GORING AND WOODCOTE MEDICAL PRACTICEPATIENT PARTICIPATION GROUP (PPG)

A GP’s DayYesterday, Today and Tomorrow

6 June 2015

Slide 1

Open Meeting

Agenda

• What is Healthwatch?• Yesterday – Dr Rhys Hamilton• Today – Dr Andy Goode and Dr Simon Pettitt• Tomorrow – Rosie Rowe (Oxfordshire Clinical Commission

• Questions

Slide 2

The ‘Good old Days’Or Were They?

The practice as it was in 1981

JIM MONKS HOUSE

The Who

IN 1981 THERE WERE 2 DOCTORS IN WOODCOTE WORKING FROM A ‘PURPOSE BUILT ‘HEALTH CENTRE OWNED BY THE HEALTH AUTHORITY.—DRS SIMPSON AND WILSON

IN GORING DR MONK WORKED FROM A SMALL ANNEX AT THE BACK OF HIS HOUSE AND—-IN STREATLEY- DR DIXEY WORKED FROM A SIMILAR COLD AND POKY ANNEX

YOU WERE NOT ENCOURAGED TO LINGER!

DR HAMILTON ARRIVES IN MARCH 1981 AS A FRESH FACED YOUTH-

ON 1ST APRIL 1981—WE MOVE INTO GORING SURGERY

The staff

GORING AND WOODCOTE WERE COMPLETELY SEPARATE

NO PRACTICE MANAGER—-LETTERS BY SHORTHAND— MAYBE 3-4 A DAY.

TWO EXCELLENT SECRETARY/RECEPTIONIST/FACTOTUMS AND ONE OTHER WHO AS WELL AS THAT DISPENSED FOR SOME PATIENTS FROM ALDWORTH AND SOUTH STOKE

THE STAFFTHEY DID EVERYTHING FROM ANSWERING

TELEPHONES TYPING AND RUNNING RECEPTION TO CLEARING UP BLOOD AND OTHER STRAY LIQUIDS

FINANCE AND PAYROLL WAS RUN BY SOMEONE CALLED LIZ WHO WORKED FROM OUR SISTER SURGERY IN PANGBOURNE

Attached staff

PART TIME PRACTICE NURSE ON THREE HALF DAYS A WEEK INITIALLY AS WE WEREN’T SURE WHAT SHE SHOULD DO!

DISTRICT NURSE WAS MORE OR LESS INDEPENDENT OF US AND HAD NO ROOM AT THE SURGERY.

MIDWIVES AND HEALTH VISITORS BASED IN THE COMMUNITY AND DID VILLAGE HALL CLINICS.

HOURS OF DUTY

EACH DR WAS LEGALLY RESPONSIBLE FOR HIS PATIENTS 24HRS A DAY, 7 DAYS A WEEK, 365 DAYS A YEAR—EVEN IF ON HOLIDAY OR WHEN OFF SICK OR OUT OF THE COUNTRY!—ANY COVER ARRANGEMENTS HAD TO BEAR THIS IN MIND!

PATIENTS WERE DISCOURAGED FROM SWOPPING DRS AND IF THEY WISHED TO THEY HAD TO APPLY IN WRITING!

EACH DR WAS EXPECTED TO DO EVERYTHING FOR HIS REGISTERED PATIENTS.

HE DEALT WITH ALL INCOMING AND OUTGOING CO-RESPONDANCE-AND SIGNED ALL HIS OWN PRECRIPTIONS.

THERE WERE FAR FEWER REPEAT PRESCRIPTIONS TO SIGN AS THERE JUST WERE NOT THE MEDICATIONS AROUND THAT WE NOW HAVE! -ALL WERE HANDWRITTEN AND INITIALLY THERE WAS NO RECORD KEPT OF THEIR ISSUE.

A DR WAS REQUIRED TO LIVE WITHIN 5 MILES OF THE CENTRE OF THE PRACTICE.

ALL BANK HOLIDAYS HAD TO BE COVERED AND INITIALLY NORMAL SURGERIES WERE RUN ON THOSE DAYS APART FROM CHRISTMAS AND NEW YEAR-WHEN ONE WAS ALWAYS ON DUTY FOR AT LEAST ONE OF THE DAYS AND USUALLY RAN A SURGERY OF URGENTS FOR THE DAY.

LOCUM DRS WERE RARELY EMPLOYED AS THEY WERE OF VARIABLE QUALITY AND AS HAS BEEN SAID- THE REGISTERED DR WAS STILL RESPONSIBLE FOR ANY ERRORS COMMITTED BY THAT LOCUM!

