help and support when they need it. The partners’ coverage and use of triage systems • An electronic patient record enabling single point Background • Build connections between doctors, nurses and care mission is to develop Thriving, Capable, and Healthier Communities. access for providers and patients The partners are developing a blue-print for health staff in different organisations – sharing what works In 2020 Erewash will be characterised by: • Sufficient clinical out-of-hours care coverage care, with feedback from communities and health and well and working together on common challenges • Strong inclusive communities Together GPs and the integrated community services care staff used to shape the plans. By understanding and opportunities. • Shared ethos between the people in the community will become a Multispeciality Community Provider, the future needs of local people, the vanguard will Partners and their trusted professional staff of self-care and working with the county and borough councils, drive closer working across organisations to deliver • NHS Newark & Sherwood and NHS Mansfield & shared decision making voluntary sector and local communities to meet the better, more joined-up and efficient services that meet Ashfield CCGs • Responsive and accessible support services needs of the local population efficiently and effectively. the current and future needs of patients, their families • Central Nottinghamshire Clinical Services • Integrated services that wrap around people and and carers. Partners • Circle Health Limited their family and carers reducing the need for bed- Provider partners This vanguard focuses on a number of important • East Midlands Ambulance Service based care areas including urgent and proactive care (for example • General Practice Provider Clinical Cabinet • Derbyshire Community Health Services NHS Background people with long term conditions such as diabetes and (facilitated by the Local Medical Committee) Foundation Trust frail older people) and early and planned care (such as • Nottinghamshire Healthcare NHS Trust (including This new care model looks to build on our unique • Derbyshire Healthcare NHS Foundation Trust surgery to replace hip and knee joints). County Health Partnerships) selling point of excellent clinical leadership to remove • Derbyshire Health United • Nottingham University Hospitals NHS Trust organisational boundaries and shape an integrated • Erewash Health For example this could: • Nottinghamshire County Council person-centred community, where people feel Commissioner partner • Reduce unnecessary visits to A&E (where patients • Sherwood Forest Hospitals NHS Foundation Trust empowered to support themselves and reduce their • NHS Erewash CCG don’t need urgent help), and provide more planned • Local Community and Voluntary Services reliance on costly statutory services. Where care is care closer to the patient’s home • United Lincolnshire Hospitals NHS Trust needed, services will be wrapped around the patient. • Empower people to take greater control of Specifically, the new models will result in: managing their own care • Resilient local supportive communities promoting • Save money that can be used to provide better education and information care – for example removing barriers between • Encouraging and empowering people to self-care Follow us at: organisations will help reduce administrative and training staff to share decision-making with @WellErewash complexity and cut costs Follow us at: patients @DCHSTrust / @bettermidnotts / #futureNHS • Integrated care services with GP-led multi- @NHS_Erewash_CCG / www.bettertogethermidnotts.org.uk disciplinary teams spanning primary and community @derbyshcft #futureNHS services which target at risk patients 6 7 Vanguard type: Multispecialty Community Provider Vanguard type: Multispecialty Community Provider

Principia Follow us at: Lakeside Partners in Health @PrincipiaMCP / #futureNHS / Healthcare (Rushcliffe) www.rushcliffeccg.nhs.uk (Northamptonshire)

