Keep up to date with NHS reorganisations by learning from Cheshire
The aim of this article is to help interested parties understand where the NHS is moving from discussion some of the local changes in Cheshire. Its taken from a briefing document that my colleague Dr David Holden GP - created for local GPs.
It will be in short note form - feel free to ask questions! Different initiatives will be happening around the country but main themes are the same. I am looking at this from a primary care perspective.
STPs are now HCPs
- Health and Care Partnerships are what were called Sustainability and Transformation Partnerships.
- There are now 44 partnerships (prev. sustainability footprints) across NHS England called Health and Care Partnerships
- Ours is Cheshire and Merseyside covering a population of 2.5million people including 12 CCGs and 20 large providers of services
- They are shaping even now the future direction of healthcare in our local areas and deciding how services should be delivered
- https://www.cheshireandmerseysidepartnership.co.uk/
- The HCP is providing the overall strategy for health and care on a large footprint
- It has been divided up into “Places” based on council boundaries.
- On this map as you will see there is no “Central Cheshire” (ie South Cheshire and Vale Royal as now!)
- So all services and practices will now be in either in Cheshire East or Cheshire West depending on the boundaries shown (this is an issue as SC & VR traditionally work together and this will split them also patient flows from VR tend to be to MCHFT which is in Cheshire East. A single Cheshire place would make a lot more sense… but is unacceptable to the politicians at least until a single cheshire unitary authority comes along…)
More info:
https://publications.parliament.uk/pa/cm201719/cmselect/cmhealth/650/650.pdf
Document from health and social care committee in parliament (pages 4-7 provide a summary of journey so far)
https://www.kingsfund.org.uk/publications/making-sense-integrated-care-systems
Kings fund paper describing various aspects of changes – first two sections probably most helpful
Place
Our “Place” is important, as this is the unit within which our local Integrated Care Partnership will be based
Our “places” have both a medical director, senior responsible officer and strategic development boards and are also working rapidly towards the formation of an integrated care partnership – which is….
Integrated care partnerships (ICPs) are alliances of NHS providers that work together to deliver care by agreeing to collaborate rather than compete. These providers include hospitals, community services, mental health services and GPs. Social care and independent and third sector providers may also be involved. – Kings fund 2018
Those practices in Vale Royal CCG are in the “Cheshire West Place”
Those practices in South Cheshire are in the “Cheshire East Place”
The integrated care partnerships within those places are as yet unformed but there are negotiations going on about the relationships between providers and indeed how practices integrate with them
Care Communities
Care Communities are smaller delivery units within each “place”
There are multiple care communities which have formed over the last two years and you will (hopefully) be aware of them as your practice is sending representatives to attending their steering group meetings
Over time it is (likely) intended that these will increase in their size and scope and include managers from primary care, community service teams, social care mental health, patients, third sector and administrative staff with an overall GP clinical lead.
With an eye on the future they are likely to become the local delivery model or hub for the whole of health and social care
Once the ICP structure and function is decided then Care Community function, expectation and capability can expect to be increased
•In Cheshire currently four separate CCGs (East, West, South and Vale Royal)
•All have been given permission by their respective memberships to make provisions and work towards a merger.
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•However this will not be formally signed off until mid-2019 by all four memberships
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•This larger CCG will have a more strategic role as it develops and reduce day to day operations
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•An accountable officer is being appointed across all four CCGs in anticipation of this and a board is being selected
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•The CCGs are also discussing with members how all the practice representatives (members) engage with this larger and more distant CCG
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•This will become more visible as the proposed merger dates near and then the memberships will have a final say on whether they accept the new proposed arrangements and formally merge or not
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•The proposed Pan Cheshire CCG will be arranged as follows across the two places…….
•Primary Care has to choose how it engages and prepares itself to function within the new structures emerging
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•Care Communities are likely to become increasingly important
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•The CCG will be more distant
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•GPs can choose to be an active part on the board of the ICPs or accept the terms and conditions which fall out of them
•The upcoming new primary care contract negotiations are important and are likely to include an imperative to integrate with other services
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•Funds from the CCG are likely to be allocated to the ICP who will then pass on via Care Communities rather than being paid to primary care direct so there is a challenge to income streams with the possibility that other providers will be sought if local GPs cannot or will not provide desired services
•There are no easy answers and the rules are being decided as we go along
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•One thing is clear though – that if primary care wishes to bid for services there will need to be consistency of offer and approach in order to attract funding and business from the ICP
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•So whatever the arrangements are, the need to work together in a smooth, consistent, uniform manner for our care community populations will be the key to success
This is all my own personal view/ interpretation/ summarisation and intending as a aide-memoir/ discussion piece/ info for others to help them perhaps understand what is going on in their area - Dr Neil Paul