MANY MORE PATIENTS THAN TODAY WERE REFERRED TO THE HOSPITAL FOR MANAGEMENT OF LONG TERM CONDITIONS.

HEART DISEASE, CHRONIC LUNG DISEASE—EVEN ASTHMA, DIABETES, DEPRESSION, ARTHRITIS,—ALMOST ALL WERE REFERRED TO SPECIALISTS.

ONCE IN THE SYSTEM PATIENTS WERE DRAGGED UP TO OUTPATIENTS EVERY 6 MONTHS FOR YEARS-OFTEN TO BE SEEN BY THE MOST JUNIOR OF THE DRS

WE WERE REALLY ALL JUST INDEPENDENT PRACTITIONERS SHARING A BUILDING AND A FEW ADMIN FACILITIES.

THE CONCEPT OF A PRIMARY HEALTH CARE TEAM WAS ONLY JUST COMING IN.

PROGRAMMED FOLLOW UP OF SUCH DISEASES AS HYPERTENSION AND DIABETES WAS VIRTUALLY NONEXISTENT-

Appointments

APPOINTMENTS WERE BOOKABLE IN ADVANCE AND WERE WRITTEN IN TO A LARGE DESK DIARY

SURGERY APPOINTMENTS WERE FOR 10 MINS AND BOOKABLE APPOINTMENTS WERE FROM 8:30 TO 10:30 AND THEN EXTRAS WERE JUST ADDED ON UNTIL THEY STOPPED.

THE SAME FOR EVENINGS BOOKABLE FROM 4 TO 6PM AND THEN EXTRAS ADDED AT THE BEGINNING OR END

Visits

FAR FEWER PEOPLE HAD CARS BUT MOST PEOPLE DID MANAGE TO ATTEND THE SURGERY-CALLING THE DR OUT WAS NOT TAKEN LIGHTLY.

THERE WAS A LOT OF SEMI ’SOCIAL’ VISITING.

THE LIST OF 100 OR SO REGULAR VISITS WAS WHITTLED DOWN BY ME TO ABOUT 5!—THOSE WHO HAD A MEDICAL NEED OR WERE HOUSEBOUND.

PATIENTS WERE OFTEN ROUTINELY VISITED AFTER A HOSPITAL STAY AND GORING AND STREATLEY PATIENTS COULD BE ADMITTED TO WALLINGFORD COMMUNITY HOSPITAL AND WERE LOOKED AFTER THERE BY THEIR DR.

THE POPULATION

THERE WERE MORE LOCAL FARMWORKERS AND SHOPKEEPERS BUT THE AREA WAS STILL A COMMUTER AND A RETIREMENT AREA. THERE ARE NOW MORE YOUNG CHILDREN AND ELDERLY THAN THERE WERE

THE PRACTICE HAD A NUMBER OF PRIVATE PATIENTS WHO PAID THE DR DIRECTLY-PAID FOR THEIR DRUGS AND EXPECTED PRIORITY OF ACCESS-NOT VERY NHS I THOUGHT!

ON CALL

PATIENTS WERE GENERALLY VERY RESPECTFUL OF DRS’ TIME .

ONE WAS ON CALL GENERALLY ONE NIGHT IN THREE OR FOUR FROM 6PM TO 8AM. ONE HAD TO BE AT HOME OR CONTACTABLE BY PHONE SO ONES SPOUSE HAD TO BE IN TOO -NOT POPULAR WITH WORKING WIVES WITH FAMILIES

ONE WAS RARELY CALLED FOR TRIVIA OUT OF HOURS BUT EXPECTED A FEW CALLS AND VISITS IN THE EVENING AND THEN TO BE WOKEN BUT NOT NECESSARILY HAVING TO GET OUT OF BED AT NIGHT.—WE DID HOWEVER OCCASIONALLY HAVE TO BE UP ALL NIGHT AND THEN WORKING THE WHOLE OF THE NEXT DAY-EXHAUSTING AND CERTAINLY NOT SAFE BUT THE SAME AS WE DID IN HOSPITAL ROTAS

MORE ON ‘ON CALL’

IN THOSE DAYS WE WERE NOT EXPECTED TO BE PROVIDING A 24HR-7 DAY A WEEK SERVICE FOR ANY QUERY GREAT OR SMALL. IT WAS ASSUMED THAT YOU DID NOT CONTACT THE DR OUT OF REGULAR HOURS UNLESS IT WAS TRULY URGENT!

