Agenda item

This report summarises the work and legacy of the Encompass MCP vanguard. This was a 3 year New Care Model which received NHS sponsorship and scrutiny between 1 April 2015 and 31 March 2018. This report will be accompanied by a presentation.

Discussion:

The Chair, Encompass MCP presented the Joint Board with a presentation on the work and legacy of the Encompass Multi-Speciality Community Provider (MCP) Vanguard. It was explained to the Joint Board that following a successful bid securing 3 years of funding, the Vanguard was established and was comprised of 14 GP practices representing circa. 180,000 patients. The Vanguard operated across 5 community hubs and brought together: health, social care, the voluntary sector and the community to work together at scale, as an integrated system of care, around the patients’ health needs, offering hub level services to populations of circa. 50,000 people (with the exception of Sandwich and Ash which had a smaller population density).

One of the foremost achievements of the Vanguard was the development of Multi-Disciplinary Teams (MDTs). These MDTs drew expertise from a range of professionals, which could be tailored to suit the local area and in some instances included the Police, Fire and Rescue and Housing Services. MDTs worked together across the footprint of the Hubs to create anticipatory care plans for the individuals within the Vanguard.

The Joint Board was advised that there were four strands to the work of the Vanguard centred around the GP Practice, these were:

1.    Routine, Prevention and Proactive Care

2.    Emergency and Reactive Care

3.    Acute Care

4.    Tertiary Care

It was explained that the Vanguard considered four population cohorts ranging from the individuals that were considered to be the most vulnerable and frail with multiple co-morbities to those that were generally well. The Vanguard initially concentrated on the cohort which was considered to be most vulnerable and frail who had the most need and expended the most resource (analysis showed that this cohort represented circa. 6% of the population but utilised 80% of the total expenditure on emergency admissions across the whole population in the Vanguard).

It was explained that in total there were 12 workstreams which were set out for the Joint Board in a Directory of Services. Some of the focus areas included:

1.    Health condition management which involved moving some services, historically provided within a hospital setting, into the community, extending the roles of GPs and other health care professionals. Fast access to services within the community avoided attendance at A&E.

2.    Supported self care which aimed to support people to make healthier lifestyle choices to avoid preventable diseases. This included social prescribing undertaken in collaboration with Red Zebra, providing a single point of access for GPs to enable them to signpost individuals to one or more voluntary organisations who could provide further support. The Vanguard also developed Health Trainers (Lifestyle Coaches), an initiative in schools to keep children active and lastly, the Vanguard developed a Waitless App which provided real time data on Minor Injury Units (MIUs) and A&E departments in east Kent.

With respect to achievements made over the three years, the Joint Board was advised patient experience had improved and there had been a reduction in short stay admissions by 33.1%, a reduction in A&E minor attendance by 6.4%, a reduction in emergency admissions by 8.2% and in relation to a specific project, a reduction in Catheter related admissions by 22.6%. Overall it was forecast that this represented a £3.4m net saving.

With respect to next steps, it was explained that the CCG had continued to support the funding of the 12 workstreams of the Vanguard. The Vanguard had also helped define the model for Local Care across Kent and Medway. Referring to the emerging national health system model, it was noted that there was a plan for each of the 8 CCG localities, within Primary Care Networks, for Local Care which had been developed across Health, Care and the Voluntary Sector to build on the model of the Vanguard.

Local Care Deliverables for 2019/20 included:

·         Delivery of all the elements of the MDT model for frail and elderly, embedding all components i.e. urgent and emergency care, Home First, care navigation and end of life care;

·         Embedding mental health into the MDT model, including dementia support; development of a a menu of services needed to support people, from wellbeing to severe mental illness

·         Developing the MDT approach for children and young people with complex conditions;

·         Upscaling of care navigation / social prescribing; and

·         Providing support for carers, including developing the next stages of the Carers App.

Members raised a number of questions, including:

Estates - In response to a question concerning the experience of the Vanguard finding suitable and affordable properties, the Joint Board was advised that it was a challenge to obtain a property stock correct for this new model of care. It was considered that the Estuary View Medical Centre in Whitstable was an exemplar facility which could be reproduced, subject to funding availability.

Services for children and young people - With respect to a question concerning services for young people, it was explained that the Vanguard introduced the daily mile within some schools. As a result of this intervention, the fitness of children increased, obesity reduced and concentration levels increased within the school environment. The Chair, Encompass MCP, added that he would support further learning within schools on subjects such as First Aid and CPR. In addition, it was considered that schools were an important community resource and should be open outside of school hours for purpose of increasing access to physical activity.

Financial savings - Clarification was sought on the realisable savings made as a result of the Vanguard. It was explained that a £3.4million saving was made on the cohort of the population within the Vanguard. It was added that real savings could be achieved if the model was upscaled which would allow for the hospital bed stock to be reduced.

Social isolation - With respect to a question on social isolation, the Joint Board was advised that circa. 80% of the patients referred into the social care programme were people suffering with social isolation. These individuals were supported by voluntary sector through Red Zebra Service.

Mental Health - A Member supported the aim of health condition management in ensuring that mental health was given the same level of importance as physical health.

Decision:

The Kent and Medway Joint Health and Wellbeing Board thanked the Chair, MCP Encompass for his presentation and noted the overview of the Encompass MCP Vanguard.