1. ‘A plan to achieve one or more goals in conditions of uncertainty’
WHAT IS A STRATEGY?
‘A plan to achieve one or more goals in conditions of uncertainty’

2. A Strategy Describes how things are now
Is clear about where we want to be in the future
Explains the opportunities for change
Shows the steps needed and the timescales to get to where we want to be

3. Strategies are very useful documents But they are often very large and difficult to read and understand

4. The Harrogate and Rural District CCG Primary Care Strategy is designed to be easy to read and understand. The content was agreed after consultation with patients and the public as well as GPs and the wider health service The Strategy is only 10 pages long but for anyone who might be particularly interested in any part of plan much more detail underlying the plan is easily available.

5. The first five pages describe
What Primary Care looks like now
The stresses and threats to the system
The positive influences that can help us get from where we are to where we want to be

6. The final 3 pages describe the steps to get from where we are now to where we want to be in 5 years time On the page before this is information about how to understand the timescales of planned steps and how to access more detailed information (if you are interested to see this)

7. Harrogate and Rural District Primary Care Strategy

9. Harrogate and Rural District Primary Care Strategy:
What do we want Primary Care in Harrogate and Rural District CCG to look like in the future and how do we make sure we achieve it?
Why do we need a strategy?
There are a number of reasons why a strategy is needed:
Primary care commissioning has now been delegated to Harrogate and Rural District CCG and we need to have a local view to guide us on making commissioning decisions.
The population is getting older. It is estimated that there will be a 2.2% total increase in the population of HaRD over the next five years. However, there will be an estimated 10.9%, 13.7% and 20.8% increase in the age bands 65+, 75+ and 85+ years respectively. This will have increased demands on primary care
Care outside of hospital is changing with more integration between health, social and voluntary sector care and an emphasis on treating more patients in the community
Primary care is arguably already running at overcapacity and, with inevitable increasing demands on the service, is not sustainable if it does not adapt
There is a funding gap nationally between projected spending requirements and resources available to commission services across the NHS
Increased patient expectations
Standing still is not an option and this strategy sets out the high level aspirations for what primary care should look like in the future
This strategy focuses on primary medical care commissioning which is the responsibility of the CCG. However, it should not be seen in isolation to other aspects of primary care (dentists, community pharmacy and opticians)
What does Primary Care in HaRD look like now? There are 17 GP practices, covering 161,000 people. There is a mixture between urban practices and rural practices with some covering both 10 practices are dispensing practices There are 152 GPs in the area (129 full time equivalent) 38% are male (compared to 48% in England) 15% are over the age of 55 years (compared to 22% in England) The headcount and number of full time equivalents of all GP practitioners per 100,000 population is high compared to our 10 closest CCGs The proportion of all GP practitioners who are 1 Full Time Equivalent (or more) is 57% compared to 73% for England The number of all practice staff per 100,000 population is similar to England but less than most of the other 10 most similar CCGs. Practice Nurse full time equivalent numbers per 100,000 population is high compared to our 10 closest CCGs. However, the proportion of advanced nurses or extended nurse roles is low The number of admin and clerical staff full time equivalents per 100,000 population is low compared to our 10 closest CCGs Most practices are under the GMS contract but 3 practices are PMS 13 practices use the SystmOne and 4 practices use the EMIS web clinical computer systems There is a mix between new and old accommodation

10. What are the strengths of our current system?
There is network of GP practices (Yorkshire Health Network) that includes all HaRD practices
There is a high quality workforce who want to come and stay in the area
The workforce is multidisciplinary
The quality of primary care locally is high
General practice gives continuity of care throughout a patient’s life
GPs have good relationships with, and know, patients and their families well
The art of general practice vs hospital medicine
Patients are informed and engaged with less mobility and deprivation than in other areas of the country
The independent contractor status of GPs gives them a good work ethic
General Practice is accessible, responsive and flexible to the needs of the patient
There is strong involvement with GP training (x practices are training practices)
Research is encouraged and several practices are part of the Primary Care Research Network
What opportunities for different ways of working have been identified?
Adopting different work patterns – recognising that the workforce is moving towards more part time working, and that there is a national request for more 7- day working
Local commissioning of primary care – removing bureaucratic processes to ensure effort is placed where it will be more effective around patient care
Using Yorkshire Health Network (YHN) to do things differently
Using New Care Models to drive forward change
Integrating teams and skills effectively – integrating with social care as well as getting the right skill mix within practices so the right person with the right skills is freeing up practice time
Improving specialist support in the community – including more pharmacist support and an emphasis on frailty
Growing a new workforce – across the whole skill mix
Investing in primary care – using opportunities such as the New Care Models
Expanding GPs as providers and improving provision in the community – where there are cost-effective alternatives to inpatient and specialist services that can be carried out in the community
Utilising GP premises
Using technology effectively
National agenda driving change
Utilising support from other agencies (eg NHS England, New Care Models, Health Education England, Academic Health Services Network)