ON THE WEEKENDS A DR WOULD OFTEN DO HIS REGULAR VISITS AND CATCH UP ON ADMIN—GETTING PATIENTS TO COME TO THE HOUSE OR MEET HIM AT THE SURGERY.

IN DIFFERENT AREAS THINGS WERE A LOT BUSIER AT NIGHT AND ONE WORKED MUCH MORE OFTEN WHILE EXHAUSTED.

VIRTUALLY NO FAMILY PLANNING AVAILABLE-WOMEN WENT TO READING OR OXFORD.

IF YOU NEEDED A BLOOD TEST YOU WERE SENT TO THE ROYAL BERKS.

THERE WAS NO DEFIBRILLATOR AT EITHER SURGERY.

NO CERVICAL SMEAR SERVICE WAS AVAILABLE AT THE SURGERY OR ANYWHERE-UNTIL 1983 I THINK!

NO MOBILE PHONES AND INITIALLY NO PAGERS-DRS LEFT A LIST OF NUMBERS TO BE CONTACTED AT IF OUT ON VISITS-OR WOULD PHONE IN FROM PATIENTS HOUSES OR PHONE BOXES.

NO COMPUTERS-ALL NOTES STUFFED INTO SMALL BUFF ENVELOPES DATING SOMETIMES BACK TO 1948-—OFTEN ILLEGIBLE AND IMPOSSIBLE TO DIG OUT PAST INFORMATION.

A MAJOR PART OF A RECEPTIONISTS WORK WAS GETTING NOTES OUT AND PUTTING THEM BACK IN THE FILING SYSTEM

NO PROPER MESSAGE SYSTEM EXISTED FOR RECORDING MESSAGES COMING INTO THE SURGERY—WE WERE RELIANT ON SCRIBBLED NOTES OF SECRETARIES.

TERMINAL CARE OFTEN CARRIED OUT AT HOME—FAMILIES OFTEN MORE APPARENT. LITTLE OR NO SUPPORT FROM SOCIAL SERVICES FOR EQUIPMENT ETC AND NO FORMAL DISTRICT NURSE TERMINAL CARE SUPPORT.

A LOT MORE ANTENATAL AND CHILD HEALTH CHECKS DONE BY DRS SO WE DID GET TO SEE PEOPLE WHEN WELL AND TO KNOW FAMILIES BETTER AND GREATLY ENJOYED SEEING NEW BORN HEALTHY BABIES!

DRS’WIVES

WHEN I WAS ON CALL MY WIFE HAD TO MAN THE PHONE LINE AND THEREFORE TO BE IN AND WITHIN EARSHOT OF THE PHONE AT ALL TIMES.

ODD TO THINK THAT ONE OF THE REASONS THAT THERE WERE SO FEW SINGLE DRS OR WOMEN DRS WAS THAT THERE WAS THAT COMMITMENT TO BE A CALL HANDLER!

THERE WAS A VERY RICKETY LOW TECH SYSTEM OF ANSWERING MACHINES AT THE RESPECTIVE SURGERIES AND THEY HAD TO BE PROGRAMMED TO THE DR ON CALL’S NUMBER EACH NIGHT.

THIS COULD NOT BE DONE REMOTELY. IF YOU WISHED TO CHANGE THE MESSAGE YOU HAD TO DRIVE TO BOTH SURGERIES.

CURRENT TREATMENTS

THERE WERE FAR FEWER AND MUCH NASTIER DRUGS FOR HIGH BLOOD PRESSURE

ASTHMA COULD ONLY BE TREATED WITH ADRENALIN SPRAYS-DANGEROUS AND UNPLEASANT—PREVENTATIVES LIKE BECOTIDE HAD JUST APPEARED

JOINT REPLACEMENT SURGERY WAS IN ITS INFANCY-BASICALLY IT WAS HIPS!

CATARACTS WERE NOT OPERATED ON EARLY

CURRENT TREATMENTS

NO STENTS OR CLOT BUSTING DRUGS FOR HEART ATTACK AND STROKES-HEART ATTACKS WERE OFTEN MANAGED AT HOME.

THERE WAS NO PARAMEDIC SERVICE AND DRS WERE NOT INFREQUENTLY CALLED TO ROAD TRAFFIC OR OTHER ACCIDENTS

THERE WERE FEW ANTIDEPRESSANTS AND THOSE THERE WERE WERE OFTEN HARD TO TOLERATE.

