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working together – a healthier Richmond for everyone Working collaboratively across the London Borough of Richmond-upon-Thames to deliver our Health & Wellbeing Strategy 2016–2020 2016–2020 RICHMOND CLINICAL COMMISSIONING GROUP (CCG) JOINT PRIMARY CARE STRATEGY

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Page 1: RICHMOND CLINICAL COMMISSIONING GROUP (CCG)JOINT … · 2018-03-15 · working together – a healthier Richmond for everyone Working collaboratively across the London Borough of

working together – a healthier Richmond for everyone

Working collaboratively across the London Borough of Richmond-upon-Thames to deliver our Health & Wellbeing Strategy 2016–2020

2016–2020

RICHMOND CLINICAL COMMISSIONING GROUP (CCG)

JOINT PRIMARY CARE STRATEGY

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CONTENTS

01 Purpose and scope of strategy page 4

02 Definitionofprimarycare page 8

03 Currentservices page 9

04 Whydoweneedaprimarycarestrategy? page 11 05 Enablers page 12

06 Priorityobjectives page 16

07 Stakeholderengagementtodatein developmentofthisstrategy page 18

08 Benefitsandoutcomesofproposedservices page 19

09 Roadmapforchange page 22

–JOINT PRIMARY CARE STRATEGY

3

Page 3: RICHMOND CLINICAL COMMISSIONING GROUP (CCG)JOINT … · 2018-03-15 · working together – a healthier Richmond for everyone Working collaboratively across the London Borough of

This is a joint strategy with Richmond Council in recognition of Richmond Health and Wellbeing Board’s aspiration for integration and joining up of services. The Council is a commissioner of primary care services, as well as a commissioner and provider of social services, and therefore a key partner in supporting patients to remain well and independent in their local community.

We are fortunate in the borough of Richmond to have stable and highly-skilled general practices, delivering care to thousands of patients every day. As Richmond CCG takes on responsibility from NHS England for delegated commissioning of general practice services, we wish to make the most of the opportunities this presents to transform primary care. We aim to undertake an audit of current services and to review the scope for future improvements to the delivery of more integrated, patient-centred and holistic care.

The future of our services will be shaped through collaboration, engagement and co-design with general practices, health and social care professionals, patients via local patient participation groups (PPGs) and the wider local community.

In particular, we wish to support primary care’s ability to enable our population to ‘Start Well’, ‘Live Well’ and ‘Age Well’, to strengthen our opportunities to prevent future ill-health (or the exacerbation of existing conditions) and to develop patients’ abilities for self-care via access to appropriate information from community pharmacies, GP practices and the voluntary sector. We will also work collaboratively with HealthWatch Richmond, and other local stakeholders groups including: Richmond Council, voluntary and charitable organisations, provider organisations including Kingston Hospital, West Middlesex University Hospital, London Ambulance Service (LAS) and professional bodies.

The objective of this strategy is to ensure that primary care is equipped and supported to provide sustainable, accessible, pro-active and co-ordinated care close to a patient’s home. This was highlighted in the ‘NHS Five Year Forward View’ and most recently in the ‘General Practice Forward View’. The challenge for the local and national NHS, and the wider public sector, is to deliver continuous improvements in quality and preventative care while demonstrating value for money.

We will continue to work closely with and support our GP federation (the Richmond General Practice Alliance, a partnership of all GP practices in the borough) and Richmond Community Education Provider Network, as a means of developing local collaboration, training and workforce development opportunities across general practices.

This document details the current primary care provision in the borough of Richmond, the proposed direction of travel, the strategic drivers and the current challenges we face. It also sets out a proposal for the priority actions to be taken, the investments required and a work-programme consistent with delivery of the GP Forward View, London’s Strategic Commissioning Framework and South West London’s Transforming Primary Care programme as part of our Sustainability and Transformation Plan (STP), and Richmond’s Joint Health and Wellbeing Strategy.

Richmond CCG does not commission community

pharmacies, dental and optometry services. This

strategy is for GP practices and community services.

4 5

01PURPOSE AND SCOPE OF STRATEGY

OUR VISION

To put patients at the heart of service delivery using their experience to reshape, improve and transform services, whilst ensuring the service is sustainable and affordable.

