Primary care at scale Why? What? How? Dr Robert Varnam Head of General Practice Development @robertvarnam

Non-specialist / failed consultant Gatekeeper / door-holder King of my castle It’s all in me Specialists Community services

Self management / social prescribing Broader skillmix Population wellbeing management and holistic person-centred care provided by a multiprofessional team led by the GP, supported by at-scale collaboration and efficiencies. Emergency care At scale Self Care Self management / social prescribing Collaboration with specialists

Flexible access to the right person at the right time Empowered to play a greater role in staying well and caring for themselves, with access to comprehensive responsive care close to home. Knowledge, skills, confidence and support More care close to home

Accessible, personal care built on a relationship from cradle to grave UK general practice is one of the world’s most comprehensive embodiments of the founding principles of primary care… Holistic perspective understanding the whole patient not just a disease Accessible, personal care built on a relationship from cradle to grave First port of call and central point of care for all, for life Comprehensive skills to diagnose & manage almost anything Community based responsible for prevention and care of a registered population Personal and population-orientated primary care is central … if general practice fails, the whole NHS fails. Simon Stevens, General Practice Forward View

Working at scale: Opportunities for practices Resilience Economies of scale System partnerships Skillmix Innovation and improvement Staff development

Not an either / or solution 4 400 Personal focus Clarity Commitment Agility Population focus Alignment Priorities Partnerships False polarities Not an either / or solution

STP footprint: 300k-2m MCP: 100-350k Hub/Home: 30-60k Core team: 3-4k Workforce & infrastructure planning Large scale service reconfiguration Major partnerships & shifts in priority MCP: 100-350k Organisational infrastructure & governance Specialist staff & services Employment & career development Model design (population management, care models) Strategic partnerships Hub/Home: 30-60k Acute care Locality-tailored services Shared MDT Place of ‘belonging’ Core team: 3-4k Coordinated, complex multidisciplinary care Continuity

Purpose > function > form Purpose > function > form

Capabilities for the future Leadership Creating shared purpose Strategic planning & partnerships Leading through change Being a leader Improvement Patients as partners Process design Using data for improvement Rapid cycle change Business Team leadership Operations management H R I T At-scale working Governance Contracts Workforce Business intelligence Interdependent capabilities for leaders & organisations One of the tasks of the Call to Action was to identify the actions necessary to promote, support and sustain the adoption of the kind of innovation and improvements we seek. We consulted with practice managers, clinicians, commissioners, policy makers and improvement experts, as well as drawing on the experience of building primary care improvement capability in the UK and internationally. A comprehensive list of areas emerged from this process. This has been tested and refined through ongoing consultation with innovators and professional leaders. The framework describes a set of intrinsic capabilities required by practices to lead service change rapidly, safely and sustainably, and a set of enablers which can be used by policymakers and commissioners to make change easier and more sustainable. Since April 2014, we have had the opportunity to use this framework in support of 1100 GP practices across England in the Prime Minister’s Challenge Fund. As these 20 groups of practices have introduced a range of service innovations, they have received a bespoke programme of capability-building and direct access to national support for key enablers. Feedback from practices and leaders has been very positive, with many examples of faster and better progress being made as a result of it. NHS England are now considering ways in which this framework can be used to secure support for other national initiatives, for example further extension of access improvements, support to workforce innovators and a programme to release capacity through reducing workload and working differently.

So …? Pick something to achieve Do it together Build relationships & capabilities as you go Build structures & contracts to sustain new things www.england.nhs.uk/gpdp

Innovations from around England that release time for GPs to do more of what only they can do. bit.ly/gpcapacityforum

bit.ly/gpcapacityforum A growing collection – submit your own examples and questions.

So …? Pick something to achieve Do it together Build relationships & capabilities as you go Build structures & contracts to sustain new ways of working www.england.nhs.uk/gpdp