1. THE REFORM AGENDA Developing the NHS 2015 - 2025
Developing the NHS
Friday 14th October 2016
The Rowley Mile
Newmarket Race Course
dr patricia oakley director, practices made perfect ltd
workforce research fellow king’s college london

2. The Next 30 years
Care of the Elderly – physically well and mobile, socially engaged and psychologically content.
Chronic Disease Management including Mental Health and Carer Support.
Specialist Surgical and Therapeutic Interventions.
New Science: Pharmaco-Therapeutics and Genetics, Molecular Imaging and Diagnostics.
Building technologies and flexible designs underpinned with real-time information e.g. Electronic Transfer of Prescriptions, Digital X-ray, Just-in-Time Training Programmes.

3. New service design principles
Home Service
Single-people enabled Homes and Campuses
Hospital @ Home Service
New service design principles
“High Street” Screening and Diagnostic Centres
(high science and technology)
Community Activity Centres and The Gym
Re-enablement, Rehabilitation and Resettlement Centres
GP Well-being Practices and Managed Care Centres
(Cancer, Stroke/Cardio, Mental Health)
© Practices Made Perfect
Trauma Centres
Urgent Care Centres
Planned Care Centres
Nursing and Care Homes
Step-down/Convalescent Homes
16j04368aso1

4. The Place In The Middle High Street The Home Tests? The Gym Tests?
Maternity & Neonatology
Care Services
(including children’s trauma service)
(includes current A&E “minors” service)
Regional Trauma Services
Urgent Care Services
Cancer, Cardiac, Stroke Care Services
Mental Health Care Services
(inpatients)
Convalescent, Observation and Place of Safety Beds and Services.
Minor Injuries and “Off-legs” Front Door Services.
Planned Care and Rehabilitation Services.
Outpatients and Long Term Care Support Programmes including Self-Care Workshops and Self-Help Networks Support Programmes.
End of Life Services.
Local Care Services
(including mental health and planned care services)
Genetics Services
Social & Probation and Police Services
(including children’s urgent care service)
Paramedic/Blue Light Service Services
High Street
Social Care Services
Hospice and Hospital at Home Services
Community Pharmacy and Medicines Services
GP Surgeries and Out of Hours Services
Community Nursing and Midwifery and Therapy Services
The Home Tests?
The Gym Tests?
Point of Testing Services?
Local Diagnostic Services?
Local Imaging Services?
Local Genomics Services?
Regional Diagnostic Services?
Regional Imaging Services?
Regional Genomics Centres and Predictive Analytics Services?

5. THE NELSON CENTRE
A modern NHS facility providing integrated care for the local community
© Practices made Perfect Ltd
*Prepared by Dr. Patricia Oakley, Practices made Perfect Ltd | Telephone | | web:

6. THE NELSON CENTRE – CRUCIBLE OF CHANGE
a happening place in the centre of a community;
a shared place of many players and professionals;
a vehicle to develop new ways of working;
a locus of major new investments;
a crucible of change in workforce deployment.
© Practices made Perfect Ltd
*Prepared by Dr. Patricia Oakley, Practices made Perfect Ltd | Telephone | | web:

7. INTEGRATED CARE ORGANISATIONS
Key Goals
Improve quality of life of old and frail people and those with long-term conditions, including mental health problems – ‘ologies, pain and skin, mobility.
Improve quality of dying and death – pain, guts, skin.
Improve primary and secondary prevention programmes – cardiovascular, diabetes and weight, mental health.
Improve rapid response, out of hours and emergency medication services.
Improve patient flows and rapid hospital discharges – TIOs, information and therapeutic handovers.
© Practices made Perfect Ltd
*Prepared by Dr. Patricia Oakley, Practices made Perfect Ltd | Telephone | | web:

8. GP WORKFORCE (ENGLAND) ISSUES
36.9k FTE GPs (+19% since 2004).
64% partners, 24% salaried.
1% growth in partners, 15% growth in employees since
Trainees, training placements, capacity #.
GPs leaving profession early, trend to part-time working – Quality of Life important.
Hospitals shifting work > primary care, > 7-day services offer, children’s care #.
Stress in running a small business and complying with all safety regulations and tax law changes.
© Practices made Perfect Ltd
*Prepared by Dr. Patricia Oakley, Practices made Perfect Ltd | Telephone | | web:

