1. Wolverhampton Total Health Limited
An NAPC rapid test site for the primary care home model
Dr Gillian Pickavance

2. Primary Care Home 1 - Wolverhampton Total Health
Who we are:
At the end of 2015 a group of 8 GP practices were successful in their bid to become a test site for the Primary Care Home model of care.
Our 8 GP practices based in Wolverhampton comprising of 26 GPs,16 nurses, 8 HCA’s and >100 admin staff are as follows:
TUDOR MEDICAL CENTRE
DRS KHARWADKAR & MAJI
KEATS GROVE SURGERY
CAERLEON SURGERY
CHURCH STREET SURGERY
EAST PARK MEDICAL PRACTICE
NEWBRIDGE SURGERY
WHITMORE REANS MEDICAL PRACTICE

3. Four core characteristics of a Primary Care Home
The provision of care to a defined, registered population size of 30,000 to 50,000 people
A combined focus on personalisation of care with improvements in population health planning, provision and outcomes
An integrated, multi-disciplinary workforce, with a strong focus on partnerships spanning primary, community, secondary, third sector, mental health and social care
Financial drivers aligned with the health needs of the whole population. 1 2 3 4

4. The PCH model will deliver multiple benefits in Primary Care
The 30-50k population of a PCH, through being the right size to scale and right size to care, brings benefits for the future development of Primary Care:
Improved patient care: Enhancing proactive and person centred care by focusing on the needs of the person rather than the needs of the service. Enriching the experience of an individual in a care system with increased satisfaction, particularly in relation to good access to services
Increased staff fulfilment: The PCH provides the environment and conditions for workforce development and effective team working, alleviating pressure across the local system and increasing the ability to attract and retain staff.
Improved utilisation of locals resources: care teams that do the work take responsibility for a whole population budget for that registered community, redirecting resources from the acute sector where they can be more appropriately invested in primary care
Delivers improvements in General Practice: multi-disciplinary teams in primary care will release more time for GPs
Helps to stabilise Primary Care: make it easier for local providers to engage with each other and disparate units of Primary Care to coalesce into more robust units

5. The PCH model has spread to 92 sites so far5

6. The PCH model will drive improvements in patient wellbeing, the quality of care, resource utilisation and staff experience
PCH rapid test sites are developing the four characteristics of the PCH across their local population health priorities
The impact of the PCH model on outcomes is being measured locally and nationally in three case study sites, across 6 domains for those populations
Improvements in each area across population of 30,000 – 50,000 will drive delivery of the triple aims of the 5 Year Forward View.
The outcome measures used by each PCH site for each domain vary based on their local priorities. The table below provides some examples of those being used by the RTS: 7

7. The PCH Model is expected to drive improved resource utilisation
Resource utilisation benefits will be dependent on local priorities, but could include:
Proactive care approach to the health and well being of the local population, reducing demand on local services
Increasing patient access to a wider range of provider services, reducing the number of queues in the system and optimising patient flows
Removing the need for outpatient attendances, increasing care provision in the right care setting
Application of a systematic approach to care of people with long term conditions leading to lower referral rates to hospital
Increasing access to key diagnostic tests to enable more completed episodes of care within the PCH
Increasing the range and reliability of therapeutic interventions through a PCH on-site ‘care bundle’ approach, reducing prescribing costs
Extending roles and responsibilities within the PCH in line with efficient ‘care bundles’ to attract and retain an effective workforce
Optimising early discharge of patients admitted by PCH clinicians collaborating with acute care specialists.

8. Primary Care Home 1 - Wolverhampton Total Health
Our organisation:

9. Wolverhampton Total Health
New Models of Care (Wolverhampton)
Primary & Acute Care Systems (PACs/VI) is a collaboration between NHS Trusts and GP Practices to meet the needs of registered list(s) of patients. This is an opportunities for trust’s to kick-start primary care expansion but reinforce out of hospital care which could evolve into taking accountability for all health needs of a registered list of patients. Part of Vertical Integration is a greater level of back office support which will care of the business element of General Practice.
Multi-speciality Care Provider is a new deal for GP’s as part of the 5 Year Forward View. This would take the shape of being a collaboration of a group practices i.e. federations, networks or single organisation(s). This is not only an opportunity to standardise back office functions and avoid replication but also a way of expanding leadership to include many healthcare professionals. Across the grouping there will be a collaborative approach to service provision whilst there will be a greater convenience for patients shifting the majority of outpatient consultations & ambulatory care out of hospital settings.
Vertical Integration (VI)
Primary Care Home
Alliance / Federation
Wolverhampton Total Health
8 practices
c49,000 patients
(1 further practice to be added)
RWT – hospital
c30,000 patients
Medical Chamber
8-12 practices
(provisionally)
c32,000 – 76,000 patients
3 practices
Primary Care Home 2
8 practices
c42,000 patients
3 practices
1 further practice confirming to transfer on
1 Nov ‘16
Medical Chamber or join PCH3
8-10 practices
(provisionally)
c30,000 – 60,000 patients
Discussions are on-going with a number of other practices and yet to be confirmed
Emerging Primary Care Home 3
3 practices
c30,000 patients
Discussions are on-going with a number of other practices and yet to be confirmed
Discussions are on-going with a number of other practices and yet to be confirmed
A Rapid Test Site for the Primary Care Home Model

