1. Primary care at scale Why? What? How?
Dr Robert Varnam Head of General Practice Development @robertvarnam

2. Non-specialist / failed consultant Gatekeeper / door-holder
King of my castle
It’s all in me
Specialists
Community services

3. Self management / social prescribing
Broader skillmix
Population wellbeing management and holistic person-centred care provided by a multiprofessional team led by the GP, supported by at-scale collaboration and efficiencies.
Emergency
care
At scale
Self Care
Self management / social prescribing
Collaboration
with specialists

4. Flexible access to the right person at the right time
Empowered to play a greater role in staying well and caring for themselves, with access to comprehensive responsive care close to home.
Knowledge, skills, confidence and support
More care close to home

5. Accessible, personal care built on a relationship from cradle to grave
UK general practice is one of the world’s most comprehensive embodiments of the founding principles of primary care…
Holistic perspective understanding the whole patient not just a disease
Accessible, personal care built on a relationship from cradle to grave
First port of call and central point of care for all, for life
Comprehensive skills to diagnose & manage almost anything
Community based responsible for prevention and care of a registered population
Personal and population-orientated primary care is central …
if general practice fails, the whole NHS fails. Simon Stevens, General Practice Forward View

6. Working at scale: Opportunities for practices
Resilience
Economies of scale
System partnerships
Skillmix
Innovation and improvement
Staff development

7. Not an either / or solution4
400
Personal focus
Clarity
Commitment
Agility
Population focus
Alignment
Priorities
Partnerships
False polarities
Not an
either / or
solution

8. STP footprint: 300k-2m MCP: 100-350k Hub/Home: 30-60k Core team: 3-4k
Workforce & infrastructure planning
Large scale service reconfiguration
Major partnerships & shifts in priority
MCP: k
Organisational infrastructure & governance
Specialist staff & services
Employment & career development
Model design (population management, care models)
Strategic partnerships
Hub/Home: 30-60k
Acute care
Locality-tailored services
Shared MDT
Place of ‘belonging’
Core team: 3-4k
Coordinated, complex multidisciplinary care
Continuity

9. Purpose > function > form Purpose > function > form

10. Capabilities for the future
Leadership
Creating shared purpose
Strategic planning & partnerships
Leading through change
Being a leader
Improvement
Patients as partners
Process design
Using data for improvement
Rapid cycle change
Business
Team leadership
Operations management
H R
I T
At-scale working
Governance
Contracts
Workforce
Business intelligence
Interdependent capabilities for leaders & organisations
One of the tasks of the Call to Action was to identify the actions necessary to promote, support and sustain the adoption of the kind of innovation and improvements we seek. We consulted with practice managers, clinicians, commissioners, policy makers and improvement experts, as well as drawing on the experience of building primary care improvement capability in the UK and internationally. A comprehensive list of areas emerged from this process. This has been tested and refined through ongoing consultation with innovators and professional leaders.
The framework describes a set of intrinsic capabilities required by practices to lead service change rapidly, safely and sustainably, and a set of enablers which can be used by policymakers and commissioners to make change easier and more sustainable.
Since April 2014, we have had the opportunity to use this framework in support of 1100 GP practices across England in the Prime Minister’s Challenge Fund. As these 20 groups of practices have introduced a range of service innovations, they have received a bespoke programme of capability-building and direct access to national support for key enablers. Feedback from practices and leaders has been very positive, with many examples of faster and better progress being made as a result of it.
NHS England are now considering ways in which this framework can be used to secure support for other national initiatives, for example further extension of access improvements, support to workforce innovators and a programme to release capacity through reducing workload and working differently.

11. So …? Pick something to achieve Do it together
Build relationships & capabilities as you go
Build structures & contracts to sustain new things

12. Innovations from around England that release time for GPs to do more of what only they can do.
bit.ly/gpcapacityforum

14. bit.ly/gpcapacityforum
A growing collection – submit your own examples and questions.

15. So …? Pick something to achieve Do it together
Build relationships & capabilities as you go
Build structures & contracts to sustain new ways of working