New models of care in primary care – ‘at-scale general practice’ Tower Hamlets New models of care in primary care – ‘at-scale general practice’

Networks Tower Hamlets before networks 8 Networks1 were formed in the borough during 2009 23 23 5 5 20 Pop: 33,186 6 6 3 5 1 4 19 22 5 2 21 26 Pop: 29,801 20 27 6 6 24 3 19 7 1 2 22 26 4 21 27 8 10 24 9 14 25 Pop: 35,720 7 12 13 11 30 32 8 10 Pop: 28,995 15 16 29 31 28 9 14 25 12 13 Pop: 18,027 30 32 17 11 18 15 16 29 31 28 Pop: 27,839 17 Pop: 29,892 8 LAPs 36 practices Total population of ~245,000 Practice list sizes of 3,000 to 11,000 33 36 18 35 Pop: 31,975 34 33 36 35 34 Why networks? Focus on population health across a geography Collaborative relationships with wide range of partners (e.g. Borough, schools, charities) Sufficient scale for specialisation of staff, ability to access rare skills and ensure access, resources (e.g. equipment) Integration with estates plan

Case for Networks Wide variation in clinical practice and outcomes for diabetes patients Economies of scale Poor uptake of diabetes education and retinal screening Need to do things differently The right people to do the right tasks at the right time Specialist support Transparency of data Putting the patient at the centre of their care

GP Care Group Journey April 2009 Development of 8 Primary Care networks November 2013 Formation of the GP Care Group September 2014 GPCG registered as a CIC November 2014 CEPN & Open Doors transferred to the GPCG March 2015 THT awarded Vanguard status/GPCG awarded PMCF April 2016 Preferred bidder for CHS contract Commencement of Health Visiting services April 2017 Commencement of CHS

GP Care Group Community Interest Company limited by shares Membership organisation 36 general practices 1 homeless access centre Board comprises: 8 elected GPs representing each network 2 elected Network Managers; 1 elected Practice Manager and 1 elected Practice Nurse Purpose to be the voice of primary care working at scale to ensure sustainability of primary care

Primary Care at Scale Current Portfolio Pipeline Surgical aftercare Pathology transport Websites CEPN Open Doors Extended access hubs Social prescribing pilots Health visiting System leadership – MCP Vanguard Network incentive scheme Out of Hours/Urgent Care Single Point of Access Health advocacy and interpreting CHS alliance manager/system leadership Medical indemnity Business Intelligence QI/ Primary Care resilience Sexual Health

Tower Hamlets Together MCP Vanguard GPCG, Barts Health, ELFT, CCG, LBTH, CVS Now = alliance via MOU Imminent = alliance partnership (stage 1 of MCP) Future = accountable care system Joint commissioner/provider board CCG devolves commissioning intentions to THT Outcomes framework Health and wellbeing strategy alignment

CHS Alliance

Alliance Partnership

Challenges & Learning Last year has been more about system than about primary care CHS procurement – somewhat distracting The future of partnership model – mixed views Practice and network sovereignty Communication and buy-in