1. GP Forward View
Transforming Primary Care
V0.2

2. General Practice Forward View: On A Page
Maureen Baker (RCGP President) called this “the most significant announcement for general practice since the 1960s.”
CHAPTER 1: £
Investing a further £2.4 billion by 2020/21 into general practice services.
This means that investment will rise from £9.6 billion a year in 2015/16 to over £12 billion a year by 2020/21.
This includes recurrent and transformational funding
Additionally a review on Carr-Hill formula in progress to ensure it reflects derivation and workload etc
CHAPTER 2: WORKFORCE
Create an extra 5,000 additional doctors working in general practice by 2020
Attract an extra 500 GPs from abroad and targeted £20,000 bursaries that have found it hardest to recruit.
A minimum of 5,000 other staff working in general practice by 2020/21
3,000 mental health therapists
1,500 pharmacists
£206 million in support for the workforce through:
£112 million (in addition to £31m already committed) for the clinical pharmacist programme to enable a pharmacist per 30,000 population
£15 million national investment for nurse development support including improving training capacity in general practice, increases in the number of pre-registration nurse placements and measures to improve retention of the existing nursing workforce and support for return to work.
£45 million benefitting every practice to support the training of current reception and clerical staff to play a greater role in navigation.
Investment by HEE in the training of 1,000 physician associates to support general practice. Introduction of pilots of new medical assistant roles that help support doctors.
£6 million investment in practice manager development, alongside access for practice managers to the new national development programme.
CHAPTER 3: WORKLOAD
Support for GPs to manage demand, unnecessary work, bureaucracy and integration with wider system
£16 million extra investment in specialist mental health services to support GPs with burn out and stress.
new standard contract measures for hospitals to stop work
3 year ‘Releasing Time for Patients’ programme to reach every practice in the country to free up to 10 percent of GPs’ time (£30m), new four year £40 million practice resilience programme (including £16m in 2016/17)
move to five yearly CQC inspections for good/outstanding practices
introduction of a simplified system across NHS E, CQC and GMC, streamlining of payment for practices,& automation of common tasks.
CHAPTER 4: INFRA-STRUCTURE
£900m for premises and IT (this is the continuation of the Primary Care Transformation Fund, now renamed)
£45m for e-consultation support
New rules to allow up to 100% reimbursement of premises developments
Over 18% increase in allocations to CCGs for provision of IT services and technology for general practice
CHAPTER 5: CARE REDESIGN
Support to strengthen & redesign general practice by commissioning and funding of services to provide extra primary care capacity across every part of England, backed by over £500 million of funding by 2020/21 incl.£171 million one-off investment by CCGs starting in 2017/18, for practice transformational support, introduction of a new voluntary Multi-speciality Community Provider contract from April 2017.

3. What does this mean for London?

4. A large proportion of London’s GP practices are working at scale
Current picture for London (April 16)
Key: Population Coverage
Enfield NG
Full coverage
Greater 75 % coverage
Less than 50% coverage
No data provided
Harrow
Barnet
Haringey
Waltham Forest
50% - 75% coverage NG
Brent
Hillingdon NG
Redbridge
City & Hackney
Camden
Islington
Ealing
Central London NG
Non- geographical footprint
Havering
West London
Newham
Barking and Dagenham
Hounslow
H&F
Tower Hamlets
Southwark
Richmond
Lambeth
Wandsworth
Lewisham
58 at scale organisations* across London provide coverage for 91% of the population of London
21 CCGs across London have at scale organisations that provide 100% coverage of their entire population
74% of at scale organisations are geographically aligned
77% of at scale organisations have plans in place to support interoperability across their geographical areas
*Currently these are mostly federations
Greenwich
Bexley
Merton
Kingston
Sutton
Croydon
Bromley
Key: List size of each scale model
<50k k
50-64k
>200k
65-100k
List size unknown

5. Potential Sources of Funding for Primary Care

6. Including an increase in Primary Care allocations
Funding
London is expected to receive approximately 15% of the total growth in England’s Primary Medical Services allocations
This growth will be split differently across different areas of London based on capitation

7. Primary Care Allocations & Growth (Forward view)
Funding

8. The GPFV outlines ambitions for more resource and investment
National Resource Increase
Supporting Activities
Further work to deliver the 10 point action plan
Major national and international recruitment campaigns
Bursaries for the areas which have struggled the most to attract into GP training
Induction and refresher courses for those looking to return to work
Support for flexible working
5,000 GPs
5,000 extra by 2020
5,000 other roles, including
3,000 extra MH therapists
Workforce improvement activities
1,500 more clinical pharmacists
Additional Funding
Clinical Pharmacy Funding
£143m
Support for practices to be more resilient
Review of best ways of working to manage outpatient demand
Reduction in CQC inspections for the best rated practices
Programme to release time for patients through
Better automation of tasks where possible
Nurse development
£15m
Reception & clerical staff training
£45m
Workload Improvement activities
Practice Manager Development
£6m
Pharmacy integration
£100m*

9. Technology & Estates will be well supported to transform
Infrastructure
London will have access to considerable Estates & Technology funding
£900m for premises and IT (PC Transformation Fund),
£45m to support for e-consultations
GP IT operating model gives an uplift on CCG GP IT revenue allocations from £146m to £173m, which in real terms provides an uplift of 18.5%.
And (not in GP FV) New NIB funds : £2,176m. Total combined Digital budget of £4.699m
Our patients will be better supported with technology & fit for purpose estates
Online access for patients to accredited clinical triage systems
Development of an approved Apps library to support clinicians and patients.
Support practices offer patients more online self-care and self-management services
Opportunity to bid for Patient Activation Measure licences
Funding will be used to improve suitability of estates as well as deliver strategic intentions
National funding to continue roll out of Digital Literacy
Ability for patients to use online bookings, repeat prescriptions etc – is increasing year on year
Our Workforce will be better supported with technology & fit for purpose estates
Summary care record to community pharmacy, rolled out by March 2017.
Enhancements on the e-referral to allow two way conversations between GPs.
Increase uptake of EPS and training for batch prescribing;
increase electronic transfer of records between practices/ DC letters
Process to review applications for estate improvement funding is being reviewed
improve remote data extraction to reduce manual processes
Wi-Fi – Funding to be made available for hardware, implementation and service costs from April 2017.
The region will be supported in effective governance and procurement
Nationally accredited catalogue and buying framework for IT products and services, supported by a network of local procurement hubs offering advice and guidance is being developed
Collaboration with the supplier market to create a wider and more innovative choice of digital services for general practice
Review of governance, IT and cyber security, data quality, clinical (systems) safety and practice IT review;
clinical system training and optimisation
Working at scale is supported through developing an appropriate estates footprint and interoperability
Estates strategies have been reviewed to ensure they reflect new ways of working
Actions to make it easier for practices to work collaboratively, including achievement of full interoperability across IT systems.
to help practices operate collaboratively, such as shared care planning, or telephone and appointment management systems
Accelerate access to patient records across different services
Interoperability of different clinical software systems
Expand digital consultations and outbound electronic messaging (texting)

10. And this will be supported with Regional activity
Infrastructure
London will have access to considerable Estates & Technology funding
What are we doing in London on this?
Review and advice on estates bids to support CCGs in ensuring strategic alignment and maximising submissions in June
Support for London to bid for new tech fund monies to support expansion of digital offers articulated through Local Digital Roadmaps
Dedicated resource to develop approaches to e-consultation for London
Utilisation of National opportunities for funding of posts
Our patients will be better supported with technology & fit for purpose estates
Dedicated estates programme (part of HLP) to improve estates footprint in London
Digital and Interoperability programmes to progress Regional & National objectives
Identity authentication project aimed at connecting citizens “once” to a range of digital services
Reviewing self care interventions and social prescribing
Our Workforce will be better supported with technology & fit for purpose estates
500+ Pharmacists booked onto SCR training, remaining to conclude Sept
Creating a review for supporting users to -‘Make Best use of existing Capabilities’
99% of London pharmacies have with EPS2, 50% and increasing
All London GP have functionality to use GP2GP to transfer patients records. 69% of all eligible GP2GP records were transferred electronically in March 16.
The region will be supported in effective governance and procurement
4 new nationally funded posts to support all aspects of governance and procurement
Regional coordination of Local Digital Roadmaps
Indicative demand for GP IT captured early to inform PC Transformation Fund and a process in place to prioritise and co-ordinate with opportunity to leverage best value procurements for general practice
Development of a London Supplier Collaborative
Working at scale is supported through developing an appropriate estates footprint and interoperability
Designed an architecture for a Health and Care Information Exchange to enable interoperability at scale across London using standards and connect different systems supported by online data sharing agreements.
Use the above to enable structured data exchange in real-time to serve specific needs
Support more effective ways of working by maximising clinical triage working with NHS 111 supplier call handling services