–JOINT PRIMARY CARE STRATEGY

01 PURPOSE AND SCOPE OF STRATEGY

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6 7

–JOINT PRIMARY CARE STRATEGY

WHERE WE ARE

Strawberry Hill

Teddington

Richmond

StrawberryHill

Hampton Hill

Hampton Wick

St Margarets

North Sheen

East Sheen

Twickenham

Castelnau

Petersham

Mortlake

Hampton

Whitton

Barnes

Ham

Kew

RichmondPark

Old DeerPark

Royal BotanicGardens,

KewSyon Park

The LondonWetlandCentre

MarbleHill Park

Fieldsand Common

Crane park

Ham Lands

Bushy Park

Hampton Court Park

KemptonNatureReserve

Lower Mortlake Road

Roe

am

pton

Lane

Great West

Road

Maltr

oke

Ro

ad

Kingston RoadCher

tsey R

oad

Chertsey Road

Cedars Road

Wel

ling

ton

Ro

ad

Wal

deg

rave

Roa

d

Petersham Ro

ad

ichm

ond Road

Kingston Road

Kin

gston

Hill

Ho

un

slo

w R

oad

Han

wor

th R

oad

Staines Road

Ham

pton

Roa

d

Lon

do

n R

oad

London Road

London Road

Hig

h St

reet

High Street

Church Road

Sheen Road Sheen Road

Hurst Hurst Road

Heath Road

Park Road

Cas

teln

au

Kew

Roa

d

Kew

Roa

d

Ho

spital B

ridg

e Ro

ad

San

dyc

omb

e R

oad

Mill Hill Road

Mill Hill Road

Richm

ond Hill

Lons

dale Road

Whitton Road

Stan

le y Road

Qu

een

's R

oad

Queen's Ride

Kneller Road

Qu

eens Road

Ealing

d

Church Road

Sandy Lane

Lower Hampton Road

Wen

sleydale Ro

ad

Powder Mill Lane

Rivers ide Drive

Rive

rside D

rive

Glouc

este

r R

oad

Hanworth Road

Suffolk Road

Dukes AvenueBurtons Road

Prio

ry L

ane

Nelson Road

Mogden Lane

Sandy Lane

Ru

gb

y Road

Percy Road

Oak Avenue

Kin

gs R

oad

Kings Road

Broom Road

Broad Lane

Lock Road

Fife Road

Acr

e Ro

ad

Meadw

ay

Roa

h

R

Road

Upper Richmond RoadUpper Richmond Road

Great Cherts

ey Road

Great Chertsey Road

Hampton Court Road

Hampton Court Road

Bear Roda Sw

anRo

ad

Hampton

Kew Bridge

Barnes Bridge

Whitton

Barnes

Hounslow

Hampton Wick

Teddington

St Margarets

Syon Lane

Mortlake

Chiswick

North Sheen

Richmond

Twickenham

Brentford

Isleworth

NorbitonKingston

Fulwell

Kew Gardens

Strawberry Hill

M4

A205

A205

A205

A308

A308A308

A316

A316

A316

A316

A316

A316

A316

A4

A4

A4

A3050

A3063

A3304

A305

A305

A305

A305

A305

A306

A307

A307

A307

A307

A307

A307

A307

A308

A308

A308

A308

A308

A309

A310

A310

A310

A310

A310

A310

A310

A311

A311

A311

A312

A312

A313

A314

A314

A315

A315

A312

A316

A312

A3050

A306

A205

A3050

B306

B322

B350

B350

B350

B351

B352

B353

B358

B358

B358

B361

B361

B531

TeddingtonMemorial Hospital

iGP practicesii

45 Barnes Surgery 020 8748 7574

46 Essex House Surgery 020 8876 1033

47 Glebe Road Surgery 020 8748 7398 020 8222 9355

48 Kew Medical Practice 020 8487 8292

49 Lock Road Surgery 020 8940 1400 020 8940 8922

50 North Road Surgery 020 8876 4442

51 Paradise Road Practice 020 8940 2423

52 Parkshot Medical Practice 020 8948 4217

53 Seymour House Surgery 020 8940 2802 020 8940 3228

54 Sheen Lane Health Centre Doctor Jezierski & Partners 020 8876 3901

55 Sheen Lane Health Centre Doctor Johnson & Partners 020 8876 4086

56 The Richmond Green Medical Centre 020 8332 7515

57 Vineyard Surgery 020 8948 0404

iPharmaciesii

58 Barnes Pharmacy 020 8876 5224

59 Boots, Bessant Drive 020 8876 6192

60 Boots, George Street 020 8940 1691

61 Boots, Upper Richmond Road 020 8876 1227

62 Dumlers Pharmacy 020 8876 4603

63 Forward Pharmacy 020 8748 1774

64 Kanset Pharmacy 020 8948 0601

65 Kew Pharmacy 020 8940 0698

66 Lloyds Pharmacy, Station Parade 020 8940 5800

67 Nima Chemist 020 8940 1861

68 Pharmacare 020 8940 7918

69 Prime Pharmacy 020 8748 3147

70 Richmond Pharmacy, Lower Mortlake Road 020 8928 8811

71 Richmond Pharmacy, Sheen Road 020 8940 3930

72 Round the Clock Pharmacy, Church Road 020 8748 9695

73 Round the Clock Pharmacy, Upper Richmond Road West 020 8876 4364

74 Sainsbury’s Pharmacy 020 8876 9554

75 Spatetree Pharmacy 020 8255 1717

76 Springfield Pharmacy 020 8940 2304

77 Superdrug Pharmacy 020 8876 1861

iGP practicesii

1 Broad Lane Surgery 020 8979 5406

2 Crane Park Surgery 020 3458 5300

3 Cross Deep Surgery 020 8892 8124

4 Fir Road Surgery 020 8898 0253

5 Hampton Hill Medical Centre 020 8977 0043

6 Hampton Medical Centre 020 8979 5150

7 Hampton Wick Surgery 020 8977 2638

8 Jubilee Surgery 020 3458 5400

9 Oak Lane Medical Centre 020 8744 0094

10 Park Road Surgery 020 8977 5481

11 Richmond Lock Surgery 020 8892 2543

12 Staines Road Medical Centre 020 8894 2722

13 Thameside Medical Practice 020 8614 4930

14 The Acorn Group Practice 020 8891 0073

15 The Green Surgery 020 8894 6870

16 The York Medical Practice 020 8744 0220

17 Twickenham Park Surgery 020 8892 1991