9. CHILDREN’S SERVICES GP WORKFORCE ISSUES
GPs deliver major part of Children’s Services.
Problems recruiting and retaining GPs means mums take their children to A&E.
Junior doctors take fright and order loads of tests and understandably over-medicalise the problem – might be meningitis.
Paediatricians’ roles have greatly expanded and rotas are unsustainable.
Need new approach where medical trainees are part- trained in RCGP, RC Paed & CH, RC Psych; and need new approach to children’s nurses.
© Practices made Perfect Ltd
*Prepared by Dr. Patricia Oakley, Practices made Perfect Ltd | Telephone | | web:

10. DEVELOPING GP PRACTICES IN THE FUTURE
Medium Enterprise Model
Acute – Primary Integrated Model
6-12 Partners working in a large practice/community resource centre.
Functionally differentiated and developed business and clinical support infrastructure.
Balance of directly employed and sub- contracted staff to support wide range of services.
GPs and community services staff employed or contracted by the local acute service.
Services organised as integrated care networks.
Back office and full range of clinical support infrastructure provided by acute service.
Small Business Model
Health Maintenance Organisation
1-2 Partners working in a traditional GP practice.
Networked back office functions to achieve some economies of scale.
Outsourced services to increase range e.g. on- call and diagnostics.
Full prevention and health maintenance programmes provided for care groups e.g. elderly, mums and babies, mentally ill.
Micro-commissioning role embedded in the contract for services including incentive schemes to reduce call on the acute services.
Back office and full range of clinical support infrastructure provided by HMO.
© Practices made Perfect Ltd
*Prepared by Dr. Patricia Oakley, Practices made Perfect Ltd | Telephone | | web:

11. MANCHESTER COMMISSIONING AUTHORITY (Bolton, Manchester, Rochdale, Stockport, Trafford, Bury, Oldham, Salford, Tameside, Wigan)
10 Local Authorities, 12 CCGs, 15 NHS Providers, Police and Crime and Fire and Rescue Commissioners, Primary Care, and the 3rd Sector.
Greater Manchester Health and Social Care Strategic Partnership Board’s Priorities:
Chronic care and long-term conditions
Severe and long-term mental health
Community and mental health care
Learning Disabilities Investment Strategy
Dementia and “Dementia United”
Greater Manchester Police’s Priorities:
Anti-social behaviour and community cohesion
Victim support
Protecting vulnerable people
Transformation Fund of £450m/£6bn.
Cornwall, Essex and Greater London Authority similar shifts and developments.
© Practices made Perfect Ltd
*Prepared by Dr. Patricia Oakley, Practices made Perfect Ltd | Telephone | | web:

12. HEALTH AND WELLBEING BOARD Prevention and Proactive Intervention Programmes
Atlas of Variation – big differences in:
Diabetes
Children and young people
Kidney disease
Respiratory disease
Liver disease.
Schizophrenia and psychoses – 20 year gap in death rates.
Rehabilitation and resettlement of offenders – 60% recidivism rates.
© Practices made Perfect Ltd
*Prepared by Dr. Patricia Oakley, Practices made Perfect Ltd | Telephone | | web:

13. NETWORKS OF EMERGENCY – URGENT CARE SERVICES*
Regional Trauma Centres (25)
Major Emergency Centres
(40 – 70)
(inc: heart attack, stroke, major trauma, vascular surgery, critically ill child).
Network of Local Emergency Centres
(c. 100)
Services outside Hospital (PIMs)
Urgent Care
*Urgent & Emergency Care Review, Phase 1 Report: Professor Keith Willetts, NHS England, November 2013.
Self care & smart calls
Home
Community Pharmacy

14. THE SHAPE OF THINGS TO COME
Science & Technology-driven Improvements
Laser 3D-printed porcelain teeth, hearing aid, implants.
Laser 3D-printed cartilage, valves, prosthetics.
Personalised Medicine based on Genomics and Predictive Analytics.
Personalised Poly-Pharmacy Unit Dose Medicines.
Biosimilars, mABs, stem-cell stimulated Corneas and Intestinal Villae.
© Practices made Perfect Ltd
*Prepared by Dr. Patricia Oakley, Practices made Perfect Ltd | Telephone | | web:

15. BETTER USE OF TAX PAYERS FUNDS
Need an improved work flows design, job design, more flexible workforce.
Elders’ Care, including mental health.
Mums and children, women’s health, babies, including mental health.
Emergency, Urgent and Trauma care, including mental health, and walk-ins.
Primary, and Secondary, prevention programmes, behavioural change, psycho- social support – loneliness and isolation.
© Practices Made Perfect
16j04368aso1