11. In London we aim to go beyond the intention of the GPFV (1/2)
Below shows the key areas of focus of the General Practice Forward View, whether it is already actively being considered in London through the HLP or other programmes of work. Outlined are also additional complementary activities happening in London
GP Forward View
London?
Other London/ HLP Activities
Increased investment in Primary Medical Services delivery
Allowing all CCGs the opportunity to access their Primary Care allocation (regardless of level of delegation)
Support package to ensure sustainable Primary Care
HLP Primary Care is considering the best use of the Practice Resilience programme alongside wider provider development activities to make most effective
Providing capital investment of £900m
Supporting bid submission review to ensure aligned with strategic ambition
Redesigning review process to ensure as efficient/ fit for purpose as possible
Reviewing funding formula
London is participating in these discussions
[What investment is needed?]
HLP Primary Care is conducting financial modelling to understand cost and ROI of Primary Care investment
Indemnity costs
HLP Workforce is investigating how to reduce (initially student) indemnity costs
[What workforce is required?]
HLP Workforce is
Conducting workforce modelling to understand ‘as-is’ and ‘to-be’ positions
Working with New Care Models team to understand future requirements
Developing a methodology to determine workforce implications of new services
Increasing numbers of GPs
HLP Workforce programme linked into HEE and the other programmes to ensure recruitment, retention and return to work campaigns are effective in London as well as Nationally
Increasing numbers of other roles
Supporting development of other roles
HLP Workforce is creating support packs for the development of different roles such as Physicians Associates and Clinical Pharmacists
[How will at scale development effect workforce utilisation?]
HLP Primary Care is working with the LMC and others to support practices to work at scale and consider how to use the workforce most effectively across federations etc
CHAPTER 1:
INVESTMENT
CHAPTER 2: WORKFORCE

12. In London we aim to go beyond the intention of the GPFV (2/2)
Below shows the key areas of focus of the General Practice Forward View, whether it is already actively being considered in London through the HLP or other programmes of work. Outlined are also additional complementary activities happening in London
GP Forward View
In London?
Other London/ HLP Activities
Investing £46m in “Releasing time for patients”
*New*
Maximising effectiveness of this will be added specifically to the scope of the HLP Primary Care
Looking at other ways to reduce burden
HLP Primary Care & HLP Workforce share best practice through a website and events to support effective ways of working
Outcomes measurements
NHS England (London) and HLP Primary Care will identify the best way to interface with this programme of work
[What are the best ways of working to reduce burden?]
HLP Primary Care is developing a “Perfect Week” pilot to look at what can be done differently and share learnings throughout London
Utilise investment opportunity to maximise infra. improvements
Several HLP programmes and NHS England (London) are working with CCGs to ensure this opportunity is used most effectively
Better deals on premises reimbursements and Stamp Duty etc
HLP Estates and NHS England (London) will work with CCGs and National colleagues in order to maximise the benefit of this for London
[What else is needed to develop Digital/ Estates?]
See slides 10 & 11 for the areas being delivered by the HLP Digital/ Estates programmes
Strengthen & redesign general practice
The HLP Primary Care programme is supporting the delivery of the Strategic Commissioning Framework (SCF) which outlines a new vision for more accessible, coordinated and proactive primary care (see next slide)
In addition to coming together to share learnings and discuss problems through the HLP Primary Care governance and events, the programme has also commissioned modelling to understand the cost and requirements of delivering extended access in every area of London
Implement service improvement learnings from PMCF & Vanguards
Spread innovation across England
The HLP Primary Care programme has an innovation group and runs several events in order to spread innovation effectively
CHAPTER 3: WORKLOAD
CHAPTER 4: INFRASTRUCTURE
CHAPTER 5: CARE REDESIGN
This analysis shows that there continues to be considerable Primary Care development and transformation support across London.
Are there other areas which you think are missing?