Harrogate and Rural District Primary Care Strategy

Harrogate and Rural District Primary Care Strategy: What do we want Primary Care in Harrogate and Rural District CCG to look like in the future and how do we make sure we achieve it?   Why do we need a strategy? There are a number of reasons why a strategy is needed: Primary care commissioning has now been delegated to Harrogate and Rural District CCG and we need to have a local view to guide us on making commissioning decisions. The population is getting older. It is estimated that there will be a 2.2% total increase in the population of HaRD over the next five years. However, there will be an estimated 10.9%, 13.7% and 20.8% increase in the age bands 65+, 75+ and 85+ years respectively. This will have increased demands on primary care Care outside of hospital is changing with more integration between health, social and voluntary sector care and an emphasis on treating more patients in the community Primary care is arguably already running at overcapacity and, with inevitable increasing demands on the service, is not sustainable if it does not adapt There is a funding gap nationally between projected spending requirements and resources available to commission services across the NHS Increased patient expectations Standing still is not an option and this strategy sets out the high level aspirations for what primary care should look like in the future This strategy focuses on primary medical care commissioning which is the responsibility of the CCG. However, it should not be seen in isolation to other aspects of primary care (dentists, community pharmacy and opticians) What does Primary Care in HaRD look like now? There are 17 GP practices, covering 161,000 people. There is a mixture between urban practices and rural practices with some covering both 10 practices are dispensing practices There are 152 GPs in the area (129 full time equivalent) 38% are male (compared to 48% in England) 15% are over the age of 55 years (compared to 22% in England) The headcount and number of full time equivalents of all GP practitioners per 100,000 population is high compared to our 10 closest CCGs The proportion of all GP practitioners who are 1 Full Time Equivalent (or more) is 57% compared to 73% for England The number of all practice staff per 100,000 population is similar to England but less than most of the other 10 most similar CCGs. Practice Nurse full time equivalent numbers per 100,000 population is high compared to our 10 closest CCGs. However, the proportion of advanced nurses or extended nurse roles is low The number of admin and clerical staff full time equivalents per 100,000 population is low compared to our 10 closest CCGs Most practices are under the GMS contract but 3 practices are PMS 13 practices use the SystmOne and 4 practices use the EMIS web clinical computer systems There is a mix between new and old accommodation

What are the strengths of our current system?   There is network of GP practices (Yorkshire Health Network) that includes all HaRD practices There is a high quality workforce who want to come and stay in the area The workforce is multidisciplinary The quality of primary care locally is high General practice gives continuity of care throughout a patient’s life GPs have good relationships with, and know, patients and their families well The art of general practice vs hospital medicine Patients are informed and engaged with less mobility and deprivation than in other areas of the country The independent contractor status of GPs gives them a good work ethic General Practice is accessible, responsive and flexible to the needs of the patient There is strong involvement with GP training (x practices are training practices) Research is encouraged and several practices are part of the Primary Care Research Network What opportunities for different ways of working have been identified?   Adopting different work patterns – recognising that the workforce is moving towards more part time working, and that there is a national request for more 7- day working Local commissioning of primary care – removing bureaucratic processes to ensure effort is placed where it will be more effective around patient care Using Yorkshire Health Network (YHN) to do things differently Using New Care Models to drive forward change Integrating teams and skills effectively – integrating with social care as well as getting the right skill mix within practices so the right person with the right skills is freeing up practice time Improving specialist support in the community – including more pharmacist support and an emphasis on frailty Growing a new workforce – across the whole skill mix Investing in primary care – using opportunities such as the New Care Models Expanding GPs as providers and improving provision in the community – where there are cost-effective alternatives to inpatient and specialist services that can be carried out in the community Utilising GP premises Using technology effectively National agenda driving change Utilising support from other agencies (eg NHS England, New Care Models, Health Education England, Academic Health Services Network)

What will help us achieve the vision and outcomes – so-called ‘Enablers’   Finance and contracting Local contract flexibility with the potential to replace QoF Development of Out of Hospital services Redistribution of PMS money Utilising the potential of YHN to do things differently Identifying opportunities to do things differently through the Vanguard support process Following national guidance on conflicts of interest Patient and professional engagement Ensuring that practices, their staff and patients are engaged with developing and implementing the strategy Acknowledging and addressing concerns and fears of change Governance and quality frameworks Strengthening the Quality and Clinical Governance committee around primary care quality Working with NHS England around professional accountability Commissioning for quality through the Primary Care Commissioning Committee Local Commissioning Ensuring we have the right staff with the right skills Using local knowledge of workforce Using ‘Soft intelligence’ Working with NHS England, Health Education England and the Local Education and Training Board What do we want our Primary Care system to look like in 5 years’ time?   The following characteristics of a future primary care system have emerged: A more empowered workforce that: is happy and feels valued, is allowed to develop skills that are needed, is encouraged to be innovative has a balance of specialist and generalist skills to meet the needs of the population maintains continuity of patient care More engaged patients and carers who: are central in any decision making about their health are empowered to prevent and manage their illnesses More sustainable provision of Primary Care that: is of high quality with equality of access to services is responsive to the needs of the population – seeing patients quickly when needed and able to the spend time needed to proactively manage long term conditions has the capacity to treat more patients in the community values mental health equally with physical health promotes continuity of care throughout has no wrong door has ambition to change by protecting and building on what already works whilst not being afraid to do things differently learns as it adapts is joined up by IT systems that work for everyone (professionals and patients) maintains General Practice as a business

