1

2

CHEADLE & BRAMHALL NEIGHBOURHOOD

ENGAGEMENT WORKSHOP SESSION TWO

4 AUGUST 2015

3

Purpose• To produce a draft Memorandum of Understanding and proposal for seven day

working delivery; for the Bramhall & Cheadle Hulme and Cheadle, Gatley & Heald Green neighbourhoods

Outcomes• Have reviewed the outputs from session one together• Be aware of the Stockport Together partnership values and behaviours

framework and relevance to the Memorandum of Understanding• Have identified the key components for the Memorandum of Understanding for

the Bramhall & Cheadle and Cheadle Hulme, Gatley & Heald Green neighbourhoods

• Have drafted an outline proposal for how seven day working will be delivered in the Bramhall & Cheadle and Cheadle Hulme, Gatley & Heald Green neighbourhoods

4

Outputs from Session One

• Strengths• Willingness for collective responsibility• Range of specialist skills• Good networks with other providers and within

neighbourhoods

• Weaknesses• Delivery and integrating the change• Workforce shortages• Accommodation

5

Outputs from Session One

• Opportunities• Sharing expertise and skills with improved integration and

communication• Opportunities for more local commissioning of services• Neighbourhood Specialists - use of GPSI and Specialist Nurse clinics• Increased chronic disease management

• Threats• Access to SHH as preferred hospital already stretched• Manchester residents and access to a Stockport service• 7 day working and support services• Lack of engagement/resistance

Neighbourhood Approach

Development phases

Core teamGPs , DNs, SWs

Core teamPlus 3rd sector

Core teamPlus 3rd sectorMental Health

Core team Plus 3rd sector, Mental Health, Therapy, Intermediate tier

Full new Out of hospital service with prevention, planned and urgent links

Plan Do

Study Act

Plan Do

Study Act

Plan Do

Study Act

Plan Do

Study Act

Plan Do

Study Act

8

Update

• Devolution Manchester• Progress• Milestones• Worth a read: THE FORWARD VIEW INTO ACTION:

New Care Models: update and initial support. http://www.england.nhs.uk/wp-content/uploads/2015/07/ncm-support-package.pdf

• Our submission

9

What is a ‘Memorandum Of Understanding’ (MOU)

• All discussions between the Parties and their representatives regarding the subject matter of this document are subject to developing contracts. Nothing in this document shall constitute a legally binding obligation.

• It is will be used to demonstrate intent and collaboration between practices.

• Sets out precursors for information sharing agreements

10

The Stockport Together NeighbourhoodGP Practice MOU

Describes:• Working behaviours• Clinical Input into the proactive care service• Clinical leadership into the neighbourhood teams• Routes to develop joint financing mechanisms, joint contracting,

service delivery and efficiency share.• Describes the neighbourhood relationship between practices and

into the wider team in its initial form.• Is an understanding that as financial support and services are

developed that you agree to work in a collaboration.• What else........?

11

 What is expected today?

• Need to discuss what should be in the agreement• Not to finalise a MOU but allow its content to be

determined for other professionals to complete• Make you aware of the potential routes of travel and

outcomes• The journey is not defined and the outcome is in

development

12

Memorandum of Understanding conversation

• What do you want to be included?• What don't you want included?• What are your hopes?• What are your concerns?• How will we introduce and embed it?• Who will commissioners contract with?• How will practices share income & expenditure?• How will shared staff be employed and by who?

13

CHEADLE & BRAMHALL NEIGHBOURHOOD

7 DAY GENERAL PRACTICE

How to make it workable & sustainable?

14

What we know so far…

• PMCF/Demonstrator• Stockport GP Development scheme• DevoManc• Vanguard• Stockport Together - Neighbourhoods

15

Neighbourhoods:Integrated Team hours (proposed)• Mon – Fri 8am – 8pm• Sat 10am – 6pm• Sun 12pm – 6pm

• 8 Neighbourhood Integrated Teams

16

Current Provision

• Core Hours 8am – 6.30pm Mon – Fri

• EH DES 30 min/1000 patients per week

£1.90/patient = £570,000 for Stockport

• CCG GP Development Scheme

“Doubles the DES”

£10/patient overall

approx £2/patient for EH

17

GM NHSE 7 day Delivery Plan

• Healthier Together:

‘by the end of 2015, everyone in Greater Manchester who needs medical help, will have access to primary care services, supported by diagnostic tests, seven days a week.’• £7 million identified by NHSE to support 7 day working• CCGs to bid for slice of the pie

18

GM NHSE 7 day Delivery Plan

‘Must haves’• ‘Hub’ based model• Additional capacity Mon-Fri• Minimum 6 hours Sat & 4 hours Sun• Some same day access but majority can be prebookable• IMT/IG infrastructure to support shared records access• Path lab services should be available• Targeted at those in most need to reduce reliance on

secondary care• To commence by December 2015

19

What would we do in Stockport?

• Hours? 8am-8pm M-F, 6h Sat, 4h Sun

• Where? Practice, Neighbourhood, Locality, Borough

• What? ‘minor illness vs Proactive/LTC/Prevention

• Skill Mix? GP, PN, HCA, Admin, ANP, Pharmacist

• Who? All reg pts, CDM/complex

• INT? How to support?

• OOH/111? How to streamline?

• Contract? Practice, MCP, Viaduct (?employer), funding flow

20

What would we need?

• Diagnostics – Path lab collection, ?Xray

• IMT – single appts/records system

• Estates

• IT support, cleaners, security etc

• Live data sharing with INT (?Skype)

21

An Example

• Weekday (Neighbourhood based – 8 across Stockport)– 18.30 – 20.00 hrs, Monday - Friday– One practice each evening, offers appts to all neighbourhood– GP x2, PN x2, HCA x2

• Weekend (Locality based – 4 across Stockport)– Sat 10.00 – 16.00, Sun 12.00 – 16.00– Locality Hub, offers appts to 2 neighbrouhoods– GP x2, PN x2, HCA x2

22

Delivery of seven days working conversation

• In neighbourhood teams, identify the goals, reality, options and way forward for the delivery of seven day working