11. What will help us achieve the vision and outcomes – so-called ‘Enablers’
Finance and contracting
Local contract flexibility with the potential to replace QoF
Development of Out of Hospital services
Redistribution of PMS money
Utilising the potential of YHN to do things differently
Identifying opportunities to do things differently through the Vanguard support process
Following national guidance on conflicts of interest
Patient and professional engagement
Ensuring that practices, their staff and patients are engaged with developing and implementing the strategy
Acknowledging and addressing concerns and fears of change
Governance and quality frameworks
Strengthening the Quality and Clinical Governance committee around primary care quality
Working with NHS England around professional accountability
Commissioning for quality through the Primary Care Commissioning Committee
Local Commissioning
Ensuring we have the right staff with the right skills
Using local knowledge of workforce
Using ‘Soft intelligence’
Working with NHS England, Health Education England and the Local Education and Training Board
What do we want our Primary Care system to look like in 5 years’ time?
The following characteristics of a future primary care system have emerged:
A more empowered workforce that:
is happy and feels valued,
is allowed to develop skills that are needed,
is encouraged to be innovative
has a balance of specialist and generalist skills to meet the needs of the population
maintains continuity of patient care
More engaged patients and carers who:
are central in any decision making about their health
are empowered to prevent and manage their illnesses
More sustainable provision of Primary Care that:
is of high quality with equality of access to services
is responsive to the needs of the population – seeing patients quickly when needed and able to the spend time needed to proactively manage long term conditions
has the capacity to treat more patients in the community
values mental health equally with physical health
promotes continuity of care throughout
has no wrong door
has ambition to change by protecting and building on what already works whilst not being afraid to do things differently
learns as it adapts
is joined up by IT systems that work for everyone (professionals and patients)
maintains General Practice as a business

12. These outcomes will be achieved by focusing on the following actions
Domain
Actions
Measures of success
Empowered clinicians
Valuing the workforce by considering the impact on the workforce of any commissioning decisions
Support for change eg organisational development work with New Care Models
Increasing the workforce skill mix by exploring opportunities for different roles to free up GP time
Making QoF more relevant for our population
The workforce feels it has time to care and is supported (staff survey)
Empowered patients and carers
Focus on quality of primary care provision and reduced variation
Meaningful engagement with the community on service redesign
More care delivered in the community
Simpler 7 day acces to primary care whilst maintaining continuity
Focus on prevention and people taking more control over their health
Being realistic about expectations
People feel in control of their health (survey)
‘You said…, we did…’
Sustainable provision
Ensuring the primary care estate meets our strategic objectives
Exploiting opportunities to link with pharmacy, dentistry and optometry
IT that works for everyone
Encouraging training of GPs and wider primary care workforce within the CCG
Measure of primary care sustainability????
These outcomes should be seen to complement, and in support of, the CCG strategic priorities of:
Long term conditions and integration of care
Vulnerable people and mental health
Health and wellbeing
Planned care
Urgent care
Primary care

13. The following pages describe the CCG’s plan of progression to the achieve the aims of the Harrogate and Rural District Primary Care Strategy by 2020.
Building on the work already in progress and the levers in the GP Forward View, the Strategy will support CCG’s vision for the future of more care being delivered in the community, closer to people’s homes.
The route to achieving the aims of the Strategy (Empowered Patients and Carers, Empowered Clinicians and Sustainable Provision) can be summarised as -

