THE REFORM AGENDA Developing the NHS 2015 - 2025 www.practices.co.uk Developing the NHS 2015 - 2025 Friday 14th October 2016 The Rowley Mile Newmarket Race Course dr patricia oakley director, practices made perfect ltd workforce research fellow king’s college london email: office@practices.co.uk

The Next 30 years Care of the Elderly – physically well and mobile, socially engaged and psychologically content. Chronic Disease Management including Mental Health and Carer Support. Specialist Surgical and Therapeutic Interventions. New Science: Pharmaco-Therapeutics and Genetics, Molecular Imaging and Diagnostics. Building technologies and flexible designs underpinned with real-time information e.g. Electronic Transfer of Prescriptions, Digital X-ray, Just-in-Time Training Programmes.

New service design principles Hospice @ Home Service Single-people enabled Homes and Campuses Hospital @ Home Service New service design principles “High Street” Screening and Diagnostic Centres (high science and technology) Community Activity Centres and The Gym Re-enablement, Rehabilitation and Resettlement Centres GP Well-being Practices and Managed Care Centres (Cancer, Stroke/Cardio, Mental Health) © Practices Made Perfect Trauma Centres Urgent Care Centres Planned Care Centres Nursing and Care Homes Step-down/Convalescent Homes 16j04368aso1

The Place In The Middle High Street The Home Tests? The Gym Tests? Maternity & Neonatology Care Services (including children’s trauma service) (includes current A&E “minors” service) Regional Trauma Services Urgent Care Services Cancer, Cardiac, Stroke Care Services Mental Health Care Services (inpatients) Convalescent, Observation and Place of Safety Beds and Services. Minor Injuries and “Off-legs” Front Door Services. Planned Care and Rehabilitation Services. Outpatients and Long Term Care Support Programmes including Self-Care Workshops and Self-Help Networks Support Programmes. End of Life Services. Local Care Services (including mental health and planned care services) Genetics Services Social & Probation and Police Services (including children’s urgent care service) Paramedic/Blue Light Service Services High Street Social Care Services Hospice and Hospital at Home Services Community Pharmacy and Medicines Services GP Surgeries and Out of Hours Services Community Nursing and Midwifery and Therapy Services The Home Tests? The Gym Tests? Point of Testing Services? Local Diagnostic Services? Local Imaging Services? Local Genomics Services? Regional Diagnostic Services? Regional Imaging Services? Regional Genomics Centres and Predictive Analytics Services?

THE NELSON CENTRE A modern NHS facility providing integrated care for the local community © Practices made Perfect Ltd *Prepared by Dr. Patricia Oakley, Practices made Perfect Ltd | Telephone 0845 862 0372 | e-mail: office@practices.co.uk | web: www.practices.co.uk

THE NELSON CENTRE – CRUCIBLE OF CHANGE a happening place in the centre of a community; a shared place of many players and professionals; a vehicle to develop new ways of working; a locus of major new investments; a crucible of change in workforce deployment. © Practices made Perfect Ltd *Prepared by Dr. Patricia Oakley, Practices made Perfect Ltd | Telephone 0845 862 0372 | e-mail: office@practices.co.uk | web: www.practices.co.uk

INTEGRATED CARE ORGANISATIONS Key Goals Improve quality of life of old and frail people and those with long-term conditions, including mental health problems – ‘ologies, pain and skin, mobility. Improve quality of dying and death – pain, guts, skin. Improve primary and secondary prevention programmes – cardiovascular, diabetes and weight, mental health. Improve rapid response, out of hours and emergency medication services. Improve patient flows and rapid hospital discharges – TIOs, information and therapeutic handovers. © Practices made Perfect Ltd *Prepared by Dr. Patricia Oakley, Practices made Perfect Ltd | Telephone 0845 862 0372 | e-mail: office@practices.co.uk | web: www.practices.co.uk

GP WORKFORCE (ENGLAND) ISSUES 36.9k FTE GPs (+19% since 2004). 64% partners, 24% salaried. 1% growth in partners, 15% growth in employees since 2004. Trainees, training placements, capacity #. GPs leaving profession early, trend to part-time working – Quality of Life important. Hospitals shifting work > primary care, > 7-day services offer, children’s care #. Stress in running a small business and complying with all safety regulations and tax law changes. © Practices made Perfect Ltd *Prepared by Dr. Patricia Oakley, Practices made Perfect Ltd | Telephone 0845 862 0372 | e-mail: office@practices.co.uk | web: www.practices.co.uk

