North Somerset Patient Group (PPG) Event June 2016 Dr Mary Backhouse Chief Clinical Officer North Somerset Clinical Commissioning Group

General Practice in North Somerset The health demographics of North Somerset Commissioning arrangements Pressures and challenges being experienced by practices Changes happening to practices, now and in the future

Proportion of the Population aged under 16 by North Somerset wards, 2013

Percentage of population aged 65 years and over by North Somerset wards, 2012

Percentage of population aged 85 years and over, North Somerset wards, 2012

Unemployment – percentage of the working age population who are claiming out of work benefits, by North Somerset wards, 2012/13

Percentage of people from Black and Minority Ethic group by ward 2011

Index of multiple deprivation in North Somerset, 2015

Population projections for North Somerset, by age categories,

Total population aged 65 and over with a limiting long term illness whose day-to-day activities are limited, 2014

The number of males and females over the age of 75 years predicted to live alone,

Commissioning of primary care Main contract held by NHS England – PMS, GMS and APMS Impact of PMS review Specific enhanced services commissioned by North Somerset Clinical Commissioning Group eg minor injury service Specific enhanced services commissioned by Public Health, North Somerset Council eg drug misuse, alcohol services

Challenges Workforce Financial challenge Ageing population Health Inequalities (next) Multiple Morbidity

Health inequalities in North Somerset North Somerset ranks 7thin the Country for the largest inequality gap in terms of range in deprivation scores between areas. Super output areas in the least and most affluent 1% nationally The current slope of inequality in the gap in life expectancy between the most affluent and most deprived deciles 9.9 years for men and for 6.7 years women Gap in life expectancy between most affluent and least wards 18 years

The leading causes of premature death in North Somerset and rankings compared to other local authorities in England,

Number of chronic comorbidities by age stratum. Miguel J. Divo et al. Eur Respir J 2014;44: ©2014 by European Respiratory Society

Understanding the Pressures in General Practice, King’s Fund, May 2016 Key findings GP workload has grown hugely, both in volume and complexity. The research sample shows a 15 per cent overall increase in contacts: a 13 per cent increase in face-to-face contacts and a 63 per cent increase in telephone contacts. Population changes account for some of this increase, but changes in medical technology and new ways of treating patients also play a role. Wider system factors have compounded the situation. For example, changes in other services such as community nursing, mental health and care homes are putting additional pressure on general practice. Communication issues with secondary care colleagues have exacerbated GP workload. Increase in workload has not been matched by a transfer in the proportion of funding or staff. The number of GPs has grown more quickly than the population but has not kept pace with groups most likely to use primary care (over 65s and over 85s). GPs are increasingly opting for ‘portfolio careers’ or part-time work. Only 11 per cent of GP trainees surveyed intend to do full-time clinical work five years after qualification.

Understanding the Pressures in General Practice, King’s Fund, May 2016 Policy implications Commissioners and policy-makers must have access to national and local data for secondary use for primary care. They cannot plan effectively or understand the impact of their decisions unless they understand how GP activity is changing. Improvements to the existing system should prioritise structured support for general practice, redesign of commissioning systems to reduce bureaucratic burdens, repairing relationships between primary and secondary care, more use of technology, and better utilisation of community assets to meet patients’ needs. New models of general practice should include new types of delivery, striking a balance between working at scale and making services responsive to local people. The service needs a workforce strategy that supports more sustainable careers for GPs and other team members, while recognising changing career preferences. Policies to change and extend access must be accompanied by commensurate increases in funding and support.

NHS England GP forward view April 2016

Simon Stevens “There is arguably no more important job in modern Britain than that of family doctor” GPs are by far the largest branch of British medicine. A growing and ageing population, with complex multiple health conditions, means that personal and population-orientated primary care is central to any country’s health system. As a recent British Medical Journal headline put it – “if general practice

NHS England GP forward view April 2016 Chapter 1: Investment We will accelerate funding of primary care Simon Stevens Chapter 2: Workforce We will expand and support GP and wider primary care staffing Chapter 3: Workload We will reduce practice burdens and help release time Chapter 4: Practice infrastructure We will develop the primary care estate and invest in better technology Chapter 5: Care redesign We will provide a major programme of improvement support to practices

Changes happening to practices in North Somerset, now and in the future Access – alternative forms of access eg telephone appointments, , scope One Care – Prime Minister's Challenge over access in hours and out of hours Accessing the multi-disciplinary team eg nurses, advanced nurses, pharmacists, physio, mental health nurses How the public/communities can help – direct access to information, prevention, self-care, community support eg befriending, third sector support

Changes happening to practices in North Somerset, now and in the future Working arrangements – mergers, Locality integrated working with Community Services and Social Care, One Care Planning for the future - North Somerset CCG Primary Care Strategy Bristol, North Somerset and South Glos Sustainability and Transformation Plan – 5 year planning including Digital Roadmap