FIBREOPTIC SURGERY WAS IN ITS INFANCY AND PATIENTS WERE OFTEN MUCH LONGER IN HOSPITAL

WE WERE ALSO AT THE DAWN OF A NEW AGE OF PHARMACEUTICALS WHEN NEW DRUGS FOR

ANYTHING AND EVERYTHING WERE BEING DEVELOPED AND THE DRIFT WAS VERY MUCH

FROM REACTIVE CARE TO PREVENTATIVE CARE

BETTER OR WORSE?

I WOULD SAY DIFFERENT—THE DEMANDS ON ONES TIME WERE VERY DIFFERENT BUT THE REWARD OF THE PERSONAL AND CONTINUING CARE WE COULD OFFER WAS GREAT.

THERE WAS MUCH LESS INTERFERENCE FROM GOVERNMENT AND FAR LESS ADMIN -ALTHOUGH WHAT THERE WAS WAS PAPER BASED AND CUMBERSOME

KEEPING UPDATED WAS ONES OWN RESPONSIBILITY AND GENERALLY TAKEN SERIOUSLY BY MY GENERATION OF DRS

FORMAL TRAINING OF GPS WAS TAKING OFF-SCARY TO THINK ONE COULD PUT UP ONES PLATE THE DAY ONE HAD COMPLETED 1 YR IN HOSPITAL AS QUALIFIED DR.

BETTER OR WORSE?

IT WAS GENUINELY EASIER TO SEE- ‘ONES OWN DR.’—A GOOD THING IF THE DR WAS A GOOD ONE.

MOST OF US WORKED 12 HR DAYS WHEN ONE COUNTED THE PAPER BASED ADMIN THAT ONE TOOK HOME.

SOME DID MANAGE TO FIND TIME TO BIRD WATCH OR PLAY GOLF ETC DURING QUIET TIMES BUT WHEN I CAME TO PRACTICE THE WORLD WAS CHANGING FAST AND SANDWICHES IN THE CAR WAS THE USUAL RELAXED LUNCH WHILE ON VISITS.

1981-2011

I HAVE SEEN MASSIVE CHANGES IN THE WAY PRIMARY CARE WORKS.

IF FEMALE DRS HAD FAMILIES IT MADE THE SORT OF ON CALL I DID IMPOSSIBLE FOR THEM.MALE SPOUSES WERE ALSO LESS READY TO BE HOUSEBOUND ON CALL.

COMPUTERISATION AND THE INTERNET AND MOBILE PHONES HAVE CHANGED THINGS HUGELY.

WE WILL NOW HEAR WHAT IT IS LIKE NOW!

BUSY, BUSY, BUSY-AND THEY ALL LOOK SO YOUNG!

THANKYOU!

A Day in the Life of a GPPast, Present and

FutureDr Andy GoodeDr Simon Pettitt

OR

Why are we talking to you today?

• We acknowledge that continuity and appointment availability are an ongoing problem…– Locally– Nationally

• We want to give some insight into what we do in a typical day to help bridge understanding of the pressures on services

• An opportunity for you to ask questions

Why we are talking to you today

• It is well publicised in the media that General Practice, as well as the NHS as a whole, is under increasing strain

• Longer waiting times• Loss of continuity

– Currently 51% with own GP– 69% with own GP or their GP ‘buddy’

• Increased strain on A&E departments

Positives

• The NHS is admired around the world

• A free at the point of use healthcare service

• Equitable care

Why I wanted to be a GP• Unique branch of medicine, see people from cradle

to grave– Multifaceted; physician, surgeon, counsellor,

pharmacist– Variety

• Yes coughs and colds but also complex chronic disease, palliative care, mental health problems, minor surgery

• As a Partner, I am an employer, a small business owner, a manager

• I didn’t choose it for an easy life, it’s a branch of medicine that I believe in

GP vs a specialist• GP

– Knows a little about a lot – ‘a Jack of all trades’• Specialist

– Knows a lot about a little

• Shift now to the GP knowing a ‘little more’ about a lot

• There are very few hospital specialties that have the broad range of presentations that GP’s see

What the media think

The Media• The headlines are not what we see

– Our waiting time is not six weeks– We don’t earn £200,000+ a year– We don’t work 9-5– We don’t just refer everyone to a specialist

• I don’t play golf• I don’t own a sports car

What do patients want?

• Continuity• Quick access to appointments• Services close to home• Competent, safe doctors

Why does continuity fail?• We acknowledge that our continuity could be

better– GPs take annual leave– GPs take study leave– A high rollover of GP registrars– Part-time working– Sometimes a patient’s urgency to be seen

outweighs the need for continuity

Why don’t we work out of hours?

