1. Primary Care Strategy An Emerging Transformation Agenda

2. Why Transform? - The challenges ahead: an ageing population – increase in consultations - 95% growth in consultation rate for people aged 85-89 in ten years up to 2008/09. growing co-morbidities - The number of people with multiple long term conditions set to grow from 1.9 to 2.9 million from 2008 to 2018 increasing patient expectations financial resource constraints push for more to be done in out of hospital settings inequalities in access and quality of primary care recruitment and retention new inspection regimes

3. Dedicated MDT managing the top 3-5 % of health & care users Advanced Care Coordination team (Extensivist) Incentivised to stop people deteriorating to higher levels of care Incentivised to keep people healthy GP Triage /telephone consultation and signposting GP specialists undertaking work on behalf of multiple/all practices Co-ordinated support to Residential and nursing care Complex Chronic disease mgt through MDTs 7 day access to GP services planned and urgent Access to specialist clinics e.g. dermatology GP and wider team Appointments Prescribing GP specialist referral pathways for some conditions Stable Chronic disease mgt Incentivised to reduce / stop unplanned admissions to hospital General Practice at Scale General Practice Health and wellbeing

4. Local commissioner expectations – direction of travel Continuation and stabilisation of elements of PMS (notably hospital diversion) Support to other providers e.g. care homes Services spanning multiple practices e.g. 7 day access Services across all practices/whole population e.g. minor surgery Working with other providers – Advanced community care (extensivist) – Joint hospital & primary care MDTs e.g. complex long term disease management Health & wellbeing management

5. Using Resources better, together “Burning platform” – cant just keep doing more of the same Joint commissioning between NHSE, the CCG and LA PMS review – NHSE pulling money out of the contracts held by GPs locally but that can then be reinvested to deliver revised requirements LINCS GP federation is in place to support practices to change and work with the CCG Practice efficiencies – doing things once for many Better estate utilisation Workforce recruitment