.

Frequently Asked Questions

1. Won’t this mean my patients have to travel huge distances to get services? 
No, we still need to build services around patients, that includes looking at how they would access services.

2. How will my asthma patient get the same quality of treatment as the ‘place’ down the road?
All ‘places’ will have core general practice and community services. If there are innovations in one area that could improve the care for all patients, then we will develop the infrastructure to learn from it and, if it’s appropriate, be able to implement it across Southern Derbyshire.  We will share the pathways and the specifications.

3. What if I feel more comfortable working with practices that are in another place?
The ‘places’ are about the population and we will commission based on those places, this will include all health and social care providers. Not just general practice. All the providers in a place will need to work together.

However, providers (including General practice) do not have to be limited to one place. (DCHS for example works across the whole of Derbyshire & some of Leicestershire and Alexin work across Southern Derbyshire and into Staffordshire). If you have good relationships and are doing good work with other organisations that cover a different place, this does not have to stop.

It is likely that many services will need to be provided across bigger populations than the places, and that over time providers will merge into bigger units so good relationships are beneficial wherever they occur. 

4. No other practice in my ‘place’ wants to get involved - should I join another ‘place’?
The places are not just about general practice. There will be opportunities to work with other organisations in your place. As above, if you want to collaborate with other practices, this does not need to be limited to your place.  

We will also be working with the other practices to try to understand the barriers to collaborative working within the ‘place’ and see if we can help. We will monitor the situation and be flexible with solutions that will support the population. 

5. How do we choose a clinical lead?
The clinical lead will be someone you trust and will act as an advocate for the place. We hope that it most cases this will be a GP, but it may be someone from other organisations eg social care or mental health. 

If you want more support on this, then let us know. The East Midlands leadership can also help with knowing what makes a good leader. 

6. I don’t feel I have enough information and want to know more.

Of course, you can contact any of the Place links (below in Q.7)

We can come and see you as a practice or as a place to discuss more. We are also building this website for you to find information. We will update it regularly so keep checking back for updates.

7. Who is my link with the CCG?
We have linked keys named individuals with each of the groups. They are supported at the CCG from more senior leaders, but also have access to a wide range of support including data and analysts. 

Amber Valley North - Emma Plummer
e.plummer@nhs.net 

Belper - Jo Finnegan 
joanne.finnegan1@nhs.net

City Centre North - Tina Brown
tina.brown6@nhs.net

City Centre South - Tina Brown
tina.brown6@nhs.net

City Northeast - Jo Finnegan 
joanne.finnegan1@nhs.net

City Northwest - Nwando Umeh
nwando.umeh@nhs.net

City South - Lem Podmore
Vacant

Heanor - Emma Plummer
e.plummer@nhs.net 

South Dales - Jane Hopkins
j.hopkins2@nhs.net 

South Derbyshire - Jane Hopkins
j.hopkins2@nhs.net   

8. What will happen with localities?
We are not sure at the moment; they are part of the CCG constitution. We want to make sure we do not lose the valuable part they play but it is likely that they evolve as the places develop. 

9. I have heard a lot about capitated budgets and new contracts what does this mean?
This is for the future. At the moment there are different approaches being tested out across the vanguards but none are clear yet, and the legal frameworks for them have not yet been tested. We believe that organisational form should be developed in response to the way people need to work together and be developed to support that.

As an organisation we will keep track on national developments so that we are ready once the relationships in the places are at a point to change their organisational and contractual form.   

10. Is this not just another reinvention of the wheel? Haven’t we been there with fundholding?
When you have been in healthcare a long time, it does feel like you go through cycles on the same thing, just with a different name. So many times in the past this has been tried without general practice. This does feel different this time. The focus is now on populations, looking at their health and wellbeing and making sure that everyone is involved. It is no longer about individual organisations, so there is a need for all of them to work better together. 

Are the CCG hiding the real plan?
No, we have shared all the information that we have. There is always information available at NHS England (www.england.nhs.uk/ourwork/futurenhs/deliver-forward-view/stp/).

We really believe that to make healthcare sustainable we all need to work together for our population. That is what is behind this.

11. Aren’t we already doing this? 
Yes, there are loads of examples across Southern Derbyshire of great collaboration.

South Derbyshire practices have previously been working with Derbyshire Community Health Services and Derby Adult care in the Unique Care Scheme. This scheme was a development to look at better managing frail elderly and complex patients. 

In the city, (Hollybrook, Lister House & Village surgery) have worked collaboratively with DCHS focusing on community matrons and care co-ordinators to strengthen the Multi-disciplinary team approach set up via care coordinators in order to provide a more proactive approach. 

