3 Public Priorities (from our engagement) More people should be supported to remain independent in their own homesSupport spending more money on community services, mental health and prevention, and less on hospital servicesAssurance of high quality of care in the homeServices should be designed to fit around the individualImproved access to a GPEmbrace technology (to support people to self-care, or to improve access)
4 Linked Strategies to deliver our commissioning plan QIPPHealthier TogetherClinically led in-hospital redesign of acute services across Greater Manchester (GM)CCGs working together across GMBolton Integration PlanRedesign of services to support more elderly people with long term conditions in their home.Reduction of hospital admissionsRedesigned intermediate tier service with 24/7 support.CCG, Bolton Health & Wellbeing partnersGM Primary Care StrategyThe core requirements of Primary care and redesign to meet future demandNHS England Area Team & CCGBolton Self Care StrategyCCG, with Public Health
5 General Practice – national news Party conferences responding to ‘NHS in crisis’National GP organisations:Not enough GPs being trainedMany GPs near to retirementWorking days getting more pressured/stressfulProportion of NHS Budget for GP reducing
6 One pot of money for Bolton Demand & costs increasing New procedures offeredNew drugsMore diseases can be treatedAgeing populationInflation (staff pay, utilities, etc)Growing 4% per yearProportion of NHS Budget spend on General Practice 10.4% - 8.4%
7 General Practice pressures Increasing demand - ‘todays work’The frail elderlyPeople living longer with more diseasesPeople discharged earlier from hospital needing supportInability to self care or reassurance neededThe worriedOther services with criteria saying no
8 Risks this creates? Reading increasing volumes of mail Reviewing increasing volumes of resultsNo time for proper medication reviewsTaking the quickest optionDecision making fatigueOver investigationOver referring, not following best practiceNot giving time to proactive care – ‘tomorrows work’GPs retiring
9 What are the answers?Investment in Primary Care to increase capacity, improve access and improve quality of careGetting more out of Primary Health Care teamUsing community services or integrated neighbourhood teams where appropriateReducing duplicationSpending longer with people who need it to help them stay more healthy for longer = proactive care
10 Using ‘Triple Aim’ to improve Better HealthBest quality care and experienceValue for money
11 The aim of our draft standards Bring together some things we already require of GPsAdd strong focus on access, quality and prevention of ill-healthBenefits to Bolton people:Get to see a GP when they need toBetter experience, improved support close to homeBetter health through getting the best care, earlyReduce wasted hospital appointmentsInvestment in capacity will be needed to meet the standardsBy meeting these standards, the shift to more care out of hospital will be supportedThe improved quality of services & reduction in unnecessary hospital visits will pay for themselves
12 What we need to do to make this happen? Make the case this is the right thing to do for Bolton peopleGet agreement from CCG Board that the investment can be madeGet agreement from NHS England & Public Health to jointly commission this new quality contract with the CCGGet agreement from all Practices to sign up to this new quality contract… we are seeking your views first
13 A new set of standards for General Practice in Bolton – your views are important
14 Standards so far…. More responsive access Safer prescribing, less wasteReferring at right time to right placeHealth checksBest care for people with long term conditionsVaccinationsSexual healthCancer referrals & learningPatient experiencePhlebotomy/ taking bloodCarers registers & health checksMental health, dementia, Learning disabilitiesCCG quality incident reporting, educationEnd of life care
15 Standard 1 - Access 8.00 – 6.30pm, Monday to Friday 10 bookable sessionsAccess to both male and female GPMinimum number of appointments per 1000 populationPre-bookable appointments 3 months in advanceProcess for unplanned / urgent apptsOffer telephone consultationsChildren under 5 seen same dayAccept deflections from services to prevent hospital admission
16 How should we measure access? Reduce use of out of hoursReduce minor A&E attendances during Practice hoursImprove on the Patient Survey measures:% of patients who were able to get an appointment to see or speak to someone at the surgery on the day they wanted to.% of patients reporting that they were very happy or fairly happy with their experience of getting through to someone at the surgery on the phone.% of patients who were very satisfied or fairly satisfied with opening hours at the practice.
17 QUESTIONS Questions? Please comment on what you’ve heard: Is a Bolton quality contract with standards for General Practice a good idea?Any particular standards you would add?How can we ensure patient experience is heard on access, and in general views of General Practice?