1. MERSEYSIDE FAMILY DOCTOR ASSOCIATION GP EVENT Saturday 14 November 2015 WHERE IS PRIMARY CARE GOING? Katherine Sheerin Chief Officer NHS Liverpool Clinical Commissioning Group

2. Overview LOCAL TRANSFORMATION  HEALTHY LIVERPOOL  GENERAL PRACTICE SPECIFICATION NATIONAL PERSPECTIVE REFLECTION AND QUESTIONS

3. The Ultimate Goal and Context Healthy Liverpool Programme Vision  ‘a healthcare system in Liverpool that is person-centred, supports people to stay well and provides the very best in care’ Outcomes  Improving health outcomes for people in Liverpool relative to the rest of England and reducing health inequalities within the city  Quality of healthcare is consistent and high quality  New model of care which is clinically and financially sustainable 3

4. £643m £83m £29m £84m £13m £128m £147m £58m LIVERPO OL HEALTH SPEND CCG PROGRAMMES PRESCRIBING CHILDREN’S SOCIAL CARE PUBLIC HEALTH ADULT SOCIAL CARE LEISURE/PARKS GENERAL PRACTICE OTHER PRIMARY CARE SPECIALISED SERVICES £37m

5. LIVING WELL LIVING WELL DIGITAL HEALTH COMMUNITY TRANSFORMATION URGENT CARE MENTAL HEALTH HEALTHY AGEING LEARNING DISABILITIES CHILDREN System Wide Transformation Programmes Continuous Improvement Programmes HOSPITAL TRANSFORMATION CANCER LONG TERM CONDITIONS HEALTHY LIVERPOOL PROGRAMME

6. Liverpool Community Care Model

7. Healthy Liverpool Community Care Programme Plan on a Page Vision and Outcome Ambition for Healthy Liverpool Improved Health Outcomes Deliver First Class Services Delivering a Sustainable System Preventing people from dying prematurely Enhancing quality of life Delaying and reducing the need for care and support Community Care Outcome Domains Ensuring that people have a positive experience of care and support Specialist Clinical Integration ‘care closer to home’ Specialist Clinical Integration ‘care closer to home’ Community Care Teams ‘no wrong door’ Community Care Teams ‘no wrong door’ Managing Complex Needs ‘supporting the vulnerable’ Managing Complex Needs ‘supporting the vulnerable’ Enablers: Digital Care Estates Proactive Care High Quality Primary Care Community Engagement Workforce Access Neighbourhood Collaborative ‘maximising community assets’ Neighbourhood Collaborative ‘maximising community assets’ Prevention of ill health, health protection and maintaining healthy lifestyles ‘a health care system in Liverpool that is person-centred, supports people to stay well and provides the very best in care’ Neighbourhood Delivery Establish Community Care Team in each Neighbourhood Community Diagnostics Seven Day Access Scale up use of Assistive Technologies Common Assessment Framework Early Help Support Clinical Model for Care Homes and Community Beds Pathways of Care for Long Term Conditions Eliminating Unwarranted Variation in Care Mental Health Integration Dementia Clinical Network Transformed Cancer Services Children’s Pathways of Care Planned Care Redesign End of Life Services Integration of non-medical programmes Directory of Service Live Well Liverpool Community Grants Support for the Homeless Collaboration with Housing and Fire and Rescue Services Maximise use of Community Estate Complex Alcohol and Addictions Healthy Lung Initiative Tackling Social Exclusion Health Trainer Services Severe Mental Illness Children with Complex Needs Learning Disability Embedding Self-Care Shared Decision Making Prevention at Scale Early Detection and Diagnosis Establish Centres for Wellbeing Targeted Support for ‘Hard to Reach’ Groups

8. EXCELLENT GENERAL PRACTICE IS FUNDAMENTAL TO DELIVERING HEALTHY LIVERPOOL!!!

9. Liverpool General Practice Specification Standards for all practices Investment equalised Differential resources at risk Clear performance targets Prevention Early Identification Improved Clinical Management Use of Resources Access What have we achieved?

10. All A&E Attendances: Trust Catchment Data Source: National AED Sitrep *Aintree A&E attendances increased during 2014/15 due to Walk in Centre activity being counted against AUH A&E Acute Benchmarks Trusts: Bradford Teaching Hospital, St Helen’s and Knowsley Hospital, University Hospital of South Manchester, Salford Royal Foundation Trust, University Hospital of Birmingham Foundation Trust, Newcastle Upon Type Hospital Trust, Southport and Ormskirk Hospital Trust Childrens Benchmark Trusts: Sheffield Children's Hospital Trust, Birmingham Children's Foundation Trust 2014/15 Royal Liverpool Hospital reported a 8.7% increase in A&E activity during 2014/15 (112,690 attendances) compared to 2013/14 (103,713 attendances) Aintree Hospital’s increase in A&E activity during 2014/15 is not comparable to previous years due to walk in centre activity being counted against AUH. Peer providers of Royal Liverpool Hospital and Aintree Hospital reported a 4.5% increase in A&E attendances Alder Hey Children's hospital reported a 0.7% reduction in A&E attendance rates during 2014/15 compared to a 5% increase reported by peer providers

