Sussex - Brighton and Hove CCG
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Sussex
Clinical Commissioning Groups
Primary Care Networks Update
January 2020
Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG
Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCGContents
1. The Journey so far in Sussex
2. Year 1 delivery
3. Year 2 onwards delivery (national service specifications)
4. Primary Care Governance
5. PCN Programme development plan
6. Integration and Partnerships
7. PCN engagement and GP voice
8. Next Steps
Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG
Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCGGP Five Year Forward View laid foundation for change in
General Practice …
GP5YFV published 2016:
• Represented a turning point in investment in General Practice – committing an additional
£2.4bn a year to support general practice services until 2020/21
• Ambition to strengthen and redesign general practice
• Vision built on the potential for transformation in general practice
– Enabling self care and direct access to other services
– Better use of the talents of the wider workforce
– Better use of digital technology
– Working at scale across practices to shape capacity
– Extended access to general practice including evening and weekend appointments
Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG
Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCGNow continuing support through NHS Long Term
Plan (LTP)
LTP Aims:
• Everyone gets the best start in life
• World class care for major health problems
• Supporting people to age well
How:
• Primary Care Networks as the foundation of Integrated Care
Partnerships
• Preventing ill health and tackling health inequalities
• Supporting the workforce
• Maximising the opportunities presented by data and technology
• Continued focus on efficiency
Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG
Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCGFuture landscape – integrated commissioning & provision
Key planning, commissioning
and delivery Units
Primary Care General practice Community Dentistry
pharmacy Primary Care
Independent providers meeting the
needs of list base local population
C P P
Neighbourhood Primary care networks
and Primary Care Local needs analysis and proactive
Networks P N C N N C population health and prevention.
Integrated delivery / MDTs
Integrated care partnership
Locality and Voluntar Communit Mental Delivery of integrated health and
Primary Acute
y care y care health
Borough care care social care across primary,
care
community and secondary care
Strategic partnerships
Brighton Collaborative & integrated
East Sussex West Sussex
and Hove commissioning for improved
Place CCGs / CCGs / councils
councils CCG / population health outcomes
councils
Underpinned by citizen
engagement
System Sussex Integrated Care System
Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG
Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCGPurpose of PCNs
• Bring practices together to deliver the collective DES and form the foundation for practices to come together
with other providers to develop and deliver integrated services
• Provide the building block for developing services with partners more widely than GP practices e.g.
pharmacy, opticians, dentistry, community and voluntary care
• Put in place seamless care across primary care and community services for physical and mental health and
remove the historic separation of these parts of the NHS
• Focus on the local population and address the inequalities at a local level
• Deliver care as close to home as possible in neighbourhoods rather than around organisational boundaries
• Integrate primary, community and acute care in PCN neighbourhoods with more clinically appropriate
secondary care in primary care settings
• Assess population health – focusing on prevention and anticipatory health – and maximise the difference
we can make operating in partnership with other agencies
• Promote and support people to care for themselves wherever possible
• Build from what people know about their patients and population
• Make a tangible difference for patients and staff:
– Improve outcomes for patients and provide an integrated care experience
– Development of sustainable and satisfying roles for staff & multi-professional teams
Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG
Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCGThe Network DES
The Network Contract will be a Directed Enhanced Service (DES).
As a DES, it is an extension of the core GP contract. It is established in
accordance with Directions given to NHS England. This compels CCGs or
NHS England to offer the Network Contract DES to all practices.
The Network Contract DES has three main parts:
1. the national Network Service Specifications. These sections set out what all
networks have to deliver. National investment and services grow in tandem.
Commence April 2020 onwards
2. National schedule of Network Financial Entitlements, akin to the existing
Statement of Financial Entitlements for the practice contract. National entitlement
increases financial certainty for everyone. Alongside these entitlements come
clear transparency requirements, including for subcontracting arrangements
3. The Additional Roles Reimbursement Scheme (ARRS)
• From 2019 Clinical Pharmacists and Social Prescribing Link Workers
• From 2020 Physician Associates and First contact Physiotherapists
• From 2021 First Contact Community Paramedics
Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG
Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCGThe journey so far across Sussex
What has been achieved in Sussex:
• 38 Primary Care Networks (PCNs) across Sussex covering 100% of population:
• All PCNs have signed their Network Agreement and appointed a Clinical Director
• All practices are delivering Extended Hours DES from July 2019
• PCNs have begun recruiting to additional roles (Clinical Pharmacists and Social Prescribers). Preparations
underway to support recruitment to further additional roles from 20/21 (Physicians Associates and First Contact
Physiotherapists).
• Some PCNs are working with local provider partners to provide joined up responsive care
• Sussex wide Clinical Directors Network Events established and development programme being designed
• Primary Care Programme Board established to provide a structure for governance of primary care strategy and
oversight of plans
• Development of Primary Care Strategy as part of the wider STP strategy
• Deployment of PCN development and accelerator monies to support organisation, leadership and infrastructure
maturity.
• Successful bid to NHSE/I for Sussex STP to become a part of Population Health Management Programme to
deliver on this ambition for the Sussex system.
Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG
Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCGWhat is expected of PCNs by March 2020
The Network Contract DES began on 1 July 2019
Year 1 Timeline
01 July 2019 Network Contract DES goes live across 100% of the country
July 2019 – Mar 2020 National entitlements under the 2019/20 Network Contract start:
• PCNs deliver Extended Hours Access appointments to all patients within their
PCN
• Year 1 of the Additional Roles Reimbursement Scheme (ARRS) –
Employment of a Clinical Pharmacist and Social Prescribing Link Worker
• Ongoing support funding for the Clinical Director
• Ongoing £1.50/head from CCG allocations
Apr 2020 onwards National Networks Services start under the 2020/21
Network Contract DES
Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG
Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCGService Specifications
• The first five draft service specifications to be delivered by PCNs (from April 2020) under the GP
contract framework (in collaboration with community services and other providers) were recently
published and NHSE/I are currently seeking feedback on these.
• The GP contract framework set out seven national service specifications that will be added to the
Network Contract DES: five starting from April 2020, and a further two from April 2021. The five
services are:
• Structured Medication Reviews and Optimisation
• Enhanced Health in Care Homes (jointly with community services providers)
• Anticipatory Care (jointly with community services providers)
• Personalised Care; and
• Supporting Early Cancer Diagnosis.
• A Sussex wide response to the consultation on service specifications will be coordinated via the
primary care board as well as detailed proposals on how PCNs will be supported to deliver each of
the new service specificaitons.
Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG
Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCGStructured Medication Review and Optimisation
PCN members will support direct tackling of the over-medication of patients, including inappropriate use of
antibiotics, withdrawing medicines no longer needed and support medicines optimisation more widely
Metric description
1 The number of individual SMR episodes undertaken, including:
• The number of SMR processes undertaken (number of individual patients given
one or more SMR appointment)
• The number of SMR follow-up appointments
2 Outcome measurement to monitor impact of SMR
Prescribing rate of nationally identified medicines of low value that should not be
3
routinely prescribed
4 Prescribing rate of low carbon inhalers
5 Prescribing rate of medicines that can cause dependency
6 Prescribing rate of anti-microbial medication
Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG
Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCGEnhanced Health in Care Homes
The aim of this service will be to enable all care homes to be supported by a consistent multi-disciplinary team of
healthcare professionals, delivering proactive and reactive care. This team will be led by a named GP and nurse
practitioners, organised by PCNs.
Metric description
1 The rate of emergency admissions for people living in care homes.
2 The rate of urgent care attendances for people living in care homes.
The proportion of people living in a care home who have a personalised care and support plan
3
in place.
The number of people living in a care home who receive an appointment as part of the weekly
4
care home round
The number and proportion of people living in a care home who receive a structured
5
medication review.
The number and proportion of people living in a care home who receive a delirium risk
6
assessment.
Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG
Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCGAnticipatory Care
PCN GP practices and other member providers will work collaboratively to introduce more proactive and intense
care for patients assessed at being high risk of unwarranted health outcomes, including patients receiving
palliative care
Metric description
1 Number of individuals in receipt of the Anticipatory Care model
Number of needs assessment carried out for individuals in receipt of the Anticipatory Care
2
model.
Number of individuals in the active cohort of the anticipatory care model with a
3
personalised care and support plan.
Number of individuals in the active cohort of the anticipatory care model receiving a falls
4
risk assessment.
Number of individuals in the active cohort of the anticipatory care model receiving a
5
delirium risk assessment
6 Number of SMRs for the active cohort on the anticipatory care model
7 Number of SMR follow-ups in the active cohort on the anticipatory care model
Number of individuals in the active cohort on the anticipatory care model given a referral to
8
social prescribing service or where social prescribing is declined
Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG
Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCGPersonalised Care
The Comprehensive Model of Personalised Care has six main evidenced based components:
• Shared decision making
• Enabling choice (including legal rights to choice)
• Personalised care and support planning
• Social ‘prescribing’ and community-based support
• Supported self-management
• Personalised health budgets and integrated personal budgets
This model will be developed in full by PCNs under the Network Contract DES by 2023/24. the minimum national
activity levels for all elements of the model will increase gradually over time in line with increases in capacity. As
part of the national requirements, PCNs will need to contribute to the ICS plan and the ICS will also need to set out
what it is doing locally, given some of the services are best delivered within a framework of wider local coordination
and support.
Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG
Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCGMetric description
The number of personalised care and support plans delivered (including measure of
1
delivery rate for required cohorts)
2 The quality of personalised care and support plans
The number of shared decision making conversations completed (including measure of
3
delivery rate for required cohorts)
4 The quality of shared decision making conversations
5 The number of social prescribing referrals made
The number of patient activation measurement assessments undertaken (including
6
measure of delivery rate for required cohorts)
7 The number of Personal Health Budgets
Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG
Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCGSupporting Early Cancer Diagnosis
PCNs will have a key role in helping to ensure that all their GPs are using the latest evidenced-based guidance to identify people
at risk of cancer; recognise cancer symptoms and patterns of presentation; and make appropriate and timely referrals for those
with suspected cancer.
Metric description
The proportion of cancers diagnosed at early stage (stage 1 and 2) – progress towards local
1
Cancer Alliance target
2 PCN-level participation in breast, bowel and cervical screening programmes
3 Proportion of urgent cancer referrals that were safety netted
The number of new cancer cases treated that have resulted from a two week wait referral
4
(the ‘detection’ rate)
5 The number of two week referrals resulting in a diagnosis of cancer (the ‘conversion’ rate)
6 Number of cancers diagnosed via emergency presentation
Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG
Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCGPrimary Care Governance
Primary Care Programme Board
• The Primary Care Programme Board has been established across Sussex CCGs to provide oversight and consistency of primary care development across
Sussex and successfully deliver the primary care strategy.
• A PCN programme plan has been developed to provide oversight and governance around PCN work streams. This has been aligned to PMO methodology
from digital and estates primary care programmes.
Primary Care Development Group
• The Primary Care Development Group reports to the Primary Care Programme Board, and supports the development and delivery of Primary Care
initiatives, including Primary Care Networks, General Practice Forward View (GPFV) and Long Term Plan (LTP), across Sussex. Its core purpose is to
facilitate the delivery of the local primary care strategy and underpinning plans.
