Benefits and opportunities of working together Dr Will Murdoch Executive Partner Modality Birmingham

Case for Change The current health and social care economy in Sandwell and West Birmingham is facing unprecedented levels of pressure and will not be sustainable in the long term without transformational intervention Demographic Pressures and Increasing Demand Poor Access to GP Services Across Birmingham Unsustainable System Strains Variations in Quality and Performance Demographic Younger population than rest of England, which is forecast to increase in all population groups over the next 10 years 65+ across Birmingham forecast to increase 30% by 2030 Ethnically diverse, transient population with higher disease burdens and prevalence, particularly mental health Increasing demand across the system, including rate of emergency admissions, elective admissions and GP referral rates Access Approximately half of patients didn’t know how to contact OOH GP services 20% of patients didn’t feel GP surgery was open at convenient times Only 4% of patients stated they booked appointments online (although 15% aware) Through investment from the PMCF Modality has already addressed some of these access issues for their population but there’s more to do Unsustainable Population growth, population mix and acuity changes will increase spending by 20-40% over the next 10 years Increased A&E use, A&E conversion to admissions and hospital days due to insufficient primary and community resource and alternative options The Right Care Right Here programme will build additional community capacity but it will still be insufficient to deal with population (particularly complex patients) needs Variation Lower life expectancies rates compared to England average Higher <75 death rates and higher than expected years lost before 75 due to CHD Higher infant mortality rates compared to England average Increasing rates of unplanned / unnecessary admissions and poor performance across acute conditions not usually requiring hospital admission Minority of patients with Long Term Conditions have a care plan in place

The Modality Partnership At a Glance Modality Population Growth 18 mergers 87,000 patients 30+ partners 1°and 2°care contracts 300+ staff single org. 19 primary care sites Integrated IT: EMIS Web Single Partnership – partners own shares of the organisation One model of care Corporate Structure Executive team manage day to day GP Partnership Board to oversee governance

Federation vs Partnership Collaboration between multiple practices May be informal or a legal entity, e.g. LLP, CIC, Ltd Co Informally or formally established organisational structures with management teams funded by member practices GMS provided by member practices Enhanced services / specialist services provided by federation May share back-office functions Using organisational scale to achieve economies Individual practices retain own identity Potential for conflicts when bidding for services Examples: Midlands Health Network, New Zealand Tower Hamlets, UK Full legal merger between practices Corporate style legal entity is the partnership Single Management team Core services, enhanced services, specialist services, community services, private services Shared back office functions Single scaled organisational infrastructure to expand scope of primary care provision. Single legal entity to hold all contracts or legal sub-divisions Potential loss of individual practice autonomy Quality Improvement through peer review process Examples: Modality Partnership, Birmingham Whitstable Medical Practice, Kent

Work with people who share your vision and values Don’t start with the end point – find the common ground

Don’t tell GPs what to do, tell them what they’re doing.

Start with the difficult conversations and myth-busting How hard will I have to work? How much will I earn? Will I still run my practice? Will you close my practice down/make my staff redundant? What will happen to my patients?

Create a structure that works

Development and implementation Exec partner Executive Operations HR&OD Transformation MD M&A FD Development and implementation Dean (Education Dev & innovation) Commercial Board and executive HR officer IT Governance Central ops

Some benefits

The CQC

Service Improvement: Service Availability and Quality Our Clinical Contact Centre Up to 1,300 calls answered every day, serving over 46,000 patients Average call waiting time is 4 seconds Average call duration has reduced from 10 minutes down to 2 minutes Demand for appointments has stabilised throughout the day, reducing the morning rush Patients call their surgery number Clinical capacity increased by 10% Clinical staff work to set days and the website is updated on a daily basis so patients can see who is accessible. We advertise this in surgery. Patients are encouraged to recontact on set days for continuity of clinician if needed. Patients are offered a choice of clinician or speed of response. (Over 70% choose speed of response) Future booking is delivered on the day by managing supply. All follow ups are by phone or skype where possible DNA (Did Not Attend) Rate reduced by 72%

Service Improvement: Monitoring and Evaluation A live data dashboard was created to support intuitive planning, resourcing, management and evaluation. We are constantly evaluating what we are doing. Automatically populated by call system and we add in website and app information. For the first time we really understand patient demand. Spikes represent Mondays.

It’s not as easy as it sounds We’ve been doing this for 7 years and learning