CHILDREN’S SERVICES GP WORKFORCE ISSUES GPs deliver major part of Children’s Services. Problems recruiting and retaining GPs means mums take their children to A&E. Junior doctors take fright and order loads of tests and understandably over-medicalise the problem – might be meningitis. Paediatricians’ roles have greatly expanded and rotas are unsustainable. Need new approach where medical trainees are part- trained in RCGP, RC Paed & CH, RC Psych; and need new approach to children’s nurses. © Practices made Perfect Ltd *Prepared by Dr. Patricia Oakley, Practices made Perfect Ltd | Telephone 0845 862 0372 | e-mail: office@practices.co.uk | web: www.practices.co.uk

DEVELOPING GP PRACTICES IN THE FUTURE Medium Enterprise Model Acute – Primary Integrated Model 6-12 Partners working in a large practice/community resource centre. Functionally differentiated and developed business and clinical support infrastructure. Balance of directly employed and sub- contracted staff to support wide range of services. GPs and community services staff employed or contracted by the local acute service. Services organised as integrated care networks. Back office and full range of clinical support infrastructure provided by acute service. Small Business Model Health Maintenance Organisation 1-2 Partners working in a traditional GP practice. Networked back office functions to achieve some economies of scale. Outsourced services to increase range e.g. on- call and diagnostics. Full prevention and health maintenance programmes provided for care groups e.g. elderly, mums and babies, mentally ill. Micro-commissioning role embedded in the contract for services including incentive schemes to reduce call on the acute services. Back office and full range of clinical support infrastructure provided by HMO. © Practices made Perfect Ltd *Prepared by Dr. Patricia Oakley, Practices made Perfect Ltd | Telephone 0845 862 0372 | e-mail: office@practices.co.uk | web: www.practices.co.uk

MANCHESTER COMMISSIONING AUTHORITY (Bolton, Manchester, Rochdale, Stockport, Trafford, Bury, Oldham, Salford, Tameside, Wigan) 10 Local Authorities, 12 CCGs, 15 NHS Providers, Police and Crime and Fire and Rescue Commissioners, Primary Care, and the 3rd Sector. Greater Manchester Health and Social Care Strategic Partnership Board’s Priorities: Chronic care and long-term conditions Severe and long-term mental health Community and mental health care Learning Disabilities Investment Strategy Dementia and “Dementia United” Greater Manchester Police’s Priorities: Anti-social behaviour and community cohesion Victim support Protecting vulnerable people Transformation Fund of £450m/£6bn. Cornwall, Essex and Greater London Authority similar shifts and developments. © Practices made Perfect Ltd *Prepared by Dr. Patricia Oakley, Practices made Perfect Ltd | Telephone 0845 862 0372 | e-mail: office@practices.co.uk | web: www.practices.co.uk

HEALTH AND WELLBEING BOARD Prevention and Proactive Intervention Programmes Atlas of Variation – big differences in: Diabetes Children and young people Kidney disease Respiratory disease Liver disease. Schizophrenia and psychoses – 20 year gap in death rates. Rehabilitation and resettlement of offenders – 60% recidivism rates. © Practices made Perfect Ltd *Prepared by Dr. Patricia Oakley, Practices made Perfect Ltd | Telephone 0845 862 0372 | e-mail: office@practices.co.uk | web: www.practices.co.uk

NETWORKS OF EMERGENCY – URGENT CARE SERVICES* Regional Trauma Centres (25) Major Emergency Centres (40 – 70) (inc: heart attack, stroke, major trauma, vascular surgery, critically ill child). Network of Local Emergency Centres (c. 100) Services outside Hospital (PIMs) Urgent Care *Urgent & Emergency Care Review, Phase 1 Report: Professor Keith Willetts, NHS England, November 2013. Self care & smart calls Paramedic @ Home Community Pharmacy

THE SHAPE OF THINGS TO COME Science & Technology-driven Improvements Laser 3D-printed porcelain teeth, hearing aid, implants. Laser 3D-printed cartilage, valves, prosthetics. Personalised Medicine based on Genomics and Predictive Analytics. Personalised Poly-Pharmacy Unit Dose Medicines. Biosimilars, mABs, stem-cell stimulated Corneas and Intestinal Villae. © Practices made Perfect Ltd *Prepared by Dr. Patricia Oakley, Practices made Perfect Ltd | Telephone 0845 862 0372 | e-mail: office@practices.co.uk | web: www.practices.co.uk

BETTER USE OF TAX PAYERS FUNDS Need an improved work flows design, job design, more flexible workforce. Elders’ Care, including mental health. Mums and children, women’s health, babies, including mental health. Emergency, Urgent and Trauma care, including mental health, and walk-ins. Primary, and Secondary, prevention programmes, behavioural change, psycho- social support – loneliness and isolation. © Practices Made Perfect 16j04368aso1