18 Woodlawn Medical Centre 020 8894 4242 020 8894 1730

iPharmaciesii

19 Boots, Broad Street 020 8977 2699

20 Boots, Hanworth Road 020 8894 4980

21 Boots, King Street 020 8892 3079

22 Boots, Priory Road 020 8979 5275

23 Boots, Station Approach 020 8979 5559

24 Boots, Tangley Park Road 020 8941 5275

25 Boots, Whitton High Street 020 8894 7858

26 C Goode Pharmacy 020 8892 1614

27 Charles Harry Pharmacy 020 8892 1846

28 Crossroads Pharmacy 020 8755 1952

29 Day Lewis Pharmacy 020 8892 1526

30 Hampton Hill Pharmacy 020 8979 9084

31 Health on the Hill 020 8977 2539

32 Herbert and Shrive 020 8977 1967

33 Herman Pharmacy 020 8894 2000

34 K C Pharmacy 020 8977 1351

35 Kirby Chemist 020 8977 5509

36 Lloyds Pharmacy, Hampton Road 020 8977 0630

37 Maple Leaf Pharmacy 020 8898 5033

38 Medco Pharmacy 020 8977 6140

39 Minal Pharmacy 020 8894 7933

40 St Margarets Pharmacy 020 8892 2434

41 Strawberry Hill Pharmacy 020 8894 3532

42 Teddington Pharmacy 020 8977 2391

43 Twickenham Pharmacy 020 8892 1376

44 Whitton Corner Pharmacy 020 8894 2006

Teddington, Twickenham and Hampton

Richmond and Barnes

1

23

45

67

8

9

10

11

12

13

14

15

16

17

18

45

46

47

48

49

50

51

52

53

54 55

56

57

19

20

21

22

23

24

25

26

27

28

29

30

31

32

33

343536

37

38

3940

41

42

43

44

58

59

60

6162

63

6468

67

71 76

70 74

65 66

69

72

737577

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02DEFINITION OF PRIMARY CARE

8

Primary care is care provided in the community for people making an initial approach to a medical practitioner or clinic for advice or treatment. In the NHS this is usually general practice (GP services). Other primary care services include dental practices, community pharmacies and optometrists, allied health professionals, physician’s assistants and nurses.

In the borough of Richmond, there are 28 general practices with a total registered population of 214,155 patients (Jan 2017).

Overall, the general health and wellbeing of our local population is above average and we will seek to build on and optimise this further. The local joint Health and Wellbeing Board strategy includes a number of initiatives that are important for delivery of good health outcomes.

Richmond – healthy, safe and asset-rich• Population 193,585• Life expectancy at birth •81.9yearsformen(1.9yearsgreaterthanLondon) •85.9forwomen(1.8yearsgreaterthanLondon)• A borough with some of highest performing primary

and secondary schools in the country• Safest London borough for violent crime •4thoutof32forcrimeoverall• 79.6% working-age adults are in employment

– the highest rate in London• 49% volunteer – highest rate in London (26%)• Open spaces •1/3rdgreenspace,100+parks,21milesofriverfrontage •23,000bikejourneysperdayintheborough,

2nd out of 33 in London

Among the national challenges facing the NHS and those of particular relevance to the borough of Richmond, are our ageing population with an increasingly higher life expectancy, growth in the number of people with long-term and complex health conditions, increases in social isolation across socio-economic groups, and a corresponding rise in public demand and expectations (Darzi 2008; NHS Five Year Forward View, 2014).

9

03CURRENT SERVICES

02 DEFINITION OF PRIMARY CARE

03 CURRENT SERVICES

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We will build upon the work we inherited from NHS England commissioners to provide a quality improvement tool to support us to reduce variation, improve performance and support practices to undertake actions required to achieve high quality care. Primary care needs to be fit for purpose and able to adapt and respond to the transformation of urgent and emergency care and the out of hospital strategy.

It is the intention of Richmond CCG and the Council to develop a primary care dashboard aligned with our overall strategic vision to achieve high quality primary care for the benefit of all our population.

Our key principles are to ensure our general practice services are:

• Safe• Improving the patient experience,

including accessibility• Effective in delivering key outcomes• Providing value for money• Working to reduce health inequalities• Monitored regularly to ensure

all the above

General practices in the borough of Richmond already provide a good standard of care. Quality care is achieved by focusing on the three domains of quality which are: patient safety, clinical effectiveness and patient experience. Quality will also be the thread linking each work stream of the primary care strategy to ensure that we:

• Embed quality in the design stage of the service• Ensure quality in delivery• Provide quality assurance

11

04WHY DO WE NEED A PRIMARYCARESTRATEGY?