14. This page explains the design and function of the following pages, which contain timescales and detail of how the CCG will progress towards its vision for Primary Care

15. NHS Harrogate and Rural District CCG
6 FACET SURVEYS COMMISSIONED
IT BIDS SUBMITTED
ETT FUNDS AVAILABLE
ESTATES BIDS SUBMITTED
RESULTS OF ETT BIDS PUBLISHED
NHS Harrogate and Rural District CCG
RESULTS OF 6 FACET SURVEYS PUBLISHED
BIDS PREPARED FOR CAPITAL DEVELOPMENT OUTSIDE ETTF/CIL
REMEDIAL ACTION AGREED AND IMPLEMENTED
CLINICAL RECORD SHARED WITH ALL COMMUNITY TEAMS AND PATIENTS
DEVELOPMENT OF SOUTH AND CENTRAL HEALTH AND WELLBEING CENTRES
TRANSFORMED HaRD PREMISES
TRANSFORMED GP/COMMUNITY INFRASTRUCTURE
TRANSFORMED RIPON INFRASTRUCTURE
PREMISES DEVELOPMENT TO SUPPORT TOWN PLAN
COMMUNITY INFRASTRUCTURE LEVY CONFIRMED
TOWN PLAN PUBLISHED
ESTATES STRATEGY PUBLISHED
HEALTHY RIPON
INFRASTRUCTURE NEEDS TO SUPPORT TOWN PLAN SUBMITTED

16. NHS Harrogate and Rural District CCG
PRACTICE LINKS TO CARE HOMES
NATIONAL PROGRAMME TO SUPPORT PEOPLE WITH LTC
NEW CARE MODELS
NHS Harrogate and Rural District CCG
SHARED CLINICAL RECORD IN CARE HOMES
INTEGRATED HEALTH AND SOCIAL CARE SERVICES
CARE PLANS FOR EVERYONE WITH FRAILTY/LTC
NATIONAL DEVELOPMENT OF APPS LIBRARY FOR PEOPLE WITH LTC
CO-COMMISSIONED INTEGRATED COMMUNITY TEAMS
INCREASED SELF CARE AND EMPOWERED PATIENTS
TRANSFORMED COMMUNITY TEAMS
DEVELOPMENT OF GP ‘ACCESS HUBS’
CHANGES TO QOF TO SUPPORT HOLISTIC CARE
FRAILTY STRATEGY DEVELOPED
TRANSFORMATION AREA FUNDING FOR EXTENDED GP ACCESS

17. NHS Harrogate and Rural District CCG
PRACTICES WORKING CLOSER TOGETHER
PRACTICES PROVIDING GP TRAINING
GENERAL PRACTICE NURSE DEVELOPMENT STRATEGY
NHS Harrogate and Rural District CCG
UPSKILL CURRENT RECEPTION AND ADMIN STAFF
PRACTICE MANAGER DEVELOPMENT
RELEASING TIME TO CARE
DEVELOPMENT OF NEW CLINICIANS
BACK OFFICE FUNCTIONS PROVIDED AT SCALE
PRACTICES TRAINING PRACTICE NURSES, HCAs AND PHYSICIANS ASSISTANTS
APPROPRIATE CLINICAL SERVICES PROVIDED AT SCALE
APPROPRIATE SKILL MIX IN PRIMARY CARE
5000 ADDITIONAL GPs IN POST
TRANSFORMED GP PRACTICES
14% INCREASE
(£2.4 BILLION/YEAR) INVESTMENT IN PRIMARY CARE
ALL INCOMING COMMUNICATION FROM NHS PROVIDERS TO BE ELECTRONIC AND CODED
EXTEND CONSULTATION TECHNOLOGY USE
STP TO ‘SECURE AND SUPPORT PRIMARY CARE’
DEVELOPMENT OF YHN AS PROVIDER
TRANSFORMATIONAL SUPPORT FROM CCG
REVISION OF CARR-HILL FORMULA
CONSIDER IMPACT ON GPs OF ALL COMMISSIONING DECISIONS
CHANGES TO NHS STANDARD CONTRACTS FOR HOSPITALS
SUPPORT FOR MEDICAL INDEMNITY COSTS