Outline Primary Care Strategy Primary Care Commissioning Committee 25 June 2019

Strategic Vision Our aim is to have sustainable and comprehensive general practice, as a cornerstone of the wider NHS system, working collaboratively to improve population health and wellbeing and reduce health inequalities. Our delivery model to achieve is predicated upon comprehensive general practice working within PCNs, based around the registered list, maximising digital and workforce opportunities working with wider partners. Approach – protect & build on strengths of general practice, provide a unified vision shared & owned by practices, LMCs, CCGs and external partners. Priorities Sustainable General Practice – working collectively within PCNs Workforce & Leadership Development Consistent, equitable, high quality services to patients Supporting quality improvement as well as sustainability & efficiency Continued & Equitable Investment Workload Management Integrated In & Out of Hours Access Digital solutions to support the future model of care Consistent approach to development of Estate On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG

Priority 1 - PCNs Wyre Forest x 2 Redditch & Bromsgrove x 3 South Worcestershire x 6 On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG

Priority 1 - PCNs PCN – Localities Herefordshire On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG

Priority 2 - Workforce GPs per 1000 patients - The current national average for a GP FTE is 0.57 per 1000 patients. The range for our CCGs varies between 0.45 - 0.51.   GP recruitment – there are a number of GP practices in our area who have GP vacancies and are unable to fill these posts- we need to focus on recruitment and supporting newly qualified GPs in their first years in practice. There is a significant amount of GPs planning to retire in the next 3 years- we need to focus on retaining their skills within general practice.

Priority 2- Workforce Herefordshire and Worcestershire GPFV Workforce Plan was developed and approved in 2018, focusing on three workforce themes in particular; Theme 1: Developing Supply Theme 2: Up-skilling Staff Theme 3: Developing New Roles This update reviews progress since the plan was developed. Primary Care Quarterly Workforce Survey is a notable achievement to support local workforce intelligence and targeted support Primary Care Workforce representation across STP; Local Workforce Action Board, Workforce and Organisational Development Action Group GP Recruitment and Retention Group On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG

GP Retention and Recruitment GPFV Workforce Clinical Lead GP trainees and ‘first fives’ Mid-career: salaried GPs; locums; partners ‘Wise fives’ Over-arching actions to address retention Rebuilding the reputation of general practice Focus on benefits of growing the wider general practice workforce Workload Professional development (including education of other professionals) Indemnity First Five Clinical Lead First Five Mentor Register and Network Building Relationships with VTS trainees GP portfolio roles Mentoring and Coaching Flexible working opportunities National GP retainer On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG

Theme 1: Developing Supply GPs Working towards increasing GP training capacity and trainee numbers GP Trainers pilot commencing June 2019 Attendance at VTS meetings to outline options post completion First Five Network development GP Training Practices have increased by 2 since Aug 2018, 64% of practices are training practices GPs in Training – increase of 3 WTE since Sept 2016 Practice Nurses Training Hub offering high quality Practice Nurse training Increase pre-registration and nurse training placements Three General Practice Nurse mentors working across the STP Strong links with University of Worcester Practice Education Facilitators Increase of 3 new student placements in 2018

Theme 2: Up-skilling Staff Developing Skill Mix Up-skilling Nurses Up-skilling the Non-clinical Workforce Practice Manager Training and Development Developing Wider Skills

Theme 3: Developing New Roles   ANP FTE Pharmacist FTE Physio FTE Emergency Care Practitioner FTE Paramedic FTE Physician Associate FTE 08/18 12/18 HF CCG 21.38 23.11 7.99 1.00 .83 3.37 2.66 .72 2.72 RB CCG 6.56 5.56 6.73 7.17 .99 2.87 3.51 SW CCG 29.56 27.54 22.70 21.61 WF CCG 15.39 16.33 6.4 5.41 Supporting the introduction of Social Prescribers and additional Clinical Pharmacists within PCNs Training Hub to support existing Physician Associates within the preceptorship programme in General Practice Increase Nurse Associates and Apprenticeship roles within PCNs

Investment and Achievements Scheme Delivery GP Recruitment and Retention Total investment £226k GP fellowships (HEE funding) No successful applications, re-advertise 19/20 via VTS schemes GP portfolio (£106k) 5 GPs recruited to a range of portfolio roles in Dermatology, Diabetes, Stroke, Elderly Care and ED. Significant interest from a range of GPs (early, mid, late career) Evaluation undertaken by GP Fellow, University of Worcester GP with Extended Roles Currently validating and aligning to Elective Care priorities to future training investment GP retainer (national scheme) 10 GPs joined during 18/19 First5 mentor network (£50k) On Target, GP lead recruited and Mentors recruited TERS scheme (national scheme) Success in Hereford, to be implemented GP Trainers (£70k) 5 GP Trainers appointed to support GP Training Capacity Clinical Pharmacists Clinical Pharmacists (national scheme) Successful, 10WTE due to commence during Q1 19/20 from latest wave Physician Associates Physician Associates / PA Preceptorship scheme (HEE) Early success, need to increase numbers Nursing 10 point GPN plan STP GPN strategy Increase in nurse training numbers (3 in last 10 months) 9 EOIs from Practices to host placements (working with Worcester University GPN Facilitator and GPN Leads/Mentors Strategy to be approved by PCCC in May 2019

Next Steps for 19/20 Single Point of Access Medical Education and Peer Support Networks GP Recruitment and Retention Named Clinical Leadership GPFV Workforce Clinical Lead First Five Clinical Lead Practice Nurse Leads Training Hub GPN mentors, Ambassadors for emerging roles Design of new roles Transition from trainee to General Practice Awareness and access to opportunities Implementation of Medical education in primary care model / Medical School developments Increased Training capacity -Training Hubs Mentoring Matching roles with system need Support in first five years Building on local initiatives to build scalable solutions to agreed standards in partnership with STP ICS HEE On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG

Priority – Digital In drilling in to the Midlands, and the H&W CCGs: Herefordshire is reported as 83.3% live, indicating 20 practices live of a total of 24. We know this to be inaccurate and have a had discussion locally between IT thoughts and believe this to be caused by a change in the national tracking database that is yet to be actioned to reflect the merger of practices in Herefordshire to give the total to be 20, not 24. Redditch and Bromsgrove is reported to be 100% live, however with 22 or 22 practices lice, so we’ll need to investigate if also a tracking database issue to reflect the correct number of 1 practices (however Woodrow in technically live so could be reporting the correct technically live practices). South Worcs is reported as 96.9% live, with 31 of 32 practices. So again, we need to investigate where it is going it’s 32nd practice from, I think Link End was the most recent to go so we’ll start in double checking records for that. Wyre Forest is reported as 100% live, 11 of 11, so all good. On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG

Priority - Estates Primary Care Estates Strategy – 30 June On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG

Priority -Investment PC Allocation – Short-funded\Risk Commitment to £11 per head for delivery of local PCE\HOF 1 April 2020 GPFV Spending Plan agreed by NHSE Need More Workforce Estates

Next Steps & Timetable THIS IS AN OUTLINE! NHSE – 24 June PCC Cttee – 25 June NHSE Response – 30 June GP Provider Board & Practice Engagement – June – October STP Executive - October On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG