Dr Paul Twomey Partnership Council Nov 2013 Primary Care Opportunities Set In the Context of Reconfiguration

OVERVIEW New System:  Commissioning  Development / Sustainability  QA / Performance Management HOW DO WE ? Focus GP Practice

GP PRACTICE Challenges / Opportunities / Threats Strategic Reviews: Shift secondary Community 7 / 7 and 8 to 8 Working > Scrutiny (keogh + CQC) Issues re recruitment + moral

GP PRACTICE Challenges / Opportunities / Threats ‘WE’ NEED: Consistent quality primary care:  for patients -focus primary care experience  For system to evolve-reconfiguration - effective utilisation + release of resources

GP PRACTICE Challenges / Opportunities / Threats HOWEVER Essential to describe ‘What is Consistent Quality Primary Care’ Headroom to enable and deliver change Super-saturated Sponge

Standard operating policies and procedures for primary care Primary medical services assurance framework

UTILISING A DIFFERENT ENVIRONMENT Primary Care Focus Area Team CCG Executive GP Practice Primary Care Professional GP Practice as a Provider

PRIMARY CARE STRATEGY Office GP Practice Full range of primary care services through the working day Collaborative approach (federal model/other providers). 11

RESPONSIBLE OFFICER FUNCTION To make available to their constituent doctors a quality assured Appraisal programme which is Fit for Purpose. Supported by the Clinical Governance Framework which will provide suitable developmental opportunities

MEDICAL REVALIDATION First cycle 3 ¼ years ¼ Year 0 = 14 % Residual cohort Year % Year % Year % Focus: Fitness for Practise vs Fitness for Purpose Total Recommendations 177 (14%)  North Yorkshire 67(10%)  Humber 104( %) Deferments 4 4 GMC Actions 2 2 Reflections

INFORMATION FOR GP PRACTICE QoF PMS (KPIs) Quality Dashboard (varied by PCTS) Ownership / Reflection Inform Commissioning and Development

GP HIGH LEVEL INDICATORS Secondary Care Activity QoF Prevalence LTC Exception Rate Prevention / Immunisations Medicines Management Patient Experience

OUTCOME STANDARDS 27 Ca ManagementAF Management -Common Ca -Survival Rates 1 year -Prevalence -Emergency Admission Smoking Management Childhood Immunisation < 2 yrsLTC Management Flu > 65 years Patient experience -Prevalence -Admission rates -Some key QoF indicators

CLINICAL GOVERNANCE FRAMEWORK KEY FOCUS Strategic Direction of the organisation consistent with individual and team objectives Formative focus benefiting from peer review and peer support = Partnership / ownership (spine)

CHARACTERISTICS OF QUALITY GENERAL PRACTICE Holistic and evidence based approach to patient care Continuity of care Positive GP practice : patient relationship Appropriate management of risk Attention to detail Good communication with patients and other health care professionals Appropriate skill mix Education Strong leadership Support from secondary care colleagues Quality IT support Delivered by culture and system

HOW CAN WE CULTIVATE HIGH QUALITY PRIMARY CARE? Nurture current resources to build on strengths Promote new growth Consider hybrids Pruning Commissioning and design

NEXT STEPS ?

SYSTEMS FOR QUALITY GP PRACTICE The Team  induction(int / ext)  mentoring  integrated training programme  individual team PDPwell-being  skill mix  communication  guidance

SYSTEMS FOR QUALITY GP PRACTICE Service Delivery  8 am – 6.30 pm Monday Friday  access to whole team as clinically required  focus patientObjectives  supported by MDTs / complex case management  seamless relationship with community services

SYSTEMS FOR QUALITY GP PRACTICE Collaboration (spectrum) Focus primary care centre  well-being  service deliverycapacity Bring / share enable Build on good characteristics Achieve 3 Rs

ACTION PLAN Focus on what we value GP practice to deliver (call to action)  Health & Wellbeing Boardsdescribe & support  Public Health consistent good GP practice Bring / share to enable  back office and clerical staff Medical Leadership  Focus Primary Care Centre ACTION PLAN SUMMARY

COMMISSIONING OF GP PRACTICE Synergy of:  Core + (Area Team) = 9 clinical sessions  Local enhanced services (HWBB)  Resource identified from reconfiguration ACTION PLAN SUMMARY

GOVERNANCE 3 steps: Conversationengagement sign off (AT) ownership delivery (CCG led)- local community Consensus (AT / CCG / Link / HWBB) ACTION PLAN SUMMARY

KEY ACTIONS Consistent quality GP practice NOW Monday - Friday 8.00 am – 6.30 pm Integrated into wider community service transparent patient sees single service SOON 7 / 7 8 am – 8 pm build on characteristics of good GP practice

COMMISSIONING Minimise safety netting Utilise ITF (protection of PMS)

SERVICE DELIVERY Timescales re impact Unplanned admissions Timely DischargeNOW LTCs2 – 5 yrs Well-being5 – 10 yrs

RECRUITMENT / RETENTION ACT NOW  change environment / culturewell-being  > relationship with Med Students and Drs in training  Year 4  5 yr sliding programme (training + Collab)  Last 5 years  Initial focus GPs but then broaden