2. The Burning Platform Evolving a New Model for General Practice Financial Constraint Workforce Crisis Increasing Demand

5. How many patients are registered with the Hurley Group?

6. How many minor illnesses and injuries do we treat a year?

8. 2.5% 4% 2% 1% 11 % 4% 11% 2% 59% 40% 25% 29% % of borough’s urgent care % of borough registered with Hurley

9. PCT Redundancies Our growth strategy working? Public Health Contract Reviews Recruitment Issues Low Morale Cuts Practice Failures Revalidation KPIs PCT meltdown Rising Patient Demand Increasing Regulation NHS Values CQC Rising Patient Demand Reduced Funding NHS Reforms PMS Reviews

13. Network Services in the new financial year 1. Diabetes (Care Package)9. Cancer screening (NEW) 2. NHS Health Checks (Care Package)10. Healthy Lifestyles (NEW) 3. Imms and Vaccs (Care Package)11. Sexual Health (New) 4. Hypertension12. Anti-coagulation (enhanced) 5. CVD: Secondary Prevention (New)13. Minor surgery & Aftercare (enhanced) 6. COPD (New)14. Phlebotomy (enhanced) 7. PBC (redesigned)15. Vulnerable Adults (New) 8. Drug and Alcohol (New)16. Children 0-5 (New)

14. The 36 Tower Hamlets practices have formed 8 geographic networks 14 6 5 * 1 2 3 4 5 6 8 Health E1 9 10 Albion LAP 2. Spitalfields and Banglatown, Bethnal Green South 8 9 10 7 LAP 1. Weavers, Bethnal Green North, Mile End and Globe Town 1 Strouts Pl 2 Bethnal Green 3 Pollard Row 4 Blithehale 7 XX place* 5 Mission 6 Globe Town 11 12 15 13 16 14 11 Shah Jalal 12 Tower 13 LAP 3. Whitechapel, St. Duncan’s and Stepney Green 14 Spitalfields Varma Stepney 17 18 19 Grove Surgery 22 St. Stephen’s LAP 5. Bow West, Bow East 20 Tredegar 21 Harley Grove 23 Ruston Street 19 24 21 22 20 23 24 Merchant Street 25 St Paul’s Way 26 Stroudley Walk LAP 6. Mile End East, Bromley by Bow 27 Nischal 25 26 27 28 29 30 31 32 28 Limehouse 30 Chrisp St LAP 7. Limehouse, East India Lansbury 29 Selvan 31 All Saints 32 Aberfeldy 33 Barkantine 35 Island Health LAP 8. Millwall, Blackwall and Cubitt town 34 Docklands 36 Island Med Ctr 33 34 35 36 17 St Katherine’s Dock 18 Wapping LAP 4. St. Katharine’s and Wapping, Shadwell 16 Jubilee St 15 East One LAP 4 LAP 3 LAP1 LAP 2 LAP 6 LAP 5 LAP7 LAP 8 7’7’ Bromley by Bow * Estimated registered population, calculated as ½ of Bromley-by-Bow and XX place combined list Source: http://www.towerhamlets.gov.uk/data/in-your-ward; Allocation practice to LAP as per Team Analysis (Aug 2008); Number of patients per practice based on LDP data (Jan 2009)http://www.towerhamlets.gov.uk/data/in-your-ward

15. Grow to Survive Challenging financial climate Bigger is better for economies of scale Ability to flex resources across the whole organisation Ability to protect our teams more Maintain this critical mass as many contracts time limited Grow to Invest People are our greatest asset Growth enables our nurturing talent programme Career progression opportunities for all Our ambition is to become London's employer of choice Grow to Make a Difference Best care to the most deprived communities Being larger gives us influence Scope to innovate and develop Primary Care Why Grow? Is bigger better?

16. The Journey? General Practice is sub-scale Limited mechanisms to enlarge to scale e.g. procurement, M&A and Federating 1. Have to do more with less 2. New skill mix and technologies 3. Commissioners Quality Conundrum 4. New models for true involvement The roll up to come…. Independents for decades but…. Enlarging Independent Contractors The FT possibility Meaningful Federations