1. Working Better With Primary Care: Testing 17c Contracts 1 October 2013

2. Introduction Catriona Renfrew David Leese

3. Why 17c now? Sense the current contract is not working for GPs or the wider NHS We need to explore together whether there is a different way to contract with practices

4. Shared challenges Addressing the increasing pressures and demand on GP practices Increasing numbers of patients with multiple long term conditions requiring complex care The impact of poverty and the different needs of patients living in our most deprived areas Providing more proactive care to vulnerable children and families

5. Shared challenges Improving care for older people, including anticipatory care planning and review Relating the distribution of resources to need Sharing good practice and providing support Making sure GP and practice time is really productive

6. Principles Guarantee the practice income at the current level, subject only to any national changes which would increase or decrease it Reduce the bureaucracy and administration required to feed the current payment systems Negotiate individual contract elements which would reflect the practice’s particular circumstances in line with an overall framework Consider how we could frame our use of locally enhanced services to contribute to this model Guarantee practices a right of return to the standard GMS contract

7. Challenges with the current contract Peter Cawston Graham Morrison

8. A view from the leafy suburbs

9. Where I am based. Kersland House Surgery Milngavie Practice population 7720

10. What do our demographics Look like currently?

12. Our most up to date figures >65 =1680 patients (22%) >75=872 patients (11%) >85=232 patients (3%) >95=13 patients (0.17%)

13. Where do we sit compared to other practices patients >65. East Dun CHP =19.4% NHS GGC = 14.9% Scotland = 16.9%

14. Worried Well?

15. Worried well? multiple morbidities dependent on aging spouse or alone Family living away Dementia Increasing numbers who are housebound

16. And FRAIL......

17. What is frailty?- From Clinical Services Review Multi-system reduction in physical capacity. Function may be severely compromised by minor environmental challenges, (unstable disability). Non-specific presentations in contrast to the classical presentations seen in younger people.

18. Future casting....

20. Current frustrations with the GP contract.

21. We recognize the contract initially brought significant benefits but..... Overburdened by increasing bureaucracy. Frustrated by one size fits all approach. Chasing targets not looking after patients. Becoming increasingly demanding- diminishing returns.

22. Relentless focus individual disease areas, overwhelming, for practice nurses and for patients. How relevant are the current targets to the frail elderly? It takes months for aspects of the contract to be ready, after the April start.

23. The future?

24. We recognise we need a contract, but....... Set us the challenge, let us find local solutions (encourage innovation). Help us develop services designed by practices and between practices for our communities. A good contract would be highly responsive to the needs of different communities. If targets, much more focused on a small number of strategic measures.

25. Some final thoughts

26. We are now, where others aspire to be in terms of life expectancy. We know elderly patients wish to avoid admission, we need investment in practices not just primary care, to help us manage this. One specific focus is, on the ground palliative care resource.

27. Multi-morbidity with deprivation

28. multi-morbidity with frailty The Long Haul

29. 17c – what is it and what are the benefits John Nugent

30. 17c – What is it? What are the benefits? The practicalities of the offer A range of options The benefits A couple of examples from elsewhere

31. The Offer By agreement ‘Income guarantee’ ‘Return ticket’ Essential Services Additional Services/QOF/Enhanced Services Options; One practice/cluster of practices

32. A range of options Minimally different; like an ES bolt-on Fundamentally different; a different way of working within and across practices and the wider health (and social care) system(s) Single practice and/or multiple practice model(s) Core and menu

33. The benefits Patients; more relevant services, more patient centred (safer and more efficient?) Practitioners; less bureaucracy, less hassle, more satisfying Practices; more focussed on outcomes of relevance, more satisfying Board; more of a focus on local issues and outcomes

34. Examples from elsewhere Scotland has c. 100 17c, 900 17j (2c) GG&C has 9; one of the smaller proportions Currently closer to the minimal change model? Grampian has a well developed programme of 17c and has developed the model over a few years Two brief examples http://youtu.be/lnC6W55S6UA http://www.youtube.com/watch?v=fKM2mOJC_B4

35. What 17j can feel like

36. What 17c can feel like

37. Questions / Discussion

38. Group Discussion Why have you come? What do you want to change? Opportunities to do things differently? What else do you want to know?

39. Plenary Discussion