1. Benefits and opportunities of working together
Dr Will Murdoch
Executive Partner
Modality Birmingham

2. Case for Change
The current health and social care economy in Sandwell and West Birmingham is facing unprecedented levels of pressure and will not be sustainable in the long term without transformational intervention
Demographic Pressures and Increasing Demand
Poor Access to GP Services Across Birmingham
Unsustainable System Strains
Variations in Quality and Performance
Demographic
Younger population than rest of England, which is forecast to increase in all population groups over the next 10 years
65+ across Birmingham forecast to increase 30% by 2030
Ethnically diverse, transient population with higher disease burdens and prevalence, particularly mental health
Increasing demand across the system, including rate of emergency admissions, elective admissions and GP referral rates
Access
Approximately half of patients didn’t know how to contact OOH GP services
20% of patients didn’t feel GP surgery was open at convenient times
Only 4% of patients stated they booked appointments online (although 15% aware)
Through investment from the PMCF Modality has already addressed some of these access issues for their population but there’s more to do
Unsustainable
Population growth, population mix and acuity changes will increase spending by 20-40% over the next 10 years
Increased A&E use, A&E conversion to admissions and hospital days due to insufficient primary and community resource and alternative options
The Right Care Right Here programme will build additional community capacity but it will still be insufficient to deal with population (particularly complex patients) needs
Variation
Lower life expectancies rates compared to England average
Higher <75 death rates and higher than expected years lost before 75 due to CHD
Higher infant mortality rates compared to England average
Increasing rates of unplanned / unnecessary admissions and poor performance across acute conditions not usually requiring hospital admission
Minority of patients with Long Term Conditions have a care plan in place

3. The Modality Partnership
At a Glance
Modality Population Growth
18 mergers
87,000 patients
30+ partners
1°and 2°care contracts
300+ staff single org.
19 primary care sites
Integrated IT: EMIS Web
Single Partnership – partners own shares of the organisation
One model of care
Corporate Structure
Executive team manage day to day
GP Partnership Board to oversee governance

4. Federation vs Partnership
Collaboration between multiple practices
May be informal or a legal entity, e.g. LLP, CIC, Ltd Co
Informally or formally established organisational structures with management teams funded by member practices
GMS provided by member practices
Enhanced services / specialist services provided by federation
May share back-office functions
Using organisational scale to achieve economies
Individual practices retain own identity
Potential for conflicts when bidding for services
Examples:
Midlands Health Network, New Zealand
Tower Hamlets, UK
Full legal merger between practices
Corporate style legal entity is the partnership
Single Management team
Core services, enhanced services, specialist services, community services, private services
Shared back office functions
Single scaled organisational infrastructure to expand scope of primary care provision.
Single legal entity to hold all contracts or legal sub-divisions
Potential loss of individual practice autonomy
Quality Improvement through peer review process
Examples:
Modality Partnership, Birmingham
Whitstable Medical Practice, Kent

5. Work with people who share your vision and values
Don’t start with the end point – find the common ground

6. Don’t tell GPs what to do, tell them what they’re doing.

8. Start with the difficult conversations and myth-busting
How hard will I have to work?
How much will I earn?
Will I still run my practice?
Will you close my practice down/make my staff redundant?
What will happen to my patients?

9. Create a structure that works

10. Development and implementation
Exec partner
Executive
Operations
HR&OD
Transformation MD
M&A FD
Development and implementation
Dean
(Education
Dev & innovation)
Commercial
Board and executive HR
officer IT
Governance
Central
ops

12. Some benefits

13. The CQC

14. Service Improvement: Service Availability and Quality
Our Clinical Contact Centre
Up to 1,300 calls answered every day, serving over 46,000 patients
Average call waiting time is 4 seconds
Average call duration has reduced from 10 minutes down to 2 minutes
Demand for appointments has stabilised throughout the day, reducing the morning rush
Patients call their surgery number
Clinical capacity increased by 10%
Clinical staff work to set days and the website is updated on a daily basis so patients can see who is accessible. We advertise this in surgery.
Patients are encouraged to recontact on set days for continuity of clinician if needed.
Patients are offered a choice of clinician or speed of response. (Over 70% choose speed of response)
Future booking is delivered on the day by managing supply.
All follow ups are by phone or skype where possible
DNA (Did Not Attend) Rate reduced by 72%

15. Service Improvement: Monitoring and Evaluation
A live data dashboard was created to support intuitive planning, resourcing, management and evaluation.
We are constantly evaluating what we are doing.
Automatically populated by call system and we add in website and app information.
For the first time we really understand patient demand.
Spikes represent Mondays.

16. It’s not as easy as it sounds
We’ve been doing this for 7 years and learning