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Primary Care Transformation Scheme 1. Background to the scheme There are several issues facing the health economy regarding urgent and unplanned care that present sufficient risk to require commissioners to explore radical transformation projects. These risks include: Capacity for emergency activity; Winter pressures; Mid Yorkshire Financial Position; Rate of A&E attendance and emergency admissions; Capacity Building for Out of Hospital Care. The demand for acute services locally continues to grow. Over the past year there has been a 3.5% growth in A&E attendances and a 4.4% increase in emergency admissions, despite continuing efforts to combat this. Historically winter has brought significant pressure to Mid Yorkshire Hospitals in terms of increased rates of attendance, emergency admissions and bed shortages. With a reduced bed base at MYHT there is significant risk of more frequent bed shortages which will impact on the quality of patient care and also the health economies performance against the A&E access targets. There is a clear requirement for a large scale project to reduce activity levels in the areas of A&E attendances and emergency admissions at Mid Yorkshire Hospitals NHS Trust. It can be demonstrated that Wakefield is a significant outlier in terms of attendances per ‘000 population and that there are clear gains to be made. Building capacity for out of hospital care is essential for ensuring that patients can be better managed within the community, lengths of stay in secondary care are reduced and that there is a reduction in admissions and attendances. The availability of non-recurrent funds presents an exciting opportunity to reduce A&E attendances and emergency admissions through increasing capacity within primary care, in areas such as access and long term conditions care planning. 2. Development work to date The transformation scheme has evolved from initial work with clinical commissioners in Wakefield to improve the management of patients with long term conditions, reduce variation across the district and manage demand for secondary care. The proposed scheme involves investment to increase capacity in primary care and falls into two sections: Reducing A&E attendances; Care Planning for Long Term Conditions. Practices applying for the scheme must undertake both aspects. However under the reducing A&E attendances there are some options available to practices in terms of the approach they would take. 1

There has been significant clinical engagement during the process. The Clinical Commissioning Groups are united in their support of the approach and are committed to working together to improve patient care and ensure the delivery of equitable access across the district. This is a QIPP project and the estimated total savings of this scheme are ÂŁ5,368,337. However, investment is required to increase capacity in primary care, with the value of the transformation scheme payments being a maximum of ÂŁ2,632,500. If the assumed activity reductions are achieved this will result in a net (QIPP) saving of ÂŁ2,735,837. 3. Next steps Following discussion at the NHS Wakefield District Board, the business case is being developed into a proposal which provides the strategic justification for the project, a firm evidence base to support the proposals and outlines the robust approach to governance and performance management that will be used to manage the project. Work is being done to remodel the payment schedule, with a number of staged payments based on achievement of robust, measurable outcomes. The proposal will also set out a strengthened assurance framework, performance management framework and the approach to risk assessment and management. Due to the need to progress the scheme in order to have an impact this winter, Cluster Board approval is sought to authorise the establishment of a sub-committee with delegated authority to approve the scheme in the next couple of weeks. The suggested membership of the sub-committee is the Chief Executive, Chair, Audit Committee Chair and Director of Finance. 4. Recommendations Board members are asked to: i

approve the establishment of a sub-committee of the Board for the purposes of considering and approving the Primary Care Transformation Scheme; and


agree the suggested membership of the sub-committee.

Jo Harcombe Head of Public Health (LTC) Matt England Head of Contracting Jo Webster Director of Commissioning 18 October 2011 2