general practice forward view, lewisham ccg
TRANSCRIPT
#GPforwardview#GPforwardview
Dr Robert VarnamHead of General Practice DevelopmentNHS England
@robertvarnam
www.england.nhs.uk/gpfv
bit.ly/161013lewisham
#GPforwardview
The problems
#GPforwardviewwww.england.nhs.uk/gpfv
#GPforwardviewwww.england.nhs.uk/gpfv
#GPforwardview
Overall new investment is a minimum extra £2.4 billion pa by 2020/21
£9.6
billion/year 2015-16
£12 billion/year
2020-21
14% real terms increase vs 8% for the rest of the NHS (plus CCG increases)
One off Sustainability and Transformation package >£500M over 5 years
#GPforwardview
Extra £33m included in 2016/17 contract
Already actioned
Repeat winter payments scheme for
OOH in 2016
Payment to all practices (weighted) Apr 17 & 18 based on
average indemnity increases
Work on new scheme for OOH support with BMA
Next steps
GP Indemnity Review Group to look at cover for new members of the workforceand other more radical options
Longer term
#GPforwardviewwww.england.nhs.uk/gpfv
#GPforwardviewwww.england.nhs.uk/gpfv
#GPforwardview
Make GP attractive again
Expand the Medical Workforce
Encourage Recruitment
Retain GPs for longerReduce workload
Bursaries in under-doctored areasInduction & refresher scheme
Retainer Scheme Leadership training opportunitiesMulti-disciplinary Training Hubs
Flexible career schemesCareer coaching for senior GPsMental Health support services
Work with medical schoolsIncreased training places250 Post-CCT fellowshipsMajor campaignsCSU Marketing support International recruitment
5,000 Net WTE doctors in general practice by 2020/21
#GPforwardview
Develop the workforce5,000 additional staff by 2020/21
• Major new practice nursing review underway
• £15M to be invested
NURSES
• 3,000 new mental health therapists• Focus on longterm physical conditions
MENTAL HEALTH
Training 1,000 physician associates by 2020• Regulatory and indemnity
enablers
PHYSICIAN ASSOCIATES
£6m of new support over 4 years• Expanded national network• Professional development
PRACTICE MANAGERS
Current £31m to pilot 470 pharmacists in >700 practices, • Plus new £112m for additional
1,500 pharmacists by 2020 (a pharmacist / 30,000 patients)
• Clinical pharmacists in 111 hubs
PHARMACISTS
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• Estates and Technology Fund - prioritisation and pipeline
• Project management support to speed up delivery
• 100% reimbursement of premises costs (rather than up to 66%)
• Fund £7M Stamp Duty for NHS Property Services tenants
• Compensate VAT where the landlord has chosen to charge VAT
• Transitional funding for significant rises in facilities costs
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Interoperability
Online and telephone
consultation systems
Summary care record in all pharmacies
Approved Apps library and
buying framework
Improve uptake of Patient
Online
Wi-Fi services in practices for
patients and staff
Improve payment systems, GP2GP, EPS,
e-discharges, ERS, Advice & Guidance
Accelerate self-care and patient
activation
#GPforwardviewwww.england.nhs.uk/gpfv
#GPforwardviewwww.england.nhs.uk/gpfv
#GPforwardview
Simplify reporting and regulationStreamline payment systemsMove away from micro-incentives
Greater specialist support
Self-help and GP Online
Better sign posting• Care navigation• Social prescribing• Minor ailments• Remote triage/care• Open access AHPs
Reformed 111/Urgent Care
Collectiveworking and MCP contract
GP PRACTICE
Community services
Changes to
Standard Contract
HOSPITAL
Access hub
Demand Management
WORKLOAD
Practice Resilience ProgrammeTen High Impact ActionsDevelopment Programme
Tools to measure & plan workReceptionist & clerical training
#GPforwardviewwww.england.nhs.uk/gpfv
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Multispeciality Community Provider contract
• CCG-commissioned. • Organic process. • 10 – 15 year contracts.• Population >100,000 (neighbourhood units 30-50k)
bit.ly/MCPframe1
Virtual MCP Alliance contract, overlaid on existing contracts
Partially integrated Pre-procurement of community services (MCP + GMS)
Fully integratedHybrid: NHS Standard Contract & primary medical servicesSingle, whole population budget for all services coveredNew performance element (replacing CQUIN & QOF) Risk share for acute activity
#GPforwardviewwww.nhsalliance.org/making-time-in-general-practice/
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10 High Impact Actions to release time for careSpreading knowledge of innovations that release GP time and improve care for patients. Practical evidence from practices throughout England who have demonstrated ways to make better use of staff time.
• 24 regional GPFV roadshows• 30 local High Impact Actions showcase events• Web resources (60 and growing)
• Fortnightly webinars• Network of experts
www.england.nhs.uk/gpdp
Ongoing programme to identify and capture robust and practical case studies, adding to the evidence base and implementation guides.
bit.ly/gpcapacityforum
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Time for Care programmes• Bespoke 9-12 month programmes to support groups of practices to
implement innovations that release time for care.
• Open to all 7,800 practices in England. Registrations received from practices in 35% of CCGs in first 3 months. Expected total of 200 local programmes to run over three years.
• Evidence indicates most practices can expect to release 10% of GP time through programme.
• Each programme designed to align with existing local initiatives.
www.england.nhs.uk/gpdp
Time for Carechange programmes
Can be aligned with new transformational funding:
• Training for reception and clerical staff, for active signposting and document management (£45m over 5 years).
• Funding towards purchasing online consultation systems (£45m over 4 years, from 2017).
• CCG transformational support (£171m over 2 years, from 2017).
www.england.nhs.uk/gpdp
#GPforwardview
General Practice Improvement Leaders programme• Training for clinicians and managers in service redesign and
change leadership. Creating at least 400 free places a year for three years.
• Focus on techniques for designing and implementing improvements within the practice rapidly and sustainably.
• Learn-while-doing approach gives immediate as well as longer term benefits.
• First two cohorts (60 staff) launched Oct 2016, next four almost full. Supporting staff from LMCs, federations and practices.
Fundamentals of change and improvement (2-day session)
Human dimensions of change (2 x 1-day sessions)
Facilitation skills (2 x 1-day sessions)
Primary care improvement community
Learn-while-doing
• Funding the RCGP Supporting Federations Network. 750+ members, 3 national events a year, 6 webinars, growing library of online resources.
• Funding NHS Collaborate (NAPC & NHS Alliance) network for leaders of at-scale primary care. Bi-monthly face-to-face networking, aiming to grow to 200 members in next year.
• Funding facilitated peer networking for managers of all 7,800 practices, with support to develop professional skills.
www.england.nhs.uk/gpdp
www.england.nhs.uk/gpdp
#GPforwardviewwww.england.nhs.uk/gpfv
#GPforwardview
www.england.nhs.uk/gpfv
www.england.nhs.uk/gpdp
www.nhsalliance.org/making-time-in-general-practice/england.nhs.uk/ourwork/gpfv/gp-indemnity/
england.nhs.uk/ourwork/gpfv/resilience/bit.ly/MCPframe1