General Practice Forward View & the STP The CCGs’ Views, General Practice Forward View & the STP Simon Trickett Lynda Dando & Interim Chief Officer Redditch & Bromsgrove CCG Director of Primary Care

The STP & the CCG perspective

The STP – Sustainability and Transformation Plan

What does it say? Implement acute reconfiguration Develop new model of community/primary care/social care – the MCP model Cross county collaboration on some other acute services which are fragile, eg stroke, cancer etc

The STP – the money £1.168 billion in 16/17 £1.327 billion in 2021 Allocative approach working through spend on programme areas 5 year journey Resource shift requires move away from PbR contracts to “allocated” population based capitated budgets Plan for use of ‘STF’ money - £50 million in 2021, £20 million for transformation

Putting that into practice 2017/18 Use emerging Alliance Board structures Develop notional/devolved budget – CCG level initially, some ideas: WHCT community services, some WHCT mental health, some non-GMS primary care, prescribing, premises, some social care Link to contracting round with Worcs Acute – activity plan outpatients, admissions and diagnostics Align CCG and WHCT management resources and capacity Voluntary participation

4 priorities for Alliance Boards Improving access to care – new ways of dealing with same day demand that release GP capacity Integrating primary care, social care and community teams – focus on most vulnerable patients Integrate specialist support – reduce steps in the pathway and time taken to access specialist support Promote prevention and self management

Implementing the General Practice Forward View: Local Delivery Plan

The GPFV published on 21 April 2016 sets out investment and commitments to strengthen general practice in the short term & support sustainable transformation of primary care for the future. Many of the actions in the GPFV are for NHS England, HEE & CQC to take forward. What Annex 6 of focusses upon are the actions CCGs need to implement more local aspects. Shared annex 6 with practices via Weekly Briefing

Local Delivery Plan By 23 December: How access to general practice will be improved How funds for Practice Transformational Support (as per GPFV) will be created and deployed How ring-fenced funding to support training of care navigators & medical assistants & stimulate online consultations will be deployed Implementation of Time for Care\10 High Impact Changes Primary Care Commissioning Committee sign off : 7 December 2016 Minim Support to strengthen and redesign general practice, including delivering extended access in primary care one off Sustainability and Transformation package of non-recurrent investments Supporting the increased use of technology backed by both increases in recurrent funding for GP IT, and investment to support the take up of online consultation systems in every practice Training for Care Navigators & Medical Assistants um requirements

Improving Access to general practice Additional recurrent funding 17/18 South Worcestershire £6 per head (weighted) - 100% coverage 18/19 Redditch & Bromsgrove & Wyre Forest £3.34 per head 19/20 All CCG’s £6 per head everyone has access to GP services, including sufficient routine and same day appointments at evenings and weekends to meet locally determined demand, alongside effective access to other primary care and general practice services such as urgent care services. Need to test the market MCP framework talks about clinical contact centres – integration OOH & 111 Learn from the work in south worcestershire

Online general practice consultation software systems 3 year funding starting 17\18 (17p per patient) National specification awaited Primary Care IT Operational Group 17/18 18/19 Redditch & Bromsgrove £45,320 £60,251 South Worcestershire £78,286 £104,087 Wyre Forest £29,546 £39,189

Training Care Navigators & Medical Assistants 5 year ring-fenced funding (9p per patient) 16\17: Local Programme in South Worcestershire “I am writing to let you know that we have had a fantastic response following the Care Navigator event I was present at in Droitwich. Several Care Navigators have been in touch with my team and are visiting our Dementia Cafes. This really is a brilliant step forward for GP Surgeries to be so engaged in the services we have to offer people living with dementia so many thanks” “currently looking after a pt who is a carer, not coping at home. Have 2 appts to discuss next steps and uptake offer of support through Worcestershire Association of Carers” Wakefield on-line programme November Redditch & Bromsgrove £15,152 South Worcestershire £26,173 Wyre Forest £9,902

Transformation Support

Transformation Support 2017\18 & 18\19 via CCG allocations (core services) Funding can take place over 1 or 2 years £3 per head as one off non-recurrent investment to commence in 2017\18 for practice transformational support as described in the GPFV: Stimulate development of at scale providers for extended access delivery Stimulate implementation of the 10 high impact changes in order to free up gp time to care Secure sustainability of general practice to improve in-hours access CCGs who have already been involved in provider development are finding that three things are most effective: creating space for practices to meet and plan together, through funding backfill; providing expert facilitation to make rapid progress on reviewing options and creating improvement plans; and focusing development on improving care and ways of working before addressing questions of organisational form. CCGs are encouraged Redditch & Bromsgrove CCG £525,000 South Worcestershire CCG £909,000 Wyre Forest CCG £336,000

Principles Different starting points across the County but same end point: Sustainable general practice – a strengthened version Practice readiness for extended hours additional funding 18\19 Readiness – MCP contract Principal purpose of Transformation Fund is to pump-prime new ways of working\care models & innovation – not emergency support Investment to be targeted where it can have most impact Build on local and wider learning

Deployment of Transformation Funding Devolve to: Practice clusters\neighbourhoods Federations Alliance Boards ‘Making Time’ analysis to shape and inform deployment Options include: Pump-prime locality hubs, clinical contact centre Primary Care Academy Build capability in general practice teams: Clinical leadership & development Change management & lean techniques Practice Manager & nurse mentorship scheme IT standardisation & template building Technology solutions Making mergers easier

10 High Impact Areas Implementation Primary care, Transformation & Locality team aligned to practices Development of a cadre of system leaders- practice managers, clinical leads, IT super users

Actions Practices complete the Make Time Audit CCGs find the money Establish county-wide GP Forward View implementation group Transformational support agreed December Submit plan - intent January – March Detail April onwards Implementation

Questions & Answers