Securing the Future of General Practice Harrow LMC Dr Michelle Drage, CEO 29 January 2014

1.The registered list - individuals and practice population 2.Expert generalist care of the whole patient 3.The consultation as the irreducible essence of delivery 4.Take into account socio-economic and psychological determinants of disease and the inverse care law 5.The therapeutic relationship 6.Deliver safe, effective long term and preventative care, balanced with timely episodic care by promoting access to relationship continuity 7.Advocacy and confidentiality 1.Sufficient consultation time 2.Sufficient numbers of GPs, nurses and practice staff per 1000 weighted patients 3.Right premises 4.Right technology 5.Right extended Primary Health Care Teams centred around the practice or networks of practices 6.Right connections and communications across services 7.Flexibility to innovate locally 1.Improve access to GPs and their Primary Health Care Teams by reducing bureaucracy, freeing up consultation time and adding more clinical staff 2.Improve support for GP and practice Primary Health Care Team delivery through integrated care centred around practices 3.Support more training and practices for General Practice Nurses 4.Use contractual mechanisms to support all of the above plus networks of practices and collaboration 5.Re-route funding from secondary care to support all the above by stopping A&E seeing and admitting non-emergencies 6.Get back to basics of service delivery: move away from models that are aimed at developing an alternative provider market. Commissioning for General Practice and Primary Care in London Core Values of General Practice Basic Building Blocks of Excellent General Practice

Core Values of General Practice 1.The registered list - individuals and practice population 2.Expert generalist care of the whole patient 3.The consultation as the irreducible essence of delivery 4.Take into account socio-economic and psychological determinants of disease and the inverse care law 5.The therapeutic relationship 6.Deliver safe, effective long term and preventative care, balanced with timely episodic care by promoting access to relationship continuity 7.Advocacy and confidentiality

1.Sufficient consultation time 2.Sufficient numbers of GPs, nurses and practice staff per 1000 weighted patients 3.Right premises 4.Right technology 5.Right extended Primary Health Care Teams centred around the practice or networks of practices 6.Right connections and communications across services 7.Flexibility to innovate locally Basic Building Blocks of Excellent General Practice

1.Improve access to GPs and their Primary Health Care Teams by reducing bureaucracy, freeing up consultation time and adding more clinical staff 2.Improve support for GP and practice Primary Health Care Team delivery through integrated care centred around practices 3.Support more training and practices for General Practice Nurses 4.Use contractual mechanisms to support all of the above plus networks of practices and collaboration 5.Re-route funding from secondary care to support all the above by stopping A&E seeing and admitting non- emergencies 6.Get back to basics of service delivery: move away from models that are aimed at developing an alternative provider market. Commissioning for General Practice and Primary Care in London

Succeeding in crucial relationship between CCGs and Member practices The patient consultation Relationship continuity Personalised care Expert generalist care of the whole patient Coordination of care across organisational boundaries Enabling patients to understand and contribute to their care Preventative care for people of all ages Deliver care taking account social and psychological determinants of health Demonstrates professionalism through training, continuous reflection and improvement

Succeeding in crucial relationship between CCGs and Member practices Strengthen the expert medical generalist Reduce unnecessary bureaucracy at practice level and free up the patient consultation Better access to personal relationship continuity Enable practices to work more closely together through an extended multidisciplinary primary health care team of community, social and mental health care focused on GP practice populations Focus investment in services that underpin effective general practice eg community health, mental health, social services and diagnostics Identify resources from shifting care out of hospitals and elsewhere and reinvest in general practice and extended primary health care teams Increase capacity to deliver longer consultations with complex patients particularly in areas of high deprivation and ageing populations Change driven from within –general practice and its patients at the forefront of delivering change Do not impose one size fits all – allow for local decision making that fits the needs of the patient population

Commissioning for General Practice and Primary Care in London Core Values of General Practice Basic Building Blocks of Excellent General Practice Extended PHCT MDT Social Services Hospital Care

What shall we integrate this week?

Turn the whole process on its head Commission FOR general practice & primary care

Facts on the ground Facts on the ground is a diplomatic term that means the situation in reality as opposed to in the abstract. Wikipedia

Better outcomes for patients Reduced A&E / Hospital attendances Enhanced integrated care across health, social and mental health care settings Improved quality of patient services Maintenance of high quality generalist healthcare service with relationship continuity at its heart Cost effective care … to deliver

Invest in general practice, primary, community & social care…….

……free up hospitals to do what they should do

Londonwide LMCs support Campaign Engagement with NHSE to shape agenda Surveys Brokering relationships beyond the CCG Policy & Influence Securing the future of general practice in London

Londonwide LMCs Support Investment fund for general practice to operate more effectively but more importantly the support services that help general practice function eg community services, social care, mental health and pharmacy Keep the existing structure as it is proven that it works well and is admired internationally Review primary care development that includes the development of collaborative working and allows the whole system to operate more efficiently

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Securing the Future of General Practice Harrow LMC Improving Primary Care through Collaborative Working Michelle Drage 29 January 2014

Case for change Health and Social Care Act Procurement Choice and Competition, AQP Transformation; system changes with LAs, H&WBs &PH, “Shaping a Healthier Future” Lack of investment/disinvestment General Practice is being challenged as the provider of choice

Key Issues Legal Governance Financial HR Services Conflicts of interest Patients

GPs as Providers Maximise opportunities Why collaborate – shared vision What do we want to achieve through collaboration Cost; benefits What level of collaboration  Management, shared costs/functions  Primary Medical Services – quality/coverage  Service providers; procurement/AQP

Organisation What does this mean for you? - Existing collaborative models  Networks; Federations  Super Partnerships  CIC  Social Enterprise  LLP  CLS/CLG  Cooperatives

Development Programme Collaborative programme for GPs Working with CCGs to meet their needs Practical tools for practices to meet commissioning/provider priorities Legal input Locally focussed - practical tools - How? What? Why? When? Local outcomes – Collaborative working is a solution not a problem

Practical Toolkit Guidance for set up and sustainability that includes: Core contract protection Legal framework Network setup Company Formation Engagement with stakeholders Workforce Premises Service Contracts/Procurement Technical guidance and examples of process infrastructure Individual practical support

The Conclusion(s) The world has changed General Practice is a priority for NHS E General Practice needs to develop

GP Providers Working Together