04 WHY DO WE NEED A PRIMARYCARESTRATEGY?

But areas to improve• Maximising prevention opportunities• Reducing health inequalities• Minimising harms and threats to health• Planning for demographic change

and promoting independence

Start well• 2,935 children in Richmond are

living in poverty• 36% young people have tried

smoking – the highest rate in England• 25% young people report being

drunk in the previous month• 19% young people report having

tried cannabis• 4th highest rate of hospital

admissions for self-harm in 10-24 year-olds in London

Live well• 17,000 adults smoke• 38,000 adults drink alcohol

at increasing or higher risk levels• 22,000 people have a common

mental disorder, such as depression and anxiety

•Thesamenumberofadults with obesity (22,000)

• The number of new diagnoses of gonorrhoea has tripled since 2011

Age well• 13,000 to 23,400: the projected

increase in number of over-67s between 2015 and 2035

•57%ofover-75shavethree or more long-term conditions (including dementia)

•50%ofover-75slivealone• 2,000 emergency admissions

annually are potentially preventable •costing£4.2millionperyear• 15,800 carers, only a fraction

are known to services

TOP FIVE DIAGNOSED CONDITIONS IN THE BOROUGH OF RICHMOND COMPARED TO LONDON AND ENGLAND

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–JOINT PRIMARY CARE STRATEGY

Condition Year England London Richmond

Hypertension 2014/15 13.79% 11.05% 10.06%

Asthma 2014/15 5.99% 4.73% 4.38%

Depression (18+) 2014/15 7.33% 5.33% 4.02%

Obesity 16+ 2014/15 9.03% 7.25% 4.01%

Diabetes Mellitus (17+) 2014/15 6.37% 6.14% 3.57%

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–JOINT PRIMARY CARE STRATEGY

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05 ENABLERS

CURRENT OPPORTUNITIES AND CHALLENGES FOR PRIMARY CARE IN THE BOROUGH OF RICHMOND

Extended Access The traditional model of offering 10 minute appointments cannot be sustained as demand continues to increase. Local practitioners maintain that as needs become more complex, sufficient time is required to undertake holistic care to reduce the frequency of appointments. Other patient groups may require less than 10 minute appointments or advice slots, and alternative models, e.g. offering telephone, email or video-based Skype consultations may help to facilitate this.

Our experience from the first year of extended GP access, offering GP consultations from 8am to 8pm seven days a week, shows the benefits of commissioning some general practice services ‘at scale’ to serve the whole population, provided by local high-calibre clinical practitioners.

The Richmond GP Alliance (RGPA) has developed an integrated IT system to allow record sharing between all general practices within the borough and we hope to build on this further to facilitate record sharing between primary and secondary care. Also, our achievements with GP Online Services, through which people can book GP appointments, order repeat prescriptions and view aspects of their medical records online, has allowed us to build on IT opportunities and streamline access to care.

Patient and resident engagementRichmond CCG and the Council are aiming for a single systemic approach to measuring and responding to local voices. We have engaged numerous stakeholders in the development of this primary care strategy, through consultation via the CCG clinical network meetings, practice manager and practice nurse networks, the Local Medical Committee (LMC), Council, Public Health Richmond, social care and community teams, the Community Involvement Group (CIG), HealthWatch Richmond, and our patient participation group networks (PPGs). We have benefited from the genuine commitment and willingness from all parties to work together across the borough.

Further work will continue via our key stakeholders with an emphasis on hearing the voice of local communities and patient groups, using patient input to strengthen the work of our pathway redesign work and to develop an ongoing conversation on the future of primary care. WorkforceThe creation of our Community Education Provider Network (CEPN) enabled the start of:

• A systematic approach to improving workforce development, introducing and expanding student placements and co-ordinating access to continuing personal and professional development (CPPD) for all staff

• Facilitation of enhanced partnership working between practices, the CCG, higher education providers and Health Education South London

• Enhanced sharing of resources and partnership working

While significant progress has been made to increase placement capacity and facilitate expansion of the practice team to include student nurses and community pharmacists (amongst other innovative experiments in interprofessional supervision), Richmond CEPN’s long-term vision is to:

“ create a sustainable infrastructure which integrates workforce planning and development with service requirements for the benefit of the population that we serve, across primary and community care providers.”

The CCG and Council, recognise the workforce challenges that local GP practices currently face, and will increasingly face as staff approach retirement. We need to address the immediate pressures while improving recruitment and retention, supporting succession planning and seek to expand the role of other primary care professionals, including physician associates, practice and community pharmacists, care navigators, nurse practitioners, and other allied practice staff. Our planning needs to consider links to all healthcare professionals within an integrated health and social care model including hospital and community services, pharmacists and the wider community workforce.

Delegated commissioningIn May 2014 NHS England announced an option for Clinical Commissioning Groups (CCGs) to co-commission primary care in partnership with NHS England. From April 2016, Richmond CCG has assumed responsibility for general practice commissioning from NHS England, with a shared role on a number of functions. We recognise that general practice can no longer be commissioned in isolation from other parts of the health economy and there is a commitment across south west London (SWL) to work with local providers, service users and the public to develop solutions that will deliver safe, high quality care for everyone. Part of our vision is to ensure that patients and service users not only experience better single episodes of care, but a higher quality experience of overlapping parts of their care.

