1. Richmond General Practice Alliance
Richmond Hubs
Richmond General Practice Alliance
17/01/2019
Richmond General Practice Alliance

2. Richmond General Practice Alliance
The Question(s)
Can transformation be made to work for General Practice?
I am going to argue ‘yes’
What form should transformation take?
I am going to argue it should be
Collaborative
Owned by its practices
Place-based
17/01/2019
Richmond General Practice Alliance

3. Richmond General Practice Alliance
About RGPA
Set up October 2014
Company limited by shares
Investment £1 per head of population
All GP partners are shareholders (some salaried GPs)
Limited liability, limited risk
Place-based
All 28 practices, covering 205K people
Elected Board and Chair
4 GPs, 2 Practice Managers
17/01/2019
Richmond General Practice Alliance

4. RGPA Mission Statement 2014
RGPA exists to
Support and strengthen General Practice in Richmond
Support Practices to maintain existing income streams
Support Practices to generate new income streams
Support Practices by reducing or paying costs
Support our CCG to meet its objectives
Be robust enough to survive NHS reorganisations
Any surplus generated by RGPA will be reinvested in Practices

5. Richmond General Practice Alliance
PMCF Wave 2: EASTIR
Extended Access and Systems Transformation In Richmond
4 Hubs, based in practices
Localities approx. 50K
7 day access 8am to 8pm
I know this is controversial
30K patients in first 9 months
All booked through GP (later 111)
No extra paperwork
17/01/2019
Richmond General Practice Alliance

6. Hub Learning: Patients
Popular
Consider it is an extension of their practice
Sunday use lowest IG
Only 1 out of first 30K refused access
Impact on demand
Reduced WIC use by 50%
Didn’t impact A&E much in Richmond
But did elsewhere
Doesn’t drive demand (unlike WICs)
17/01/2019
Richmond General Practice Alliance

7. Hub Learning: Workforce
Conversations with Junior Doctors
Despairing
Not confident in future of GP
Lack of trust
Not planning to work full time
Well thought-out Plan Bs
Unhappy about terms and conditions
Pay
Intensity
Risk
17/01/2019
Richmond General Practice Alliance

8. Hub Learning: Workforce
Workforce Terms and Conditions for GPs
£90 per hour
15 minute appointments
12 per 4 hours session
Educational support
No unexpected work (paperwork, scrips etc)
Increase from 5 to 65 GPs on books
17/01/2019
Richmond General Practice Alliance

9. Hub Learning: Practices
Popular
Shift of workload
Patients chosen by practice
Added resilience
Day 1
Enabled some to shift to 15 minute appointments
Doubling productivity
‘Owned’ by Localities
Nominal Appointment Allocation
Self-policed
17/01/2019
Richmond General Practice Alliance

10. Richmond General Practice Alliance
Other RGPA PMCF Wins
First Interoperable IT in UK
Working with Vision
Read-write real time to Vision and EMIS
Hub and mobile
6 weeks, £30K, on time, under budget
Runner up in National EHI Awards 2016
Flying RAT GP
Won RSM John Horder Award 2016
Health Help Now App
Screens in Practices
17/01/2019
Richmond General Practice Alliance

11. Richmond General Practice Alliance
Biggest win?
Credibility
Lots more projects
17/01/2019
Richmond General Practice Alliance

12. RGPA Project Assessment
How do we assess a project?
What benefits does it deliver to patients?
How does it improve efficiency/reduce costs?
How does it bring resources into General Practice?
How does it reduce pressure in General Practice?
We aim to deliver a surplus to
Reinvest in our practices
Deliver better Terms and Conditions to our staff
17/01/2019
Richmond General Practice Alliance

13. Richmond General Practice Alliance
What this has led to (1)
Physical Health OBC
Outcomes Based Commissioning
RCCG attempt at ACO
GP Federation a ‘fixed point’
Joint Venture with Community Services
December 2016
RCHiP
Partially-integrated MCP (with federation benefits)
£25m annual contract 10 years
17/01/2019
Richmond General Practice Alliance

14. Richmond General Practice Alliance
What this has led to (2)
Mental Health OBC in process
Alliance contracting
6 partners (2 MHTs, 3 Third sector)
GP Federation a ‘fixed point’
£25m annual contract 10 years
CCG Pharmacy Contract in shadow
£22m annual contract 3 years
Pharmacists back supporting practices
17/01/2019
Richmond General Practice Alliance

15. Examples of Other Projects (1)
Practice Support
Practices in trouble
We have helped with management, staffing, improving quality and efficiency, and estates issues.
Backroom expenses
Eg purchased a uniform staff training package
IT support (eg Docman Hub)
New Clinical Pathways
Diabetes
Dermatology
MSK
COPD Pathways
17/01/2019
Richmond General Practice Alliance

16. Examples of Other Projects (2)
Physio First
Direct access
Pharmacy First
Extended minor ailments (UTIs, LBP)
AHSN
Sore throat ‘test and treat’ project
Primary Care Home
with CEPN and CCG
17/01/2019
Richmond General Practice Alliance

17. Richmond General Practice Alliance
Other Consequences
Other SWL GP Federations
Kingston, Wandsworth, Sutton, Merton, Croydon
same place-based model
SWL GP Federation Collaborative
First met December 2015
Operate under MOU
STP Engagement
STP Plan
Localities and Hubs across SWL
Shift of care
17/01/2019
Richmond General Practice Alliance

18. Richmond General Practice Alliance
Our System Plan
Level 1
Delivery by practices
Level 2
Delivery by practices working together in localities
Level 3
Delivery by Federation with Community Services
Hospital support for some services
This is where Outpatients should sit
Level 4
Delivery by Hospital
Only delivering the care that only it can deliver
17/01/2019
Richmond General Practice Alliance

19. Richmond General Practice Alliance
Take Home Points
Working at scale can be made to work for General Practice
Place Based Federations are an attractive model
Built quickly, don’t require new contractual models
Widely distributed ownership
Support existing practices
Maintain traditional virtues of General Practice
Attractive to commissioners (require a supportive CCG)
Deliver major systems transformation
‘Savings share’ from this reinvested in General Practice
17/01/2019
Richmond General Practice Alliance

20. Richmond General Practice Alliance
Fin
17/01/2019
Richmond General Practice Alliance