Primary Care Programme Reporting to :
Board 7 CCGs Governing Bodies
Primary Care Co Commissioning
PCN Development Group Committees
NHSE
Primary Care Workforce
7 CCGs
Primary Care Estates Executive meetings
Clinical Director meetings
Primary Care Digital
Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG
Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCGOverview – PCN programme
There is a need to ensure there are sufficient primary care and community services to meet the needs of an ageing population with increasingly complex health and care needs. This national
Primary Care Networks programme has bought together general practices to work at scale around a combined patient population to improve each practices ability to recruit and retain staff,
to manage financial and estate pressures, to provide a wider range of services to patients and to more easily integrate with community services and the wider health care system.
Objectives Planned Outputs Highest risks
To ensure governance and oversight of the PCN 1. Single process to have oversight of PCN 1. Insufficient workforce / not
development programme covering: development developed to provide new
2. PCNs delivering the services outlined in specifications.
• Implementation of the Network DES service 2. Non alignment of community
the network DES specifications
specifications nursing teams to PCNs reduces
3. Primary and community care teams
• PCN maturity, development and planning the ability to deliver integrated
delivering integrated patient care.
• Developing adequate and appropriate PCN services
workforce. 3. No single PMO process leads to a
Milestones
• System working and alignment to the ICS lack PCN programme oversight.
• July 2019 –PCNs signed off
priorities; 4. Insufficient Clinical director
• August 2019 – PMO process agreed
• Integration and partnerships support leads to PCN lacking vison
• Sept/Oct 2019 – PCN self assessment and leadership
• Primary Care estates;
completed and development plans 5. Lack of clinical system integration
• Digital transformation and client records
agreed is a risk to effective collaboration
across providers
• March 2020 – PCNs ready to deliver new and patient care
specifications network DES
Key details
1. There are 38 PCNs in Sussex; all with Resources
Interdependencies • £1.50pp to PCN for development
Clinical Directors; across 7 CCGs. Nationally • Community services integration
the PCN programme has been implemented • Legal advice
• PCN and Clinical Director Development • PCN Clinical Director funding
at pace with a national prospectus plan
2. Integration relies on community services • PCN Workforce funds to provide
• GP Forward View Programme new staff
aligned to each network • NHS Long Term Plan • PCN Development fund
• Primary Care Strategy • PCN Accelerator funds
Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG
Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCGPCN Development
• £1.3million allocated for PCN and Clinical Director development across Sussex for 19/20 (recurrent)
• NHSE have launched the following support documents:
• Maturity matrix for PCNs - outlines core components that underpin the successful development of
networks.
• Prospectus - sets out key components that should be used as the basis of any support offer
• PCNs will use the matrix to self-assess their development and prospectus to formulate a development plan
• PCNs will be supported by CCG primary care leads and network events to self-assess and develop plans to
deliver their PCN and ICP ambitions for their neighbourhoods
Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG
Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCGPCN Development – indicative timeline
Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG
Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCGPCN Development - update
• All Sussex PCNs (38) have completed self-assessments against the NHSE/I maturity matrix and begun to
formulate development plans. Monies were allocated to PCNs at end of Q3.
• PCN development funding is overseen by the Sussex CCGs Primary Care Programme Board with approach
to allocation agreed by PCCCs. PCN development monies have been top sliced 10% and allocated equally
between the 38 PCNs to earmark a specific fund for PCNs to use on leadership development. The
remaining has been allocated according to PCN population size.
• Self-assessment of the developmental domains outlined in the matrix indicate similar levels of maturity
across Sussex PCNs.
Below Foundation Step 1
foundation
Leadership, planning and partnerships 2 28 7
Use of data and population health management 2 32 4
Integrating care 1 34 3
Managing resources 3 35
Working with people and communities. 6 29 3
Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG
Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCGPCN Development - update
• The top 3 themes for development identified from our 38 Sussex PCN self-assessments were:
• Organisational Development
• Team development and Support to set up new teams/services
• Leadership and change management
• Other areas identified include:
• Using Public Health population data
• Wider engagement including councils, community, PPGs, patients etc.