Aim Aim This vanguard brings together general practice, urgent care services, community and local mental health services, This vanguard brings together a wide range of health and social care partners to develop home and community- social care, the third sector and hospital providers. By fully integrating health and care services the vanguard will based services that will put patients at the very centre of health and care service provision. promote the health and wellbeing of 124,000 local people. Background • Lakeside Ambulatory Surgery Centres - outpatient For example: Background This partnership focuses on the population served by centres that will deliver high efficiency care in Rushcliffe has a higher than average population of • Enhanced support to care homes - aligned GP Lakeside Healthcare - the largest GP partnership in the a place convenient for the patient, with better older people, many living alone. Combined with practice for each home, resident and family NHS with a patient list of over 60,000. From its HQ in scheduling of services that will bring about rising life expectancy, this means increasing demands involvement in care planning, regular clinical Corby, it has branch surgeries in local communities, increased patient choices on services. In response Principia and its partners and medication reviews, reduction in emergency which means this vanguard will benefit over 100,000 • CorbyCare Urgent Care – this system will operate are developing new ways of working that shifts care hospital admissions and direct access to falls patients. either as a stand-alone service or on a hospital site, specialists and district nursing with satellite primary pharmacy spokes. upstream - from hospital into the community through a The partners are seeking to further develop Lakeside • Fracture Liaison Service – providing IV treatment four-part model focused on: Healthcare’s home and community based service that Partners for osteoporosis in the community to prevent hip • Self Care – providing people with the information puts the patient at the very centre of everything they • Celesio fractures and reduce acute care and medication and support they need to take control of their own do. • Corby Borough Council costs by more than £70,000 each year care, and where possible prevent conditions from In summary, the vanguard will offer patients four new • Kettering General Hospital NHS Foundation Trust developing or progressing Partners models of care that complement each other: • Lakeside Healthcare • Care at Home – helping people to live • Patients and the wider population of Rushcliffe • Lakeside Extensivist Services - a joined-up • Leonard Cheshire Homes independently in their homes for as long as possible • PartnersHealth care system that will provide coordinated, • Lloyds Pharmacy • Community Care – avoiding unplanned hospital • Principia Partners in Health and NHS Rushcliffe CCG comprehensive care to the most needy and frail • Olympus Social Care Services admissions by moving some hospital care into the • Nottingham University Hospitals NHS Trust patients. It will ensure patients receive highly • Northamptonshire County Council community • Circle Health Ltd Nottingham personal care with better access, and will ensure • University Hospitals of Leicester NHS Trust • Hospital Care – reducing avoidable admissions. • Nottinghamshire Healthcare NHS Foundation Trust they are involved in the management of their Build connections between doctors, nurses and care and Health Partnerships conditions staff in different organisations – sharing what works • Rushcliffe Borough Council • Lakeside Enhanced Primary Care - a team-based well and working together on common challenges • Nottinghamshire County Council care system that will provide comprehensive and and opportunities • HealthWatch convenient medical care to a specific patient New interventions and initiatives have been developed • Rushcliffe CVS, Carers Trust & Age UK segment. This will also allow patients to receive and are already making a difference, with new services • Sherwood Forest Hospitals NHS Foundation Trust better care that understands and responds to their set up to reduce hospital attendance and bring care • Local Community and Voluntary Services needs, delivered by their current GP closer to home. • United Lincolnshire Hospitals NHS Trust Follow us at: @Lakeside_Corby / #futureNHS

8 9 Vanguard type: Enhanced Health in Care Homes Vanguard type: Urgent and Emergency Care Nottingham City Greater Clinical Commissioning Nottingham System Group Resilience Group