10. Primary Care Homes Challenges Money Working as a team
Trust across the teams
Involving people outside of the normal practice network
Involving and listening to patients
Access into secondary care consultants
Time
Employment issues
Indemnity
Training

11. Primary Care Homes Planned Work so far and key objectives:
Increasing access to appointments
GP appointments can be difficult to get and we will be training reception staff to help patients navigate how to use new members of staff such as pharmacists, advance nurse practitioners and social prescribers
We aim to set up HUBS allowing patient access at weekends and evenings for routine and emergency problems. This will involve the practices working together to offer this service. Details are being discussed now based on the NHSE Operational plan to improve access and developing initiatives to meet the 10 high impact actions to release capacity
Active signposting; New consultation types; Reduce DNAs; Develop the team; Productive work flows; Personal productivity; Partnership working; Use social prescribing; Support self-care and management; Build QI expertise

12. Primary Care Homes Meeting the Planned Work so far:
Over The Christmas and New Year Period we participated in the CCG scheme to provider extended opening hours for GP practices
This was mobilised within two weeks meeting a proposal specification to the pilot looking to offer a HUB model covering the practices from Primary Care Homes 1 and 2 over the three localities in Wolverhampton and offer extended hours core services to their registered patients over the Christmas and New Year period, excluding Christmas and New Year’s Days.
Preferably consisting of 1 GP and 1 Nurse offering appointments of 15 minutes per patient for 6 hours per opening day, with a mix of pre-booked and walk-in patient options with 15 minutes administration time at the end of the day and two reception staff.
In addition to this we are also participating in a NHSE scheme to offer a HUB model covering the practices from Primary Care Homes 1 and 2 covering the three localities in Wolverhampton and offer extended hours core services to their registered patients over the Christmas and New Year period, excluding Christmas and New Year’s Days and recurring each Saturday until Saturday 25th. February.
This has 3 sites one in each of the localities providing services consisting of 1 GP, offering appointments of 15 minutes per patient for 4 hours per opening day, with a mix of pre-booked, bookable on the day and walk-in patient options with no decrease in other appointments and activity and a 15 minutes administration time allowance at the end of the session.
The service would therefore provide 72 additional appointments provided from 3 sites Saturday mornings with 2 Receptionists at each site serving a patient population of c100,000 patients from 16 GP practices.

13. Primary Care Homes
Meeting the Planned Work so far evaluation of the CCG scheme
The service was offered by 5 practices
Newbridge; Whitmore Reans; Church Street; East Park and Caerleon
The overall performance with respect the service uptake is summarised as below:
In short the service dealt with 465 patients over the 5 days and GP appointment take up was 68% overall.

14. Primary Care Homes
Meeting the Planned Work so far evaluation of the CCG scheme
From the patient survey exercise receiving 138 feedback forms from 465 patients a 29.7% return rate.

15. Primary Care Homes
In addition we are changing the way we look at our services
Design and develop a new workforce : physicians assistants, pharmacist, ANPs, HCA
Use of voluntary services and non NHS partners: Age UK, chatterbox, memory matters, fire service
Sharing resources across practices e.g. using GPSI
Better use of existing resources by liaising with the better care fund team
Coordinating primary and secondary services and blurring the lines between the two.

16. Primary Care Homes New Clinical Pathways For April 2017
Frailty pathway – Clinical Lead Dr. Pickavance
Extended diabetes pathway – Clinical Dr. K. Majid
Public Health initiatives – Clinical Lead Dr. Mohindroo
On-going for the future
Cardiology – Clinical Lead Dr. Roshan
Gynaecology – Clinical lead Dr. Kharwadkar
Minor ops clinics

17. Primary Care Homes Workforce and Services –
Prescribing / Pharmacy – Andy McGee
Mental Health – Dr N. Ram
Neuro Rehab - Dr. Kharwadkar
Frailty – Dr Pickavance
Dermatology – Dr Ravindran
Musculosketal – Dr Vij; Dr Asghar
Gynaecology – Dr. Kharwadkar; Dr Vij
Diabetes – Dr K Majid; Dr N Badar
Sexual Health – Dr Pickavance; Dr. Kharwadkar; Dr Vij; Dr Ravindran
Cardiology – Dr Roshan

18. Primary Care Homes
What we need to prioritise and deliver:

19. Test Sites for the Primary Care Home Model
Primary Care Homes
Comments please
Test Sites for the Primary Care Home Model

20. Want to know more about
Primary Care Home?
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@NAPC_NHS #primarycarehome