developing primary care v7

© 2014 Primary Care Commissioning CIC

Development and support programme

Transforming primary careCommissioning, federations and collaborative ways of working


One of our key aims is to enable general practice, community pharmacy and other primary care services to play a much stronger role, at the heart of a more integrated system of community-based services.

This will mean access to a broader range of services in primary care, in their own homes and in their communities, centred on a much more pivotal and expanded role for general practice to co-ordinate and deliver comprehensive care in collaboration with community services and expert clinicians.

Everyone Counts: Planning for Patients 2014/15 to 2018/19

General practice and primary care at the heart of transforming the NHS

For those patients with a moderate mental or physical long-term condition (about 20 percent of the population) we need to secure access to all the support and care they need from wider primary care, provided at scale.

Everyone Counts: Planning for Patients 2014/15 to 2018/19

General practice – the hub of care

Integrated general practice

Integrated community based healthcare

Integrated community based health and social care

Transforming primary care – putting patients and primary care at the heart

Commissioners need to focus on what is commissioned and how.

They also need to develop the provider landscape, which demands clinical engagement and full participation of patients in the design process.

This demands a new commissioning mindset and skills.

This approach will promote a community based service model with general practice as the hub of care.

Potential for general practice?


Developing general practice programme design

CCGs and members are looking at new business models to:

• Ensure sustainability• Support primary care to develop• Protect what is great about general practice• Safeguard recruitment and retention• Create the platform for community-based health care • Make the most of opportunities • Develop generalist led, patient centred integrated services

How PCC can help

• Share our experience of supporting other groups of practices• Independent insight and advice• Understanding of general practice issues and ambitions• Knowledge of regulation, policy, funding and contracts• Expert facilitators to help create consensus• Programme design, planning and management• Project support to make it happen• Partnerships with trusted general practice experts

PCC develops programmes and interventions with CCGs and practices across the country. We design and deliver tailored support to enable practices to understand the bigger picture and agree development plans.

‘The workshop really lit the blue touch paper’Dr Richard Bull, Clinical Lead North

Derbyshire CCG

‘I cannot believe how much we got agreed’Jacqui Tonge, practice manager


Developing general practice programme


Practical support for local solutions

Facilitated developmentTo develop new models of working, practices need to come together to explore common vision and values. PCC uses its expert facilitators to support development and facilitate agreement.

InsightOur support for you is informed by experience working with practices in other parts of the country. It starts with raising of awareness of the opportunities for collaborative working and leads to practical considerations of form and function. We help you to clarify the vision and mission and plan the necessary governance arrangements.

ExpertsWe provide expert advice, including access to business planning and legal specialists, to assure your plans and put them on the path to implementation.

WHAT DO PRACTICES NEED

TO DO TO COMMIT?

Where you are Where you want to be

Primary care networks are at different stages of growth with different aspirations.

All need to work together to achieve the scale to deliver services their populations need and the growth to make general practice sustainable.

This will not be an overnight process but a journey for primary care.

Stage 1: Existence● Constitution in

place

● Legal entity formed or plans to firmed up

● Begin to win small primary care led contracts

● Direct supervision of practice / collaboratively operated services

Stage 2: Survival● Formality legally in

place – delivering shareholder value

● Supervised services with key managers

● Growth in clinical skills and expertise

● Increased scale of work being won / pipeline

Stage 3: Success

● Functions established with their own plans

● Clinical service portfolio / capability significantly expanding (eg into community, intermediate / social care)

● Systems developed and talented individuals attracted

Stage 5: Maturity

● Highly structured management

● Maximise profitability

● Large service delivery component to the primary care entity requiring clear performance management and service development strategy

Stage 4: Take off

● Significant contracts won (£m)

● Autonomous management systems with clinical and general divisional leaders

● Divisional / decentralised structure evolves to accommodate delivery of services

Stage 0: Design● Initiate design work

for collaboration

● Develop engagement and build consensus

● Agree principles, decide governance and agree initial collaboration form and relationships

● Identify and progress initial collaborative opportunities

Stage 1Existence

Stage 2Survival

Stage 3Success

Stage 4Take Off

Stage 5Maturity

Creative growth

Directive growth

Delegated growth

Co-ordinated growth

Collaborativegrowth

Leadership Autonomy Control

Bureaucracy Unknowns

Org

anis

atio

n s

ize

and

co

mp

lexi

ty

Time

Stage 0Design

Formation

Co-design

Developing capability


Procurement and responding to tenders

• The changing face of community based services• Procurement• How to win tenders

Example workshops

Key considerations

• Existing models for collaborative working• Making form follow function• The potential for general practice• Mission vision and values