These outcomes will be achieved by focusing on the following actions Domain Actions Measures of success Empowered clinicians Valuing the workforce by considering the impact on the workforce of any commissioning decisions Support for change eg organisational development work with New Care Models Increasing the workforce skill mix by exploring opportunities for different roles to free up GP time Making QoF more relevant for our population   The workforce feels it has time to care and is supported (staff survey) Empowered patients and carers Focus on quality of primary care provision and reduced variation Meaningful engagement with the community on service redesign More care delivered in the community Simpler 7 day acces to primary care whilst maintaining continuity Focus on prevention and people taking more control over their health Being realistic about expectations People feel in control of their health (survey) ‘You said…, we did…’ Sustainable provision Ensuring the primary care estate meets our strategic objectives Exploiting opportunities to link with pharmacy, dentistry and optometry IT that works for everyone Encouraging training of GPs and wider primary care workforce within the CCG Measure of primary care sustainability???? These outcomes should be seen to complement, and in support of, the CCG strategic priorities of: Long term conditions and integration of care Vulnerable people and mental health Health and wellbeing Planned care Urgent care Primary care

The following pages describe the CCG’s plan of progression to the achieve the aims of the Harrogate and Rural District Primary Care Strategy by 2020. Building on the work already in progress and the levers in the GP Forward View, the Strategy will support CCG’s vision for the future of more care being delivered in the community, closer to people’s homes. The route to achieving the aims of the Strategy (Empowered Patients and Carers, Empowered Clinicians and Sustainable Provision) can be summarised as -

This page explains the design and function of the following pages, which contain timescales and detail of how the CCG will progress towards its vision for Primary Care

NHS Harrogate and Rural District CCG 6 FACET SURVEYS COMMISSIONED IT BIDS SUBMITTED ETT FUNDS AVAILABLE ESTATES BIDS SUBMITTED RESULTS OF ETT BIDS PUBLISHED NHS Harrogate and Rural District CCG RESULTS OF 6 FACET SURVEYS PUBLISHED BIDS PREPARED FOR CAPITAL DEVELOPMENT OUTSIDE ETTF/CIL REMEDIAL ACTION AGREED AND IMPLEMENTED CLINICAL RECORD SHARED WITH ALL COMMUNITY TEAMS AND PATIENTS DEVELOPMENT OF SOUTH AND CENTRAL HEALTH AND WELLBEING CENTRES TRANSFORMED HaRD PREMISES TRANSFORMED GP/COMMUNITY INFRASTRUCTURE TRANSFORMED RIPON INFRASTRUCTURE PREMISES DEVELOPMENT TO SUPPORT TOWN PLAN COMMUNITY INFRASTRUCTURE LEVY CONFIRMED TOWN PLAN PUBLISHED ESTATES STRATEGY PUBLISHED HEALTHY RIPON INFRASTRUCTURE NEEDS TO SUPPORT TOWN PLAN SUBMITTED

NHS Harrogate and Rural District CCG PRACTICE LINKS TO CARE HOMES NATIONAL PROGRAMME TO SUPPORT PEOPLE WITH LTC NEW CARE MODELS NHS Harrogate and Rural District CCG SHARED CLINICAL RECORD IN CARE HOMES INTEGRATED HEALTH AND SOCIAL CARE SERVICES CARE PLANS FOR EVERYONE WITH FRAILTY/LTC NATIONAL DEVELOPMENT OF APPS LIBRARY FOR PEOPLE WITH LTC CO-COMMISSIONED INTEGRATED COMMUNITY TEAMS INCREASED SELF CARE AND EMPOWERED PATIENTS TRANSFORMED COMMUNITY TEAMS DEVELOPMENT OF GP ‘ACCESS HUBS’ CHANGES TO QOF TO SUPPORT HOLISTIC CARE FRAILTY STRATEGY DEVELOPED TRANSFORMATION AREA FUNDING FOR EXTENDED GP ACCESS

NHS Harrogate and Rural District CCG PRACTICES WORKING CLOSER TOGETHER PRACTICES PROVIDING GP TRAINING GENERAL PRACTICE NURSE DEVELOPMENT STRATEGY NHS Harrogate and Rural District CCG UPSKILL CURRENT RECEPTION AND ADMIN STAFF PRACTICE MANAGER DEVELOPMENT RELEASING TIME TO CARE DEVELOPMENT OF NEW CLINICIANS BACK OFFICE FUNCTIONS PROVIDED AT SCALE PRACTICES TRAINING PRACTICE NURSES, HCAs AND PHYSICIANS ASSISTANTS APPROPRIATE CLINICAL SERVICES PROVIDED AT SCALE APPROPRIATE SKILL MIX IN PRIMARY CARE 5000 ADDITIONAL GPs IN POST TRANSFORMED GP PRACTICES 14% INCREASE (£2.4 BILLION/YEAR) INVESTMENT IN PRIMARY CARE ALL INCOMING COMMUNICATION FROM NHS PROVIDERS TO BE ELECTRONIC AND CODED EXTEND CONSULTATION TECHNOLOGY USE STP TO ‘SECURE AND SUPPORT PRIMARY CARE’ DEVELOPMENT OF YHN AS PROVIDER TRANSFORMATIONAL SUPPORT FROM CCG REVISION OF CARR-HILL FORMULA CONSIDER IMPACT ON GPs OF ALL COMMISSIONING DECISIONS CHANGES TO NHS STANDARD CONTRACTS FOR HOSPITALS SUPPORT FOR MEDICAL INDEMNITY COSTS