1. Transforming General Practice Unlocking the Potential

3. Current Market Context Increased demand for primary care GP contract – doing more for less CQC and new QoF - ‘demonstrating quality’ CCG developments and pressures on commissioners Shift of focus of care from secondary to primary Greater cooperation with social care GP demographics

4. Traditional Practice Model Federations ‘ Super Partnerships’ (Sole trader, multi-partners) Full Merger/Integration CollaborationConsultation 2k – 15k patients 30k – 500k patients 80k + patients Emerging Models in General Practice

5. The Vitality Partnership Built on local general practice with local GPs Single partnership Delivery at scale: 50k + patients Clinically and quality focused Commercial structure

6. The Numbers… List size: 2009 26k 2010 32k 2011 38k 2013 50k (LCG 125k, CCG, 550k) 15 equity partners + 3 fixed share partners PMS and GMS contracts £10m+ turnover 200+ staff NHS specialist services Private services 7 primary care sites (plus university sites)

7. Partners Salaried Partners Associate GP Salaried GP Corporate Overview

8. Partnership Structure Executive Partner Medical Director PPI lead HR and workforce Estates Commissioning Director of Primary Care Director of Specialist Services Outlet Directors Comms and marketing IT and informatics Teaching/Training

9. Organisational advantages Deliver Services at scale Long term planning and investments Greater ability to bid for AQP In house business development Greater level of local influence Staff employment protection and development Multi -sites – patient choice Standardised policies and procedures

10. Clinical Quality Increase in overall quality in merging practices (QOF points increase, access increase, range of services) Increased uptake of flu vacs, cytology etc. Reduction in OPD referrals in merged practices Integrated care pathways Single patient record (EMIS web) Peer review of referrals and prescribing

11. Patient Engagement Greater level of strategic discussions Increased scope of topic feedback Changes to practice information – pt led. Prompt feedback on service change Innovative surveys

12. Challenges Clinical time investment into merged practices Financial investment Culture change – partners and staff Communications – vision and decisions Local GP politics NHS in transition (PCTs/NCB/CCGs) Accurate data to enable service planning and evaluation Optimum size? How much risk?

13. Challenges (2) Lead and manage merger and acquisitions Strategic business and investment planning Organisational development Property and estates support Legal, accountancy, financial management and HR support New business and market opportunities

14. Our Vertical Integration Rheumatology Dermatology Orthopaedics Immunology Substance Misuse X-ray Intermediate Care ENT Urology Paediatrics Neurology Pain Management Gynaecology

15. Our Horizontal Integration Community partnerships Health and wellbeing services Social Care Mental health

16. Vitality Partnership Innovative Organisational Dynamic