South Tyneside Primary Care Strategy – progress and plans update South Tyneside Patient Reference Group Thursday 8th February 2018 Jo Farey, Head of Commissioning (Primary Care)

General Practice Strategy – 5 Work Streams In Place Stakeholders working together to deliver primary care at scale Reducing variation Changing the focus of primary care Improving Access to Primary Care Workforce planning General Practice Strategy initially developed summer 2016 5 workstreams remain in place to focus work Time to refresh and refocus Changing world ……. Investment and Initiatives via GP Forward View Increased scrutiny and reporting Aspiration nationally to reduce services delivered in secondary care & increase the community offer Path to excellence

Stakeholders working together to deliver Primary Care at scale Redesign care provision unconstrained by organisational barriers Co-design with partners and stakeholders an organisational model fit to deliver out of hospital services, using a locality based approach Develop primary care estates strategy Maximise the role of community pharmacy and its integration with wider primary care Deliver integrated care with an integrated workforce Need update on out of hospital model and how to describe progress 90% of practices have had 6 facet survey done looking at the of the building – General condition Functional Suitability Space utilisation Quality Fire, health and safety requirements Environmental management Summary – practices aren’t in bad condition but they appear to be full – need to do more work on details and how this impacts on services ? In a geographical area We anticipate that the estates work will be woven into and support rather than be separate to the primary care strategy and a small group of people are beginning the process to put this into place and enable the estate to develop to meet the emerging needs of ouot of hospital care.

2. Reducing variation Ensuring that primary care access is improved and that local standards are developed and consistently implemented Using HealthPathways to create a systematic approach to delivering care and promote consistency Using the primary care dashboard to highlight variation and drive quality improvements across primary care in South Tyneside Developing and implementing a primary care incentive scheme which delivers improved health outcomes, consistently, across localities and the wider borough

3. Changing the focus of primary care Proactive, people in control of their health, embed approaches to patient activation A Better U – self management of conditions Using patient stories to inform and improve the development of primary care services Focusing on staff skills and competencies to deliver services that match need Increase numbers of GPs and other professionals working within primary care

4. Improving access to primary care Defining and measuring good access and ensuring the right professional with the right skills at the right time. Care redesign with appropriate streaming in place Increase capacity using skill mix Promote role of receptionist Increase the delivery uptake of social prescribing Use of enhanced technology Improved management of appointments within the practice and by patients. Promote telemedicine e.g. by using remote devices and by promoting GP remote working Evaluate the role of e-consultations and plan delivery as appropriate Improve access to general practice in and out of hours

5. Workforce Planning Make South Tyneside an attractive place to work by creating innovative, impactive and balanced roles. Establish a workforce that can deliver new and emerging models of Primary Care Further develop the workforce to achieve clinical specialisms which will enable services to be transferred out of hospital Maximise voluntary sector assets and relationships All professionals to encourage healthier lifestyles and achieve better health outcomes

Progress – key highlights  Foundation of primary care estates and workforce strategies – 90% of practices have had their premises surveyed for suitability and all but one of our practices are using a unique workforce development tool  Young Practitioners Forum has commenced and meets bi-monthly  Continued rise in the number of patients using Think Pharmacy First and excellent working relationships with our local community pharmacies  Attracting a skilled workforce to South Tyneside Student Nurse and Physicians Associate placements

Progress (2)  Innovative Better Outcomes Scheme (BOS 4) in place focusing on delivering improved outcomes in Respiratory, Cancer and CVD and other areas identified by practices as priorities  Regular practice visits – great source of soft intelligence & particularly useful in supporting resilience (helping to nip problems in the bud where we can)  Quarterly quality meetings with a well developed CCG dashboard highlighting variation and outcomes

Progress (3)  Patient navigation/signposting Most administration and clerical staff trained in Active signposting Level 1 and level 2 Managing medical correspondence programme of training commenced Some of our practices now have a welcome telephone message from the GP telling them the receptionist will ask them for a brief nature of their need for an appointment

Progress (4)  Extended access in place and live from September 2017 13 practices across 3 rotating hubs 78 hours a week since September 2017 – 312 extra appts per week Mix of appointment types GP’s, Nurses and Healthcare professionals So far over 5300 additional appointments have been offered across South Tyneside (Sept to Dec ‘17 position)  

Real results….

Prescribing Prescribing spend is forecast to be below budget for the first time in several years. e.g. we are now prescribing significantly more inhalers from the local COPD guidance to improve management of COPD and considering cost effectiveness. This alone has led to prescribing cost savings from April to September 2017 of £150,000 for the CCG. Electronic Prescription Items are the highest in the North East at 75%

Breast Cancer Screening 2012/13 2013/14 2014/15 2015/16 STCCG 75.23% 74.66% 75.77% 76.31% England 72.18% 72.34% 72.21% 72.47%

Care Homes 2014 – 2448 A&E attendances 2015 – 2433 A&E attendances 2016 – 2356 A&E attendances 2017 (April-Dec only) – 1459 A&E attendances a potential improvement of 411 fewer care home residents attending A&E)

Admissions COPD admission rate has fallen at the current rate, end of year predictions could see 19 fewer patients admitted across the year

Cancer diagnosis at stage 1 and 2

Ease of getting through to GP surgery on the phone Q3. Generally, how easy is it to get through to someone at your GP surgery on the phone? CCG’s results over time CCG’s results Comparison of results CCG National 72% 68% Easy Easy 24% 28% Not easy Not easy Practice range in CCG - % Easy Local CCG range - % Easy Lowest Performing Highest 38% 95% Lowest Performing Highest 64% 74% Base: All those completing a questionnaire: National (804,177); CCG 2017 (2,948); CCG 2016 (2,990); CCG 2015 (3,049); CCG 2014 (3,192); CCG 2013 (3,423); Practice bases range from 56 to 149; CCG bases range from 1,203 to 6,967 %Easy = %Very easy + %Fairly easy %Not easy = %Not very easy + %Not at all easy

Challenges We still have over reliance on urgent care via the A&E route Primary Care Access can be variable and we have ‘hotspots’ of areas with known access problems Increasing patient expectations Workforce remains a pressure – we need to concentrate on skill gaps Telemedicine implementation is slow and can be complex but could help us with many of our challenges and help patients to better access services

Summary Lots of work going on, but still lots to do Huge transformation agenda Supporting our clinicians and other professionals – particularly those at the front line Primary Care Strategy is key and needs to be constantly evolving T h a n k y o u