NHS Chorley and South Ribble Clinical Commissioning Group NHS Greater Preston Clinical Commissioning Group Out of Hospital Strategy 2 Out of Hospital Strategy Contents 04 Foreword 19 Our plan for the future 05 Introduction 20 Locality model 07 About us 21 Our journey 09 National context 22 Sustainable care 11 The challenges we face 23 The case for change 13 Population 27 Delivery 18 Our guiding principles 29 Enabling work streams Out of Hospital Strategy 3 Foreword As Chairs of Chorley and South 2017 marks the 70th anniversary of the National Health Service. Over the last 70 years we have Ribble, and Greater Preston Clinical seen lives transformed as a result of the medical Commissioning Groups, and as general advancements. However, the founding principle practitioners, we fully understand the of the NHS remains that it should provide care for significant challenges facing primary all on the basis of need and not ability to pay. We care, and general practice in particular. believe that more than ever we need to mobilise our primary care workforce to work together to achieve The increases in workload and the a clear vision for our population. need to manage more patients with As working GPs we personally experience the multiple and complex health needs, multiple pressures and challenges faced in respect combined with the uncertainty of of workforce, premises, facilities and technology, all future workforce, means we need to of which are key enablers to delivering high quality radically rethink our delivery model if care for all closer to home. We also recognise the changes in the types of patients we see in our we are to remain sustainable beyond practices, with large numbers of patients having the next decade. multiple complex conditions that require careful management and monitoring and we recognise that some of the traditional methods of delivering primary care are no longer fit for purpose. This strategy is not an attempt to reinvent the wheel. We recognise there is a huge amount of good practice, collaboration and service transformation that has occurred in general practice since we were authorised as Clinical Commissioning Groups. But if we are to deliver at speed we need to refresh and refocus a framework on which we can underpin our entire decision making in an effective and efficient way. Given the challenges Dr Gora Bangi Dr Sumantra Mukerji currently facing local services, we recognise the Chair Chair need to do this quickly, transitioning to a sustainable Chorley and South Greater Preston primary care offer and new model of out of hospital Ribble CCG CCG provision that delivers our vision. This strategy aims to support and enable our members as key health providers to deliver effective healthcare to patients, in a timely fashion, in the most appropriate setting. It also outlines our intentions for an integrated approach to delivering out of hospital services for the local community. 4 Out of Hospital Strategy Introduction This strategy sets out our vision for out of hospital care in Chorley, South Ribble and Greater Preston. It sets out the principles on which we will seek to transform community and primary care (general practice) and bring together our vision and priorities to support investment, redesign services and to improve access and outcomes for our patients in central Lancashire. General practice is the foundation of healthcare delivery in the NHS. It is central to bringing care closer to home, managing long term conditions, preventing unnecessary hospital admissions and helping people stay well and healthy. Our patients want to be able to see their GP and general practice when they need to. We have seen a steady rise in demand for general practice and patient expectations have grown. Alongside this has been a growing shift of work from secondary care to primary care, and all of these factors have placed unprecedented pressure on practices. These pressures impact on staff and patients, and it has been recognised that the need to support and develop general practice has never been greater. Therefore, the focus of this strategy is sustainability. This strategy has been co-produced with local general practitioners, and is aligned to a number of strategic plans, including our local Our health Our Care transformation programme (local delivery plan) and those principles set out in both the Five Year Forward View and General Practice Forward View. Other CCG-produced strategies linked to this document include the health economy workforce strategy, the estates strategy, and the internal and external relations strategy. Out of Hospital Strategy 5 General practice is the foundation of healthcare delivery in the NHS. It is central to bringing care closer to home, managing long term conditions, preventing unnecessary hospital admissions and helping people stay well and healthy. 6 Out of Hospital Strategy About us NHS Chorley and South Ribble Clinical Commissioning Group (CCG) and NHS Greater Preston CCG are clinically-led, GP membership organisations that plan, arrange and buy a range of healthcare services on behalf of our local population. The CCGs are made up of the 31 GP practices in Chorley and South Ribble and 31 GP practices in Greater Preston. Vision Together, they serve a combined registered population of almost 400,000. Our vision is to ensure equal and fair access to safe, While the CCGs are two separate statutory organisations, we work very closely effective and responsive together, sharing a management team, health and social care for staff, vision, and have a single operational our communities that and strategic plan. represent value – now and We also share the same vision, values and in the future. strategic objectives. Combined population 400,000 Combined number of GP Practices 62 Out of Hospital Strategy 7 Values The values, which should be at the heart of everything we do, are TO CARE, TO LISTEN, and TO ACT. In more detail, the values have the following ethos: • Be open and accountable to our patients, their carers and the local community • Be professional and honest • Work in partnership with others to achieve our goals Open and Professional and • Listen and learn, and be accountable honest willing to change based on what we hear • Respect and care for our staff, the people we work with and our local community • Protect and invest the public funds that are given to us in a well-managed way We have a legal duty to make sure that the healthcare services Partnership Listen and we buy are safe, effective and working learn of the highest quality, but also that these services provide value for money. Respect and Invest care wisely 8 Out of Hospital Strategy National context The Five Year Forward View (FYFV) published in 2014 sets out a new road map and expectations for the NHS. While setting out a whole range of changes, primary care is prominently placed. “The foundation of NHS care will remain list based primary care” This strategy has been co-produced with local general practitioners, and is aligned to a number of strategic plans, including our local Our health Our Care transformation programme (local delivery plan) and those principles set out in both the Five Year Forward View and General FIVE YEAR Practice Forward View. FORWARD VIEW Other CCG-produced strategies linked to this document include the health economy workforce strategy, the estates strategy, and the internal and external relations strategy. The FYFV points out that England is too diverse for one model but nor is the answer to simply let a “thousand flowers bloom”. Health economies instead will be supported to choose from a small number of October 2014 radical new delivery options. In early 2015, the vanguard programme commenced, with these new emerging models of care being tested within 50 sites across England, including: 9 6 8 13 Primary Acute and Enhanced care in Urgent and emergency Acute care Care Systems care home pilots care schemes collaborations More details on the Vanguard Programme can be found at: www.england.nhs.uk/futurenhs/new-care-models/ Out of Hospital Strategy 9 The Next Steps on the NHS Five In April 2016, NHS England Year Forward View published published the General Practice in 2017 outlines that the NHS GENERAL PRACTICE Forward View. The document NEXT STEPS ON THE FORWARD VIEW AP RI L 20 16 NHS FIVE YEAR FORWARD VIEW needs to evolve to meet the sets out a range of measures new challenges as we live longer to support general practice, with complex health issues, addressing the evidence sometimes of our own making. It presented by the British Medical #GPforwardview March 2017 focuses on how we deliver more Association, the Primary Care responsive services, covering the Foundation, the NHS Alliance issues that matter most to the public, including: and others. The document announced: • Providing urgent and emergency care 24 hours a • Investment of an additional £2.4 billion a year by day, 7 days a week 2020/21 in general practice • Improved access to GPs in the evenings and • A further £0.5 billion of non-recurrent weekends Sustainability and Transformational Plan • Speeding up cancer diagnosis investment • Increased investment in psychological therapies • A practice resilience programme • Supporting the frail and older people stay healthy • A range of workforce measures including: and independent • 5,000 new general practitioners • Fully integrated services and funding • Practice nurse development www.england.nhs.uk/wp-content/ • Practice manager development uploads/2017/03/NEXT-STEPS-ON-THE-NHS- • Supporting new