1. Outline Primary Care Strategy
Primary Care Commissioning Committee
25 June 2019

2. Strategic Vision
Our aim is to have sustainable and comprehensive general practice, as a cornerstone of the wider NHS system, working collaboratively to improve population health and wellbeing and reduce health inequalities. Our delivery model to achieve is predicated upon comprehensive general practice working within PCNs, based around the registered list, maximising digital and workforce opportunities working with wider partners.
Approach – protect & build on strengths of general practice, provide a unified vision shared & owned by practices, LMCs, CCGs and external partners.
Priorities
Sustainable General Practice – working collectively within PCNs
Workforce & Leadership Development
Consistent, equitable, high quality services to patients
Supporting quality improvement as well as sustainability & efficiency
Continued & Equitable Investment
Workload Management
Integrated In & Out of Hours Access
Digital solutions to support the future model of care
Consistent approach to development of Estate
On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG

3. Priority 1 - PCNs Wyre Forest x 2 Redditch & Bromsgrove x 3
South Worcestershire x 6
On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG

4. Priority 1 - PCNs PCN – Localities Herefordshire
On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG

5. Priority 2 - Workforce
GPs per 1000 patients - The current national average for a GP FTE is 0.57 per patients. The range for our CCGs varies between  
GP recruitment – there are a number of GP practices in our area who have GP vacancies and are unable to fill these posts- we need to focus on recruitment and supporting newly qualified GPs in their first years in practice.
There is a significant amount of GPs planning to retire in the next 3 years- we need to focus on retaining their skills within general practice.

6. Priority 2- Workforce
Herefordshire and Worcestershire GPFV Workforce Plan was developed and approved in 2018, focusing on three workforce themes in particular;
Theme 1: Developing Supply
Theme 2: Up-skilling Staff
Theme 3: Developing New Roles
This update reviews progress since the plan was developed.
Primary Care Quarterly Workforce Survey is a notable achievement to support local workforce intelligence and targeted support
Primary Care Workforce representation across STP; Local Workforce Action Board, Workforce and Organisational Development Action Group
GP Recruitment and Retention Group
On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG

7. GP Retention and Recruitment
GPFV Workforce Clinical Lead
GP trainees and ‘first fives’
Mid-career: salaried GPs; locums; partners
‘Wise fives’
Over-arching actions to address retention
Rebuilding the reputation of general practice
Focus on benefits of growing the wider general practice workforce
Workload
Professional development (including education of other professionals)
Indemnity
First Five Clinical Lead
First Five Mentor Register and Network
Building Relationships with VTS trainees
GP portfolio roles
Mentoring and Coaching
Flexible working opportunities
National GP retainer
On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG

8. Theme 1: Developing Supply
GPs
Working towards increasing GP training capacity and trainee numbers
GP Trainers pilot commencing June 2019
Attendance at VTS meetings to outline options post completion
First Five Network development
GP Training Practices have increased by 2 since Aug 2018, 64% of practices are training practices
GPs in Training – increase of 3 WTE since Sept 2016
Practice Nurses
Training Hub offering high quality Practice Nurse training
Increase pre-registration and nurse training placements
Three General Practice Nurse mentors working across the STP
Strong links with University of Worcester Practice Education Facilitators
Increase of 3 new student placements in 2018

9. Theme 2: Up-skilling Staff
Developing Skill Mix
Up-skilling Nurses
Up-skilling the Non-clinical Workforce
Practice Manager Training and Development
Developing Wider Skills

10. Theme 3: Developing New Roles
ANP FTE
Pharmacist FTE
Physio FTE
Emergency Care Practitioner FTE
Paramedic FTE
Physician Associate FTE
08/18
12/18
HF CCG
21.38
23.11
7.99
1.00
.83
3.37
2.66
.72
2.72
RB CCG
6.56
5.56
6.73
7.17
.99
2.87
3.51
SW CCG
29.56
27.54
22.70
21.61
WF CCG
15.39
16.33
6.4
5.41
Supporting the introduction of Social Prescribers and additional Clinical Pharmacists within PCNs
Training Hub to support existing Physician Associates within the preceptorship programme in General Practice
Increase Nurse Associates and Apprenticeship roles within PCNs

11. Investment and Achievements
Scheme
Delivery
GP Recruitment and Retention
Total investment £226k
GP fellowships (HEE funding)
No successful applications, re-advertise 19/20 via VTS schemes
GP portfolio (£106k)
5 GPs recruited to a range of portfolio roles in Dermatology, Diabetes, Stroke, Elderly Care and ED. Significant interest from a range of GPs (early, mid, late career)
Evaluation undertaken by GP Fellow, University of Worcester
GP with Extended Roles
Currently validating and aligning to Elective Care priorities to future training investment
GP retainer (national scheme)
10 GPs joined during 18/19
First5 mentor network (£50k)
On Target, GP lead recruited and Mentors recruited
TERS scheme (national scheme)
Success in Hereford, to be implemented
GP Trainers (£70k)
5 GP Trainers appointed to support GP Training Capacity
Clinical Pharmacists
Clinical Pharmacists (national scheme)
Successful, 10WTE due to commence during Q1 19/20 from latest wave
Physician Associates
Physician Associates / PA Preceptorship scheme (HEE)
Early success, need to increase numbers
Nursing
10 point GPN plan
STP GPN strategy
Increase in nurse training numbers (3 in last 10 months)
9 EOIs from Practices to host placements (working with Worcester University GPN Facilitator and GPN Leads/Mentors
Strategy to be approved by PCCC in May 2019

12. Next Steps for 19/20 Single Point of Access
Medical Education and Peer Support Networks
GP Recruitment and Retention
Named Clinical Leadership
GPFV Workforce Clinical Lead
First Five Clinical Lead
Practice Nurse Leads
Training Hub
GPN mentors, Ambassadors for emerging roles
Design of new roles
Transition from trainee to General Practice
Awareness and access to opportunities
Implementation of Medical education in primary care model / Medical School developments
Increased Training capacity -Training Hubs
Mentoring
Matching roles with system need
Support in first five years
Building on local initiatives to build scalable solutions to agreed standards in partnership with STP ICS HEE
On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG

13. Priority – Digital In drilling in to the Midlands, and the H&W CCGs:
Herefordshire is reported as 83.3% live, indicating 20 practices live of a total of 24. We know this to be inaccurate and have a had discussion locally between IT thoughts and believe this to be caused by a change in the national tracking database that is yet to be actioned to reflect the merger of practices in Herefordshire to give the total to be 20, not 24.
Redditch and Bromsgrove is reported to be 100% live, however with 22 or 22 practices lice, so we’ll need to investigate if also a tracking database issue to reflect the correct number of 1 practices (however Woodrow in technically live so could be reporting the correct technically live practices).
South Worcs is reported as 96.9% live, with 31 of 32 practices. So again, we need to investigate where it is going it’s 32nd practice from, I think Link End was the most recent to go so we’ll start in double checking records for that.
Wyre Forest is reported as 100% live, 11 of 11, so all good.
On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG

14. Priority - Estates Primary Care Estates Strategy – 30 June
On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG

15. Priority -Investment PC Allocation – Short-funded\Risk
Commitment to £11 per head for delivery of local PCE\HOF 1 April 2020
GPFV Spending Plan agreed by NHSE
Need More
Workforce
Estates

16. Next Steps & Timetable THIS IS AN OUTLINE! NHSE – 24 June
PCC Cttee – 25 June
NHSE Response – 30 June
GP Provider Board & Practice Engagement – June – October
STP Executive - October
On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG