Pressing ahead with our key priorities

NOW our elections are complete, and we have formally set up Bradford Care Alliance as a Community Interest Company, our focus now is to ensure that robust governance arrangements are in place to ensure we are in the strongest possible position to deliver services. We are now in an advanced position in terms of developing all the different policies, procedures and protocols that are required of us. This is a major step forward for us and once they are finalised, we will share them with you.

We are working closely with our partners in the Provider Alliance to shape our bid for the delivery of diabetes services across Bradford in what will be a major 10-year contract commissioned by both City and Districts CCG. This work is being coordinated by Bradford Teaching Hospitals NHS Foundation Trust; Bradford District Care NHS Foundation Trust; Bradford District Council; and ourselves.

The original ambition was for a single diabetes service coving the whole of Bradford, Airedale, Wharfedale and Craven. However, this has now been revised after Airedale, Wharfedale and Craven CCG decided to procure a separate diabetes service, based on a similar Accountable Care System (ACS), on a three-year contract. This will result in Airedale NHS Foundation Trust concentrating on the delivery of this work as prime contractor, rather than be part of the Provider Alliance for the bigger Bradford service.

Airedale NHS Foundation Trust will still act as a sub-contractor to our Provider Alliance and continue to be involved in the service re-design process. It has been suggested that this reciprocity should also apply to the Airedale diabetes re-design process.

Going forward, it has therefore been agreed by everyone that the make-up of each group is as follows:

The boundaries of each ACS were discussed. It was agreed that the boundaries should be defined by the geography of the registered list of CCG member practices. This fits in with the council who will operate services by where people pay their council tax

We recognise that challenges may exist in those areas, such as Bingley, where the population is also served by a neighbouring ACS. It is felt that these boundary issues account for 15-18% of activity. It was agreed that principles should be established for these boundary areas, with reciprocity of sub-contracting and risk share arrangements. These contractual complexities will need to be worked through. It was agreed that a helpful starting point would be to look at acute activity flows crossing boundaries in both directions. It may be that a block contract arrangement is possible. It was also suggested that services could be categorised by the levels of service overlaps between Trusts.

It was agreed that a set of partnership principles should be developed, to manage collaboration, learning, boundary issues and sub-contracting between the two ACS systems, to the benefit of the patient. It was agreed that a quarterly meeting of all providers should be established to promote ongoing collaborative working.

We will keep you informed as these discussions progress.

Meanwhile, we have staged three high-level workshops involving representatives from our Provider Alliance, other stakeholders, the voluntary sector, and patients as part of our work exploring how best we can deliver diabetes services in the future – with a focus on where we can break new ground and deliver the full potential of this new model of care.

The initial session investigated primary prevention of diabetes with an important inside-track from colleagues from public health. We know that the Bradford diabetes service budget is likely to be around £15m-£18m a year and currently nothing in invested specifically on prevention. Part of the Provider Alliance’s agreed ‘big vision’ for the future will be to do things differently, and better, by moving money around the system – and that includes a bigger priority on prevention as we take a longer-term view, perhaps over 5-10 years, of the improved health outcomes we are determined to achieve.

Our second one focused on secondary intervention, where the patient voice provided a helpful insight. Further workshops will take place on more serious diabetes-related conditions, such as amputation and retinal failure, as well as prescribing.

Together, these events and the people contributing to their success, will act as a real catalyst for identifying the changes we need to make and how we may incorporate solutions into our proposed model of care.

Following on from each workshop, we have set up Task and Finish groups to really develop the ideas and work through the challenges with a view to shape the proposed service design.

We are not assuming anything in terms of the proposals we put forward. Nor will we. That is why these workshops are important in shaping our thinking and providing a platform for taking services into a new era. We expect to be putting forward our plans to the CCGs in November as to how the Provider Alliance will meet the diabetes challenge in Bradford in new ways.

The current intention is that the new contract will ‘go live’ from April next year – if there are any changes, we will share them with you as soon as we know.

• MEANWHILE, following a competitive tender, we have recruited a consultancy called Attain in a project management role. Its work will primarily centre on helping us with our financial modelling as well as developing our proposed new model of care to its full potential, adding an extra dimension to our in-house skills. For more about Attain, click here to visit their website.