Patient Participation Group (PPG) Network 17 May 2019

Agenda 10:00 Welcome and Programme for the Morning 10:10 Introduction of Primary Care Networks Bronwyn Barnes - Programme Manager, Primary Care, Localities & Variation, NHS Gloucestershire Clinical Commissioning Group (CCG) 10.40 Primary Care Infrastructure Plan – Update and Forward Look Andrew Hughes - Associate Director, Commissioning, CCG Questions and Answers 11:15 Break – Networking and Market Place Market Place includes: MIND Swindon, Stroke Association, Healthy Lifestyles 11:35 PPG Spotlight 11:50 Gloucestershire’s Long Term Plan, workshop 12:20 Sum up, messages and Close

Primary Care Networks Update Countywide PPG Network Friday 17th May 2019

General Practice and the Long Term Plan “The biggest reform to GP services in 15 years” HSJ “The most important change to the GP contract since 2004 and a potential game changer” BMJ “These are the most significant changes in 15 years” BMA “The start of a new era for general practice” NHSE In January 2019 NHS England and the BMA General Practitioners Committee in England published a five-year framework for GP Contract reform to implement The NHS Long Term Plan. The agreement sets out the changes in the 19/20 GMS Contract and joint proposals for reform for the four subsequent years. The Framework sets direction for primary care and seeks to address the core challenges facing general practice.

Primary Care Networks (PCN) Increasing patient need, complexity, Long Term Conditions and other factors contribute to rising workloads, making proactive, joined up care more and more important. PCNs are groups of practices that collaborate locally, in partnership with community services, social care and other providers of health and care services. They allow practices to continue doing what they do best, while working together to share other services that require additional scale. PCNs build on the core of current primary care and enable greater provision of proactive, personalised, coordinated and more integrated health and social care. It is about proactively caring for the people and communities they serve. 15 Benefits : primary care can continue to meet patients’ and the wider public’s changing needs, with the support of the rest of the health and care system • GPs and other professionals have a manageable and appropriate workload and greater job satisfaction; • primary care can attract and retain the staff it needs. Experience from around the country has shown that practices working collaboratively and at scale as networks offers the opportunity for this to happen. By working collaboratively or more formally together, practices can become more resilient, improve work-life balance by deploying a wider team, and more effectively meet the holistic needs of their patients and populations. Primary care networks should build on the core values and strengths of general practice.

Primary Care Networks– PCNs are based on GP registered lists, typically serving natural communities of around 30,000 to 50,000, which experience has shown is the optimal size for integrated locality-based working. PCN register by 15 May 2019 Complete Network Agreement documentation by 30th June 2019 PCNs officially commence and can start receiving national investment from 1 July 2019. Each PCN will appoint a Clinical Director as its named, accountable leader, responsible for delivery. 15 Networks should be small enough to still provide the personalised care valued by both patients and GPs, but large enough to have impact and economies of scale through deeper collaboration between practices and others in the local health and social care system. Networks will provide a platform for providers of care being sustainable into the longer term,

Primary Care Networks– Additional Workforce National Funding available to PCNs for additional staff in five groups by 2024 (linked to training numbers qualifying each year): Social prescribing link workers (reimbursement from 2019/20) Clinical pharmacists (reimbursement from 2019/20) First contact physiotherapist (reimbursement from 2020/21) Physician associates (reimbursement from 2020/21) First contact community paramedics (reimbursement from 2021/22). 15

Primary Care Networks– Digital A digital NHS ‘front door’ through the NHS App to all practices in 2019 A number of digital development including: Online and video consultation by April 2021 Online access to patient record At least 25% of appts available for online booking by July 19 All practices to have up-to-date online presence with key information standardised as metadata for other platforms by April 2020 All patients have access to online correspondence by April 2020 15

Primary Care Networks– Gloucestershire PCNs To be confirmed. PCNs will be formally approved by 31st May Likely 14 PCNs across the 6 Localities in Gloucestershire, with PCNs comprising between 1 and 11 GP practices 15

Questions/ for consideration What opportunities do you foresee PCNs will give? How could you align your PPG to your new PCN? Any further questions?

