Deciding who will do what, where and when
Once each provider network has established the interventions that they want to provide, they will need to think about the specifics of these interventions, or the operational model. Providers will need to detail in their business cases how the interventions will be provided at a very granular level. The box below shows the questions that they will need to answer about each intervention individually.
When answering the questions below, provider networks will need to consider the baseline that they established in Section 2, and they will need to assess how to make the best use of the resources that already exist in their areas.
THREE ESSENTIAL QUESTIONS
There are three questions that each locality will need to answer about the proposed interventions they will use to build their new models of care. These questions are:
1. What?
What are the specific services that make up the intervention, and what are the interventions themselves that will make up the larger model of care ?
2. Who?
Who in particular will provide these interventions, and how often?
3. Where?
In which setting of care will these interventions be delivered?
Below is a five-step process that providers will need to follow to establish the details of their models. This is vital to deciding how the entire model will operate.
What?
1. Decide on the specific services that will be a part of the intervention for different types of individuals
Who?
2. Decide who will provide each of the specific services
3. Decide how often specific services will be provided
4. Establish the entire team that will be needed to provide the model for the target population
Where?
5. Decide where the specific services will be provided (and consequently, where teams will need to be located)
1. DECIDE ON THE SPECIFIC SERVICES THAT WILL BE PART OF THE INTERVENTION FOR DIFFERENT TYPES OF INDIVIDUALS
Every intervention is made up of a set of individual services. Breaking down whole interventions into their smaller parts will help cost them. Below is an example of the specific services that could make up a care coordination intervention.
2. DECIDE WHO WILL PROVIDE EACH OF THE SPECIFIC SERVICES
The next step is to decide who specifically will provide each of the services established above. There are many choices for who can provide services, and provider networks should consider not only who has the clinical expertise, but also who is best placed to interact with the individual and who will be most cost effective for the level and type of care required. Some people who can provide services surrounding the four essential interventions include:
- GPs
- Nurse practitioners
- Community nurses
- Volunteers
- People in the community, including friends and neighbours
- Family members
- Community pharmacists
- Dieticians
- Physical therapists
- Psychiatrists and community mental-health professionals
- Social workers
3. DECIDE HOW OFTEN SPECIFIC SERVICES WILL BE PROVIDED
After deciding who will provide the specific services, the next step is to determine the frequency and duration of these services for different types of service users. The exhibit below shows a proposed operational model for the top two risk segments (e.g., high-risk and medium risk).
4. ESTABLISH THE ENTIRE TEAM THAT WILL BE NEEDED TO PROVIDE THE NEW MODEL FOR THE TARGET POPULATION
After establishing the specific services, how often they will be provided and by whom, the next step is to determine what the entire team will need to look like for that particular model to cover the target population. The two following exhibits show an illustration of a model of care for mental-health.
5. DECIDE WHERE THE SPECIFIC SERVICES WILL BE PROVIDED
Provider networks will operate across all types of care, in all settings: home, community, ambulatory and inpatient. This means that a whole range of providers will be included in implementing these interventions: primary care, mental-health trusts, community care, social-care and the acute sector. All of these providers will need to work together to provide truly integrated care that will meet the needs of the individuals in North West London.