• Change in GP workload• Not uncommon previously for a GP to have

middle of day at home• Maybe 1-2 visits a night out of hours• Would work the next day• Now…

– Local out of hours GP attendance has soared with associated visits

– It would be impractical and unsafe

About us…

Goring and Woodcote Medical Practice

Now• 6 GP Partners (5 Whole Time Equivalent)

• 3 GP Associates (1.5 Whole Time Equivalent)

• 3 GP Registrars (3 Whole Time Equivalent)

• 2 Nurse Practitioners• 3 Practice Nurses• 3 Healthcare Assistants• The Practice employs over 50 people

Goring and Woodcote Medical Practice

• Practice List Size– 9500 as of end of March 2015

• 1461 patients per full time GP• 1650 is national average (60 GP’s per 100,000population)• In some areas as high as 2500/GP

– Why is ours lower• Extra doctors funded by our ability to dispense

medications• If we didn’t have dispensing, ratio would be increased• Felt to be justified due to an elderly weighted population

often with multiple chronic medical problems

10 years ago• 300-350 bookable appointments a week• A large gap in the middle of the day• Practice population was similar

– Demand has gone up despite nearly double the appointments

– No big influx of patients• Average patient age was much lower• Less chronic illness managed in primary care

N u m b e r s• 308 home visits in the first quarter of 2015• 700-850 bookable GP appointments available

each week• At nearly 41,000 appointments a year this is

40.6% of the 101,000 patients seen by RBH A&E in a year for 2013/14

• 250-350 average triage calls made each week

Appointments• 10 minute appointments

– Research has shown that typical appointment takes 12 minutes

– Note keeping needs be more and more thorough• Patients are encouraged to bring one problem

– Many bring more than 1– Patients can book a double appointment, if

appropriate

Typical Day• Surgery opens at 0800• Morning surgery from 0830 to 1230

– 16 face to face appointments• 12x Routine appointments• 1x 48 hour appointment• 1x 24 hour appointment• 2x urgent appointments

– 6 telephone consultations

• Afternoon surgery from 1500 to 1800– 13 face to face appointments

• 9x Routine appointments• 1x 48hr appointment• 1x 24hour appointment• 2x urgent appointments

– 4 telephone consultations

• Surgery closes at 1830

So what do we do from 1230 to 1500(& before 0800 / after 1830)?

• Receive up to 200 letters per working day as a practice from secondary care.– Need to be read through– Appropriately actioned– New problems coded

• Receive up to 150 blood test results a day– Need to be read through– Appropriately actioned

• Upward of 250 routine prescriptions a day to be checked and signed• Visits (308 between 01/01/15 and 31/3/15) can take between 20-60

minutes each• We meet weekly with our District Nursing team to discuss and manage our

housebound and palliative care patients• We meet weekly as a Practice to discuss local updates, learning points,

share news, deal with feedback and plan for the future• We present audits of our clinical practice

We sometimes even find time for…

Keeping up to date• A requirement of all doctors

– Demonstrate that we are safe, up to date, reflective• 50 hours of continuing professional development a year

outside of our normal working day– Locally sponsored events– Self funded courses

• Annual appraisal• Revalidation every 5 years• Must carry out an audit cycle• Life support training• Child protection training• Review of significant events

Additional Roles• Training Practice

– Programme director/Fellow of Royal College– Examiners for future GP’s– Examiners for GP exit exam– Medical student teaching

• In order to attract people to general practice we need to be involved in this

• Minor operations• Freezing Clinic• Locality Clinical Commissioning Group• Dispensary• Day to Day management of the business• Care Quality Commission • PPG

Why is there more pressure?

• Increased demand– We are used to instant access to lots of things– Change in health seeking behaviour– Increased population with no change in resources

• Funding not keeping up with demand

– We are better at picking things up so create more work in the process

– People are living longer and with more chronic medical problems• We are having to do more

– Medication reviews– QOF (Quality Outcomes Framework)– Commissioning

Why is there more pressure?