Primary Care Infrastructure Plan Update and Forward Look Countywide PPG Network Friday 17th May 2019

Primary Care Infrastructure Plan 2016/2021 2019 refresh and forward look to 2026

Primary Care Infrastructure Plan 2016 to 2021 Why refresh? Is the plan still aligned with policy and strategy development? Progress update Financial implications Sense check against housing plans Identify next stage priorities 2021 to 2016 Review business case processes and governance Primary Care Infrastructure Plan 2016 to 2021

Recap on PCIP 2016/ 2021 Future direction of primary care service provision Challenge of existing estate Future population Flexible- respond to changing strategies Estimated to be around 713,000 by 2031 Condition of surgeries Service strategies- expanded primary care provision, practices employing or hosting larger teams and increasingly working more in networks Joined up care and wider out of hospital care strategies General practice operating at larger scale and where appropriate, development of hubs A more progressive approach by commissioner, reaching out Recognising financial investment required A streamlined business case process and patient engagement requirements

Policy development - Development of integrated care

Individual Neighbourhood Place System Supporting individuals to manage their own care through self-care, care navigation and improving patient activation. Individual Primary Care Networks that bring together local health and care professionals around natural local neighbourhoods of care – improving integrated ways of working and more joined-up pathways; and embedding population health approaches. Neighbourhood 30~50k Groups of local primary care networks that work alongside partners in secondary care, mental health and with CCGs and local authorities, to: Integrate health and care services Work preventatively to stop people becoming acutely unwell Care models to redesign care Place ~250-500k Primary Care Networks (PCNs) are an essential building block of Integrated Care Systems. NHSE are introducing a new Network Contract – this is a Directed Enhanced Service (DES) PCNs will cover a typical population of 30-50,000 – we expect 100% geographical coverage by July 2019. All PCNs will have a Network Agreement. The Network Agreement is both the means by which the PCN sets out its collective rights and obligations, as well as how it will partner with non-GP practice stakeholders. Every Integrated Care System will have a critical role in ensuring that PCNs work in an integrated way with other community staff such as community nurses, community geriatricians, dementia workers, and podiatrists/chiropodists Providers and commissioners collaborating to: Hold a system control total Implement strategic change Take on responsibility for operational and financial performance Population health management System 1+m

Service strategy Estate implications Enabling active communities Greater use of primary and community facilities. Increased number of services to be accommodated. Greater use by community and voluntary sector. Increased group activity, some of which likely to take place in local surgeries as well as non health related venues. Reducing unwarranted clinical variation Whilst partially offset by increased population, less requirement for acute based outpatient facilities for face to face appointments. Greater requirement for primary and community facilities and in many instances provided through new models of care. Clinical programmes Ensuring suitable primary and community care facilities across, assessing the implication on acute hospital facilities and implication of hub and spoke service models One place, One budget, One system Development of the acute hospital estate, development of community hospital infrastructure and development of primary care facilities Primary care Greater range of services in local surgeries and increased numbers of professionals. Some services being offered across large populations of 30,000 to 50,000, building capacity of primary care infrastructure as many of the existing surgeries are too small to accommodate increased populations and an additional services, Development of large scale centres with colocation/ merger of practices into less buildings

Housing forecast 2019 to 2031 Watching brief Stroud District Local Plan review – possible changes including Berkeley, Whaddon, additional housing at Stonehouse, Wisloe Green Future of MOD site at Beachley, Gloucestershire Forest of Dean post 2026 MOD site at Ashchurch JCS review 4,887 10,325 9,368 3,318* 5,030 7,295 1,370 * To 2026

Housing forecasts and population growth District Number of new houses April 2019 to March 2031 Lower assumption Upper assumption Cheltenham 9,368 10,492 15,176 Cotswolds 5,030 5,634 8,149 Forest of Dean* (2026) 3,318 3,716 5,375 Gloucester 10,325 11,564 16,727 Stroud 7,295 8,170 11,818 South Gloucestershire 1,370 1,534 2,219 Tewkesbury (including Wychavon) 4,887 5, 473 7,917 Total 41,593 46, 584 67,381 January 2019 to March 31st 2031 registered list size increase from 652,500 to between 700,000 and 720,000 – still in line with original PCIP assumption. Since baseline (July 2014 list size increased from 627,545 to 652,500 at April 2019. An average annual increase of over 5,500 patients. ONS estimates for residents are 686,000 to 2031

