1. The General Practice Forward View in Gloucestershire Equipping Primary Care to meet future challenges
Helen Edwards – Associate Director Primary Care and Locality Development, Gloucestershire CCG

2. Gloucestershire Context
2 densely populated urban localities
5 surrounding rural localities
81 GP Practices; 635,000 patients
Perform well in many measures, e.g. CQC, QOF, GP Patient Survey
However, significant challenges…

3. 2016/17 – Planning and acting
Primary Care Strategy developed as key component of STP, inclusive of Primary Care Workforce and Estates plans
Embraced General Practice Forward View – Project Team inclusive of LMC, RCGP, HEE, NHSE, led by CCG
Recruited seven GP Provider Leads, funded 3 sessions
16 ‘clusters’ of practices formed organically
Every cluster given management support
Place-based pilot started with four clusters, integrating care for local population
Primary Care ‘launch’ event; 200 GPs & PMs

4. Delivery of our Strategy and the GPFV
2017/18
Delivery of our Strategy and the GPFV

5. Where we are now …
Workforce
Estates IT
Place-based integration
Transformation
Resilience
Care Navigation
Clinical Correspondence
Improving Access
Productive General Practice
General Practice Improvement Leaders
Releasing Time for Care
Over 60 projects across the County, often led by Provider Lead GPs, all with management support from CCG:

6. Focus on …
Workforce

7. Primary Care Workforce
Surveying practices annually; baselining and planning
Community Education Provider Network (CEPN) established.
A rotation scheme to retain newly qualified GPs in the county
GP Retention Scheme and Portfolio Careers
Practice nurse education, training and workforce planning
International Recruitment
BMJ – “Be a GP in Gloucestershire” Campaign”

8. Primary Care Workforce Developments
General Practice Improvement Leaders
Productive General Practice
Releasing Time to care
Clinical Correspondence and Care Navigation
Feedback from practices taking part in The Productive General Practice programme is very positive. All 35 practices are now working on their second chosen module, supported by visits from their coach. The programme will run until December 2017. 
Also as part of the Time for Care programme, a second cohort of our local General Practice Improvement Leaders training programme took place in October, with a good mix of clinical and support staff attending.  Once again, the feedback was excellent from those who attended.
Planning has commenced for next year’s quality improvement programme, focused on the Ten High Impact Actions for General Practice. This will run from March – December 2018 as the Releasing Time for Care Collaborative across clusters.
Clinical Correspondence and Care Navigation: We are continuing to support clusters with rolling out these two training initiatives.

9. Focus on …
Primary Care at Scale

10. Practice Transformation
GCCG made funding recurrent at £1.89/head
Bids had to be collaborative, transformational and deliver sustainability
81 practices formed 16 clusters
Created foundations of ‘Primary Care at Scale’
81 practices
Offered opportunity for recurrent funding
Had to be collaborative bids, practices could come together how they wanted but had to be based on a sensible geography and demography that would make sense for their patients and bring resilience, sustainability and be transformative
Different sizes, range of 18,000 – 60,000; fine but needed to bring resilience and sustainability and be transformative
The most profound change we made and the basis of everything that followed
Our platform for New Models of Care

11. Practice Transformation
This investment has led to:
20 (>12 WTE) Clinical Pharmacists working as a shared resource across practices within clusters, reducing GP workload
Community Matrons as a shared resource for all practices within their cluster, supporting their frail patients
Shared Urgent Visiting Service, utilising paramedics
Repeat Prescribing hub for all practices within a cluster

12. 1. General Practice Resilience
Practice Resilience – Aspen
1. General Practice Resilience
Four practice merger
Supported by resilience funding
Change management
Wraps together: resilience, transformation, access, training …

13. Focus on …
Access

14. Improved Access £6 per head of patient (weighted)
7 day access to Primary Care across the county, including weekday evenings and weekends
Countywide offer under former PMCF stream
Asked clusters for ideas of innovative ways of delivering evening and weekend appointments that would also support Primary Care and the wider system.

15. Improved Access
Working collaboratively across STP, clusters will have:
Paramedics employed by the Ambulance Trust undertaking home visits
Physios and GOAM consultants employed by the Community Trust
Mental Health Workers employed by Mental Health Trust
Pilots commence in October

16. Integration: Place-based
Focus on …
Integration: Place-based

17. Place-based Now developing more integrated, place-based approach
Pilots in Gloucester City (5 clusters – 170,000 patients) and Stroud (4 clusters – 120,000 patients)
Involves all STP partners; community and mental health trusts particularly at this stage

18. Place-based Pilot areas have trialled joint initiatives including:
Mental health practitioners in primary care
CDNs in primary care
Multi-disciplinary team meetings to provide integrated care “without walls”

19. Focus on …
Estates

20. Primary Care Estates
Significant CCG investment to improve, modernise and expand primary care
In excess of £500K towards fees, an extra £1.5m for rent and rates & over £100k in improvement grants awarded
New Devereaux Centre opened in March 2017
Kingsway surgery approved with additional CCG support and construction underway
Longlevens extension completed and opened
Churchdown surgery approved and construction started
Glevum surgery extension approved with additional CCG support and building work underway
Solution for new Stow surgery in place and construction due to start over the next couple of weeks
Sevenposts – new surgery proposal finalised and construction due to start this November
Over £4m worth of ETTF funding successfully obtained
Delivering the PCIP – number of business cases in progress across the County for Cheltenham, Tetbury, Cirencester, Cinderford, Minchinhampton, Stroud, Brockworth & Hucclecote and hopefully soon Gloucester.
All of these examples demonstrate the significant investment in primary care premises since the CCG was awarded Delegated Authority.
ETTF = Estates Technology Transformation Fund.

21. How does the General Practice Forward View feel for practices?

22. Thank you for listening
Helen Edwards –