1. City & Hackney GP Confederation
What are we?
What have we done?
Challenges and learning

2. Our aims: Voice of primary care Umbrella organisation for GP practices
Support and develop primary care
Maintain practice financial viability
New ways of working/innovation

3. Community interest company
CIC September 2014
practices are shareholders (1pence share)
legal constitution, shareholding agreement, Individual practice agreement
£1per patient per year fee/equity
43 member practices, 311,056 population (100%)

4. governance Board of directors/clinical board Lay members x 2
Audit committee/external auditors
Watertight payments to practices process

5. What have we done? Contract model 1: Confederation wins contract
Confederation sub contracts with practices which commit to:
deliver to specification
seek help if at risk
pay for practice support if needed
(some practices deliver on behalf of others)
100% population coverage
Focus on quality improvement

6. Contract models 2 & 3
Direct provision – smoking cessation
Developmental – practice support team, QI, childhood immunisation, health app, workforce
Total contract value 16/17 £11.9m

7. Achievements: Workforce
Salaried GP scheme (17)
Trainee practice nurse programme (14 & 15)
Advanced HCA programme (12 & 7)
Apprenticeship programme (54 & 19)
Clinical pharmacists (5 & 3)
Trainee practice manager scheme (6)
Medical Assistants pilot site (6)

8. ACHIEVEMENTS – health gain
Smoking cessation – over 1800 quitters so far
Diabetes blood pressure control - 94% in target (top QOF score in England)
CHD blood pressure control - 95% (top QOF score)
1st in 12 of the 65 QOF clinical indicators 2015/16
Health checks – 5421 checks in 9 months
Substance misuse – 17accredited practices managing 255 patients in shared care

9. Achievements – improved care/patient experience
1887 patients on Frail home visiting register
Duty doctor in every practice core hours – 30 min response time
1752 patients with a CMC plan
Health Visitors & GPs review all vulnerable children
3540 extra appointments per quarter to improve access

10. Achievements – organisational and personal development
Practice monthly MDT meetings
Quadrant MDT learning events on case studies
Templates, dashboards, coding, searches
Facilitation skills training
Commission education and training for primary care (CEPN)
Group consultation skills via econsult

11. Challenges and learning
Relationship with member practices
NHS pension scheme
VAT
Full cost recovery

12. The future? Super-partnership(s)? Community nursing?
Consultants? GP specialists?
In hours and out of hours?
Bigger role in unplanned care?
Social care and carers?
Mental health?