1. Mid Notts General Practice Models of Care
David Ainsworth
Exec Director of Primary Care
Helping to shape future health and social care in Mid Nottinghamshire

2. Mixture of rural and inner city practices 27 30 26 29 41 20 25 28 21
16,17,18,19 15 40
3 1 13 24 14 22 23 10 32
11,12 9 33
4,5,6,7,8 34 35 3
36,37,38 2 1 39
41 practices
Mixture of rural and inner city practices
List sizes range from 4k to 20K
High levels of deprivation
Areas with higher than national average levels of domestic violence and homicide

3. Context Workforce risks:- Number GPs per head of population
Number approaching retirement age
Demographic differences:-
Rural and inner city practices
High levels of deprivation indices
High levels of homicide
Workload risks:-
The same as other CCG areas

4. New Care Model
Decision support tools
New roles
Wrap around services
Proactive community services
Ambulatory pathways
New Care model incorporates support for individual practices; the development of locality hubs, alignment with community services and links into the system priorities.
The component parts:
Decision support tools
New roles
Wrap around practice services
Proactive community services
Ambulatory pathways

5. Decision Support Tools
Ardens referral management software
Optimise Rx – prescribing
Consultant connect – advice & guidance
Electronic Decision support tools have been:-
implemented across all 41 practices
built into System 1 as integral part of patient notes
tackles unwarranted clinical variation
Supports an evidence base of best clinical practice
Standardises admin functions such as referrals
100% referrals now electronic (except Ca 2ww)

6. New roles Clinical pharmacists Mental health support workers
Therapists
ANP Direct access to diagnostics
Admin staff as navigators
Clinical pharmacists carrying out annual medication reviews and post inpatient stay reconciliation
Mental health support workers picking up lower level anxiety and depression in support of the practice team
Therapist trial – direct to physio and direct to O.T for equipment
ANP direct to diagnostics
Admin staff trained through GPRP in navigation – what impact will the newly announced App have on this?

7. Wrap around services Acute home visiting
Centralised nurse treatment facility
GP chambers
Care Home service
AHVS – timely visits; to avoid arrival at hospital teatime bulge and to increase the out of hospital opportunity to avoid admission
Centralised nurse treatment facility picking up dressings, wound care inc care homes, post op follow up
GP chambers is the establishment of our own internal locum system using local GPs and nurse
Care home service – proactively managing patients and increasing education and support to care home staff

8. Proactive Community Services
LICT (Local Integrated Care Teams)
Implementation of a Frailty Index to identify raising risk patients
moving from 2% high risk to 10%. August implementation using evidence based Frailty Index and GPRCC
C4C (call for care)
Initially single point of access for GPs; moving to expansion of patient pathways and moving to single point of access for complex discharges from acute trust
I.H.S (intensive Home Support)
Newark and Sherwood service to be implemented October 2017
linking with bed utilisation and Integrated Discharge review process
LICT – 7 across mid Notts, health & social care, linked to GP practices, joint care planning.
Call for Care – community service, navigation and rapid care responses, linked to other professionals and take referrals
Intensive home support – therapy, nursing, social care, capable of more than traditional community services – linked to integrated discharge process

9. Ambulatory pathways DVT – low risk Paediatrics Anaemia INR
Hyperkalaemia
Hypertension
Renal Colic
MSK
Ambulatory care can, in principle, be provided in any care setting; providing the correct governance and infrastructure to support its delivery.
Expands the out of hospital care offer
Allows easy, fast track referral pathways for practices.

10. Non Elective Admissions Run Rate Analysis
Non elective admissions are reducing

11. Reduction in mortality
Reduction in length of stay

12. Reduction in admissions to nursing and residential homes
Emergency Access within four hours
Reduction in admissions to nursing and residential homes

13. Next Steps: One of 11 national sites for international recruitment
Expand wrap around service to include:
- near patient testing
- health optimisation
Single provider vehicle
GP Access
Core Plus
International recruitment – get up to 28 new GPs
Near patient testing – quicker results at source
Health optimisation to ensure patients don’t get bounced between pre-op and GP
GP Access – 100% coverage
Core Plus – core contract, extended access and now looking to extend what we believe is outside core contract (microsuction, phlebotomy, ECG analysis, DMARDS, PSA)
Links to STP