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

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)

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

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

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%

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

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

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

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

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

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

A new set of standards for General Practice in Bolton – your views are important

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

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

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.

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?