agenda item: 4 - centrallondonccg.nhs.uk...be brought about by the nhs itself. other actions require...

Agenda item: 4

Date Thursday, 01 December 2016

Presenter Richard Ellis – Interim Programme Lead, SCF

Author Richard Ellis – Interim Programme Lead, SCF

Responsible Director

Penny Emerson – Interim Programme Director, Local Services Transformation

Clinical Lead Dr. Neville Purssell, GP Chair, Central London CCG

Confidential Yes ☐ No Items are only confidential if it is in the public interest for them to be so

The Committee is asked to: Note the attached paper on the GP Forward View, and estimates of future funding

Summary of purpose and scope of report

The General Practice Forward View (GPFV) was published by NHS England in April 2016. It sets out 4 key themes for local and national strengthening of general practice, over coming years, and the headline investments required to help facilitate these. The 4 themes are:

• Workforce • Workload • Practice infrastructure • Care redesign

The attached summary demonstrates the links between the GPFV and the Strategic Commissioning Framework for Primary Care in London, and summarises the available funding across NW London that is likely to be available. (Final details awaited from NHS England).

Quality & Safety/ Patient Engagement/ Impact on patient services:

Much of the GPFV proposals are based on extensive feedback from primary care professionals and their patients, on both the strengths and the challenges of a national primary care service.

The opportunities provided by the additional investment in NW London primary care enables improvements to quality of services, the accessibility of services, and the ability by primary care practitioners to provide services both locally and at scale.

Finance, resources and QIPP The papers set out the resources that each CCG can expect in 2016/17, 17/18 and beyond.

Title of paper General Practice Forward View

Agenda item: 4

Equality / Human Rights / Privacy impact analysis

No additional analytical work undertaken as yet

Risk Mitigating actions

Ongoing demands on CCGs, local GP practices and other primary care stakeholders

Joint work within and between each CCG Primary Care team to identify where learning from local best practice can improve standards and save planning time

Supporting documents • Please see attached

Governance and reporting (list committees, groups, other bodies in your CCG or other CCGs that have discussed the paper)

Committee name Date discussed Outcome

N/A

1

Joint Co-Commissioning

Committee in Common

GP Forward View

Planning for submission to NHS

England

V 0.1 DRAFT Local Services Transformation

2

Re-cap on the GP Forward View

• The GPFV sets out a clear direction for the NHS – showing why change is needed and what it will look like. Some of what is needed can be brought about by the NHS itself. Other actions require new partnerships with local communities, local authorities and employers. Some critical decisions – for example on investment, on various public health measures, and on local service changes – will need explicit support from the next government.).

• The GPFV, published on 21 April 2016, sets out details on proposed investment and commitments to strengthen general practice in the short term and to support sustainable transformation of primary care for the future. It includes specific, practical and funded investment proposals in four areas:

• Workforce; • Workload; • Practice infrastructure; and • Care redesign.

CCGs will prepare summary plans, for submission by 23 December, to present local and NW London proposed initatives

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Operational Planning Guidance: Workforce

Summary of guidance:

NHS England has retained some national funds to support workforce developments as indicated in the investment section. This includes: International recruitment: NHS England will produce a framework for CCGs along with other partners to recruit doctors internationally and will fund several overseas recruitment projects up to 500 doctors nationally. Further information will be available by the end of December 2016. Clinical pharmacists in general practice: in addition to the clinical pharmacists recruited in phase 1, additional funding will be available (as set out in the GPFV) for providers over the next three years to assist in costs of establishing the role in practices. Further information will be made available by December 2016. HEE and NHS England will produce frameworks and models to support the expansion of physician associates, medical assistants and physiotherapists.