PCIP 2016/ 2021 Completed and approved schemes ILP Practice(s) Status Gloucester City Longlevens surgery Completed and open in Jan 2017 Tewkesbury Church Street & Mythe Completed and opened in March 2017 Cheltenham Sevenposts surgery (now Cleevelands) Completed and open in January 2019 Stoke Road Surgery Completed and open in June 2018 Stroud & Berkeley Vale Culverhouse Completed March 2018 Churchdown Completed and opened in March 2018 Hadwen Medical Practice Completed and fully opened in September 2018 Rosebank health Completed and opened in December 2018 Cotswolds Stow Surgery Approved, currently being built and due to be open by July 2019 Forest of Dean Dockham Road and Forest Healthcare – Cinderford Approved and construction starting in June 2019 due to open June 2020 Berkeley Place, Crescent Bakery and Royal Crescent surgeries Approved, planning application submitted. Subject to planning construction expected to start before the end of this year Around £40m capital investment with revenue implications funded by CCG

Remaining priorities status ILP Practice(s) Scheme Status Stroud & Berkeley Vale Locking Hill and Stroud Valleys Locking Hill and Stroud Valleys are progressing a 3rd Party led Town Centre development. Business case expected summer/ autumn 2019 Stroud & Berkeley Vale Minchinhampton Replacement of existing surgery Business case expected summer 2019 Gloucester City Gloucester City Health & GHAC Gloucester Primary Care Hub at Quayside for around 18,000 patients Business case expected for June 2019 Cotswolds Phoenix Development of primary care facilities for around 11,500 patients as part of the Chesterton housing development Business case expected Autumn 2019 Cirencester Health Group Development of single facility to replace the Avenue and St Peters Road buildings Site options being scoped Gloucester Brockworth & Hucclecote Development of single facility to replace existing surgery sites for up to 25,000 patients Business case expected August 2019 Forest of Dean Coleford and Brunston surgery Development of primary care facilities in Coleford for around 12,500 patients Business case anticipated New Year of 2020 Phoenix (Tetbury) Development of new facility for around 10,000 patients to replace Romney House Cheltenham North West Elms New GP building to serve a population of around 10,000 by 2028/ 2031. The housing development is likely to be phased over a number of years. Delivery route to be agreed Stonehouse practices Assumed a new surgery would be built on the west of Stonehouse as part of the new housing development led by Regent Street surgery for around 7,000 to 10,000 patients Need to review options.

Forward look to 2021/ 2026 emerging priorities ILP Potential priority Cotswolds Development of a new facility in Chipping Camden Stroud & Berkeley Vale Development of Chipping surgery in Wotton under Edge Development of Marybrook Medical Centre in Berkeley Long term plan for Beeches Green Health Centre Forest of Dean Development of primary facilities across Lydney as part of the wider Forest of Dean infrastructure programme for up to 18,000 patients Gloucester City Development of options for the development/ replacement of Cheltenham Road surgery Development of Bartongate surgery Linked to the wider regeneration of Matson estate, the potential for GP facilities in Matson to be relocated to new integrated community facility in an enhanced central area of Matson Cheltenham Development options for specific Cheltenham practices

Conclusions, your thoughts and next steps Is there anything you believe we are missing? What are your views on the plan? How do you think patients should be involved? Is there anything we should do differently? How could we improve things even further? PCIP remains aligned with policy development Housing and population growth remain in line with planned assumptions A number of proposals have been delivered and a number remain on track There remain a number of issues that impact on delivery The financial implications are higher than initially estimated The next phase of priorities from 2021 to 2016 see a more steady state

QUESTIONS Countywide PPG Network Friday 17th May 2019

Countywide PPG Network Friday 17th May 2019 PPG Spotlight Countywide PPG Network Friday 17th May 2019

Countywide PPG Network Friday 17th May 2019 Gloucestershire’s Long Term Plan Countywide PPG Network Friday 17th May 2019

Date of next meeting: Friday 19 July 2019 Close Date of next meeting: Friday 19 July 2019