1. Have your say on our plans for Primary Care in Warrington

2. Dr Andy Davies, Clinical Chief Officer Why are we doing this?

3. What are we doing? NHS Warrington Clinical Commissioning group have drafted a strategy outlining our vision for the future of Primary care in Warrington. We want the views of members of the public, patients, Doctors, Nurses and other key stakeholders on the changes we are proposing.

4. The Priorities There are ten priorities identified in the strategy…

5. Development of the strategy Access, Demand and Capacity Issue: Demand is increasing More complex cases requiring a different type of response to traditional 10 minute appointment Shortages of staff and new types of staff with different skill mix Higher public expectations Solution: Provide services across Warrington and across clusters to increase capacity and share expertise and resources New technology to provide services in a different way, e.g. telehealth and telemedicine More focus on preventative measures to reduce demand More focus on anticipatory and proactive care to prevent problems escalating and causing an increase in demand Benefits: Patients have better access to appropriate services when they need them, including opportunity for different types of access such as telephone consultations, and evening and weekend appointments, more same day appointments Opportunity for longer appointments for more complex cases

6. Development of the strategy Medicines Management and Prescribing Issue: High spend on medicines that if not all appropriate could be used to fund alternative services Potential poor outcomes due to polypharmacy (if on more than two medications) Solution: Medicines management integrated within the multi disciplinary team made possible by cluster working Proactive holistic assessment including medicines review and management Risk satisfaction tool to identify patients who may benefit from review Benefits: Better patient outcomes by medicines review and improved prescribing Better use of resources by saving on prescribing costs that can be used to fund other services

7. Development of the strategy Care Homes - Nursing and Residential Issue: Increasing older population 1600 care home residents in Warrington care homes Care provided to these very vulnerable patients is reactive and as a result is felt that there are admissions to hospital that could be avoided Inefficient use of GP time to visit multiple care homes to see individual patients Solution: Multidisciplinary team developed assigned to care homes to take a proactive approach to care of residents Undertake holistic assessment that anticipates problems and avoids escalation that would require admission to hospital Regular contact with home improves skill level and confidence of care home staff to enable less reliance of primary care/Bridgewater care home team More effective use of GP time that can be utilised for other services Benefits: Better patient outcomes by holistic proactive assessment More proactive care for early diagnosis and treatment Reduced admissions to hospital and A&E Reduced number of GP home visits Improved continuity of care

8. Development of the strategy Whole System/Right Care Issue: High pressure on the health system Integration makes best use of resources, better for patient, especially those with complex care needs Solution: Care co-ordinators available to offer single point of contact Different levels of care co-ordination being identified Risk stratification tool to identify patients’ needs and allow planning of appropriate services to meet their needs System integration – social and health care services organised around practice lists within clusters Benefits: More co-ordinated and joined up care for patients More focus on non medical response Increased patient independence Improved patient outcomes Reduced duplication of services and more effective use of available resources

9. Development of the strategy Complex Care (Including long term conditions and cancer rehab) Issue: Increase patients with long term conditions Complex care packages which are provided by multiple agencies often in an uncoordinated way Care is often reactive with not enough focus on self care and proactive management to avoid escalation of patient’s condition Solution: More proactive care with greater focus on self care and prevention Care co-ordinators to support patients with complex care packages Different ways of assessment with opportunity for longer, more in depth appointments / assessments Benefits: More co-ordinated and joined up care for patients Improved patient outcomes Patients more independent

10. Development of the strategy Promoting Prevention and Self-Care Issue: Unhealthy lifestyle can cause ill health Solution: More scope for self management and prevention services in clusters Local health campaigns in every practice Health check and health mentor referrals Benefits: Healthy lifestyle can prevent ill health Less demand on primary care Improved patient outcome

11. Development of the strategy Mental Health Issue: Access can be difficult Need services close to the patient Solution: To provide Improving Access to Psychological Therapies (IAPT) and outreach Community Psychiatric Nurse services within the cluster model Benefits: Improved local access Improve overall care for patient

12. Development of the strategy Workforce Development and Sustainability Issue: Warrington is currently under doctored by 29 whole time equivalent GPs Hard to attract new GPs Several GPs close to retirement Other staff groups hard to recruit e.g. nurses Patient understanding of health professionals role within primary care Solution: Opportunities for skill development, building expertise and gaining experience via provision of service over bigger geographical area than single practice Closer working with secondary care to improve skills Development of new roles and review of skill mix Improve understanding of the role of other health professionals i.e. practice nurse Benefits: Improved chance of attracting high quality staff Improved work life balance for primary care staff to help with retention and recruitment and improve quality of care Improved quality of care More efficient use of all primary care health professionals leading to increased access

13. Development of the strategy Last but not least….. Public engagement and communications in primary care We need to ensure that we build on what we do now and improve the way in which we engage with patients, the public, Doctors, Nurses and other key stakeholders so that we continue to take their views into account as we further develop our services.

14. The Warrington ‘brand’ The Quality Standard for Primary Care From 2015, with the changes around the commissioning responsibility for Primary Care, the CCG has had the opportunity to closely influence the way in which Primary Care works. This ‘co-commissioning’ means a significant move to more local commissioning of Primary Care. This has given us the opportunity to look at what Primary Care looks like across Warrington and by working with local GPs we have developed a Quality Standard for Primary Care… The Warrington ‘Brand’.

15. The Warrington ‘brand’ In real terms The Warrington ‘Brand' will address equality of service across Warrington, helping to ensure that every registered patient has the same access to the same services in each GP practice. It will also ensure there is a quality benchmark for all GP practices.

16. Challenges facing General Practice Your GP surgery is the first point of contact for most people when they are unwell or need medical advice. This presents a real challenge… as people are living longer with multiple long-term conditions the pressure on Primary Care is increasing year on year and has seen unprecedented leap in the last decade. This adds to the already significant financial challenge on health and social care.

17. Since 2008 the workload in General Practice has increased by 40% Whilst at the same time The growth in the number of people becoming a GP has fallen well behind other clinical professions (Between 2006 and 2013, GP numbers grew by just 4%) More Demand + Less GPs = The need to work differently General Practice The Challenge

18. Clusters – GPs working together One of the proposals within the draft Primary Care strategy is around the idea of GP practices working in a cluster model with neighbouring practices, sharing some services and resources. This could mean that patients may access some health care services in other local locations as well as their usual practice. This doesn’t mean your usual GP consultation, but maybe additional services e.g. extended GP hours, service for people with long term conditions

19. Next steps The draft Primary Care strategy and summary document are available to view on the CCG website. http://www.warringtonccg.nhs.uk/get- involved/consultations_2.htm http://www.warringtonccg.nhs.uk/get- involved/consultations_2.htm