Development of Primary Care Plan Exploring the potential to help sustain primary care through different ways of working Time to Learn September 2016

PURPOSE OF TODAY’S SESSION Give an overview of the national Forward View framework Summarise the challenges facing primary care Talk through opportunities for cooperative working Give examples of changes elsewhere Seek feedback from attendees on how we (primary care and the CCG) can improve the sustainability primary care

What is the General Practice Forward View saying? Funding By 2020/21 there will be £2.4bn a year additional funding for general practice (a 14.4% real term increase Workforce Attempt to double the growth rate in GPs Other clinical staff Addressing some challenges primary care face Support for struggling practices Red tape reduction New forms of primary care Support for practices, federations, super partnerships

Pressures facing primary care (adapted from the King’s Fund – Securing the future of general practice: new models of primary care) Rising Patient Expectation Rising prevalence of chronic disease and associated demand on appointments Constrained funding growth (reduction in proportion of NHS budget although a commitment to redress this) Workforce pressures Inability to recruit (long term vacancies) Increased number of salaried GPs/part time GPs etc Inability to convert trainees into partners Increased administrative workload both directly patient facing e.g. chasing results, referring, liaising with hospitals and non patient facing e.g. CQC Domino effect of individual practices handing back contracts/failing Undertaking clinical commissioning Insufficient time to future plan & a lack of a primary care approach to future planning (rather than an individual practice approach)

Strengths and weaknesses for greater cooperative working across primary care; Greater ability to influence/transform factors external affecting your day to day business (including planning for issues such as the fate of other practices) Potential economies of scale Potentially reduces threat of providers entering local market Greater potential to deliver any new requirement of general practice Greater opportunity to free up clinical leadership time to dedicate to the future development Improve quality of primary care, improve career opportunities for clinical and non clinical staff, diversify income Weaknesses Potentially surrender of some autonomy of what happens within the practice Movement away from the “known” way of working

Hubs providing Episodic Care Hubs to deliver “on the day” episodic care Hub Practice Aim – would be to provide part of the on the day episodic care through a centralised hub to enable primary care capacity to be greater protected to deliver continuity of care Features - ? Federated model of delivery GP triage Application for funding through central transformation monies (in the short term) ? Level of buy in from practices

Diversifying Skill Mix in Primary Care Employing new roles to work across a number of practices Pharmacists (monitoring repeat prescriptions, medicines use reviews, care homes, prescribing policies) Physicians Assistants (used for different functions usually the less complex fewer comorbidity caseload) Nurse practitioners/Clinical Nurse Specialists/Advance practitioners Therapists E.g. Nairn – 24/7 nurse led advice line, specialist service for frail older people, host merged health and social care team Meeting potential new requirements ? Extended hours/seven day working GP specialists or working jointly with secondary care consultants “Micro teams” managing complex patients E.g. Vitality Birmingham – new forms of consultation, specialist outpatient provision, enhanced diagnostics, ambulatory care

Shared back office functions Centralised management/back office functions Centralised training and development programme Common response to regulatory requirements Clinical oversight of roles working across practices Care for specific population groups Nursing homes End of life care Integration Hosting community nursing/therapy services within general practice Out of hospital models incorporating primary/community and secondary care services. E.g. Tower Hamlets – locality based long term conditions management with shared incentives and outcome measures

Questions Primary care clinical services Primary care back office Review the following aspects of primary care when considering the questions Primary care clinical services Primary care back office Wider system change What changes do you think we could take forward at a local level to support the sustainability/enhancement of primary care (prioritise within your groups) What opportunities do you think exist for more collaborative working between practices to support the sustainability/enhancement of general practice