Achieving vertical and horizontal integration: working with partners

Achieving vertical and horizontal
integration: working with partners across
primary, community, social and secondary
care to provide a better level of service to
patients
Sarb Basi, Managing Director,
Vitality Partnership
Realising the potential of primary care
Current Political Context
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Managing Long Term Conditions
Reducing demand on hospital care (urgent care)
Shift of care into community settings
Increased demand for primary care
Better value from GP contract
Focus on ‘demonstrating quality’
NHSE/CCG/PH commissioning intentions
Drivers for change
• Need for greater GP involvement in driving better care…
but can’t wait for commissioning led innovation
• Fragmented general practice infrastructure a barrier to
reducing hospital activity and service redesign
• Poor quality primary care remained largely unchallenged
by commissioners
• CQC will start shutting down poor general practice
• Current GP model unsustainable: economics,
demographics
• Transformation of non-clinical and clinical capabilities is
overdue
Future of Primary Care
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The patient voice at the heart of all provision
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General practice should be the ‘locus of community based
integrated services at scale’
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Specialist expertise is an essential component
of effective integration
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Integrated services to incorporate social care
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Technology is an enabler to manage demand
All quiet on the western front
GP partnerships will be gone in ten
years, says NHS England official
Dr Mike Bewick
He also said that he expects each new
provider model to accommodate around
300,000 patients - similar to CCGs
the current organisational structure of
primary care is no longer ‘sustainable’ or
‘desirable’
Andy Burnham: Why general practice
should move towards a salaried model
Shadow health secretary Andy Burnham talks
exclusively to Pulse about why GPs should be
predominantly employed by large health and
social care organisations
17 September 2014
10 September 2014
Practice closures set to widen GP
privatisation
All new GP contracts will be thrown out to
private providers under APMS, in a move
described as the ‘death knell’ for traditional
practice
09 September 2014
Practice hands contract back after four
partners are forced to resign
Four partners in a practice in a deprived area
have been forced to take the decision to resign
and hand back their contract to NHS England
due to problems recruiting partners.
15 September 2014
GP Provider led innovation
• GPs need to lead and own the transformation of General
Practice
• Do not wait for policy or national direction
• The status quo is not an option so lead or work with other
innovators
• Future proof the professional with a proactive and
progressive model NOT from a protectionist approach
• Embrace the future landscape and opportunity to provide
at scale
• Think differently – there is no limit to the possibilities
• Partner with like minded NHS providers
Emerging Models in General
Practice
Consultation
Traditional Practice Model
Collaboration
Federations
Full
Merger/Integration
‘Super Partnerships’
(Sole trader, multi-partners)
2k – 15k patients
30k – 500k patients
80k + patients
Size Matters
• Specialist Services
• Intermediate care
• Mental Health
Workers
• GP practices
• Pharmacy
• Dentist
• Optometrist
• Social Workers
• Health & Well Being
• 3rd Sector
Secondary
Social
Primary
Community
• District Nurses
• Health Visitors
• Physiotherapists
• Case Managers
Vitality Partnership
Vitality Birmingham
• 2009
26k
• 2010
32k
• 2011
38k
• 2012
40k
• 2013
58k
• 2014
68k+
• 2015
150k+
(CCG, 550k)
Vitality Walsall
Vitality Leicester
Vitality London
• 10 mergers
• 21 partners
+ 3 associate
+ 2 fixed share
• 5 PMS and 4 GMS contracts
• £12m+ turnover
• 250+ staff
• NHS specialist services
• Private services
• 13 primary care sites (plus
university sites)
• Integrated IT: EMIS Web across
all sites (except one)
Integrated/Additional Services
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Rheumatology
Dermatology
Orthopaedics
Immunology
Substance Misuse
X-ray
Zero Tolerance
Physiotherapy
Podiatry
Osteopathy
•ENT
•Urology
•Gynaecology
•District Nurses
•Intermediate Care
•Healthy Communities
Collaborative
•Pain Services
•Private Services
Our Horizontal Integration
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Acute and Community Strategic partnerships
Health and wellbeing services
Social Care
Mental health
Public Health and population management
3rd Sector
Innovative Organisational
Dynamic
Provision at scale
Vitality Partnership
Primary Care Demand (1)
NOTE: Analys is by c alendar years
copyright QRESEARCH 2003-2009 (Database version 22)
20
08
20
07
20
06
20
05
20
04
20
03
20
02
20
01
20
00
19
99
19
98
19
97
19
96
19
95
0
1
2
3
4
5
6
QRESEARCH crude consultation rates per person-year
All clinicians and all locations (England)
Primary Care Demand (2)
Age band
Males
NOTE: Analysis by calendar years
copyright QRESEARCH 2003-2009 (Database version 22)
Females
ye
ar
s
90
+
ye
ar
s
9
ye
ar
s
4
85
-8
ye
ar
s
80
-8
9
ye
ar
s
75
-7
4
ye
ar
s
9
70
-7
ye
ar
s
4
65
-6
ye
ar
s
60
-6
9
ye
ar
s
55
-5
4
ye
ar
s
50
-5
9
ye
ar
s
4
45
-4
ye
ar
s
9
40
-4
ye
ar
s
35
-3
4
ye
ar
s
30
-3
9
ye
ar
s
4
25
-2
ye
ar
s
9
20
-2
ye
ar
s
15
-1
4
ye
ar
s
10
-1
9
5-
0-
4
ye
ar
s
0
5
10
15
QRESEARCH crude consultation rates per person-year in 2008
All clinicians and all locations (England)
Digital Vitality – Our Consumers
• 82% of UK population
using broadband to
transact…
• <1% of patients using
the internet to interact
with clinicians!
• Birmingham has
highest penetration of
smartphone use in the
U.K….nearly 30%
more than London..
We have the population
and capability to shift the
balanace of provision to
the web!
Digital Vitality
Digitally enabled transformation of healthcare is not about
systems, data, technology, analytics….or any of the usual
NHS IT/Informatics stuff….
Delivering real change is about changing the business
model, through the power of the internet, to create new
provider models….engaging consumers in new, highly
efficient and scalable ways of actually receiving a service.
IT/Informatics operates at the margins of
healthcare….Digital is the future of healthcare delivery!
Our Digital Operating Model
Our Digital Capability Model
Making it Happen –
www.vitalitypartnership.nhs.uk
Further reading