The General Practice Forward View in Gloucestershire Equipping Primary Care to meet future challenges Helen Edwards – Associate Director Primary Care and Locality Development, Gloucestershire CCG

Gloucestershire Context 2 densely populated urban localities 5 surrounding rural localities 81 GP Practices; 635,000 patients Perform well in many measures, e.g. CQC, QOF, GP Patient Survey However, significant challenges…

2016/17 – Planning and acting Primary Care Strategy developed as key component of STP, inclusive of Primary Care Workforce and Estates plans Embraced General Practice Forward View – Project Team inclusive of LMC, RCGP, HEE, NHSE, led by CCG Recruited seven GP Provider Leads, funded 3 sessions 16 ‘clusters’ of practices formed organically Every cluster given management support Place-based pilot started with four clusters, integrating care for local population Primary Care ‘launch’ event; 200 GPs & PMs

Delivery of our Strategy and the GPFV 2017/18 Delivery of our Strategy and the GPFV

Where we are now … Workforce Estates IT Place-based integration Transformation Resilience Care Navigation Clinical Correspondence Improving Access Productive General Practice General Practice Improvement Leaders Releasing Time for Care Over 60 projects across the County, often led by Provider Lead GPs, all with management support from CCG:

Focus on … Workforce

Primary Care Workforce Surveying practices annually; baselining and planning Community Education Provider Network (CEPN) established. A rotation scheme to retain newly qualified GPs in the county GP Retention Scheme and Portfolio Careers Practice nurse education, training and workforce planning International Recruitment BMJ – “Be a GP in Gloucestershire” Campaign”

Primary Care Workforce Developments General Practice Improvement Leaders Productive General Practice Releasing Time to care Clinical Correspondence and Care Navigation Feedback from practices taking part in The Productive General Practice programme is very positive. All 35 practices are now working on their second chosen module, supported by visits from their coach. The programme will run until December 2017.  Also as part of the Time for Care programme, a second cohort of our local General Practice Improvement Leaders training programme took place in October, with a good mix of clinical and support staff attending.  Once again, the feedback was excellent from those who attended. Planning has commenced for next year’s quality improvement programme, focused on the Ten High Impact Actions for General Practice. This will run from March – December 2018 as the Releasing Time for Care Collaborative across clusters. Clinical Correspondence and Care Navigation: We are continuing to support clusters with rolling out these two training initiatives.

Focus on … Primary Care at Scale

Practice Transformation GCCG made funding recurrent at £1.89/head Bids had to be collaborative, transformational and deliver sustainability 81 practices formed 16 clusters Created foundations of ‘Primary Care at Scale’ 81 practices Offered opportunity for recurrent funding Had to be collaborative bids, practices could come together how they wanted but had to be based on a sensible geography and demography that would make sense for their patients and bring resilience, sustainability and be transformative Different sizes, range of 18,000 – 60,000; fine but needed to bring resilience and sustainability and be transformative The most profound change we made and the basis of everything that followed Our platform for New Models of Care

Practice Transformation This investment has led to: 20 (>12 WTE) Clinical Pharmacists working as a shared resource across practices within clusters, reducing GP workload Community Matrons as a shared resource for all practices within their cluster, supporting their frail patients Shared Urgent Visiting Service, utilising paramedics Repeat Prescribing hub for all practices within a cluster

1. General Practice Resilience Practice Resilience – Aspen 1. General Practice Resilience Four practice merger Supported by resilience funding Change management Wraps together: resilience, transformation, access, training …

Focus on … Access

Improved Access £6 per head of patient (weighted) 7 day access to Primary Care across the county, including weekday evenings and weekends Countywide offer under former PMCF stream Asked clusters for ideas of innovative ways of delivering evening and weekend appointments that would also support Primary Care and the wider system.

Improved Access Working collaboratively across STP, clusters will have: Paramedics employed by the Ambulance Trust undertaking home visits Physios and GOAM consultants employed by the Community Trust Mental Health Workers employed by Mental Health Trust Pilots commence in October

Integration: Place-based Focus on … Integration: Place-based

Place-based Now developing more integrated, place-based approach Pilots in Gloucester City (5 clusters – 170,000 patients) and Stroud (4 clusters – 120,000 patients) Involves all STP partners; community and mental health trusts particularly at this stage

Place-based Pilot areas have trialled joint initiatives including: Mental health practitioners in primary care CDNs in primary care Multi-disciplinary team meetings to provide integrated care “without walls”

Focus on … Estates

Primary Care Estates Significant CCG investment to improve, modernise and expand primary care In excess of £500K towards fees, an extra £1.5m for rent and rates & over £100k in improvement grants awarded New Devereaux Centre opened in March 2017 Kingsway surgery approved with additional CCG support and construction underway Longlevens extension completed and opened Churchdown surgery approved and construction started Glevum surgery extension approved with additional CCG support and building work underway Solution for new Stow surgery in place and construction due to start over the next couple of weeks Sevenposts – new surgery proposal finalised and construction due to start this November Over £4m worth of ETTF funding successfully obtained Delivering the PCIP – number of business cases in progress across the County for Cheltenham, Tetbury, Cirencester, Cinderford, Minchinhampton, Stroud, Brockworth & Hucclecote and hopefully soon Gloucester. All of these examples demonstrate the significant investment in primary care premises since the CCG was awarded Delegated Authority. ETTF = Estates Technology Transformation Fund.

How does the General Practice Forward View feel for practices?

Thank you for listening Helen Edwards – helen.edwards28@nhs.net