• A shift in work from secondary care to primary care

– Diabetes predominantly managed in General Practice

– Memory clinics moved to primary care– COPD and Asthma reviews

Change in working styles

• More GPs working part-time– Typical working day is now up to 12 hours– Unsustainable full-time over a 30+ year

career– Not just women choosing this but men as

well• Majority of GPs now women

Predictable Changes• Conservative Government

– 7 day access to a GP by 2020,• Same number of doctors• Takes appointments from weekdays• Improves access, doesn’t improve availability

– 8000 extra doctors• >8000 GP Practices in the UK• <1 doctor per Practice• Difficulty filling training places already• Will not cover the increase in retiring doctors/leavers

– Cost savings

The Future• Attracting and retaining GPs a problem for the future

– 40% of GPs under 40 will leave and never return– 6 in 10 GPs considering retiring because of

increased pressures• General Practice not inspiring for trainee

doctors– Media criticism– Lack of support from secondary care colleagues

The future• Burnout

– Expectation to work longer hours with the same resources• Work-life balance• Patient safety

• Continuity• Legacy

– Will there be enough people wanting to be GP Partners in the future to sustain the business

• Technology– Virtual consultations

• Moving secondary care services into primary care– We are needing to move from knowing a little about a lot to knowing a

lot about a lot

What is putting people off

• Morale is low– Doctors don’t want to work in an overstretched

sector of the healthcare system– Not always seen as exciting compared to other

specialities– Training has not kept up with retirement– Media vilification– Lack of support/recognition by secondary care

What are the positives?• Build a relationship (wouldn’t in secondary

care)• Multi-disciplinary team working• Seeing patients in their own environment• Family medicine• Following patient from birth to death• Going to become even more important in the

future as services move closer to patient

OxfordshireClinical Commissioning Group

OCCG Vision and Strategy for Primary Care in Oxfordshire

Rosie RoweRosie.rowe@oxfordshireccg.nhs.uk

OxfordshireClinical Commissioning Group

Aim

To enable primary care to survive and thrive

OxfordshireClinical Commissioning Group

Challenge

Primary care cannot do more of the same

OxfordshireClinical Commissioning Group

Transformation

OxfordshireClinical Commissioning Group

Transformation: Federation

OxfordshireClinical Commissioning Group

Transformation: building on what works

Continuity of careNamed GPWider practice

teamAllow clinicians to

focus on clinical work

OxfordshireClinical Commissioning Group

Building on Public PrioritiesI want to be able to see

my GP within 5 daysI did not know my practice

was open until 6:30

I want to be able to book my appointment on-line

I want to be able to see someone quickly when

my son is ill

I want to be able to email my GP for advice

I would be happy to go to another surgery for

an urgent appointment

I would like to be able to see a GP at the weekend

I am willing to see a nurse to help me manage my

long–term condition

OxfordshireClinical Commissioning Group

Addressing Practice Sustainablitiy

Healthcare budget invested in primary care 4% between 2007-2013

Population growth Ageing population

1995 Average patient: 3.9 consultations

2008 average patient: 5.5 consultations

Workforce crisis Early retirement Difficulties in recruitment Burn-out Plans to leave general practice

OxfordshireClinical Commissioning Group

Vision for Primary Care

Enhanced Primary and Community Care

Primary Care

Self Care

OxfordshireClinical Commissioning Group

Stratify Demand

Urgent 1-off health care

need – resolved by a health care

professional

Patient with complex needs

who need to see their own

GP

OxfordshireClinical Commissioning Group

Expand Primary Care Team

OxfordshireClinical Commissioning Group

Support Practices to Work in Federations

PML

Oxfed

Abingdon

SEOX

OxfordshireClinical Commissioning Group

Strategic ObjectivesProactive holistic careResponsive accessEnhanced range of servicesIncreased prevention and patient self-

careIncreased capacity and resources in

primary careIncreased practice collaborationSustained high quality care

OxfordshireClinical Commissioning Group

Key EnablersIntegrated ITWorkforce developmentSupport from wider

primary careTraining and educationPremises fit for purpose £6.8m Investment

2015/2016

OxfordshireClinical Commissioning Group

Action Plan 2015/2016Set up and evaluate pilots funded

by Prime Minister’s Challenge Fund

Provide enhanced proactive care to nursing homes

Support public health programmes e.g. flu immunisation/weight management

Procure new primary care mental health service

Procure local web-site to support self care

OxfordshireClinical Commissioning Group

Action Plan 2015/2016Increase use of social prescribingProvide learning and development

supportFinalise out-of-hospital workforce plan to

fund wider range of primary care rolesSeek funding for new workforce roles e.g.

‘Interface medicine’Engage proactively with planning

processesSupport practiced to bid for national

premises development funding

OxfordshireClinical Commissioning Group

Commissioning Primary Care

Oxfordshire

Clinical Commissioning Group

OxfordshireClinical Commissioning Group