• Data analyst support (CCG performance data)
• Vision and strategy setting
• Scaling and connectivity will be overseen by the primary care board. A further update on PCN maturity and
use of resources against development plans will be requested in Q4.
• Review of PCN development monies allocation approach will be undertaken in Q4 by the primary care
board with a view to taking forward proposals through PCCCs in 20/21.
Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG
Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCGPCN development : accelerator sites
To support PCNs to move at pace, ahead of the national minimum requirements, an accelerator programme will be established to
drive progress, support the desired integration of services, and reduce clinical variation across the Sussex STP foot print. The
aims of the programme are as follows.
• To support PCNs across Sussex STP who want to develop faster in 2019/20, and deliver more than the national
Progress PCN specification requirements.
faster
• Test out how PCNs and local health, care or voluntary sector providers can come together to better integrate and
transform care and services for their local population with PCNs as a key part of the local transformation
Integration approach.
• Identify and demonstrate how practices in the PCN can come together to enable local transformation and
delivery of elements of the Sussex STP clinical variation programme and or LTP ambitions in their PCN to
Clinical improve population health.
variation
Four specific areas of focus have been identified, for PCNs to accelerated and respond to the challenges and focus on:
1. Development and acceleration of the PCN through the maturity matrix
2. Delivery / test the Sussex STP Clinical Variation Programme ambitions and requirements (Musculoskeletal falls, Diabetes, and Cardiovascular disease)
3. Delivering the requirements of the LTP (including anticipatory care, personalised care and early diagnosis for cancer)
4. Integrated joint working of the PCN with other providers to better support integrated care, MDTs and improve the PCN population health; and better
integrate urgent or planned care pathways to improve system flow, avoid admission and improve value for money).
Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG
Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCGPCN development - accelerator sites - update
• £20K per PCN across Sussex has been made available to support accelerator sites. The deadline for
submission of bids aligning with the areas of focus outlined is end Q4 19/20.
• As of end December 2019 – 21 PCNs submitted bids for this funding. Bids were evaluated by the Primary
Care Development Group, which has representatives from NHSE, the LMC, primary care clinical and
commissioning; and approved through the primary care board.
• The bids can be broadly categorised into three areas;
a. Bids that support PCN and community provider integration and plans to redesign some services to meet the
PCN population health needs
b. Bids that support the MSK clinical variation programme and the introduction of First Contact Practitioner
roles
c. Bids that support PCN governance and maturity and bids that support the early diagnosis of cancer.
• Deployment of funding will be monitored and outcomes reported through the Primary Care Board.
Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG
Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCGPCN development – additional accelerator sites - update
• An additional £20K accelerator opportunity has been made available for up to 10 PCNs only who can
demonstrate that they will use the additional fund to progress initiatives and plans either at a faster pace, or
greater scale. The criteria for the additional PCN funding includes:
• Readiness to share the learning
• Fast tracking the project
• Patient outcome focused
• Focused on integrated teams addressing a PCN population need
• 24 PCNs have bid for the additional accelerator funding across Sussex.
• Bids are being reviewed through the primary care development group for decision on the 10 sites that will
receive monies, for final approval via the Primary Care Board in February 2020.
Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG
Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCGPCN and provider engagement, integration & partnerships
• All PCNs are at a different place in their maturity, ambition and aspiration. There are many local examples of integration of primary and
community services in PCN neighbourhoods and places across Sussex.
• A PCN development and engagement programme is being developed to provide the forum to build on and share the learning from these
examples of joined up care, supporting PCN CDs to engage with local voluntary, acute and community care providers, stakeholders and the
public.