11. LCCG Data Source: General practice systems / immform return England Data Source: http://www.phoutcomes.info/public-health-outcomes-framework Year2011/122012/132013/142014/15 % Variance on 11/12 Patients aged >65 LCCG77.80%77.69%76.92%77.12%-0.68 England74.00%73.40%73.20%72.70%-1.30 Patients aged <65 at risk LCCG54.90%57.47%57.94%58.24%3.34% England51.60%51.30%52.30%50.30%-1.30 Influenza Vaccinations

12. Vacs up to age 2: DTaPIPV at 1 year, HibMenC at 2 yrs, MMR1 at 2 years, PCV1 at 2 years Vacs up to age 5: DTAPIPV at 5 years, MMR2 at 5 years *England benchmarks estimated using data from http://www.hscic.gov.uk/pubs/immstats. 2011/122012/132013/142014/15 % Variance on 11/12 Year Vaccs up to age 2 LCCG95.40%95.77%94.45%93.82%-1.58% England*93.73%94.13% 93.44%-0.29% Vaccs up to age 5 LCCG87.90%92.31%91.40%89.61%1.71% England*86.70%88.30%88.37%88.58%1.88% Childhood Vaccinations

13. Data source: general practice systems Year Patients drinking over recommended levels Of those, number offered brief intervention % Offered brief intervention Year on year % variance 2011/12141461131780.00%5.00% 2012/13145781262486.60%6.59% 2013/14123931115990.04%3.44% 2014/15112441034792.04%2.00% Alcohol: brief interventions

14. Data source: general practice systems Prevalence in patients aged 40+ Since baseline year (2012) Liverpool has reported a 15.6% increase in QOF disease registers As at March 2015 Liverpool’s disease register size stands at 145,414 The number of extra entries on the register does not necessarily equal 16159 (as reported end of March 2013) additional new patients as 1 patient can be on multiple registers

15. Data Source: Local SUS data flow Based on ACS admissions to RLBUHT, AHT, AHCH, ST H&K Definition: ACS admissions for Angina, Asthma, Cellulitis, Congestive Heart Failure, COPD, Convulsions and epilepsy, Diabetic complications, ENT, Flu and Pneumo Year Non-elective admissions % Variance (on previous year) 2011/126667-11.47% 2012/1367761.63% 2013/146590-1.59% 2014/15732811.19% Variance 11/12 to 14/156619.19% Non-Elective ACS Admissions: LCCG

16. Data Source: Dr Foster National ACS definition for 19 Ambulatory Care Sensitive Conditions Benchmark: North of England Commissioning Region Non-Elective ACS Admissions trends 2014/15 LCCG reported a slight increase in ACS admission rates in 2014/15 with a rate of 21.4 per 1,000 population Based on historical data LCCG have moved from reporting the highest ACS admission rates in 2009/10, ranked 68 out of 68 CCGs within North of England Region to being ranked 31 out of 68 in 2014/15

17. Data Source: Local Sus data Definition is GP referred (03) first outpatient attendances to Dermatology, T&O, Gynaecology, Rheumatology, ENT, Gastroenterology, Vascular Surgery and Urology (using TFC to define speciality) Data source: Local SUS dataflow *Includes activity at ICATS, MCAS, RheuCAS but does not include those in primary care such as H Pylori testing, minor surgery Based on activity at RLBUHT, AHT, AHCH, St H&K Year GP Ref’d first OP atts* % Variance (on previous year) GP Ref’d first OP atts plus assessment services* atts % Variance (on previous year) 2011/1243113-8.73%72403-5.01% 2012/1341338-4.12%69338-4.23% 2013/14424322.65%66863-3.57% 2014/1538625-8.97%63997-4.29% Var 11/12 to 14/15-4488-10.41%-8406-11.61% GP Referred first outpatient attendances: LCCG

18. Prescribing Cost Prescribing cost increased by 2% (£1,829,924) during 2014/15 compared to 2013/14 for Liverpool CCG Cost variance reduced from 4% increase in costs reported in 2013/14 to 2% increase in cost reported in 2014/15 Liverpool increase in prescribing cost during 2014/15 is reported to be lower than North West and National increase Datasrouce: EPACT

19. Prescribing trends *ASTRO PU figures included above are different to those previously reported due to ASTRO PUweightings changing. North West changed to Merseyside Area Team in 2012/13 therefore coding changed and as such old North West data is not available 2012/13 and before for comparison

20. Diabetes 9 care processes Datasrouce: EMIS Overall performance has increased by 22.7% since 2012/13 Performance variance across the city has increased by 27.2% The increase in performance variance is due to higher performing practices increasing their rates and lower performing practices reducing their rates

21. EXCELLENT GENERAL PRACTICE IS FUNDAMENTAL TO DELIVERING HEALTHY LIVERPOOL – BUT IS THIS ENOUGH?

22. NATIONAL PERSPECTIVE FIVE YEAR FORWARD VIEW NEW CARE MODELS – ‘VANGUARDS’ SEVEN DAY PRIMARY CARE SERVICE RCGP ‘BLUEPRINT’

23. THOUGHTS AND QUESTIONS