GMS CONTRACT AND PRIMARY CARE TRANSFORMATION

INTRODUCTION GMS IS A DELEGATED FUNCTION TO INTEGRATION JOINT BOARDS FOR STRATEGIC PLANNING PURPOSES NHS BOARDS RETAIN RESPONSIBILITY FOR EMPLOYMENT, CONTRACTS, PREMISES, IT ETC IN BOARDS WITH >1 INTEGRATION BOARD THE NHS BOARD HAS TO TAKE AN OVERVIEW FOR THE WHOLE POPULATION IN LOTHIAN WE HAVE A MIXED ECONOMY: IJBs PLAN INDEPENDENT CONTRACTORS DELIVER HSCPs DELIVER NHS BOARD DELIVERS

THE NEW CONTRACT KEY ELEMENTS IN 2018/19 – PRACTICE FUNDING £23M NATIONALLY INCREASED FUNDING TO PRACTICES NHSL GETS £3.7M (16%) OF 121 PRACTICES 30 DO NOT GET AN INCREASE 26 EDINBURGH, 3 MIDLOTHIAN, 2 EAST LOTHIAN, 0 WEST LOTHIAN INCREASES RANGE FROM £1K TO £180K BASED ON SIZE AND DEMOGRAPHICS

THE NEW CONTRACT KEY ELEMENTS IN 2018/19 – TRANSFORMATION FUNDING £46M NATIONALLY FOR INTEGRATION AUTHORITIES NHSL GETS £6.7M (14.8%) PLUS NHSL OWN INVESTMENT OF £4M EDINBURGH £6.1M MIDLOTHIAN 1.1M EAST LOTHIAN 1.3M WEST LOTHIAN 2.2M FUTURE YEARS 2019/20 - £55M 2020/21 - £110M 2021/22 - £155M

THE NEW CONTRACT FUNDING REPLACES PREVIOUS NATIONAL FUNDING FOR: Pharmacy teams in General Practice Vaccination Transformation Programme Primary Care Transformation Fund Community Links Workers Mental Health Primary Care Fund Pharmacy First PLUS OTHER LOTHIAN COMMITMENTS ALREADY MADE Diabetes Phlebotomy Advanced Nurse Practitioner Training

LOTHIAN WIDE ARRANGEMENTS TRIPARTITE OVERSIGHT GROUP – GP SUB/HSCPs/NHS BOARD 9 AREAS OF WORK REPORTING TO IT PREMISES IT VACCINATIONS FINANCE WORKFORCE QUALITY PHARMACOTHERAPY CONTRACTS OUT OF HOURS

LOTHIAN WIDE PLANNING AREAS THAT NHSL MUST LEAD ON PREMISES IT EMPLOYMENT CONTRACTS AREAS WHERE THERE IS AGREEMENT TO WORK JOINTLY ACROSS LOTHIAN VACCINATIONS WORKFORCE REDESIGN OUT OF HOURS CLINICAL GOVERNANCE PHARMACOTHERAPY CTACs

WHERE ARE WE? MEASURES OF SUSTAINABILITY RESTRICTED LISTS

WHERE ARE WE? MEASURES OF SUSTAINABILITY ASSIGNMENTS BY PSD TO LOTHIAN PRACTICES

WHERE ARE WE? MEASURES OF SUSTAINABILITY PRACTICES IN “DIFFICULTY” (AS ASSESSED BY HSCPs) NUMBER OF 2C PRACTICES 2004 2013 2014 2015 2016 2017 2018 4 5 6 9 10 12 8

WHERE ARE WE? MEASURES OF SUSTAINABILITY LUCS BASE CLOSURES

WHERE ARE WE? MEASURES OF SUSTAINABILITY SOME SIGNS OF STABILITY? FAR TOO EARLY TO BE POSITIVE LIMITED IMPACT FROM NEW CONTRACT SO FAR WORRYING NEW TREND IN OUT OF HOURS?

PRIMARY CARE TRANSFORMATION THE TRIPARTITE ARRANGEMENTS ARE LED AND SUPPORTED BY DIRECTOR OF PRIMARY CARE TRANSFORMATION THE ROLE GOES BEYOND IMPLEMENTATION OF THE GMS CONTRACT RESPONSIBLE FOR ALL PRIMARY CARE CONTRACTS, PCCO AND OUT OF HOURS LEADERSHIP ROLE IN JOINT ACTION BETWEEN GP SUB/HSCPs/NHS BOARD RESPONSIBLE FOR NHS BOARD DELIVERY IN PRIMARY CARE RESPONSIBLE FOR NHS BOARD LEVEL PRIMARY CARE STRATEGY

PRIMARY CARE TRANSFORMATION EARLY WORK HAS FOCUSSED ON GMS CONTRACT AGREEING AND IMPLEMENTING COMMON APPROACH ON VACCINATIONS APPROACH TO PHARMACOTHERAPY WORKFORCE ISSUES COMMON APPROACH TO OUT OF HOURS SPECIFICATION AND MODELLING OF CTACs SETTING UP SYSTEM TO MANAGE PREMISES LOAN APPLICATIONS (AND LEASES IN THE FUTURE)

PRIMARY CARE TRANSFORMATION NEXT PHASES OF WORK DEVELOP A VISION FOR THE FUTURE OF PRIMARY CARE IN LOTHIAN FOR THE NHS BOARD DEVELOP AN NHS BOARD LEVEL PLAN FOR IMPLEMENTATION OF THE CONTRACT – PARTLY BUILD ON HSCP PLANS AND PARTLY ON THE NHS BOARD VISION AND RESPONSIBILITIES