Primary Care in Scotland: GP Clusters and the new GP contract Dr Gregor Smith Deputy CMO

Why we need to change the world is changing Demographics Health and Social Care integration – the new world keeping people in the community is right thing to do Staying at home or homely setting is what people want Investment in primary care is cost effective the status quo is not sustainable The system is under growing pressure All professions are keen to operate to the top of their professional capabilities Health inequalities demand creative responses Out of Hours review has demonstrated a clear way forward

“a new world” “My vision puts primary and community care at the heart of the healthcare system, with highly skilled multidisciplinary teams delivering care both in and out of hours, and a wide range of services that are tailored to each local area. That care will take place in locality clusters, and our primary care professionals will be involved in the strategic planning of our health services. The people who need healthcare will be more empowered and informed than ever, and will take control of their own health. They will be able to directly access the right professional care at the right time, and remain at or near home wherever possible.” Shona Robison, Scottish Parliament, 15 December 2015

performance time now transition “old world” “new world” “Changing the world”

GP Contract 2016/17 QOF and TQA Quality and Outcomes Framework (QOF) dismantled from 1 April 2016 Transitional Quality Arrangements (TQA) –Cluster working; 6-8 practices?; Practice Quality Leads; Cluster Quality Leads; focussing on the outcomes and needs of the practice populations –Disease Registers; Flu immunisation; Access; GP cluster working; Anticipatory Care Plans; Quality Prescribing

GP Contract 2016/17 – dismantling QOF QOF funding associated with 659 points transferred to Global Sum Based on the 3 year average achievement Expectation that clinical services will continue, based on clinical judgement and the professionalism of GPs and their staff Removes the link between achievement and payment

Scottish GP Contract 2017 on – a re-focus Building on 2016/17 agreement Deputy CMO group - Quality proposals Future role of the GP; expert-generalist in complex care; undifferentiated illness; quality and leadership Future role of all professionals; ‘top of licence’ GPs; a voice in the wider system Towards a ‘Primary care led NHS’

Future Role of the GP; Expert Generalist Complex care; reactive and proactive Reactive; support for other professionals working to the ‘top of their licence’ Pro-active; supported to identify and to work with others to address the needs of a cohort of ‘high gain’ individuals

Expected Benefits Patients; more time for complex needs; quicker access to right professional All practitioners; focus on quality of care for high need patients, greater job satisfaction Wider system; best use of expensive resource; secondary benefits of high quality ACPs, acute referral and admission rates

Future Role of the GP; undifferentiated illness Who needs further assessment, investigation, referral, treatment Currently mainly done by GPs (future?) Those people who ‘need to see a GP’ Not those who ‘need to see a n other (health) care professional/worker’ Needs more a n others!

Expected Benefits Patients; more time for undifferentiated care; quicker access to right professional All practitioners; focus on quality of care for people who ‘need to see them’ Wider system; best use of expensive resources; secondary benefits of most effective rates of assessment, investigation, referral (and admission?)

Future Role of the GP; quality and leadership Through a ‘peer led, values driven, quality process -Professionalism in care delivery at an individual practitioner level -Cluster working across practices Practice Quality Lead; role within practices Cluster Quality Lead; role across practices

Role of the GP Cluster Intrinsic Learning network, local solutions, peer support Consider clinical priorities for collective population Transparent use of data, techniques and tools to drive quality improvement – will, ideas, execution Improve wellbeing, health and reduce health inequalities Extrinsic Collaboration and practise systems working with CMDT and third sector partners Influence priorities and strategic plans of IJB Provide critical opinion to aid transparency and oversight of managed services Ensure relentless focus on improving clinical outcomes and addressing health inequalities

Expected Benefits Continuous Quality Improvement is an intrinsic part of every practice (and practitioner within) A greater focus on outcomes that matter (to individuals and communities) Practitioners have a voice in the wider health and social care system; with the aim of improving outcomes by action across the whole of the patient pathway

Goal Quality framework that enables improvements in known and omitted care –within GP clusters and –across local health and social care systems Supporting infrastructure –Appropriate data, analysis and tools –Leadership and Improvement capability –IT; coding, extraction, CDSS –Culture, protected time, trust

A safe transition Need to ensure stability in the system Transfer only when safe to do so Deciding/agreeing what changes have greatest benefit Evolution rather than revolution