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Place in an Integrated Care System

and

PCN Workforce

Health Professionals In Primary Care Conference

30th January 2020

Helen Goodey

Director - Localities and Primary Care – Glos. CCG

Director – Gloucestershire Health and Community Trust

#GlosPCTH

What is Place based care?

Individual Individual support to manage their own care through:

Self-care

Care navigation

Improving patient activation

Neighbourhood

~30-50k

Primary Care Networks that bring together local health and care

professionals around natural local neighbourhoods of care to:

Improving integrated ways of working

More joined-up pathways

Embedding population health approaches

Place

~250-500k

Integrated Locality Partnerships (ILPs) that are groups of local PCNs that

work alongside partners in secondary care, mental health and with CCGs

and LAs to:

Integrate health and care services

Work preventatively to stop people becoming acutely unwell

Care models to redesign care

System

~1m

One Gloucestershire includes providers & commissioners collaborating to:

Hold a system control total

Implement strategic change

Take on responsibility for operational and financial performance

Population health management

Place Summary

• Place-based working enables the NHS, councils and other organisations to collectively take responsibility for local resources and population health.

• We are working together with partners to plan and provide joined up, better coordinated care for Gloucestershire people.

• Strategic Place meetings, ILP meetings and ILP Plans are the enablers to develop place-based care within Gloucestershire.

Place: Gloucester City

Gloucester City ILP

Overarching aims

Best start to life and reducing health inequalities

Partners in Health PRIORITIES

• Respiratory education & link to housing

• High intensity users • Connecting up our services • Children & Young Peoples’

mental wellbeing

Inner City

PCN 5 practices

RHQ PCN

3 practices

Aspen PCN

1 practice

North & South Gloucester (NSG)

PCN

5 practices Public Health

VCS Alliance

Gloucestershire’s 14 PCNs

What is a Primary Care Network (PCN)?

• Groups of primary and community staff working

together to deliver preventative, out of hospital care

in their neighbourhood.

• Services and staff based around the GPs registered

list with PCNs upwards of 30,000 registered patients.

• Long Term Plan aim - Expectation to work closely

with all providers on the patch – healthcare, statutory

and VCS

• From April 2020, every PCN will receive new

national Network Dashboard to measure impact;

• A new national Network Investment and Impact

fund, linked to performance against metrics in the

Network Dashboard from 2020.

NHS England Strategic Goals

NHS England has five aspirations for Primary Care:

1. Stabilise the GP partnership model;

2. Create 20,000 new staff working in general practice

through an ‘Additional Roles Reimbursement’ scheme;

3. Create a wider platform for investment;

4. Dissolve the historic divide between primary and

community care;

5. A clear, quantified, positive impact for the NHS

system and our patients, with fewer patients

being seen in hospital and more being seen

and treated in our communities.

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New roles to Support the Seven new service specifications being introduced to deliver NHS Long Term Plan primary care goals in a phased way

• Services starting by April 2020:

– Structured Medications Review and Optimisation (increasing in scope and scale each year)

– Enhanced Health in Care Homes

– Anticipatory Care requirements for high need patients typically experiencing several long-term conditions

– Personalised Care

– Supporting Early Cancer Diagnosis

• Services starting by 2021:

– CVD Prevention and Diagnosis

– Tackling Neighbourhood Inequalities

System based collaboration

priorities

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NHSE Recurrent Funding

“Additional Roles Reimbursement”

Additional staff in five groups by 2024

• Social prescribing link workers (up to B5) 100% funding from 2019/20

• Clinical pharmacists (B7/8a) approx. 70% from 2019/20

• First contact physiotherapist (B7-8a) approx. 70% from 2020/21

• Physician associates (B7) approx. 70% from 2020/21

• First contact community paramedics (B6) approx. 70% from 2021/22

• Maximum re-imbursable amount available for each role - Practices in PCN’s

need to fund remainder of salary through their own income streams.

• Different opportunities/challenges with each of the professional groups

Workforce Development – New Roles

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National Investment into Primary Care

Projected aspiration for PCN’s

could look like….

5 Clinical Pharmacists

3 Social Prescribers

3 Physiotherapist First

Contact Practitioners

2 Physician’s Associates

1 Specialist Paramedic

• £891 million nationally – next 5

years

• Network Contract Directed

Enhanced Service - Additional

Roles Reimbursement Scheme

Guidance

PCN Size Patients weighted

2019/20 9 months

2020/21 2021/22 2022/23 2023/24

30,000 53,942.25 129,300 208,800 319,000 448,300

150,000 161,827 646,600 1,044,100 1,595,100 2,241,700

• 14 Primary Care Networks in

Gloucestershire PCNs ranging

from 30,000 to 63,000 patients.

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ICS wide considerations

• Development of Career pathways

• Integrated Roles – in key providers and Primary Care

Stakeholder engagement to include:

• Professional Leads

• Education Leads

• Primary Care Representation

• CCG Commissioning Leads – Specialist leads and Primary

Care

• Higher Education Establishments

• HR arrangements

Advanced Roles in Primary Care – ICS

Integration and Alignment

Clinical Pharmacists Physiotherapists Paramedics Physician’s Associates Social Prescribers

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Any Questions?