1. Development of Primary Care Plan
Exploring the potential to help sustain primary care through different ways of working
Time to Learn
September 2016

2. PURPOSE OF TODAY’S SESSION
Give an overview of the national Forward View framework
Summarise the challenges facing primary care
Talk through opportunities for cooperative working
Give examples of changes elsewhere
Seek feedback from attendees on how we (primary care and the CCG) can improve the sustainability primary care

3. What is the General Practice Forward View saying?
Funding
By 2020/21 there will be £2.4bn a year additional funding for general practice (a 14.4% real term increase
Workforce
Attempt to double the growth rate in GPs
Other clinical staff
Addressing some challenges primary care face
Support for struggling practices
Red tape reduction
New forms of primary care
Support for practices, federations, super partnerships

4. Pressures facing primary care (adapted from the King’s Fund – Securing the future of general practice: new models of primary care)
Rising Patient Expectation
Rising prevalence of chronic disease and associated demand on appointments
Constrained funding growth (reduction in proportion of NHS budget although a commitment to redress this)
Workforce pressures
Inability to recruit (long term vacancies)
Increased number of salaried GPs/part time GPs etc
Inability to convert trainees into partners
Increased administrative workload both directly patient facing e.g. chasing results, referring, liaising with hospitals and non patient facing e.g. CQC
Domino effect of individual practices handing back contracts/failing
Undertaking clinical commissioning
Insufficient time to future plan & a lack of a primary care approach to future planning (rather than an individual practice approach)

5. Strengths and weaknesses for greater cooperative working across primary care;
Greater ability to influence/transform factors external affecting your day to day business (including planning for issues such as the fate of other practices)
Potential economies of scale
Potentially reduces threat of providers entering local market
Greater potential to deliver any new requirement of general practice
Greater opportunity to free up clinical leadership time to dedicate to the future development
Improve quality of primary care, improve career opportunities for clinical and non clinical staff, diversify income
Weaknesses
Potentially surrender of some autonomy of what happens within the practice
Movement away from the “known” way of working

6. Hubs providing Episodic Care
Hubs to deliver “on the day” episodic care
Hub
Practice
Aim – would be to provide part of the on the day episodic care through a centralised hub to enable primary care capacity to be greater protected to deliver continuity of care
Features - ? Federated model of delivery
GP triage
Application for funding through central transformation monies (in the short term)
? Level of buy in from practices

7. Diversifying Skill Mix in Primary Care
Employing new roles to work across a number of practices
Pharmacists (monitoring repeat prescriptions, medicines use reviews, care homes, prescribing policies)
Physicians Assistants (used for different functions usually the less complex fewer comorbidity caseload)
Nurse practitioners/Clinical Nurse Specialists/Advance practitioners
Therapists
E.g. Nairn – 24/7 nurse led advice line, specialist service for frail older people, host merged health and social care team
Meeting potential new requirements
? Extended hours/seven day working
GP specialists or working jointly with secondary care consultants
“Micro teams” managing complex patients
E.g. Vitality Birmingham – new forms of consultation, specialist outpatient provision, enhanced diagnostics, ambulatory care

8. Shared back office functions
Centralised management/back office functions
Centralised training and development programme
Common response to regulatory requirements
Clinical oversight of roles working across practices
Care for specific population groups
Nursing homes
End of life care
Integration
Hosting community nursing/therapy services within general practice
Out of hospital models incorporating primary/community and secondary care services.
E.g. Tower Hamlets – locality based long term conditions management with shared incentives and outcome measures

9. Questions Primary care clinical services Primary care back office
Review the following aspects of primary care when considering the questions
Primary care clinical services
Primary care back office
Wider system change
What changes do you think we could take forward at a local level to support the sustainability/enhancement of primary care (prioritise within your groups)
What opportunities do you think exist for more collaborative working between practices to support the sustainability/enhancement of general practice