1. NHS Five Year Forward View and the 10 Point Plan – Building the Workforce – the New Deal for General Practice Lisa Soultana Director of Business Development and Liaison, Derby and Derbyshire LMC Executive Lead for Organisational Development (Derbyshire), Primary Care Development Centre (PCDC) GPTAG Development Meeting - 24 June 2015

2. NHS Five Year Forward View (5YFV) The 5YFV looks positive for General Practice, but on closer inspection it signals a significant threat to General Practice as we know it. It indicates that it is highly supportive about General Practice. ‘The foundation of NHS care will remain list-based primary care’. Given the pressures they are under, we need a ‘NEW DEAL’ for GPs. Over the next 5 years the NHS will ‘INVEST’ more in primary care.

3. 10 Point Plan Building the workforce – the New Deal for General Practice NHS England, (NHSE) Health Education England (HEE) and the General Practitioner Committee (GPC) are working closely together to ensure that we have skilled, trained and motivated workforce in General Practice. Produced a 10 point plan to address IMMEDIATE ISSUES, and to take the initial steps in building the workforce for the future and new models of care. Part of the implementation of the 5YFV and the NEW DEAL for primary care, which set out a specific commitment to tackle workforce issues. Designed to complement some of the local initiatives (for example, GP fellowship, Community Education Provider Networks (CEPNs)) are already underway. HEEM are leading on many initiatives and with co commissioning delegated authority, CCGs will increasing be driving the need for transformational change

4. 10 Point Plan – Building the workforce – the New Deal for General Practice RECRUIT 1. Promoting General Practice 2. Improving the breadth of training 3. Training Hubs 4. Targeted support RETAIN 5. Investment in retainer schemes 6. Improving the training capacity in General Practice 7. Incentives to remain in practice 8. New ways of working RETURN 9. Easy return to practice 10. Targeted investment in returners

5. NHS Five Year Forward View (5YFV) The narrative in the 5 YFV walks a delicate balance between the challenge and the opportunity for General Practice. Playing it safe it says, ‘smaller independent GP practices will continue in their current form where patients and GPs want that.’ Bear in mind that carrying on in their current model also means operating with ‘stabilised’ core funding which, so frequently is not enough. This means that while this is technically possible, it is unlikely to remain financially sustainable in the medium term.

6. Overriding message is that the NHS and General Practice needs to change One of the main ways it needs to change is to end the historic separation of GPs and hospital consultants. ‘The traditional divide between primary care, community services, and hospitals – largely unaltered since the birth of the NHS - is increasingly a barrier to the personalised and co-ordinated health services patients need’. All our Clinical Commissioning Groups have signed up to co-commissioning and have delegated authority and more control over the wider NHS budget, enabling a shift in investment from acute to primary and community services.

7. No more funding Over the next 5 years the NHS will invest more in primary care, whilst stabilising the core funding for General Practice nationally over the next 2 years. Any investment and opportunity for General Practice will come as a result of much greater integration with the rest of the NHS. So as it stands today there will be no more funding for General Practice other than that which they already have and other than that which CCGs can extract from hospitals, which in turn requires a significant change in the way General Practice operates. There will also be QUIPP savings to be made!

8. Raising to the challenge Key organisations and stakeholders working together to raise to the challenge. GPs have the opportunity to drive the changes through the creation of Multi-speciality Community Providers (MCPs) for example, but if they don’t get them set up quickly acute and community trusts can set up Primary and Acute Care Systems (PACS) or MCPs that can, amongst other things, deliver General Practice – North Derbyshire - Chesterfield and Cresswell! Remember, in many cases the money is going to those ‘organisations ‘that manage the demand out of acute care and will not be going into core General Practice. That funding will only be ‘stabilised’. So the 5YFV is really saying General Practice has to change fundamentally or stick with core. Partnering with others and operating at a much larger scale and at pace! If it doesn’t, it will not only lose the chance to shape its own future, but will potentially be subsumed by the other large provider organisations that surround it.

9. Transformational change ‘General practice is entering the next stage of its evolution…’ A range of contracting and organisational forms are now being used to better integrate care, including lead/prime providers and joint ventures. There is a national, regional and local drive to make it possible for extended group practices to form – either as federations, networks or single organisations, Multispecialty Community Providers (MCPs) and Primary and Acute Care Systems (PACS). 4 GP provider companies established in Derby City and Derbyshire County. Vanguards are testing new models of care…. Only time will tell if they deliver on their ambition! We need resources to get involved and free up time – who sees our patients if not! We need resources for backfill, to deliver on the transformational change agenda and the training and development to support this.

10. How do we start? The purpose of the GPTAG development Session today… We start together today to ARTICULATE OUR NEEDS, RISKS AND CHALLEN!GES