Agenda item

Transformation Fund Review - Primary Care Proposals Inclusive of Focused Care

Minutes:

The Commissioning Partnership Board gave consideration to a report regarding the GM Transformation Fund Investment Review and Assurance Process and provided with an update on progress against the implementation of transformation proposals for health and social care.   The report also provided an update on the due diligence work that had taken place around Primary Care proposals which had been approved in February 2019 which recommended that the Advance Visiting Service and the Health Champions Scheme would commence whilst the Express Care Hub required further development and appropriate sign-off of the medical workforce model before implementation.

 

It was recommended that £1m be ring-fenced from transformation funds for focused care related activity.  It was recommended that £501k of funding be allocated to the current provider Focused Care CIC for 2019/20 to support the ambition to roll out to 23 practices which would provide full population coverage.  Focused care workers would be based in practices identified by the greatest need which were identified by deprivation ranking but any practice could refer into the service.  A wider-place based procurement exercise delivering similar targeted interventions to cover delivery from 1st April 2020 would be undertaken by Oldham’s Integrated Commissioning Function using the remaining ring-fenced transformation funds.

 

The Board were assured that the £21.3 m Transformation Funding had been allocated across Oldham Cares Transformation Programmes and continued to support care pathway development in Oldham for place-based prevention, community resilience and care closer to home in line with local, regional and national requirements.

 

The Board were informed of work over the last period on investment through the Locality Plan, Thriving Communities and Focussed Care.  New proposals evolved from the NHS Long Term plan meant that the Locality Plan would have to be redone for Health and Social Care.  This provided an opportunity to better link the plan with other strategies such as Housing.  Conversations would begin over the next couple of months.

 

Focused Care was an approach pioneered in Oldham and was not to be underestimated.  It was in response to the triad of clinical complexity, social complexity and poverty in Oldham and was a key part of integrated working.  Focused Care was already in operation in some GP practices across Oldham.  The initiative had been designed in a way to take pressure from GPs and help people in a different way as those who presented themselves at surgeries did not always need medical help.  Focused Care was a complementary model to Oldham’s new models of care working side by side with an emphasis upon operational integration.  The Focused Care Workforce model was being assessed and evaluated.  It would be looked at as part of the wider primary care and social care workforce strategy. 

 

The Board were also provided with an update related to the express care hub.

 

Members were informed and supported that the service was more than a financial investment but resulted in life improvements and chances.  It was noted that this sat alongside Thriving Communities and Place Based Initiatives.

 

Members were informed that the Homelessness and Advice Service had returned to the Council which assisted residents with a number of issues.  The Board were informed that the Council had also taken back control of the housing register and that data was contributing to the approach to housing which also fed into early prevention.  It would be helpful to review the opportunity to bring everything together.  The Board were informed of the early prevention review which was ongoing which included targeted intervention and interconnection of services.  There was no ‘wrong front door’.

 

Members also discussed the governance process related to the commissioning of services which included the role of the Commissioning Partnership Board, Cabinet and the Health and Wellbeing Board.  The Board were informed that a review had been commissioned to look at the range of governance to achieve clarity and simplicity.  Members requested that this included engagement with members.  The Board welcomed the Governance Review.

 

 

Options/Alternatives Considered

Option 1 – The Commissioning Partnership Board are asked to agree the recommendations.

Option 2 – The Commissioning Partnership Board not to agree the recommendations; this puts transformation funding set aside for the Oldham Locality Plan and winter resilience at risk as it will delay decision making and, so, funding is likely to be re-assigned to another GM Locality Programme.

 

RESOLVED that:

 

The contents of the GM Transformation Fund Investment Review and Assurance Process Update and Approval of Further Schemes Report be agreed and assurances noted that:

 

1.         The transformation proposals continued to support the delivery of the Oldham Vision and Outcomes Framework for the people of Oldham as well as the national NHS requirements for service developments.  The proposals enabled a sustainable Health and Social Care System closer to home and reduced the reliance on acute hospital services.  The proposals delivered Oldham Cares’ commitment to create a health and social care system which was focussed on prevention and early intervention in our “Thriving” Communities.

 

2.         The outstanding equality impact assessment for the Focused Care proposal had been assessed by GMSS with no outstanding issues as shown at Appendix A of the report.

 

3.         The governance process for the allocation of transformation funding and the development of the plans had been followed for all the proposals for Integrated Community Care.  The proposals approved by the Commissioning Partnership Board related to Thriving Communities, Start Well (Avoidable Admissions), Mental Health and Community Enablement were now in the delivery phase of transformation as per the previous CPB reports.

 

4.         Due diligence for the Primary Care proposals related to the Acute Visiting Service and Health Champions was not complete and had been approved to move to delivery.  The Express Care Hub required further development of the medical model by Oldham CCG’s Chief Clinical Officer and the Strategic Director of Commissioning with South Cluster.

 

5.         The risks highlighted in the report had sufficient mitigating actions to reduce their likelihood, which included ensuring adherence across the system to implementing gateway review points, the evaluation of pilots and a robust change management methodology.  Oldham was working with GM and the national vanguard evaluators on a three year evaluation programme of transformation.

 

6.         Release of funds by Oldham Care (CCG fund holder) would be subject to:

a)         Confirmation that proposed service changes would deliver sufficient savings both to contribute to the financial sustainability challenge and cover the incremental costs of the new service.

b)         A quarterly review process, assuring the Commissioning Partnership Board that adequate progress was being made.

c)         An equality impact assessment would be produced for each proposal.

d)         Required procurement rules (inclusive of OJEU) would be adhered to and legal advice sought and considered.

 

7.         Transformation funds in the amount of £1m had been ringfenced for focused care related activity.  It was agreed that £501k be allocated to the current provider Focused Care CIC for 2019/20 to enable the roll out to 23 practices in 2019/20 which would provide full population coverage.  Focused Care Workers would be based in practices identified by the greatest need as identified by deprivation ranking but any practice could refer into the service.  A wider place-based procurement exercise to deliver similar targeted interventions to cover delivery from 1st April 2020 would be undertaken by Oldham’s Integrated Commissioning Function using the remaining £499k ring-fenced transformation funds.

 

8.         Information management was an important consideration in the development of integrated services.  Information sharing remained a risk to the Oldham system that resource for the development of information governance policy and guidance needed to be identified at a one Oldham Care level.  It was approved that IG specialist resources be made available for Oldham Cares (commissioning and providers) and, where additional transformation funding was required, the Joint Leadership Team would agree an allocated sum from its already delegated ‘Seed Funding’ pot and in line with GM Transformation Funding guidelines.

 

Supporting documents: