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Leak reveals plan for single health and care governance on south coast

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Health leaders in central Sussex and east Surrey have an “ambitious programme” to create a string of fully operational multispecialty community providers by 2020, a leaked document reveals.

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375_lgc_hsj_reporting

A section of the Sussex and East Surrey sustainability and transformation plan leaked to LGC’s sister title Health Service Journal proposes that primary care will be organised into 20 “hubs” serving 30,000-50,000 patients. Each MCP will have at least 100,000 patients. The population covered by the model – which does not refer to the entire STP footprint – is 778,000.

The document, produced by the Central Sussex and East Surrey Alliance, notes that the organisational form or local delivery model for each MCP may be different. A spokeswoman said the plan was a draft and does not constitute the entire STP.

It also says a single health and social care governance model will eventually be established across the patch, which includes five clinical commissioning groups and four local authorities.

Public consultation will begin in March 2018. The legal form each MCP takes will not be clear until September 2018, however the document says there is an “appetite for full integration” – the most complete version of the MCP model, which creates a single provider for primary care and community physical and mental health services.

Under the plans, primary and community care would be integrated through networks of general practice. This could mean federations of practices “joining organisations” with community providers, or it may mean a “prime/subcontractor” model.

Local primary care would be provided via a mix of informal alliances, federations or super-partnerships. GPs will decide whether to work as partners or subcontractors within the MCP model.

Under the proposals:

  • MCP contracts would be “outcome based”, with separate contracts for acute care;
  • discussions are “already underway for early shadow budgets”; and
  • workforces will be shared, with staff given “place-wide” job contracts.

A key aim of the MCP model, the plan says, is to help reduce demand for acute services. Proposals include improving access to GPs, increasing community diagnostics, making use of mental health “safe havens”, placing GPs in A&E, and developing home based care.

The model is expected to generate savings worth £92m by 2021.

Over five years, other proposed savings include:

  • £296.4m from moving elective care from hospital into the community. Elective care appointments would be moved to day cases; day cases would be moved to outpatient appointments; outpatient appointments would be moved into community settings.
  • £47.4m from reducing the number of outpatient appointments.
  • £21.2m from treating the elderly in “frailty units” rather admitting elderly patients to hospital via A&E.
  • £8.1m from moving elderly patients who don’t need to be in hospital into “alternative settings”.

However, the financial modelling does not take into account the “one off or ongoing investments in primary care” that will be needed to enable savings to be made, the authors acknowledge.

Despite this, the plan says the “clear timelines” and “demonstrable work in progress” means the “credible vision” is in a “strong position to register an expression of interest for the next wave of vanguard funding”.

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