This week’s message is sent from Rob Webster, CEO Lead for West Yorkshire and Harrogate (WY&H) Health and Care Partnership. You can find out more about our partnership.

Hello my name is Rob and welcome to this week’s update

It was genuinely pleasing to see that 97% of practices in Yorkshire & Humber are now rated good or outstanding in the latest Care Quality Commission Report on the state of general practice. In a period of significant pressure, our practices have both improved and achieved very high standards. This is a very good platform from which to invest in and build good primary care services, with general practice as the cornerstone of good care.

Supporting general practice and effective new models of primary care is good for local people and good for the overall system. Our primary and community services work stream is looking at how we achieve this in each of the local contexts within which we work. The emergence of GP Federations as a provider block is a positive move. Placed alongside effective local medical committee (LMC) engagement and innovative community, voluntary and social care services we have the potential to improve care.

The National Association of Primary Care (NAPC) have been quietly getting on with showing how this works in practice and published a new suite of documents on the “primary care home”. Whatever you think of the name, there is something very compelling about a model that allows practices and services to be very locally based and operate at scale when needed too. People want and need locally tailored services with teams they know for frailty, long term condition management and so on.

They also want something that can operate locally when needed and are happy for that to be shared local resources. Specialist therapists, social workers, nurses and community based diagnostics are examples of this shared resource. What’s emerging is that “primary care home” or neighbourhood style models will form the basis of many “accountable care partnerships” in each of our six local places. The NAPC resources and evidence shows it works for people and practices.

Our draft plan sets out extra investment in primary, community and social care services growing faster than those in hospitals. This will only be possible if we are able to manage demand in communities and deliver efficient services in hospitals. Part of this will be ensuring that we have really strong community services, really effective hospitals and a consistent interface between the two. Hospitals shouldn’t have to work differently to discharge patients on their wards because there are different administrative processes with community providers they serve. Similarly, admission protocols for ambulances, community services, social and primary care should be clear and standardised as much as possible. This may all sound sensible and practical – getting there requires a coordinated and collaborative effort. This is one of the reason we have the partnership and we will be progressing this work as a priority.

Understanding the difference that we make with our financial resources is part of our financial strategy work, requiring the biggest areas of change in relationships and behaviour. If we are differentially investing in services outside hospital, we need to develop better approaches to risk sharing. We also need to build on the good work we have done on sharing financial forecasts across the system and our varying financial positions.

The leadership executive group, met on Tuesday, with this topic very much on the agenda. Nick Hex from the York Health Economics Consortium joined the meeting to discuss financial planning. This complements the work Jonathan Webb (STP finance director) is leading on to develop a better understanding of the combined commissioner and provider control totals across WY&H and at place. Discussions continue on what we can do locally to make this a reality in the way we work and the leadership day on 3rd October will include feedback from the team and next steps on building a credible plan.

On Thursday, I spoke at the Chartered Institute of Public Finance and Accountancy / Healthcare Financial Management Association conference on integration. The role of financial professionals in STPs cannot be underplayed. Our progress on the financial strategy is consistent with many places across the country. It was good to see we are doing some things well and that there are things we can learn from other places too. Our finance leaders will be crucial in delivering a strategy and risk/reward framework for WY&H. The finance group is a strong part of the WY&H partnership and I am confident we can deliver a greater understanding of our strategy, the choices we will need to make and their consequences. This will also allow is to move to greater autonomy sooner, with more control over capital and transformation funding.

We are moving into an important phase of our partnership. We are on with the development of a system wide Memorandum of Understanding that articulates the arrangements between us and the arrangements with the centre. This will be discussed widely and it is also essential that we build effective and meaningful political leadership in the process. Learning from Canterbury underlines the importance of this – and on sticking to what makes the biggest difference. In their case, really effective joined up services and primary care teams that support people in communities and keep hospitals functioning effectively. We have the chance to replicate this here. We shouldn’t waste it – or underestimate the effort that this will require.

Have a good weekend

Rob

What else had been happening this week?