We are using the opportunities of delegated commissioning, alongside flexibilities within locally commissioned services, to explore the overlaps between the different aspects of our primary, community and secondary care commissioning. Delegated commissioning will strengthen our out of hospital strategy, help us to manage demand on acute services and provide more appropriate care in the community. This will support our pro-active care vision to enable people to live well and manage their conditions before escalation or crises arise. The outcomes based commissioning (OBC) route will drive the pathway redesign to deliver more services closer to home.

Continued over

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05ENABLERS

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–JOINT PRIMARY CARE STRATEGY

Continued from over

Information management and technology (IM&T)IM&T is essential to improving and supporting the patient experience and pathway within primary care.Theprimaryhealthcareinformation/recordssystem provides vital clinical records support, as well as a public health and quality (QOF) overview of a practice’s population. In addition, it assists clinical staff to manage conditions safely and systematically. If systems are clinically supported, they should have a focus on patient care rather than administrative processes. Richmond CCG, in consultation with GP practices, suppliers and key stakeholders, will aim to ensure that all practices have robust, well-functioning clinical systems. Feedback from practice managers and clinicians indicates that our developing IM&T strategy has to be reinforced with effective plans for good quality user support, advice and system maintenance, as well as a process that delivers the timely replacement of basic IT equipment such as hardware and printers.

EstatesOur vision for estates is that there needs to be a strategic and proactive estates planning process, which can support both the sustainability of local primary care services and the cost-effective investment across the NHS estate. This work will be driven by the Richmond local estates strategy, which will focus on future requirements to ensure that both general practice and the wider health estate are fit for purpose and strategically located. To ensure that Richmond CCG maintains a clear overview of GP estate issues, a regular GP premises group has been established, with membership from NHS England, the Healthy Urban Development Unit (HUDU), NHS Property Services (NHSPS) and the London Borough of Richmond-upon-Thames (LBRuT). Through the GP premises group, Richmond CCG aims to support and enable:

•Better service integration which improves patient experience and service efficiency, and helps to deliver better health outcomes for patients

• New service models to deliver more services in community settings

• The release of savings and achievement of value for money through the optimum use of healthcare premises, conveniently located for patient services and able to accommodate the appropriate skill-mix of clinicians in the right care setting

Strategic planning for general practice (and the wider NHS community and secondary estate) has been fragmented over recent years, with changes in organisational responsibility for estates affecting the system’s ability to plan strategically. Our responsibility to commission local services through the powers of delegated commissioning brings an opportunity to improve the co-ordination of estates planning and to respond to some of the associated challenges and opportunities locally. These include:

•Acting on the results of the ongoing condition and utilisation surveys of general practice premises

•Using the opportunity of the Estates and Technology Transformation Fund to submit appropriate bids for central investment in local estates and IM&T facilities

London’s ambitious vision outlined in the Strategic Commissioning Framework can only be delivered through providers working ‘at scale’ in larger primary care organisations, to enable them to increase their capacity and capability and support sustainability across the NHS. This new way of working will enable providers to benefit from shared economies of scale across services, functions or infrastructure.

The Transforming Primary Care programme (TPC) is supporting providers to develop in their maturity and put in place the infrastructure required for greater integration to enable them to contract with commissioners of primary care to deliver services such as extended access.

QualityAcross primary care, there are a range of measures available to understand local performance and quality; some based on patient experience (for instance the annual GP patient survey, or the regular friends and family test), and others based on clinical reporting.

Quality and outcomes framework (QOF)QOF is an annual reward and incentive programme; it rewards practices for the provision of quality care and helps standardise improvement in the delivery of primary medical services.

To support CCGs to measure their progress against the ambition set out in the Strategic Commissioning Framework, the TPC programme has developed a measures dashboard. This dashboard currently analyses a number of the general practice patient survey (GPPS) measures, along with data from areas such as Patient Online, General Practice Outcome Standards (GPOS) and e-Declaration responses. Richmond CCG aims to reduce unwarranted variation in all aspects of quality and to bring measurable standards up to those of the best of local and national general practice.For patients and the public this will mean:

•They will receive the same high quality, safe service regardless of where they are registered or who they see

•They will have an improved experience of accessing general practice

•Their views are welcomed and are seen as part of the solution to supporting successful general practice.

For practices this will mean:

•Assurance that there is a focus on meaningful measures of high quality care

•An increase in the amount and quality of patient views

•Ensuring the sharing of learning from incidents, complaints, etc.

•Supporting the implementation of new national guidance and local best practice.

In partnership with local practices, and our Quality Committee, we will develop a quality framework to inform the work of our new Primary Care Commissioning Committee. This will focus on a range of key quality domains to improve quality and safety, as follows:

Safety and effectiveness•Reduction in medication errors•Improved management and learning

from serious incidents•Understanding and fulfilment of

safeguarding responsibilities•Understanding and fulfilment of infection

control responsibilities•Care Quality Commission (CQC) compliance•Increase in screening and immunisation uptake•Improved management of long term

conditions (LTC)•Reduction in delayed diagnosis (including

appropriate two-week cancer referrals)

We are also in the process of developing a menu of ‘gateway interventions’ to support quality improvement in primary care that are intended to assist the delivery of improvements in quality and safety across the four NHS domains. A sample practice-profile (Table 2) will be developed, to assist the Primary Care Commissioning Committee in its commissioning approach.

