East Leicestershire and Rutland Clinical Commissioning Group (ELR CCG) is embarking upon significant change to commissioning future community and primary care services which has been clearly articulated in a number of strategic documents including the CCG’s Integrated Community Services Strategy, Primary Care Operating Framework: A GP Guide November 2014 and health economy wide Better Care Together Programme.
The emergence of GP federated models is also underway and offers the opportunity for partnership working to strengthen any new out of hospital and community services model that is commissioned.
In order to develop and scope a proposed draft model for the future of community services we have spent time engaging with local stakeholders including providers, Local Authority, voluntary sector and GP locality groups.
Our engagement process has enabled us to understand current issues and the breadth of potential for bringing together community and primary care services. It is our aim to set out potential ways in which each locality can have the right level and range of services to serve the needs of local patients.
To achieve this, Primary Care is placed at the core of our model development with a proposal for discussion centred on wraparound community services to achieve greater integration of health and social care professionals.
We have identified a number of areas that need to be addressed through the proposed model to ensure a solid foundation for community services.
These areas are not exhaustive and include:
- Changing the current model of community services commissioning to give the CCG and its GPs more accountability to influence how services are delivered;
- Creation of joint GP/Provider posts to enhance accountability;
- Delivery of a rehabilitation and re-ablement model that moves services from a hospital to a home environment;
- Improving access to community services that are currently considered sub-optimal including physiotherapy;
- Expanding the times when care is available both at home and in health facilities;
- Establishing clinical support networks and services in acute and primary care to identify, enable and manage both complex care, frail elderly and sub-acute care locally;
- Making the most of the land and estate available to deliver local services avoiding unnecessary travel to acute hospitals;
- Minimising service barriers through simplified specifications and joint commissioning of primary, social and community services; and
- Changing the model of community services commissioning to focus on outcomes rather than inputs.
Our proposed model is likely to require significant organisational change both within each locality and by community service providers requiring leadership, time, skill and resources to ensure change is achievable.
Robust governance arrangements including joint working with and through Local Authority structures will be essential to ensuring strategic alignment and successful local implementation.
The next stage will be to agree support for further engagement with our wider stakeholders and public to further strengthen and develop our proposed model.
We do not believe that most aspects of this proposed model should require formal public consultation over and above robust and widespread engagement, however where there are such aspects, we are aware and concur that this consultation should be taken forward as part of the wider LLR-wide Better Care Together consultation, rather than as a separate exercise.