David Colin-Thomé National Clinical Director for Primary Care, Medical Adviser Commissioning and System Management Directorate and clinical lead for 18w programme Former GP, Castlefields, Runcorn Honorary Visiting Professor, Centre for Public Policy and Management, Manchester University Honorary Visiting Professor, School of Health, University of Durham

Our health, our care, our say – a new direction for community services  Ambition  Enabling health, independence and well being  Better access to GP  Better access to community services  Support for people with longer term needs  Care close to home  Ensuring reforms put people in control  Making sure change happens

Choice Choice embraces three key components designed to improve people’s overall experience by providing them with more: Power to shape their pathway through services and keep control over their lives Preferences to choose how, when, where and what treatments they receive Personalised services organised around their lifestyles

Why is GP access a problem?: Survey data shows most patients are satisfied with access but a minority remain dissatisfied The recent GP access survey of 2.4 million patients reveals that people are largely satisfied with current access arrangements: –86% satisfaction with telephone access –86% satisfaction with 48 hour access –75% satisfaction with advance booking –88% satisfaction with access to specific GP –84% satisfaction with opening hours –85% satisfaction on average across all 5 measures There are relatively few variations in satisfaction at PCT level. It is the variation between practices which reveals access issues, with patient demographics accounting for the most differences in results. Dissatisfied patients were more likely to be: –Younger (20-35) –Full time working –With young children –Middle class –Black and ethnic minority Satisfaction increases with age and with the amount of contact patients have with their GP.

General Practice Good and universal Mal-distributed Inaccessible to significant groups of people Unwarranted and sometimes large variation in quality Does it lack ambition -for responsiveness, CQI and scope? Does it need competition or at least contestability?

Primary Care Reform GP contracts GP practice procurement Quality and Outcomes Framework Pharmacists contract Nurse leadership (other clinicians) Practitioners with Special (clinical) Interests Practice Based Commissioning Capital into primary care Primary care services as social capital

Next Stages review-Darzi (1) Journey so far. Improvement but…. World class NHS- -fair-SoS announced strategy for reducing health inequalities, -personalised now to focus on primary care and LTC, -effective-Health Innovations Council - safe-Patient Safety Direct to support NPSA AND reduce rates of Health Care Associated Infections -focused relentlessly on improving the quality of care

Darzi (1) –new GP practices for deprived areas New resources for over 100 new GP practices with 900 GPs/nurses/assistants into the 25% of PCTs with the poorest provision. Will be based on those with fewest primary care clinicians, lowest patient satisfaction with access and poorest health outcomes. These new practices will increase capacity and offer an innovative range of services, including extended opening hours. –GP-led health centres for all PC –New investment to establish new GP-led health centres in every PCT area, offering flexible range of bookable appointments, walk-in services and other services for either non-registered or registered patients. Guiding principle to ensure that public can access GP services at any time between 8am and 8pm, seven days a week –extending opening hours for at least 50% of GP practices –each weekend or on one or more evenings each week. Where existing GPs do not start to offer these extended services, PCTs will be able to commission new services from other GPs, GP federations or other providers. –linking greater proportion of pay to patient satisfaction We will ensure that an increasing proportion of the NHS payments made to GP practices are linked to their success in attracting patients, and the views of their patients, including advance appointments and the ability to see a GP in 48hrs -Later this month key information about all GP practices including the results of the patient survey, practice opening times and performance against key quality indicators – will be made available on a single website, NHS Choices via

Next Stages review-Darzi (2) Deliver vision across eight areas of care -Maternity and newborn -Children’s health -Planned care -Mental health -Staying healthy -Long term conditions -Acute care -End of life care

Next Stages review-Darzi (2) Future strategy on primary and community care

More health care in the community Increasing % of healthcare provided locally reflecting:  international best practice  advances in technology  public preference  ageing population  Wanless review

Commissioning Primary Care Quality (What Patients Value) Availability and Accessibility Technical Competence Communication Skills Interpersonal Attributes of Care Continuity of care Range of On-Site Services

Benefits of a first contact in primary care. (Starfield) Higher patient satisfaction with health services Lower overall HS expenditure Better population health indicators Fewer drugs prescribed per head of population The higher the number of family physicians the lower the hospitalisation rate.

General Practice (Roland and Wilson) We identify three areas in which British general practice performs well, leading both international policy analysts and the public to their favourable conclusions: Equity Quality Efficiency and three important characteristics that contribute to this success: Co-ordination Continuity Comprehensiveness

General Practice and Health Inequalities (Roland) Practices in affluent and deprived areas achieving the target of over 80% of eligible women having received a cervical smear. The figure shows not only that overall rates are high and have increased since 1990, but that there has been progressive narrowing of the difference between affluent and deprived districts since Similar narrowing in the social gradient for childhood immunisation is seen in this period.

Functions of General Practice First point of contact care Continuous person and family focussed care Care for all common health needs Management of chronic disease Referral and coordination of specialist care Care of the health of the population as well as the individual ‘Their doctor’ Is the registered population the unifying focus?

Keeping it Personal Build on the best of traditional General Practice Primary Health Care more than general practice …but registered population and 80% of all NHS clinical consultations 90% of care solely undertaken in primary care Support for self care Long term conditions management Care Closer to home The practice can link the wider public’s health and bio-clinical care The practice as the local micro yet strategic health organisation

21st Century Primary Care Multiple information and access points Continuing importance of Personal Care The potential of the registered list Emphasis on Long Term Conditions Management including Self Management and especially of Co- morbidity Public Health oriented Clinicians Expanding Ambulatory Care Quality Assured Active in commissioning of Secondary Care Integrated services Choice for patients, clinicians and all staff Increasing accountability (inc ‘Good doctors, safer patients) New forms of ownership Premises as part of Social Capital

Transparent accountability leads to transparent autonomy- Degeling