1. © Nuffield Trust Transforming general practice: Setting the context Dr Rebecca Rosen Senior Fellow The Nuffield Trust May 15 th 2013

2. © Nuffield Trust Multiple drivers of demand Lack of access to social care New medical technologies Aging populations Rising patient expectations Rising prevalence of chronic disease New providers/ supply induced demand Primary care

3. © Nuffield Trust

4. Relentless rise in number of GP consultations

5. © Nuffield Trust Changes in workforce and working practices Key findings from M&E survey of GPs 2012. Majority work 8 – 9 sessions/week If working 2 sessions/day, > 10hrs Believe quality remains high but  workload is challenging this Workload  due to admin, QOF, LTCs and exceeding appt times Many believe that more capacity would help to  quality/  burnout Concerns expressed about ability to recruit GPs in future Many report changing skill mix in response to increasing demand

6. © Nuffield Trust The Primary Care Paradox.... ‘... a paradoxical situation: the tension between the relative weakness and un- attractiveness of this level of care versus the intention to assign critical strategic functions to it’ From : Primary Care In The Driver’s Seat? Saltman, Rico and Boerma (eds) 2006

7. © Nuffield Trust Primary care ‘fit for the future’ Attributes Comprehensive Patient-centred Co-ordinated Continuous if required Accessible Safe and High Quality Population focused Adapted from Agency for Healthcare Research and Quality 2013 Sustainability Financial Workforce Public trust Fit with wider health system

8. © Nuffield Trust Mechanisms for change Innovation from within general practice Extended scope and scale of primary and community based care Payment systems and contracting arrangements CCG initiatives to commission new services from primary care Acute sector innovation Hospitals setting up primary care services and integrated systems Regulatory drivers of change Competition rules driving CCGs into competitive procurements New technology / information technology Creating opportunities for new types of (rural) clinical encounter

9. © Nuffield Trust How can new models of general practice achieve these design principles? Two broad organisational arrangements emerging for GP: Large partnerships Networks Common challenges, including Financial constraints Uncertain regulatory context Workforce pressures New interface with commissioners New opportunities, including Clinical commissioning driving collaboration between practices Policy focus on Integrated care Changing expectations of general practitioners

10. © Nuffield Trust Hostile policy context, no clear view of role of primary care in national health system

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