dr tim ballard,vice chair external affairs, royal college of general practitioners
Post on 18-Jul-2015
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Building the New Deal:Why, what and how?
The future for English General Practice
Dr Tim Ballard FRCGP
Vice Chair of Council
RCGP
Overview
• 10 years under-investment in general practice
• Failure to develop the workforce in general practice
• The Five year Forward View – Building the New Deal
• Building the workforce – the 10 point plan
• Why - are we where we are?
The wider picture
• Shipman
• The 2004 Contract
• Sustainability & Austerity
• Changing Demography
• The personalised Society
• The Health & Social Care Act 2012
• What - are the other pressures for
change?
• A Call to Action (NHSE)
• The Future Hospital Report (RCP)
• The Dalton Review
• The Urgent & Emergency Care Review
• What - are the pressures for change?
• Specialised Services in OOH Settings
• The Oldham Report
• Chen – Med & Segmentation of Primary Care
• General Practice Delivered at Scale (NHSE)
• CQC
English
General Practice
today
• Around 1.2m patients seen every working
day – increasing complexity
• 340-370 million consultations per year
(300m in 2008)
• Increase in workload, static funding and
falling resource is bringing general practice
to its knees
Funding of
UK general practice
General practice funding has fallen by 8% across Britain in real terms since 2005/06 – at a time when the rest of the NHS budget has grown by 18%
Source: RCGP analysis
Rising Demand
Between 1995 and 2008, the number of consultations in General Practice rose by 75% to
more than 300m. A sharp increase in consultations for those over 65 has contributed to this
Not enough GPs: The general practice workforce crisis
The rise in numbers
and complexity
“Epidemiology of Multimorbidity” – Lancet, May 2012
“Epidemiology of Multimorbidity”
Lancet, May 2012
• Set up by Secretary of State
• Target for GP training numbers
in England to be 3250 per annum
– 50% of Graduates
• Target missed 6 consecutive years. Around 2700
recruited annually
• 2014 – 2564, lowest number since 2007
• Also worsening retention – GPs nearing
retirement; young women
General Practice Taskforce
• Three strands to this plan
• Improving recruitment into general practice
• Retaining doctors within general practice
• Supporting those who wish to return to general
practice
Building the workforce
the 10 point plan
• Major promotion of general practice
– the first ever RCGP national recruitment video
launched last Saturday.
• Widespread
coverage across
all media
• Over 7,000 views
in less than a
week
Recruitment
• Improving breadth of training. Opportunities for
additional training in areas where it is hard to
recruit (clinical, leadership, academic)
• Training hubs – groups of
practices, multi-professional
training
• Targeted support. Additional financial incentives
in under-doctored areas
• Improved retainer scheme, meeting needs of retainers
and practices
• Improving training capacity in
practices – including investment
in infrastructure
• Incentives to remain in practice (funded mentorship
scheme, access to portfolio career, clearer range of
career pathways)
• New ways of working (pharmacists, medical
assistants, physicians assistants, care navigators)
Retention
• Safe, proportionate route to return to
practice
• Targeted investment in returners. For
areas of greatest need, resources to help
with cost of returners and employment of
returners
Return to Practice
• Puts a strengthened primary care at the centre of its vision for the
NHS, based on building a ‘new deal’ for general practice
• States clearly that more of the NHS budget will be invested in
primary care
• NHS England will work to increase GP recruitment
• Puts general practice at the heart of new models of care –
particularly the Multispecialty Community Provider model.
• Backed by funding announced in the Autumn Statement – including
a fund of over £1bn for GP premises
• Commitments wouldn’t have happened without pressure from the
College and others
• Established by HEE following announcement by
SoS at RCGP conference
• Chaired by Prof Martin Roland
• Prof Amanda Howe is one of the commissioners
• Identify models of primary care to meet needs of
future NHS
• Highlight good examples of integrated, patient
focused ‘out-of-hospital’ care
• Report by end of June 2015
Primary Care Workforce Commission
• How can the Profession Respond?
• 2022 - A Vision for General Practice (RCGP)
• The inquiry into Patient Centred Care
(RCGP)
• Put Patients First Campaign (RCGP)
• Your GP Cares (BMA)
• How - do we know we are making progress?
• The Labour Party Conference
• The Conservative Party Conference
• The RCGP Conference
• How – should the profession respond?
• A salaried service – APMS and private
providers?
• Vertical integration or Integrated Care
Organisations?
• Independent contractor status?
• How – should the profession respond?
• Networks and Federations, Networks and Federations, Networks and Federations,
Networks and Federations, Networks and Federations, Networks and Federations,
Networks and Federations, Networks and Federations, Networks and Federations,
Networks and Federations
• Why – are Federations & Networks part of the
answer?
• Enable Professional Control
• Keep the traditional patient facing feel of GP
• Demonstrate the will to tackle variability
• Control Segmentation
• Control the way we work with Secondary Care
• Why – are Federations & Networks part of the
answer?
• The 5 Year Forward View
• Multiprofessional Community Partnerships
(MCPs)
• Primary & Community
Services (PACs)
• How – do we organise ourselves?
• The Use of Co-Commissioning
• The Whole systems Integrated Care Toolkit
• RCGP Clinical Commissioning Workshop on
Feb 26th
• New Models of Care – Design Principles
• Based around the Registered List
• The centrality of relational care
• Driven by Primary Care
• New Models of Care – Examples :
External
• Dermatology
• Diabetes
• Care of the Elderly
• SPA Schemes
• New Models of Care – Examples :
Internal
• Doctor First
• Online Access
• Pathology Services
• Near Patient testing
• Medical Assistants
To meet the challenges
We need to build a new deal:
Workforce - Premises – Resources-New Models of
Care
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