Community, social care services and specialist mental and physical health services will be organised to work effectively with these networks, enabling GPs to ensure their patients are getting the very best person-centred care. We will deliver on the new provisions of GMS, including named GP for patients aged 75 and over; and practices will take responsibility for out of hours services and individuals will be able to register with a GP away from their home. We will be investing in co-ordinated care that promotes a holistic view of individual needs and works with people to empower them and enable them to stay as independent as possible. This means ensuring there is a good quality care plan in place for all those at risk, backed by co-ordinated provision commissioned to deliver on the required support and outcomes envisaged in each and every plan. The volume of emergency and planned care activity in hospitals, together with the number of residential and nursing care placements, will be reduced through enhanced preventative and community independence functions, and improved support in the community and in the home. By improving individual health and wellbeing, and access to home and community based services, we will relieve pressures on our acute services and help to eliminate the costs that arise from failures to provide adequate help to those at greatest risk of deterioration. In parallel, results of investment in 7 day social care provision and critical capacity areas such as neuro-rehabilitation will help us to eliminate delayed transfers of care. In order to manage and track outcomes, we will leverage investments in data warehousing, including total activity and cost data across health and social care for individuals and whole segments of our local populations. We are developing interoperability between all systems to provide both real time information and managerial analytics. By autumn 2014, our GP practices will all be using the same IT system, providing the opportunity for our care providers to all use the same patient record; the BCF will help ensure this happens by joining up Health and Social Care data across the linked via the NHS number. We will guarantee that individual information is shared in an appropriate and timely way to maximise safeguarding, wellbeing and user experience; and aggregated to allow effective identification and management of need and outcomes across our health and care economy as a whole.
Community, social care services and specialist mental and physical health services will be organised to work effectively with these networks, enabling GPs to ensure their patients are getting the very best person-centred care. We will deliver on the new provisions of GMS, including named GP for patients aged 75 and over; and practices will take responsibility for out of hours services and individuals will be able to register with a GP away from their home. We will be investing in co-ordinated care that promotes a holistic view of individual needs and works with people to empower them and enable them to stay as independent as possible. This means ensuring there is a good quality care plan in place for all those at risk, backed by co-ordinated provision commissioned to deliver on the required support and outcomes envisaged in each and every plan. The volume of emergency and planned care activity in hospitals, together with the number of residential and nursing care placements, will be reduced through enhanced preventative and community independence functions, and improved support in the community and in the home. By improving individual health and wellbeing, and access to home and community based services, we will relieve pressures on our acute services and help to eliminate the costs that arise from failures to provide adequate help to those at greatest risk of deterioration. In parallel, results of investment in 7 day social care provision and critical capacity areas such as neuro-rehabilitation will help us to eliminate delayed transfers of care. In order to manage and track outcomes, we will leverage investments in data warehousing, including total activity and cost data across health and social care for individuals and whole segments of our local populations. We are developing interoperability between all systems to provide both real time information and managerial analytics. By autumn 2014, our GP practices will all be using the same IT system, providing the opportunity for our care providers to all use the same patient record; the BCF will help ensure this happens by joining up Health and Social Care data across the linked via the NHS number. We will guarantee that individual information is shared in an appropriate and timely way to maximise safeguarding, wellbeing and user experience; and aggregated to allow effective identification and management of need and outcomes across our health and care economy as a whole.
04.2.a)%20Triborough%20Better%20Care%20Fund%20Plan%20March%202014.docx