Aim Aim The Nottingham City Care Homes vanguard aims to support residents living in a care home to be healthier, have Greater Nottingham will create a sustainable and resilient integrated urgent and emergency care system, a better quality of life, and to be treated with dignity and respect, focusing on residents’ capabilities rather than navigating citizens directly to appropriate, enhanced urgent mental and physical health services. The approach their dependencies. It is our aim that all residents and their families will have a positive experience of care. will avoid the emergency department and core hospital provision being the default option, supporting a more sustainable system; improving patient and staff experience and clinical outcomes. Background This will be achieved by: The vision of the partners is to transform the way that • Managing complex conditions more effectively, Background • Supporting navigation and referral of patients which will result in reducing ambulance callouts, health and social care services are delivered in care The urgent care challenges have been clearly identified. to appropriate settings offering an alternative to A&E activity, and hospital admissions homes. Objectives include: Urgent care services can be fragmented and generate urgent hospital admission or direct admission into • A greater use of technology (such as blood pressure • Ensuring residents have an improved experience confusion amongst patients and clinicians about how specialties without the patient going through A&E monitors) and IT in care homes (such as video through the delivery of high quality care and where to access care. Often there is an inequitable • Extending the clinical navigation service to include consultations) • Ensuring residents are admitted to secondary care service response to physical and mental health needs. Mental Health; facilitating clinician to clinician • Improved and targeted medicines management only when they have a medical need, and are Citizens, commissioners and provider partners will work communication to ensure patients are directed to interventions discharged when that need is met together to transform the models of care. This will: the most appropriate support • Ensuring residents remain as independent as • Supporting residents to develop and maintain Partners relationships and participate in activities that • Ensure citizens who need urgent care get the right possible and are involved in important decisions • County Health Partnership maintain or improve their health and well-being advice in the right place, first time such as place of care and place of dying • Provide responsive, urgent physical and mental • Derbyshire Health United (NHS 111) This will be achieved by: Partners health services outside of hospital every day of the • East Midlands Ambulance Service NHS Trust • Putting in place agreed goals of care for every • Care home providers week so people no longer choose to queue in our • Healthwatch Nottingham and Nottinghamshire resident • hospital emergency department • Nottingham University Hospitals NHS Trust • Improving the quality of care through effective • Nottingham CityCare Partnership Partners are implementing a range of innovative • NHS Nottingham City CCG, NHS Nottingham West coordination and use of technology • Nottingham University Hospitals NHS Trust approaches, for the population of around 700,000 CCG, NHS Nottingham North and East CCG, NHS • Ensuring residents can rely on access to familiar • Nottinghamshire Healthcare NHS Foundation Trust people. The vanguard is already registering positive Rushcliffe CCG and NHS Erewash CCG health professionals • impacts, including reductions in emergency admissions • Nottingham CityCare Partnership • Nottingham City Council and Nottinghamshire Care home residents have complex needs - many are • Community, voluntary and social enterprise sector and has a strong collaborative ethos to build on. County Council cared for in hospital, even though for some their care services and volunteers Example approaches include: • Olympus Social Care Services • Nottinghamshire Healthcare NHS Foundation Trust could be provided at home or in the community. The • Delivering an integrated urgent care pathway • Northamptonshire County Council • Nottingham Emergency Medical Services vanguard will work with partners to put in place plans offering a viable alternative to A&E for patients • University Hospitals of Leicester NHS Trust that will safely reduce length of stay in hospital, reduce supported by the development of a clinical hub ambulance call-outs and reduce hospital admissions. • Providing primary care clinicians within A&E Follow us at: Follow us at: @NHSNottingham / #futureNHS @NHSNottingham / futureNHS

10 11 Vanguard type: Urgent and Emergency Care Vanguard type: Acute Care Collaboration Leicester, Leicestershire Working Together & Rutland System Partnership (South Yorkshire, Resilience Group Mid Yorkshire and North Derbyshire)

Aim Aim This vanguard’s vision is for a new urgent and emergency care system that removes organisational boundaries to Building on the strong foundations of an established partnership of seven NHS Trusts, this vanguard crosses meet the diverse needs of over 1 million people who live within Leicester city and the counties of Leicestershire regional boundaries and will develop a clinical strategy involving different models highlighted in the national and Rutland. Dalton Review.