System Leadership Executive Group

The Executive Group received a presentation on maternity services from Anne-Marie Henshaw, Head of Midwifery and Associate Director of Nursing, Calderdale and Huddersfield Foundation Trust, Carol McKenna, Chief Officer for Greater Huddersfield Clinical Commissioning Group (CCG) and Karen Poole, Head of Children’s and Maternity Commissioning, NHS North Kirklees CCG.

The National Maternity Review ‘Better Births: Improving outcomes of maternity services in England’, sets out the wide-ranging proposals designed to make care safer and give women greater control and more choice.

Here in WY&H we have established a Local Maternity System Board (LMS) with reps from across the area including midwifery, public health, Yorkshire Ambulance Service, the clinical network, commissioners and obstetricians. The LMS will need to put in place effective operational and clinical governance which will enable it to operate effectively across organisational boundaries.

By October 2017, we will need to have a final LMS plan that will deliver on the shared vision of Better Births and the work streams of the National Maternity Transformation Programme. The LMS plan has to be implemented by 2020/21.

Urgent and emergency care network event

An integrated urgent care event took place on Wednesday. Led by Carol McKenna, Chief Office Greater Huddersfield CCG, there was good representation from our clinical commissioning groups, NHS England, nursing, ambulance services, adult social care, dentistry and pharmacy.

The aim of the event was to reach a shared understanding of the requirements and interdependencies of the new integrated urgent care service specification. There were some good conversations around governance, the Joint Committee, and work taking place across our six local places i.e. direct booking, extended GP access and NHS 111.

Cancer

The Tobacco Control Programme of the West Yorkshire and Harrogate Cancer Alliance held a workshop on Wednesday. Our partnership has an ambition to reduce smoking prevalence from 18 per cent to 13 per cent, achieving 150,000 fewer adult smokers by 2020/2021. Delegates explored what actions are needed to achieve this ambition, and how we can work together across the area to deliver them. The workshop has been organised by Scott Crosby, Regional Tobacco Control Policy Manager and the Alliance’s Programme Lead on Tobacco Control.

Mental health

Dr Mike Doyle (South West Yorkshire Partnership NHS Foundation Trust) and Emma Fraser (WY&H programme lead for mental health) alongside other colleagues are developing a Suicide Prevention, 5-Year Strategy, 2017-2022. The recent government update, Preventing Suicides in England (2017) is very clear that a multi-agency suicide prevention plan is required for each local authority with support from partners in health, social care, police, fire, and ambulance, independent, voluntary and criminal justice services. The STP has identified suicide prevention as a key strategic objective for the mental health programme.

Primary and community care programme

Kathryn Hilliam discussed the primary care delivery plan when the work stream met on Tuesday. There was also an update from Dr Andrew Sixsmith on the draft workforce strategy and Gulnaz Akhtar (NHS England) gave an overview on community care.

Harnessing the Power of Communities

A meeting took place on Thursday to discuss how we work much closer with voluntary and community organisations. This is a vital part of our work. The work stream has led two models over the summer that explores how healthy communities can look different in different parts of the world, but with a common theme - that it is the “community” aspect that really makes us healthy.

Fatima Khan-Shah has been looking at the work we do with unpaid carers. Rory Deighton and the Healthwatch group have also been exploring how we may be able to explore a different relationship with communities. Their campaign #changetheconversation will be tested across Kirklees in the next few months.

What’s happening next week?

  • The stroke task and finish group will meet on Tuesday. This is chaired by Dr Andy Withers.
  • WY&H regional lay member reference group will also meet on Tuesday. This includes representatives from each of our 11 clinical commissioning groups.
  • Ian Holmes will attend the North Region STP directors meeting on Wednesday.
  • The first unpaid carers’ project group meeting will take place on Thursday. The work is being led by Fatima Shah-Khan and is part of the ‘harnessing the power of communities” programme.
  • Corinne Harvey will chair the WY&H Public Health Directors meeting on Thursday.