Legal considerations

• Legal requirements for collaborative working• Mergers• Legal entities to enable collaborative working

Governance

• Corporate governance for legal entities• Developing the operational governance frameworks

• Clinical • Information• Financial

Commercial success• Establishing the vision• Setting up an entity• Understanding the procurement opportunities

“Very helpful, clearly presented, practical

information. Honest and clear answers to difficult questions”

Dr Andy John, GP

“Well worth the money”

Dr Anita Patel, North Barnet locality lead


Case studies: our experience

NE London PM Challenge Fund

What we were asked to do As part of a partnership we are commissioned to establish three CCG wide federations to build the infrastructure and engagement to successfully deliver their programme

Outcome Working with partners we are developing the legal entities required and supporting the delivery of new ways of working with all practices in the three CCGs

Leeds North CCG

What we were asked to do The CCG requested support for their localities and practices in develop their approach collaborative working

Outcome PCC delivered a launch event to over 200 delegates to raise awareness and facilitate collaboration. We are now working with the CCG to determine support programmes to facilitate and enable the development of local solutions.

Barnet practices and CCG

What we were asked to do PCC provided direct support to two practice networks to agree a vision and values for collaborative working and help identify appropriate legal entitles.

Outcome PCC designed and developed facilitated engagement session to raise awareness, build consensus and agreement to create the legal entities. PCC has now been commissioned by the CCG to further support the development of collaborative work and primary care transformation.



North Derbyshire CCG

What we were asked to do As part of the development of its primary care strategy the CCG requested our support to raise awareness of the need for change within general practice and identify the steps to make it happen.

Outcome PCC delivered an awareness raising session for practices to understand the drivers and opportunities for change. The session used scenarios to enable practices to discuss options objectively. In a separate session practices scoped an approach. PCC ran a workshop with representatives from all practices to discuss the plan and developed a roadmap for the practices. The practices agreed a clear set of priority areas to develop and confirmed next steps and actions.

Isle of Wight practices

What we were asked to do Isle of Wight CCG requested support for their member practices to understand how they could work together more effectively.

Outcome PCC ran a session with practice managers to gauge the potential of and desire for collaborative working. Managers were able to consolidate their positions, develop proposals and form a working group. A second event allowed GPs to consider a range of potential options and agree the plan. As a result there was CCG-wide agreement to invest in jointly provided services including minor injuries and acute home visiting, phlebotomy and anti-coagulation, and a notes summarising service.

East Lancashire CCG

What we were asked to do The CCG wanted to support the development of its practices while allowing practices to develop their own approaches at their own pace.

Outcome PCC developed, designed and delivered a flexible programme of support that has evolved with the national and local requirements. The practices are being supported through a combination of informed facilitation sessions, specialist training and development sessions and dedicated support for groups of practices.



Lewisham practices

What we were asked to do Practices in Lewisham wanted to measure the appetite for collaborative working among all the practices in the borough. The research discovered a range of views and issues that were used to shape an options appraisal. Practices were given the opportunity to debate the options and understand their implications at a workshop.

Outcome PCC delivered a tailored programme included an online survey, a support network, webinars and face-to-face interviews to engage practices and discover their views. The workshop helped practices agree to work together, articulate a vision and identify workstreams for development. It resulted in a working group with a clear remit and timescales to develop a local solution.

Wyre Forest GP Association

What we were asked to do PCC ran workshops for Worcestershire CCGs on the legal considerations for collaborative working. Subsequently Wyre Forest GPs requested further support to develop their approach.

Outcome PCC designed and delivered a workshop that enabled the practices to explore their concerns and understand the opportunities of formal collaboration. Working through the issues enabled the practices to agree a collaborative approach and develop an action plan to make it happen.

Southwark CCG

What we were asked to do Southwark CCG wanted to commission extended services from neighbourhoods and not individual practices. Driven by a tight deadline, the CCG recognised the need to support practices to come together to form viable working groups.

Outcome PCC delivered a flexible programme of support from CCG wide awareness and development workshops to one to one advice and guidance on establishing the legal entities. PCC also advised on governance and financial arrangements. The practices have formed two federations which went live on 1 June 2014.


“Very helpful in allowing us to express our ideas and helping

organise our thoughts and actions.”Julie Mackenzie, practice manager,

Isle of Wight

“The workshop really helped us understand how we can work

together and develop a plan to make it happen”

Dr Roy Williams, chair, Wyre Forest GP Association

“Great day, brilliant insight and opportunity to develop thoughts”Dr Andy Havercroft, GP South

Worcestershire

Get in touch: [email protected]

developing primary care v7

Health & Medicine

primary care services

primary care entity

small primary care

primary care networks

wider primary care

hub of care

comprehensive care

general practice issues