1. General Practice Forward View -
Making it work for you..
Tankersley Manor 11th May 2017
Dr Andrew Sixsmith

3. Focus: Transform V Restore?

4. Capacity Smarter working Investment Accelerate funding of primary care
Workforce
Expand and support GP and wider primary care staffing
Smarter working
Workload
Reduce practice burdens and help release time
Practice infrastructure
Develop the primary care state and invest in better technology
Care design
Provide a major programme of improvement to support the practices
Consolidate and enhance Added Value of GP Practice within wider community services

5. Investment Supporting better access to general practice for the public
£220 Million through annual contract negotiations invested into general practice funding pot in 2016/17
£102 Million used by CCGs to cover population growth and local investment
If fully used provides an increase of 4.4% and represents almost 13.5% of the £2.4 Billion recurrent funding expected by 2010/21
* Compared with 2014

6. Workforce Medical By 2020 additional staff working Other staff
5,000 doctors
500 doctors from overseas
500 ‘returner’ GPs
Other staff
5,000 other staff
3,000 mental health therapists (MHFYFV)
470 clinical pharmacists via a pilot (1st wave)
Additional 1,500 ‘pharmacists’ to enable ratio 1:30,000 patients
New and evolving / enhanced roles
Physician Associate
Medical Assistants
Practice Manager
Nurses
Reception /admin
By 2020 additional staff working
in GP Practice (wet*)
* Compared with 2014

7. Workforce- so far Medical Improved Induction and Refresher scheme
With monthly bursary increasing from £2,300 to £3,500
A top up of:
£1,250 to assist indemnity costs
£464 for GMC membership
Up to £1000 towards assessment fees
So far 370 new GPs on the scheme (with 76 completed)
Other staff
Clinical Pharmacists
So far £112 Million contribution in addition to the £31 Million pilot
Phase one has supported 658 practices co-funding of 491 posts
Phase two deadline is 12th May so far includes WTE in 465 practices
* Compared with 2014

8. Workforce- so far Improving Leader Programme
Free personal development programme to build confidence and skills for leading service redesign in practice or federation- free for any clinician or manager
Events in Birmingham, London, Leeds and Bristol future events planned
So far 96 people have completed with 61 booked for future dates
GP Career Plus Scheme
One year flexible working pilot to recruit approx 80 GPs who are at risk of early retirement in 11 pilot areas
Expecting recruiting by the end of May (coaching sessions have been provided for 318 GPs over 632 sessions)
* Compared with 2014

9. Workforce- so far GP Retention Scheme
A package of financial and eduactional support to help doctors at risk of leaving the profession to remain in GP
Practices to receive £76.92 per session for each GP on the scheme they employ
GPs themselves receive annual professional expenses supplement of £1000 to £4000 depending on how many sessions they do up to four
Scheme began on 1st April 2017 replacing the existing scheme
NHS GP Health Service
Programme to improve access to mental health support for GPs and GP Trainees inclusing stress and burnout
Total contribution £19.5 Million across next 5 years
Went live in January out of 28 LMCs reporting service is being promoted in their area. NHSE reporting current service workload of 450 patients
* Compared with 2014

10. Workforce- so far Practice Manager development programme
£6 Million contribution to support growth of local networks of practice managers sharing good ideas, action learning and peer support
Regional events in Liverpool, Birmingham, London and Devon in 2016
Training for reception and clerical staff
Total of £45 Million contribution towards costs of practices training reception and clerical staff into enhanced roles including active signposting and managing clinical correspondence
£5 Million spent in
* Compared with 2014

11. Workload Supporting better access to general practice for the public
General Practice Resilience Programme
A menu of supporting programmes to help practices become more resilient and sustainable and put them in a better position to deliver high quality care in an environment of challenge now and in the future
Total of £40 Million contributions over 4 years-
£16 Million committed for
LMCs reported that funding had started to reach practices by end of March (£17.2 Million on 1,279 practices)
NHSE report to date 86 schemes covering 107 CCGs
* Compared with 2014

12. Workload Supporting better access to general practice for the public
Vulnerable practices programme
External support for practices of greatest concern who are struggling
Total of £10 Million contributions (£10 Million committed in 2016/17)
NHSE reporting £10.1 Million on 714 practices
22 out of 28 LMCs reported that practices have received support in 2016/17
* Compared with 2014

13. Workload Supporting better access to general practice for the public
Time for Care programme
Total contribution of £30 Million to support for groups of practices in a CCG area to have workshops and learning to help develop their own time for care programme
15 out of 28 LMCs reported that practices have been applying for this with many applications in process
NHSE report to date 86 schemes covering 107 CCGs
* Compared with 2014

14. Practice Infrastructure
Supporting better access to
general practice for the public
Estates and Technology Transformation (ETTF) Fund and Premises
Investment to accelerate the development of infrastructure
To enable improvement and expansion joined-up care
Capital and revenue funding
ETF is a major part of a £900 Million investment over 5 years
Processes for CCG to bid closed in June 2016
So far 653 schemes have been completed with 219 in process for
22 out of 28 LMCs reported practices in their areas secured funding
* Compared with 2014

15. Care redesign Supporting better access to
general practice for the public
Improving access to general practice services
18 transformation areas that have been asked to accelerate extended access should already have £1.50 per head of support in 2016/17
* Compared with 2014

16. Care redesign Supporting better access to
general practice for the public
Improving access to general practice services
18 transformation areas that have been asked to accelerate extended access should already have £1.50 per head of support in 2016/17
* Compared with 2014

17. Care Pathway & Governance
The Challenge
Need to get it right for every patient
Keep it simple
- but complex New Models of Care
Multi-disciplined team approach
all individuals must know their role and contribute effectively
Confidence or Uncertainty?
The issue of indemnity
Addressing the uncertainty of
MDOs
NHS Litigation Authorities

18. Supported Primary Care
Accommodating the STP?
Increased Skills
Increased Skill Mixing
Wider
Primary
Care
Secondary
Self MH
Workers
Pharmacists
PAs
ANPs
Specialists working
in the community
Making Every
Contact Count
MDTs
Social
Prescribing
Integrated
Team Working
Complex
patients
Pharmacy
First Contact
Supported Self Care
Supported Primary Care
Pharmacist Medication
reviews of complex patients
Expanded Workforce
Asset Based Community
Development
Health Coaching
Care Navigation

19. Strategic thinking GP Practice offer to STP
Address credibility and confidence gap
> clarity
Focus quality
And consistency

20. Strategic thinking Opportunities and challenges for CCGs
Lead for primary care development, however to-date limited focus- can they describe progress?
Have Co-commissioning and STP provided further opportunities? Can they be described?
Are the challenges really being addressed:
Capacity/skill mix/resilience
Membership organisation
conflict