Background Background Partners Supported by all local commissioner and provider The vanguard also has plans to work with the The development of this vanguard was informed by the • Doncaster and Bassetlaw NHS Foundation Trust organisations throughout health and social care, this regional and national partners, including IBM and publication of the Dalton Review in 2014. In particular • Barnsley Hospital NHS Foundation Trust ambitious partnership is creating a new alliance-based University, to use real-time and historic the review identified the critical importance of bringing • Chesterfield Royal Hospital NHS Foundation Trust urgent and emergency care system where all providers data to effectively identify and respond to service together partners across wider health economies to • Mid-Yorkshire Hospitals NHS Trust work as a single network. demand develop new and better ways of working. • Rotherham NHS Foundation Trust This will bring together ambulance, NHS 111, out-of- Partners The partners will be developing a series of innovative • Sheffield Teaching NHS Foundation Trust hours and single point of access services to ensure that solutions and models for joint ventures on shared • Sheffield Children’s NHS Foundation Trust patients get the right care, first time. Key initiatives will • Arriva (patient transport service) services, working across regional and organisational include: • Derbyshire Health United (NHS 111) boundaries. • East Midlands Ambulance Service NHS Trust • Development of a combined health and social care The focus will be to address key issues that will • NHS Leicester City CCG, NHS East Leicestershire patient navigation hub working with local authority transform patient outcomes and experiences, including and Rutland CCG and NHS West Leicestershire CCG partners provision of effective Seven Day Services. • Providing a consistent urgent centre service across • Initiatives could include: Leicester, Leicestershire and Rutland • Leicestershire County Council • • Greater use of networking • Improving urgent mental health services and • Leicestershire Partnership NHS Trust • Sharing clinicians across sites working towards parity of care, including crisis • Soldiers, Sailors, Airmen and Families Association • Delivery of specialist and diagnostic services across a support for mental health from NHS 111, a mental (acute visiting services) number of different providers. health triage car and increased liason psychiatry • University Hospitals of Leicester NHS Trust The partners’ ambitious vision is to make sure that University of Leicester Hospitals NHS Trust runs the services for millions of people are both clinically and largest single site A&E department outside of London. financially viable in the future. The urgent and emergency care front door of Leicester Royal Infirmary will be re-launched to include an Follow us at: assessment team with the ability to refer patients @MidYorkshireNHS / @DBH_NHSFT / to ambulatory clinics, assessment beds, on-the-spot @SheffChildrens / @royalhospital / urgent care centres or primary or community care. Follow us at: @RotherhamNHS_FT / @SheffieldHosp / @UrgentCareLLR / #futureNHS @barnshospital / @MidYorkshireNHS

12 13 Vanguard type: Acute Care Collaboration Supporting system-wide transformation East Midlands East Midlands Radiology Consortium Partner Organisations (EMRAD) (‘EMPO’)

Aim This vanguard unites seven East Midlands NHS trusts to create a clinical network that will provide timely and expert Within the East Midlands there are radiology care for a population of around 6.5 million people who are served by the partners. a number of health organisations with the same region-wide footprint. Background Partners Whilst their remits are different they share a collective aim; to serve the The vision of this ambitious partnership is to create a • Chesterfield Royal Hospital NHS Foundation Trust NIHR CRN EM EMAHSN national benchmark for a new model of collaborative • Kettering General Hospital NHS Foundation Trust East Midlands’ 4.6 million residents, working for NHS radiology services – potentially • General Hospital NHS Trust improving health outcomes for patients benefiting many millions of patients both within and • Nottingham University Hospitals NHS Trust and the public. beyond the East Midlands. • Sherwood Forest Hospitals NHS Foundation Trust They are individually and collaboratively EMLA NIHR CLAHRC EM In order to achieve this vision the collaboration will • United Lincolnshire Hospitals NHS Trust committed to working with health deliver a number of improvements. • University Hospitals of Leicester NHS Trust and social care colleagues to explore IMPROVING For example, already the vanguard has started to all opportunities to share resources, PATIENT deploy a shared, technical system to allow access to develop joint projects and reduce OUTCOMES patient radiology images at the point of clinical need. the risk of duplication. East Midlands AND EM CNs Councils EXPERIENCE To maximise the benefits of this technical investment To find out more about how the the vanguard will develop and implement new regional partners can support health and systems of governance, patient consent, commissioner social care organisations with their support and education. improvement and transformation plans, visit www.emwheel.org HEE EM EM Clinical The partners are also planning to develop a Senate collaborative network of services, aided by the shared Public Health technical systems, which support network-wide clinical England care for patients. East Midlands The intention is to develop a mechanism for working regionally, bringing work back into the NHS which is currently being delivered in other sectors, providing expert trusted opinions within the NHS, and supporting both large and small trusts by creating cross-trust This publication has been produced with the support of expert radiology networks. the East Midlands Academic Health Science Network, which is working to transform the health of 4.6 million Follow us at: people and generate economic growth. For more @EMRADNHS / #futureNHS information visit www.emahsn.org.uk

14 15 This publication has been produced with the support of the East Midlands Academic Health Science Network, which is working to transform the health of 4.6 million people and generate economic growth.

For more information visit www.emahsn.org.uk