The purpose of these PCN provider forums are for PCN CDs and local providers to :
• Review the PCN population health data and agree priority areas for focus to improve PCN population health
• Develop population based commissioning and delivery and further develop plans to join up care
• Formation of integrated multidisciplinary care configured around PCNs neighbourhoods
• Development of Integrated Care Partnerships
• Gain consensus on how to get PCN CD provider voice and representation at system / place / local forums
• Share examples of best practice and learning and feedback from wider meetings
• Support PCNs to identify how to best engage with and listen to the public and patients
Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG
Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCGPCN network forums
• We have established PCN Network Events across Sussex PCNs to support partnership working, PCN
development and integration throughout 20/21.
• The next PCN Operational Event is on 21st January 2020 at the Amex, Brighton.
• The next Sussex Wide PCN Event is on 18th March at the Amex, Brighton.
• The focus of these sessions will be around the following areas
• Understanding and utilisation of population data
• Supporting implementation of the DES service specifications
• Citizen engagement
• Partnership working and integration
Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG
Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCGPrimary and community care - a landscape for integration
Primary Care Commissioners
Integrated Care Strategy
Provider Partners • Local authority
GPFV priorities council partners
• PCNs PCN development
• Social care Practice resilience (borough, district,
• Physical and Mental Workforce plans unitary & county)
Health • CCGs
Primary, • NHS England
• Voluntary sector community &
• Independent sector acute, health and Local (NHSE)
care providers general
delivering the practice
Long Term Plan resilience
priority areas needs
Local engagement
• Public STP
• Patients Population
• Patient Health
Check
representative
groups, including
general practice
PPGs
Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG
Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCGIntegrated care
model operates at You can access a wide
range of professionals
three levels, and is within primary care, who
underpinned by will work together to
support your social, Seamless end to end care In your local area
three fundamental physical and mental health across all services to (~250-850k
Extended access to needs wherever you live
building blocks. GP appointments and
provide the best possible
outcome for you along a
population), primary,
improved access to online community and local
coordinated pathway hospital services will
resources
provide joined-up
You, your family and place-based care
Each neighbourhood We will provide through Integrated
carers will be supported to
(30-50k population) will have the knowledge, skills Services health and social Care Partnerships, at
Prevention
be supported by a and confidence to self- to improve
designed to care at or as close or close to home.
address the to home as possible
Primary Care Network manage your health and population wider
wellbeing to start well, live health and
where a range of wellbeing
determinant
well, age well and die well s of health
professionals work with
you to manage your
social, physical and All decisions about your
Enabling people to
mental health needs. manage their own care will be inclusive:
We will share best health and care made with you
better, supported by
practice and use our skills services
and knowledge to deliver
safe and coordinated care
for you in your home,
We will
local community, hospital In Sussex (1.8m
Care will be based on the harness
and beyond
research and
population), we will work
best knowledge available in partnership to deliver
innovation to
Hospitals will work together to provide the meet local high quality specialist and
best quality, safety, value and equity of care needs complex services to
in a timely manner achieve the best
outcomes based upon
Digital Workforce Estates
the best knowledge
available.
Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG
Hastings and Rother CCG | High Weald Lewes Havens CCG | 29
Horsham and Mid Sussex CCG 29Next steps
Primary Care Strategy
• Finalise the Primary Care Strategy at Governing Bodies – November 2019
• Gain and incorporate stakeholder and membership views on Primary Care Strategy
PCN development
• Develop aggregated plan for PCN development and implement process for support funding
• Deployment of advanced accelerator monies
• Implement Sussex wide process for ARRS and support workforce expansion and retention
• Provision of data offer PCNs for segmentation and stratification to support specification delivery
• Support PCNs to prepare for the delivery of the new services specifications
Integration of primary, voluntary, community, acute, health and care services
• Establish Sussex wide PCN, place based and individual PCN and provider
• Support the Primary Care Networks in Sussex to work as part of an Integrated Care Partnership providing care to each neighbourhood
• Support PCNs to engage with the public, patients and stakeholders in the design and development of PCNs and Integrated Care
Partnerships
Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG
Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCGYou can also read