Belper 5 have worked together with Derbyshire Community Health services and the CCG to look at collaborative working and have developed different roles around advanced Care practitioners and pharmacists. 

Ripley practices have also done some excellent joint work in relation to the carers agenda and has worked jointly with Derbyshire carers to set up a carers support service at practice level. 

There has been better working with secondary care and Royal Derby Hospital including better access to advice and guidance through NHS eRS and through bed bureau for ‘Clinician Connect’. These have made access to advice much better for Orthopaedics, Cardiology, Endocrinology and Imaging to name but a few. 

There has been work on musculoskeletal services looking at improving pathways across Southern Derbyshire and we will be looking at linking named consultants across the places. 

We want to promote this, take the lessons learnt, but doing this at a bigger scale across Southern Derbyshire. 

There is also work underway on condition specific pathways i.e. Stroke, Dementia and Diabetes which can be linked into to gain better understanding of existing good practice both locally and Nationally. 

12. I want to get involved, but I don’t think I have the skills.
We don’t expect everyone to have the right skills from day one. But we need to understand more specifically what development or support is needed. 

We have access to leadership and facilitation skills training, and we are developing a team of data analysts & project managers who will be working directly with the groups. But this is new to all of us so those teams will have to learn as we go in the same way you will. 

Again, working together, co-producing to use the trendy jargon. 

13. What development support will I receive?
The CCG offers a minimum of two days per week of time from one of our transformation managers. This can support the place in a number of ways: 

  • Offer wider context and clarity.
  • Support places to work with all key stakeholders to explore options for integration and development of services for their population.
  • Facilitate joint working and collaborative working between different organisations including community providers, voluntary sector and local authorities.
  • Link places with others and wider developments in the CCG and nationally.
  • Access wider CCG support e.g. Data Analyst time.
  • Help places to understand population needs.

  • Provide Project Manager support to develop plans, milestones and manage risks etc.

14. Practices are finding it difficult now, how am I supposed to do this and keep the practice going?
We understand there is a need to keep practices sustainable now in order to be involved with the transformation. The diagram below tried to summarise some of those challenges, and some of the transformational ideas could be also aimed at addressing some of these areas.

We are developing support for practices to ensure they remain sustainable. There will be more details that follow.

Challenges

15. That sounds great. How do I get started?
If you haven’t already been approached, then please see the contact details above and we can look at the next steps for you and your place. 

Difficult areas:                                                                                                

Data sharing
There is a lot of confusion over what data can & cannot be shared and with who. There is clear national guidance about this that we can refer to when needed, and again we have learning from the care co-ordinator implementation. 

Other areas are showing that some of the barriers linked to information governance can be broken down.  The Mid-Nottinghamshire Better Together programme is close to implementing a multi-agency, across health and social care, data sharing and consent model. 

Digital technology
Health often lags behind other industries in the use of technology. We will look at where technology will make a difference and look for learning elsewhere. 

Workforce
This is a challenging area as we need to develop a workforce with the skills for the future. There are a number of projects and  groups focusing in this area  both locally and across the East Midlands and we will keep linked in to make sure the needs around the community are recognised.  

Indemnity
Changing ways of working obviously raised concerns over how that changes indemnity. Some of this is unknown. However, this is recognised as a national issue. And so, there will be wider support and learning from elsewhere. 

Finance
Money is tight. However CCGs and providers across Derbyshire have come together to develop the sustainability and transformation plan (STP) and understand there is a need for significant investment and plans are underway to shift resources to support place based care.  

The current health care system has a lot of perverse incentives and payment mechanisms that often work against doing the ‘right’ thing. 

Money should not be the main focus for the improvement, but without finance in place we know that many schemes won’t be able to happen. 

We all know that patients are often ‘bounced’ around a system having duplicate and wasted appointments. There are inefficiencies that frustrate both clinicians and patients. We believe that improving these areas will release money, but also improve patient and clinician satisfaction.  

We recognise to start to make changes there may need to be initial investment. We have a small amount of transformational funds that contain non-recurrent money to help schemes. Some of this money has been released by reviewing how we use clinicians at the CCG.  We are not asking for places to bid for money, but will review requests on a discretionary basis to see what we can support. We will fund a session a week for the lead clinician for each of the ‘places’. We recognise that this won’t cover all the work that will be needed to make the changes for all the clinicians involved. Once we have a clearer picture of what resources become available, we will, of course let you know.