Future of General Practice Delivery in North Tyneside Dr George Rae Chief Exec. Newcastle & N Tyneside LMC GPC Member BMA Council Member Dr Ken Megson Exec. Officer Newcastle & N Tyneside LMC Hon. Sec. Gateshead & S Tyneside LMC Hon. Sec. North East & Cumbria Regional LMC

Context General Practice on cusp of most radical change since NHS inception In N Tyneside we are reacting within a very short timescale due to CCG deficit (£17m?) As your representative committee, the LMC will play its part to ensure the best deal for your future contract and delivery of care – also best deal for patients

Context Many questions to be asked and answered Two issues running concurrently Intertwined with each other Will define our future

Two Concurrent Issues New “voluntary” GP contract New models of care- Five Year Forward Review – Simon Stevens

New GP Contract To support doctors to deliver 7-day services and integrate care All patients to have access to 7-day GP care by 2020 Cameron- contract to get rid of box ticking and form filling Micromanagement of GP’s work through QoF and other sorts of old fashioned bureaucracy to be scrapped New voluntary contract integrated with community nurses and other healthcare professionals

New Contract -Key Principles More money for primary care More control over the way GPs work More time to care for patients AND services 7 days a week!

New Contract Cameron – “patient guarantee” Government will mandate NHSE and CCGs to ensure that every patient has access to 7-day services by 2020 By April 2017 the new contract will be offered that recognises the OUTCOMES that GPs and colleagues offer to patients, including 7-day services The new contract will be voluntary. With FEDERATIONS or practices that cover populations of at least 30,000 patients

New Contract Underpinned by a strong economy and £10 billion of investment in the NHS Northumbria Trust mentioned a lot by Cameron and Hunt in 7-day services and new models of care!!

New Models of Care Simon Stevens Five Year Forward View To dissolve traditional boundaries between general practice, health and social care and mental health services Multi-speciality Community Providers (MCPs)- forming extended primary care group practices through federations, networks or single organisations to provide a wide range of care using a broader range of professionals e.g. employing consultants or taking them on as partners

New Models of Care Primary and Acute Care Systems (PACS) – a new variant of vertically integrated care allowing single organisations to provide GP, hospital, community and mental health services Urgent and emergency care networks Enhanced care in care homes

Development of contracting under MCPs, PACS and ACOs  GPs RUNNING THE ORGANISATION GPs themselves, through a federation or super practice form the basis of an MCP providing a wider range of services to a registered population The network could start by providing extended access and enhanced services but move on to provide community services and eventually sub-contract or provide secondary care services, this becoming an ACO

Development of contracting under MCPs, PACS and ACOs B) PACS TYPE OF ORGANISATION OR LOOSE ACO To develop new integrated models CCGs would closely align incentives between primary acre and other parts of the health economy Scope within this model for development of significant role for GP federations- become the contract holder for range of primary care services General practice might remain largely unchanged in this model

Development of contracting under MCPs, PACS and ACOs C) ACO HOLDS CONTRACT FOR ALL POPULATION CARE INCLUDING GP SERVICES Not recognisably based on GP led organisations More likely to grow out of Foundation Trust based PACS The ACO would have an effect on your contractual status

Contractual Options under ACO The ACO could: a) Sub-contract GP provision to individual practices, using a lead provider as contractor b) Run local practices directly c) Employ GPs to provide primary care d) Bring GPs in as shareholders/partners with implications for risk share/gains e) Use a combination of methods a), b) and c)

Key Issues National/core contract, nGMS, PMS, APMS Robust federation imperative Must be GP led Pensions Lead provider, management Salaried service increase Adequate, appropriate consideration time imperative Job security How quickly and how much debt will be saved by ACO

Dr Ken Megson Exec. Officer Newcastle & N Tyneside LMC Hon. Sec. Gateshead & S Tyneside LMC Hon. Sec. North East & Cumbria Regional LMC

Context Need to change Improve integrated care CCGs leading on change CCG in financial deficit ACO a proposed model TTIP

Proposed ACO Model Board of providers Lead provider Other providers subcontracted to lead CCG

ACO Board Membership Legal standing Balance of power Holds budget Has GMS contracts

Lead Provider Will be a FT What will they provide Day to day management Holds GP contract

GP Contracts GMS – who with? Subcontracts – who with, security Enhanced services Relationships – ACO, federation, lead provider, CCG, NHSE

What we want out of tonight? Raise awareness Collate questions that need answers Slow the process down Look at alternatives –Plan B Practices to remain united Need promise of individual vote Just the beginning of the process

Questions & Answers