1. Primary Care: Working on a new set of standards
Su Long
Chief Officer

3. Public Priorities (from our engagement)
More people should be supported to remain independent in their own homes
Support spending more money on community services, mental health and prevention, and less on hospital services
Assurance of high quality of care in the home
Services should be designed to fit around the individual
Improved access to a GP
Embrace technology (to support people to self-care, or to improve access)

4. Linked Strategies to deliver our commissioning plan
QIPP
Healthier Together
Clinically led in-hospital redesign of acute services across Greater Manchester (GM)
CCGs working together across GM
Bolton Integration Plan
Redesign of services to support more elderly people with long term conditions in their home.
Reduction of hospital admissions
Redesigned intermediate tier service with 24/7 support.
CCG, Bolton Health & Wellbeing partners
GM Primary Care Strategy
The core requirements of Primary care and redesign to meet future demand
NHS England Area Team & CCG
Bolton Self Care Strategy
CCG, with Public Health

5. General Practice – national news
Party conferences responding to ‘NHS in crisis’
National GP organisations:
Not enough GPs being trained
Many GPs near to retirement
Working days getting more pressured/stressful
Proportion of NHS Budget for GP reducing

6. One pot of money for Bolton Demand & costs increasing
New procedures offered
New drugs
More diseases can be treated
Ageing population
Inflation (staff pay, utilities, etc)
Growing 4% per year
Proportion of NHS Budget spend on General Practice 10.4% - 8.4%

7. General Practice pressures
Increasing demand - ‘todays work’
The frail elderly
People living longer with more diseases
People discharged earlier from hospital needing support
Inability to self care or reassurance needed
The worried
Other services with criteria saying no

8. Risks this creates? Reading increasing volumes of mail
Reviewing increasing volumes of results
No time for proper medication reviews
Taking the quickest option
Decision making fatigue
Over investigation
Over referring, not following best practice
Not 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 care
Getting more out of Primary Health Care team
Using community services or integrated neighbourhood teams where appropriate
Reducing duplication
Spending longer with people who need it to help them stay more healthy for longer = proactive care

10. Using ‘Triple Aim’ to improve
Better Health
Best quality care and experience
Value for money

11. The aim of our draft standards
Bring together some things we already require of GPs
Add strong focus on access, quality and prevention of ill-health
Benefits to Bolton people:
Get to see a GP when they need to
Better experience, improved support close to home
Better health through getting the best care, early
Reduce wasted hospital appointments
Investment in capacity will be needed to meet the standards
By meeting these standards, the shift to more care out of hospital will be supported
The 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 people
Get agreement from CCG Board that the investment can be made
Get agreement from NHS England & Public Health to jointly commission this new quality contract with the CCG
Get 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 waste
Referring at right time to right place
Health checks
Best care for people with long term conditions
Vaccinations
Sexual health
Cancer referrals & learning
Patient experience
Phlebotomy/ taking blood
Carers registers & health checks
Mental health, dementia, Learning disabilities
CCG quality incident reporting, education
End of life care

15. Standard 1 - Access 8.00 – 6.30pm, Monday to Friday
10 bookable sessions
Access to both male and female GP
Minimum number of appointments per 1000 population
Pre-bookable appointments 3 months in advance
Process for unplanned / urgent appts
Offer telephone consultations
Children under 5 seen same day
Accept deflections from services to prevent hospital admission

16. How should we measure access?
Reduce use of out of hours
Reduce minor A&E attendances during Practice hours
Improve 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?