City & Hackney GP Confederation What are we? What have we done? Challenges and learning

Our aims: Voice of primary care Umbrella organisation for GP practices Support and develop primary care Maintain practice financial viability New ways of working/innovation

Community interest company CIC September 2014 practices are shareholders (1pence share) legal constitution, shareholding agreement, Individual practice agreement £1per patient per year fee/equity 43 member practices, 311,056 population (100%)

governance Board of directors/clinical board Lay members x 2 Audit committee/external auditors Watertight payments to practices process

What have we done? Contract model 1: Confederation wins contract Confederation sub contracts with practices which commit to: deliver to specification seek help if at risk pay for practice support if needed (some practices deliver on behalf of others) 100% population coverage Focus on quality improvement

Contract models 2 & 3 Direct provision – smoking cessation Developmental – practice support team, QI, childhood immunisation, health app, workforce Total contract value 16/17 £11.9m

Achievements: Workforce Salaried GP scheme (17) Trainee practice nurse programme (14 & 15) Advanced HCA programme (12 & 7) Apprenticeship programme (54 & 19) Clinical pharmacists (5 & 3) Trainee practice manager scheme (6) Medical Assistants pilot site (6)

ACHIEVEMENTS – health gain Smoking cessation – over 1800 quitters so far Diabetes blood pressure control - 94% in target (top QOF score in England) CHD blood pressure control - 95% (top QOF score) 1st in 12 of the 65 QOF clinical indicators 2015/16 Health checks – 5421 checks in 9 months Substance misuse – 17accredited practices managing 255 patients in shared care

Achievements – improved care/patient experience 1887 patients on Frail home visiting register Duty doctor in every practice core hours – 30 min response time 1752 patients with a CMC plan Health Visitors & GPs review all vulnerable children 3540 extra appointments per quarter to improve access

Achievements – organisational and personal development Practice monthly MDT meetings Quadrant MDT learning events on case studies Templates, dashboards, coding, searches Facilitation skills training Commission education and training for primary care (CEPN) Group consultation skills via econsult

Challenges and learning Relationship with member practices NHS pension scheme VAT Full cost recovery

The future? Super-partnership(s)? Community nursing? Consultants? GP specialists? In hours and out of hours? Bigger role in unplanned care? Social care and carers? Mental health?