Practice Pharmacy Group Symposium Dr Nav Chana 23 March 2017

The Quadruple Aim Improving the health of populations Improving the individual experience of care Reducing the per capita cost of care Improving the experience of providing care - Increasing joy and meaning for the workforce Sikka et al (2015)BMJ Quality and Safety - http://qualitysafety.bmj.com/content/early/2015/06/02/bmjqs-2015-004160.full 2

Determinants of population health outcomes www.kingsfund.org.uk/time-to-think-differently/trends/broader-determinants-health

Population cube Self care Informal care Generalist care Childhood Adulthood Older age Essentially well Long Term Condition(s) Higher Complexity need Generalist care Specialist care Informal care

Better health for all through… Primary Healthcare Better health for all through… Reducing exclusion and social disparities Organising health services around people Integrating health into all sectors Pursuing collaborative models Increasing participation WHO Definition 2008

Primary care First point contact Personalised Comprehensive Co-ordination and integration of care

Summary GP Forward View 1. Active signposting 4. Develop the team 7. Partnership working 2. New consultation types 3. Reduce DNAs 5. Productive work flows 6. Personal productivity 8. Social prescribing 9. Support self care 10. Develop QI expertise Investment Workforce Managing Workload Infrastructure Care redesign Source: GP Forward view, NHS Networks

Workforce Trends 2002 - 2012 HEE Workforce Plan for England 2013

Primary care workforce CfWI In Depth Review 2014

Workforce initiatives GPs Net growth of 5,000 by 2020 Nurses Extra minimum £15m investment as part of general practice nurse development strategy Physician associates 1,000 new funded Clinical pharmacists 1,500 extra co-funded, on top of 470 already existing Mental health practitioners 3,000 new fully funded practice-based mental health therapists Physiotherapists Paramedic practitioners Welfare rights advisers Care navigators Medical assistants Initially piloting the roles Source: NHS England presentation

Clinical Pharmacy Functions 1 Medicines usage specialist expertise (public health and social needs) Clinical assessment and treatment (specific disease areas) Prescribing Medicine reviews: polypharmacy: elderly, care home residents/ co- morbidities Medicines optimisation Integration and liaison NHSE (2017) GPFV Clinical Pharmacists in General Practice Phase 2 Guidance for applicants

Clinical pharmacy functions 2 Access Systems Processes Audit Quality improvement Supervision and mentoring Management Leadership

A great squad…

Self management / social prescribing Broader skillmix Emergency care At scale Self Care Self management / social prescribing Collaboration with specialists #GPforwardview

Workforce design for new care models Where education networks add value 15

Population based workforce design The key link is to understand the care functions needed by that population segment e.g. Assessment Treatment Medicines management Rehabilitation Crisis response Recovery Functioning well etc. Then to ‘build’ a team with the requisite skills 16

Multidisciplinary Squad with Generalist Values Life Course Subdivisions Generally Well Lower Higher Risk Risk Long Term Conditions Lower Higher Risk Risk Complexity of LTC(s) and/or Disability Lower Higher Risk Risk Children and Young People Neonates Infants Toddlers Children Adolescents Working Age Adults Young Middle Aged Older working age Older People 65-80 80-90 90+ Neurological (e.g. CP) Multidisciplinary Squad with Generalist Values Respiratory (e.g. CF, Asthma) Learning Disability Mental Health Problems Inactivity Alcohol Smoking CVD Resp. D Cancer Dementia Frailty

Core characteristics of a Primary Care Home 1 Population health planning, provision and outcomes An integrated, multi-disciplinary workforce Focus on 30, 000- 50,000 people Financial drivers aligned with the health needs of the whole population 2 3 4 © 2016 National Association of Primary Care

What sort of interventions 1? Access Web based access Separating urgent care from elective care Home visiting teams Care navigation Integrated provision Musculoskeletal Mental health Pharmacy Community nursing/ palliative care

What sort of interventions 2? Community asset based approaches Voluntary organisations Primary care navigators Social prescribing Population segmentation and workforce redesign addressing primary/ secondary interface Frailty Diabetes/ COPD MSK Mental health

What sort of interventions 3? Integrated care record e-consultation Centralised telephony Diagnostics/ point of care testing © 2016 National Association of Primary Care

Pilot Site Example Benefits PCHs have been successful in releasing a range of benefits for patients, staff, practices and the wider system Pilot Site Example Benefits A&E Attendances £27k of savings each year enabled by providing extended primary care access in Thanet A&E Admissions £295k of savings from reductions in A&E admission driven by Thanet Health GP Referrals 330 GP referrals to hospital avoided given a slowdown in the growth rate demonstrated by Beacon Medical Group Prescribing Costs £220k of prescribing savings demonstrated by Larwood and Bawtry Staff Satisfaction 67% of staff surveyed felt that PCH had improved their job satisfaction Utilisation 78% of staff felt PCH had decreased or not added to their workload Staff Retention 86% of staff regarded Beacon Medical Group as a good employer Patient Experience 82% of staff felt that PCH had improved patient experience GP Waiting Time 6 day reduction in the average time patients wait to see their GP Population Health 13% increase in flu vaccinations for patients with COPD registered with Beacon Medical Group Length of Stay 8 day reduction for admitted care home residents registered with Beacon Medical Group Speaker notes: So, The PCH is a model of care but not a prescriptive one. It presents the opportunity and acts as a catalyst for PCHs to develop and roll out a broad range of initiatives that are relevant to their local population needs and the workforce that serves that population. A lot is being asked of Primary Care in STPs and in the GPFV and the PCH is a way to deliver some these asks. As the table here shows… Over the last month we commissioned a small piece of work to look at 3 of the PCHs and understand the impact they have been able to make on patient care, staff satisfaction, and wider system priorities including the triple aim NAPC (2017) Does the primary care home make a difference. Awaiting publication