SAMPLE PRACTICE PROFILE

Capacity GP per 000 population

Extended hours

Responsibility for care home

Workforce Single-handed

Skills mix / GP with special interests (GPwSI)

Current / forecast vacancies

Premises ‘Fit for purpose’ – RAG

IT Systems upgraded

Evidence of active use of mobile working

Quality A & E attendances (per weighted 000 population)

Out of hospital (OOH) attendances/calls

First outpatients (OP) referrals (per 000)

Outliers on Primary Care WebTool

Friends and Family Test

Patient/public engagement – active PPG

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–JOINT PRIMARY CARE STRATEGY

06 PRIORITY OBJECTIVES

Primary care is fundamental to the delivery of effective out of hospital services across Richmond and south west London and it is important in tackling the issues that we know our local populations. We have a vision that supports localised general practice (list-based care) that is quality driven, minimises variation and provides a consistent offer but also provides the opportunity to work ‘at scale’ to deliver:

• Accessible care that is timely, responsive to individual needs for routine and urgent advice and care and is not limited to consultations in the practice

• Co-ordinated care that is holistic, provides continuity and reassurance for patients whose condition and complexity of care require it

• Pro-active care that focuses on prevention, encourages self-management, patient activation and supports the overall health and wellbeing of the population

Priorities for primary care in south west LondonRichmond CCG is proud to be part of the South West London Primary Care Collaborative to support primary care that:

•Isenabledtotakecollectiveresponsibilityforthehealthofthe population and support a consistent, quality driven ‘offer’ across our patch

•Demonstratesanincreaseintheuseoftechnologytocreateadditional capacity and access

•Iskeytoco-ordinatingcareincommunitiesandworkingmorepro-actively with community services, mental health, dental, ophthalmic, social care and specialist services, amongst others.

•Embracesnewrolessuchasphysicianassociates,practicepharmacists and care navigators and supports practice nurses, practice managers, PAs and receptionists who in turn can better assist GPs in their role

•Deliversthe17specifications(below)thatformtheLondonprimary care strategic commissioning framework (accessible, proactive and coordinated care) and form a key component of delivering our vision.

17

06PRIORITY OBJECTIVES

Q2 2018 100% delivery across SWL

Q1 2019 100% delivery across SWL

Q4 2019 100% delivery across SWL

Access specifications Co-ordinated specifications Pro-active specifications:

1 Choice 1 Case finding and review 1 Co-design

2 Contacting the practice 2 Named professional 2 Developing assets and resources for improving health and wellbeing

3 Routine hours 3 Care planning 3 Personal conversations focused on individual’s health gains

4 Extended hours 4 Patient supported to manage their health and wellbeing

4 Health and wellbeing liaison and information

5 Same day access 5 Multi-disciplinary working 5 Patients not currently accessing primary care services

6 Urgent emergency care

7 Continuity of care

DELIVERY OF 17 PRIMARY CARE SPECIFICATIONS ACROSS SOUTH WEST LONDON

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07STAKEHOLDER ENGAGEMENT TO DATE IN DEVELOPMENT OF THIS STRATEGY

07 STAKEHOLDER ENGAGEMENT TO DATE IN DEVELOPMENT OF THIS STRATEGY

Patient and public engagement began with the Call to Action and Better Care Fund engagement heldin2013/14,whichtogetherwithotherengagement activities informed Richmond CCG and Council’s joint overarching Better Care Closer to Home (Out of Hospital) strategy. Since then we have continued to receive feedback on primary care as part of broader engagement work locally and the South West London Collaborative Commissioning (SWLCC). This included the community research and engagement project to inform an outcomes framework for a new outcomes-based out of hospital health and care contract.

The views and comments of patients and the public are important to Richmond CCG and Richmond Council. We regularly encourage patients and the public to give us their views at local forums, community events and patient groups and through opportunistic feedback. This information is used to inform on-going service improvement and commissioning plans. We have undertaken a range of stakeholder engagement approaches to inform this strategy.

We aim to deliver:

Accessible care through general practice, community pharmacies, out-of-hours services, access-hubs (offering seven day access, 8am – 8 pm general practice services), with additional services available through NHS 111. We aim for patients to be able to book appointments online and via the use of mobile apps and to be able to access and input into their medical records in a similar manner. Using touchscreens in practices to allow patients to check in on arrival will also become more prevalent. Such measures will reduce the burden on reception staff and the frustration that patients experience when trying to access healthcare.

Pro-active care through our outcomes based commissioning work on pathways for the care of frail elderly patients, peoplewith diabetes, respiratory and

cardiology conditions, and end of life care. This work is already underway, co-designing pathways with clinicians, patients and their carers with direct knowledge of our local services, and bringing together primary, community and third sector organisations to work collaboratively. We will be working closely with the Council on preventative work-streams to reduce the burden on healthcare services in the longer term. As an example, improved detection of hypertension and atrial fibrillation with blood pressure (BP) machines in GP practice receptions, community pharmacies and shops and opportunistic pulse checks will help us to proactively detect and manage these conditions and reduce the incidence of strokes. We will look at investing in self-management via the use of apps such as symptom checker and sign post appropriately so that patients are encouraged to take

some responsibility for their own health thereby reducing some of the demand on GP appointments.

Co-ordinated care to identify patients who would benefit from care continuity, provide them with a named clinician responsible for their care co-ordination and the development of a holistic care plan, which will be shared with appropriate services involved in the patient’s care. Patients will be regularly reviewed by a multidisciplinary team involving health and social care professionals who will co-ordinate the care they receive from the GP practice as well as linked services. We will link into the local ambulance service to identify frequent attenders and work closely with practices and community services to identify how we could manage them better in primary care.

Our vision, as outlined in the Strategic Commissioning Framework, is for a general practice that operates without borders, and in partnership with the wider health and care system. Primary care teams in London (and the borough of Richmond) are working in new and innovative ways, and practices in our local areas are working together; either within clinical networks to achieve joint improvements in care, or within Richmond General Practice Alliance (RGPA) to work collaboratively ‘at scale’.

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08BENEFITS AND OUTCOMES OF PROPOSED SERVICES

08 BENEFITS AND OUTCOMES OF PROPOSED SERVICES

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HOWWILLWEDELIVERTHISVISION?

We will collaborate with colleagues in south west London to create a sustainable model for general practice that can:

Work ‘at scale’ – the key to transforming services is to deliver primary care ‘at scale’ covering the whole population, supporting providers to make the necessary change in infrastructure by forming federations or networks in order to benefit from shared economies across services. There are currently 57 federations in London, covering 91% of the population of London . The Transforming Primary Care programme is supporting providers by building a bespoke 12-month development programme that will support the growth of ‘at scale’ primary care organisations across London.

Demonstrate multi-disciplinary working – general practice is increasingly working in a multi-disciplinary way with other health, social, mental health, community and voluntary organisations. The model of care to achieve this varies across London and is owned by local commissioners.

Deliver more effective ways of working – the vision for primary care in London requires innovative new ways of working, doing more with the resources available to us and sharing learning and best practice with other localities.

Use technology for the benefit of patients – work is underway by the Healthy London Partnership and local teams to support the roll out of inter-operable solutions for primary care. In addition, work is in progress to increase usage of GP Online Services making more appointments available to be booked online, and a public campaign to encourage more local people to sign up and use it.

STRATEGIC OBJECTIVES OVER THE NEXT FIVE YEARS

HOW WILL RICHMOND CCG ACHIEVE THE OUTCOMES

IMPROVEMENT AREAS

OVERARCHING ACTIONS – WE WILL

Proactive care

Increase the use of technology to enable patients to be better equipped to manage their own conditions, and access support and advice on-line

Improved primary care services that involves patients and builds capacity. Patients will be empowered to take control of their care to stay healthy

Self management Power to commission local services

Improved access

Proactive care

Integrated careImproving the quality of primary care

Utilising mordern technology

Development of Providers to provideservices

Fully utilised estates

Workforce development

Accessible qualitive care

Work with the GP Providers and other Providers to increase access to Hubs and address demand

Premises to be utilised to ensure the premises that are being used for primary care services have the capability

A quality accessible service that responds to different patient needs and preferences

We will provide opportunities for primary care to work in collaborative ways with other providers to increasingly offer services in the community

Providing patient centred, co-ordinated care

Co-ordinate care

WORK AREAS

OUTCOMES

WHAT THE SPECIFICATION WILL MEAN FOR OUR POPULATION

We are fortunate in having a thriving Community Education Provider Network (CEPN) to support issues of retention, training and workforce development. We aim to support our local practices to:

•Increasetheirresiliencethroughnewwaysofworkinganddeveloping a skilled, energised and sustainable workforce

•Facilitatemoreflexibleworking•Developpeersupportnetworksandorganiseworkloads

effectively to facilitate attendance and learning from these•Developaflexibleworkforcemadeupofskill-mixedteams

and extended teams that reflect the needs of the population•Positionthemtoimplementnewapproachestothedelivery

and organisation of care such as integration, extended roles in risk stratification, care planning and case management

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09 ROAD MAP FOR CHANGE

In Richmond, we plan to make progress on these improvements, as follows:

Priority projects for

Year 1 2016–2017

Year 2 2017–2018

Year 3 2018–2019

Accessible care

Delivery of primary care access hubs, with clear and streamlined links to urgent care and A&E provision, with choice of appointments bookable, in a range of settings, and across the 8 am – 8 pm seven day timescale

Website and health app development to support patient education and communication

Telephone triage schemes in place, providing back-up to the risk-stratification schemes at practice-level

Ongoing roll-out of GP Online Services

Active signposting to provide a single point of contact to services, online, access to solutions and suggestions for self-care, and support by community navigators

Extended care rolled out (including mental health, physiotherapy, occupational therapy and care navigators) to support general practice locally

Infrastructure availability and review for accessibility (e.g. hearing loops)

Website development at practices to provide email consultations

Triage schemes such as Doctor First or AskmyGP being piloted in parts of south west London if successful would be adopted

Full implementation of an outcomes-based commissioning framework in primary careFull implementation of named GP with responsibility for ongoing care coordination and continuity

Review of e-consultations and virtual appointments

Scoping services and options for identifying patients not currently accessing primary care services