What this means for 23 Dec:

In their GPFV Plans, CCGs will want to include a general practice workforce strategy for the local system that links to their service redesign plans. These should be clear about the current position, areas of greatest stress, examples of innovative workforce practices, the planned future model and actions to get there. NHSE suggests that this can include:

• a baseline that includes assessment of current workforce in general practice, workload demands and identifying practices that are in greatest need of support;

• workforce development plans which set out future ways of working including the development of multi-disciplinary teams, support for practice nursing and establishing primary care at scale;

• commitment to develop, fund and implement local workforce plans in line with the GPFV and that support delivery of STPs;

• initiatives to attract, recruit and retain GPs and other clinical staff including locally designed and nationally available initiatives;

• actions to ensure GPs are operating at the top of their licence, for example through use of clinical pharmacists in a community setting and upskilling other health care professionals to manage less complex health problems;

• actions which facilitate an expanded multi-disciplinary team and greater integration across community services to optimise out of hospital care for patients including access to premises, diagnostics, technology and community assets

Plans to include a general practice workforce strategy for the local system that links to their service redesign plans

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Operational Planning Guidance: Workload


Guidance for the General Practice Resilience Programme sets out indicative funding allocations of £8m each year for 2017/18 and 2018/19 for NHS England Regional Teams to deliver a menu of support to help practices become more sustainable and resilient.

Local teams should work in partnership with STPs and CCGs to ensure this funding is used to target support at areas of greatest needs and work in line with the processes set out in the operational guidance to deliver upstream support for practices.

CCGs will work with practices to establish the principal local areas identified in ‘Making Time in General Practice’, and how the ‘Time to Care’ initiatives can work to greatest benefit for local practices, and their care for patients.

STP footprints should ensure that people living with long term conditions reporting low levels of support or confidence to self-care (or for those STPs using the Patient Activation Measure, low levels of activation) undertake regular personalised care and support planning and are signposted to tailored support. Personalised care and support planning should take place in general practice and should produce a single care plan, which is owned by the patient and shared with the system

Commissioners should also have established pathways of care that integrate with community pharmacy.


• Proposals on support to identified vulnerable practices, and pan-CCG support for practice resilience

• Identification of opportunities for optimising access by patients, including use of online consultations and telephone triage etc, and links with other health pathways (eg, pharmacies) that can support patients in self-care

• Further automation of common practice tasks, and streamlining of referral, discharge and outpatient procedures to assist with reduction in NHS bureaucracy

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Operational Planning Guidance: Practice Infrastructure


• CCGs should have clear local estates and digital roadmaps which lay out the plans to create the infrastructure to support new models of care.

• These should deliver against the requirements set out in recent guidance (Local Estates Strategies: A Framework for Commissioners and the GP IT Operating Model 2016/18).

• Estates and technology schemes funded or part funded by the Estates and Technology Transformation Fund must meet the specified core criteria.

• NHS England will work with CCGs to agree the pipeline of investments.

• Digital Roadmaps, as highlighted in the GP IT Operating Model 2016/18, should set out priorities and deliverables for each year.

• Interoperability must feature as must the pursuit of innovative technologies to transform triage and consultations with patients to alleviate workload pressures.


• Understanding of required infrastructure to support care redesign

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Operational Planning Guidance: Care redesign


As part of their GPFV Plan, CCGs should have a clear, articulated vision of the care redesign that will deliver sustainable, transformed services, that is part of the STP vision.

This should include details of the changes to be made to redesign services for improved outcomes, including the ways in which greater use will be made of self-care, technology and a wider workforce, and other actions to address challenges with general practice capacity.

CCGs should agree a plan for implementation of these changes across all member practices and other providers, with an indication of how this has been developed in co-production with primary care providers themselves.

Improved Access Covered under GP Access Fund extended access programme. In order to be eligible for additional recurrent funding, CCGs will need to commission and demonstrate the following: • Timing of appointments

(appointments 8-8, weekend appointment times at population requirement);

• Capacity (30 mins/1000 pts/ week);

• Measurement (ensure usage of a nationally commissioned new tool to automatically measure appointment activity);

• Advertising and ease of access (sign-posting and patient choice);

• Digital (very vague- use of digital tools to support new models of care); and

• Inequalities (tackling access issues)

Effective access to wider whole system services Effective connection to other system services enabling patients to receive the right care from the right professional, including access from and to other primary care and general practice services such as urgent care services. CCGs will need to provide plans outlining their approach to improved access as part of their GPFV plan. This should include trajectories on improved access coverage for their local population. There are currently significant inequalities in different groups’ experience of access. Whilst making changes designed to improve access, CCGs should ensure that new initiatives work to reduce inequalities as well as improve overall access.

Time for Care Programme CCGs should have clear plans for how they will support the planning and delivery of a local Time for Care development programme, to implement member practices’ choice of the 10 High Impact Actions. This could include details of: • how this piece of practice

development is being aligned with other developments locally such as technology and estates investment, workforce development and improved collaboration between providers; and

• the investment being made by the CCG to create headroom for practices to engage in development.

Funding for reception and clerical staff training, and online consultation systems As part of their GPFV Plan, CCGs should describe how these funds will be used for member practices. Could be done at-scale. This should include evidence that the plan: • has been developed in

consultation with general practices themselves;

• will be delivered in alignment with other development activities such as local Time for Care programmes, and wider workforce and technology strategies;

• includes plans to use early adopters to help spread innovations in workforce and technology; and

• provides assurance that this funding is ring-fenced for the intended purposes.

7

Operational Planning Guidance: Investment


• Primary Medical Care allocations by CCG have been published for the next 5 years.

• In addition to those allocations, other primary care funding is available for specific purposes as part of the £500m-plus Sustainability and Transformation package announced in the GPFV.

• Transformational support is to come from the CCG core allocations • CCG funding allocation formula has been published for online general

practice consultation software systems. • CCG funding allocation formula has also been published for training of

care navigators and medical assistants for all practices • Indicative funding for 2016/17 for GP resilience has been published by

NHSE London. 2017/18 funding for NW London is £1.3m and 2018/19 is £1.3m.

• Access funding through GPAF - £4.4m for NW London in 2016/17 and £4.12m for 2017/18

• Other funding includes: • increases in funding for GP trainees funded by Health

Education England; • Increases in funding for nationally procured GP IT systems; • Increases in the section 7A funding for public health services,

which support payments to GPs for screening and immunisation services; and

• 3,000 new fully funded practice-based mental health therapists to help transform the way mental health services are delivered.

Investment by CCG for each facet of the GPFV is detailed in the slides below What this means for 23 Dec:

• How access to general practice will be improved

• How funds for Practice Transformational Support (as set out in the GPFV) will be created and deployed to support general practice

• How ring-fenced funding being devolved to CCGs to support the training of care navigators and medical assistants, and stimulate the use of online consultations, will be deployed.

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GP Forward View Allocations – NW London CCGs NHS England allocations for Primary Care (medical) were published for five years to 2020/21. The allocations for NW London are as follows: NWL Primary Care Medical Allocations – 5 years In addition to these allocations, other national primary care funding is available for specific purposes as part of the £500m-plus Sustainability and Transformation package announced in the GPFV, alongside specific funding to support improvements in access to general practice, and improvements in estates and technology.

1) Elements of Sustainability & Transformational Package. a) Transformational support 2017/18 and 2018/19: CCGs should plan to spend a total of £3 per head as a one off non-recurrent investment commencing in 2017/18, for practice transformational support. This represents an investment of £7.1million for NW London. The investment is designed to stimulate: o Development of at scale providers for improved access o Implementation of the 10 high impact actions to free up GP time CCGs are expected to fund this from CCG core allocations. b) Online general practice consultation software systems: £45million funding will be available nationally for this programme (over 3 years). £15million will be devolved to CCGs in 2017/18, along with rules and a specification, a further £20million in 2018/19, and £10million in 2020/21. Details of the specification and monitoring arrangements have not yet been published.

Brent Central Ealing H’smith & Fulham Harrow Hillingdon Hounslow West 2017/18 Projected Registered Population 376,396 215,988 435,186 211,202 265,495 313,971 315,262 246,463

£ 3 per head investment - 2017/18 and 2018/19 (£) 1,129,189 647,963 1,305,558 633,607 796,484 941,914 945,785 739,389

Brent Central Ealing H’smith & Fulham Harrow Hillingdon Hounslow West £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000

2016/17 Allocation 42,618 27,629 48,192 24,869 29,840 35,274 35,250 36,301 2017/18 Allocation 46,687 28,451 53,017 27,245 30,824 38,470 37,859 36,708 2018/19 Allocation 48,571 29,446 55,261 28,812 31,890 40,281 39,511 37,256 2019/20 Allocation 50,247 30,515 57,252 29,977 33,238 42,040 41,184 38,050 2020/21 Allocation 52,386 31,857 59,958 31,111 35,128 44,548 43,569 39,510


2017/18 Allocation (£) 97,053 55,692 112,212 54,458 68,457 80,957 81,290 63,550

2018/19 Projected Registered Population 379,673 218,431 439,577 211,975 268,589 318,521 319,791 247,590

2018/19 Allocation (£) 129,598 74,560 150,046 72,356 91,681 108,725 109,158 84,513

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GP Forward View Allocations – NW London CCGs 1) Elements of Sustainability & Transformational Package (Contd.). c) Training care navigators and medical assistants for all practices: £45million funding will be available nationally for this programme (over 5 years), with £10million in both 2017/18 and 2018/19, with £5million already allocated in 2016/17.

d) General Practice Resilience Programme: £40million funding will be available nationally for this programme (over 4 years). £16m of this has already been allocated in 2016/17. In 2017/18, £8million will be allocated nationally and a further £8m in 2018/19. This funding will be devolved via NHS England local teams on a ‘fair shares’ basis.

2) Funding to improve access in general practice: The GP Access Fund allocation for NW London is £4.4m which is to be allocated across CCGs based on registered population. This funding will be utilised to meet the GP Access Fund specifications below by March 2017. o Appointments available at least 6.30 - 8pm Mon – Fri o Appointments available 8-8 Saturday and dependent on demand on Sunday o Available to all registered patients in area o Pre-bookable appointments available o Same day appointments available o Bookable via the practice and online o Bookable via 111 o Hubs have access to patient records 3) Estates and Technology Transformation Fund (Primary Care): North West London has submitted bids over the next 3 years from the Estates and Technology Transformation Fund to improve capacity in primary care.

4) Other Funding for general practice: There will also be some non-recurrent funding held nationally to support GPFV commitments in the areas listed below: o Growing the general practice workforce o Premises o National development programme In addition, there will be increases in funding for: o GP trainees funded by Health Education England o Nationally procured GP IT systems o Section 7A funding for public health services, which support payments to GPs for screening and immunisation services; and o 3,000 new fully funded practice-based mental health therapists


2017/18 Allocation (£) 64,702 37,128 74,808 36,305 45,638 53,971 54,193 42,367

2018/19 Projected Registered Population 379,673 218,431 439,577 211,975 268,589 318,521 319,791 247,590

2018/19 Allocation (£) 64,799 37,280 75,023 36,178 45,840 54,362 54,579 42,256

Brent Central Ealing H’smith & Fulham Harrow Hillingdon Hounslow West 2016/17 (£) 168,581 96,435 194,605 95,106 118,557 139,743 140,316 110,876

Brent Central Ealing H’smith & Fulham Harrow Hillingdon Hounslow West CCG Population 1st April 2016 369,166 212,847 426,086 209,683 260,612 304,147 304,686 242,428

GPAF Allocation based on population size (£) 697,241 402,002 804,745 396,027 492,216 574,440 575,458 457,872

agenda item: 4 - centrallondonccg.nhs.uk...be brought about by the nhs itself. other actions require...

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