1. Dr Arvind Madan Director of Primary Care
Deputy Medical Director NHS England

2. The problems

5. £12 14% real terms increase £9.6
Overall new investment is a minimum extra £2.4 billion pa by 2020/21
£9.6
billion/year
£12
14% real terms increase
vs 8% for the rest of the NHS
(plus CCG increases)
One off Sustainability and Transformation package >£500M over 5 years

7. Already actioned Next steps Longer term
Extra £33m included in 2016/17 contract
Already actioned
Repeat winter payments scheme for OOH in 2016
Payment to all practices in April 2017 and 2018 based on average indemnity increases
Work on new scheme for OOH support with BMA
Next steps
GP Indemnity Review Group to look at cover for new members of the workforce
and other more radical options
Longer term

10. Expand the Medical Workforce
5,000 Net WTE doctors in general practice by 2020/21
Encourage
Recruitment
Make GP
attractive again
Work with medical schools
Increased training places
250 Post-CCT fellowships
Major campaigns
CSU Marketing support
International recruitment
Reduce workload
Induction & refresher scheme
Bursaries in under-doctored areas
Retainer Scheme
Leadership training opportunities
Training Hubs
Retention
Flexible career schemes
Career coaching for senior GPs

11. Develop the workforce PHARMACISTS NURSES PARAMEDICS & PHYSIOS
5,000 additional staff by 2020/21
Current £31m to pilot 470 pharmacists in >700 practices,
Plus new £112m to extend by a pharmacist per 30,000 patients
For an additional 1,500 pharmacists by 2020
Clinical pharmacists in 111 hubs
PHARMACISTS
Support with return to work
Improved practice placements
£15M to be invested
NURSES
New Care Models
PARAMEDICS & PHYSIOS
3000 Therapists for longterm physical conditions
MENTAL HEALTH
1000 to be trained
Regulatory and indemnity enablers
PHYSICIAN ASSOCIATES
Expanded national network
£6M on development
PRACTICE MANAGERS

14. Collective working and MCP contract
Access hub
Collective
working and
MCP contract
Community services
Demand
Management
GP PRACTICE
Self-help and GP Online
Better sign posting
Care navigation
Social prescribing
Minor ailments
Remote triage/care
Open access AHPs
Reformed 111/Urgent Care
Practice Resilience Programme
Development Programme
Ten High Impact Actions
Capacity Planning tools
Streamlined back office
Medical Assistant training
HOSPITAL
Greater Specialist Support
Changes to the Standard Contract
Simplify reporting and regulation
Streamline the payment systems
Move away from micro-incentives

15. General Practice Development Programme
(£30M over 3 years)
Innovation Spread
10 High Impact Actions to release time for care
Regional GPFV roadshows
Local High Impact Actions showcase events
Webinars
Web resources
Network of experts
Time for Care
Bespoke 9 month action learning programmes with expert input - aligned to local initiatives
Rapid on-site Lean redesign support from The Productive General Practice
Building Capability
Training to build change leadership capabilities – up to 400 places / year
Support RCGP Federation Network and NHS Collaborate
Practice Manager networking and development
Sign up at

18. Estates Estates and Technology Fund - prioritisation and pipeline
Project Management support to speed up delivery
100% reimbursement of premises costs (rather than up to 66%)
Fund £7M Stamp Duty for NHS Property Services tenants
Compensate VAT where the landlord has chosen to charge VAT
Transitional funding for significant rises in facilities costs

19. Technology Accelerate self-care and patient activation
Improve uptake of Patient Online
Approved Apps library and buying framework
Interoperability
Wi-Fi services in practices for patients and staff
Online and telephone consultation systems
Summary care record in all pharmacies
Improve payment systems, GP2GP, EPS, e-discharges, ERS, Advice & Guidance

21. Where are we now?
What might I see in my practice?
Where are we going?

22. Where are we now? Indemnity solution Induction & refresher scheme
Retainer Scheme changes
Return to Work improvements
£20K bursaries
250 Post-CCT fellowships
International recruitment
450 clinical pharmacists
GP Health service Jan 2017
Vulnerable and Practice Resilience Programmes
General Practice Development Programme
Medical Assistant and Care Navigation commencing
Standard Contract changes
GPAFs & Access Hub Network
GMC/CQC/NHSE joint work
Pipeline of premises schemes
IT Operating Guidance
GPFV delivery/scrutiny architecture in place
Stakeholders aligning
Planning Guidance issued until April 2019 to provide financial and operational clarity

23. What might I see in my practice?
Support from
CCG for headroom
Easier to recruit GPs & nurses
Online & phone
consultations
More collective
working
Improved access
in collaboration
More productive
use of time
Improved technology
Enhanced capabilities for improvement
More money for services
Less work from hospital
Money for
Indemnity
Patients using
self care more
Rapid support
for resilience
Less work & better
collaboration from 111
100%
premises
grants
Stronger
federations
Broader skillmix
Reduced
medicalisation of LTCs

24. Where are we going? Redirection Consider New Consult Models Self Care
Social Prescribing
Minor ailment scheme
Open Access Services e.g. physio
Care navigation
Additional GP/nurse capacity
Locality MDTs
Specialist Clinics
Redirection
Fewer patients
see the GP
Consider
Self Care
New Consult Models
Attend
A&E
nhs.uk
Apps and wearables
Phone triage
and care
Online triage
and care
Advanced Nurse Practitioner
Clinical Pharmacist
Specialist support
Patient Activation
for LTCS
111 Online and 111 Hubs
Physician Associate
Mental Health Therapist
Enhanced Advice and Guidance / Consult