Implement ways to reach vulnerable patients

Telephone triage systems being piloted in a number of GP practices

Priority projects for

Year 1 2016–2017

Year 2 2017–2018

Year 3 2018–2019

Co-ordinated care

Develop multi-disciplinary team (MDT) working, in particular with care home sector

Workforce development to make every contact count

Case-finding to ensure that risk-stratified registers are as accurate as possible in identifying the known and expected individuals at risk

Support vulnerable patients with intermediate care teams, and direct patient/carer support

Data-sharing enabled between health and social care partners

Increased access to diagnostics (e.g. blood pressure monitoring and interpretation) at non-clinical sites

Embedded multi-disciplinary team (MDT) working across all sectors

Named professional in place across all practices

Personal conversations focussed on an individual’s health goals

Developing assets and resources for improving care

Priority projects for

Year 1 2016–2017

Year 2 2017–2018

Year 3 2018–2019

Pro-active care

Development and roll-out of the community access strategy and social prescribing

Identification of critical points on the patient pathway

Systematic primary care support for uptake of lifestyle advice programmes

Introduction of care-navigator role to support single point of access for primary care and links with adult social care

Risk-stratification tools in place

Exploration of training to better support staff to have personal conversations

Active community programmes in place to support Health and Wellbeing strategy

Introduction of expert patient programme and self-management programmes

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09 ROAD MAP FOR CHANGE

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PRIMARY CARE FUNDING – FINANCIAL RESOURCES

The primary care funding for the next five years (to 2020/21) was announced in December 2015. The revenue allocations are summarised below:

HIGH LEVEL PLAN – 2016 TO 2020

A sample structure to measure our success in delivering our plan is shown below:

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09 ROAD MAP FOR CHANGE

TABLE 4PRIMARY CARE REVENUE ALLOCATIONS

TABLE 5SAMPLE STRUCTURE TO MEASURE OUR SUCCESS N DELIVERING OUR PLAN

2016/17£m

2017/18£m

2018/19£m

2019/20£m

2020/21£m

Croydon 47,839 50,382 52,255 54,414 57,441

Sutton 24,973 25,578 26,239 27,141 28,448

Merton 28,107 28,595 29,286 30,230 31,638

Richmond 23,536 24,623 25,533 26,515 27,747

Kingston 24,576 25,233 25,916 26,858 28,148

Wandsworth 46,817 47,795 48,905 50,634 52,823

SWL SPG 195,848 202,206 208,134 215,792 226,245

Dimension Outcome Measure

Patients Are equipped to self-manage their condition and daily life independently

Percentage of people with a long-term condition managed solely in primary care

Are enabled to take control and be pro-actively involved in their care

Increased community pharmacy activity on minor alignment

Use new technologies and two way communication to enable support and partnership

Percentage of patients booking appointments online

Increased use of the Health Help Now app

Expect high quality and more integrated services

Receive continuity of care and access to urgent care where they matter most

Reduction of A&E activity

Receive care as close to home as possible Implementation of the Primary Care Home

Professionals A sustainable, skilled, flexible and happy workforce

Working across boundaries for the benefit of patients

Skill mixed teams that reflect the needs of the population Development of the locality team model

General practices that work as part of an extended team and network that understand and know their community

Development of the locality team model

Partnerships Patients as partners

Carers

Voluntary, community and social care providers

Networks focused upon population health

Local groups to support community resilience

Volunteers within extended teams

Sharing good practice

Pooling resources

Premises Innovative use of premises

Fit for purpose and flexible estate that can shift to support service configuration

Understanding of room utilisation to facilitate optimal service configuration

Process Interoperability of systems

Rapid electronic transfer of information

Easy access to expertise, guidelines and decision making tools

Improved communication between professionals

Reduced variation

The differential between allocations and expenditure commitments shifts over time, ultimately generating an investment pool for each CCG by the last year of the five-year period.

Primary care investment poolAn investment pool will exist for all CCGs by 2020/21.Thispoolistheminimumavailablefor investment and could be increased by the following factors:

•Primary care transactional QIPP (list cleansing, value for money on premises costs etc.)

•Redirecting resources from the Personal Medical Services (PMS) reviews (particularly for the above target CCGs)

• Additional transfer of resources from planned reductions/avoidanceofhighcostreactiveacute care

For the boroughs of Croydon and Richmond the initial investment pool resources will be available muchearlierfrom2017/18.TheotherCCGswillretain more immediate flexibility through the PMS reviews.

In addition all CCGs have access to bid for capital funding to support premises or IT developments through the Estates and Technology Transformation Fund (ETTF).

The investment pool will be directed towards the following enabling areas to support service transformation:

• Organisational models (GP federations, optimum clinical networks)

• Workforce development• Workforce growth• Premises development (revenue implications)• IT infrastructure• Incentivising changes in provider behaviour

e.g. outcomes based commissioning and other performance standards.

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You can find out more about the CCG at: www.richmondccg.nhs.uk

Follow us on Twitter: @NHSRichmondCCG

Follow us on Facebook: www.facebook.com/RichmondCCG

You can write to us at: Richmond CCG, First floor, Civic Centre, 44 York Street, Twickenham, TW1 3BZ

You can call us on: 020 8734 3000

CONTACT US

–JOINT PRIMARY CARE STRATEGY