using policy to your advantage · multi morbidities and more complex needs more paperwork to do...
TRANSCRIPT
Using policy to your
advantage
A focus on primary care
Bronwen Thompson, Policy adviser to PCRS-UK
November 14, 2014 RL workshop, Studley Castle
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● Challenges in primary care
● Reports on future of primary care
● Five year forward view from NHS England
● Implications for respiratory care?
Overview
Challenges in primary care
● More patients to see
● Multi morbidities and more complex needs
● More paperwork to do
● Spending time inputting to CCGs
● Falling staff numbers
● Staff having time off for stress
● Increased pressure on remaining staff
● Temps/locums create greater workload
● Many GPs retiring or due to retire
● Longer surgery opening hours
● Less income for practices
● Traditional boundaries limit opportunity for innovative
approaches5
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Reports on primary care
‘Commissioning and funding general
practice’
● Makes the case for:
● Collaboration across practices and close
working with social services
● Need scale for integration of services
● ‘Family care network’ model proposed
● Risk stratification of the population
● More skills to manage financial risk
● Based on 4 case studies
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February 2014
Reports on primary care
‘Is general practice ‘in crisis?’
● Guidance for government from May 2015
● Levels of patient satisfaction remain high
● But – access starting to get harder
● But – too few GPs in training and many GPs planning to
leave/retire
● Number of small, single handed GPs practices giving way to
larger practices
● General practice funding has impeded shift of care away
from hospitals
● New funding not enough – new models are needed
● Centre should facilitate innovation at grass roots
● Basic information about primary care workload is lacking
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November 2014
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http://www.nuffieldtrust.org.uk/graphic-general-practice-crisis
Reports on primary care
‘Is general practice ‘in crisis?’
● Guidance for government from May 2015
● Levels of patient satisfaction remain high
● But – access starting to get harder
● But – too few GPs in training and many GPs planning to
leave/retire
● Number of small, single handed GPs practices giving way to
larger practices
● General practice funding has impeded shift of care away
from hospitals
● New funding not enough – new models are needed
● Centre should facilitate innovation at grass roots
● Basic information about primary care workload is lacking
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November 2014
But let’s be crystal clear about the current context: general practitioners have been put through the wringer.
They’re tired – the average working day is often 12-13 hours. And they’re tired of
being an afterthought of the NHS.Dr Amit Bhargava
Reports on primary care
‘Securing the future of general practice’
● Highlights 21 models of care from around the world,
showcasing work that could help primary care to
organise itself more efficiently and relieve the strain
● Recognises that it will be a challenge to achieve
economies of scale while maintaining the personalised
care that UK primary care is renowned for
● No 0ne-size-fits-all but some design principles
proposed
● Important principle is to link together small units into
networks or federations for a coordinated wider service
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July 2013
Reports on primary care
‘Improving general practice – a call to action –
phase 1 report ‘
● 5 ambitions –
● Proactive, coordinated care
● Holistic, person-centred care
● Fast, responsive access to care
● Health-promoting care
● Consistently high quality care
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‘We need to invest in
primary care by relaxing
the rules that stifle
innovation’
“Part of the problem is that CCGs do not commission primary care, they cannot, due to conflict of interests. Before you can get integrated care you need to
have integrated commissioning”
NHS England (March 2014)
15October 2014
Across the system – expect £30bn shortfall per year by 2020/21
● Only ways to mitigate –
● Reduce demand
● Efficiencies
● Greater funding
● Several options considered
● Without more funds, could achieve £8bn saving in
2020/21 through moderate efficiency gains, but still
£22bn short
● If significant efficiency gains achieved, could halve it to
£16bn
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Across the system – expect £30bn shortfall per year by 2020/21
● Only ways to mitigate –
● Reduce demand
● Efficiencies
● Greater funding
● Several options considered
● Without more funds, could achieve £8bn saving in
2020/21 through moderate efficiency gains, so still
£22bn short
● If significant efficiency gains achieved, could halve it to
£16bn
● Only with increased investment to enable new ways of working, could £30bn gap be closed
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Five year forward view (5YFV)
● Proposes
● Radical upgrade in approach to prevention
and public health
● Patients having greater control when they
do need healthcare
● Breaking down barriers and innovating in
how care is provided
● Choice of new models of care for different
health communities
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New models of care
● Multi-specialty community providers
● Groups of practices with experts and generalists working
in clusters or federations
● Primary and acute care systems
● Which allow integrated primary and secondary services
within a single organisation
● Urgent and emergency care services to align
● Currently too fragmented and uncoordinated
● More proactive and enhanced healthcare for people in care
homes
● Specialised care
● Smaller hospitals to be made viable
● Midwife led maternity units
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List- based primary care to remain core and have more investment
● ‘New deal’ for GPs
● Stabilise core funding over next 2 years
● Look into allocation of funding between practices
● Expand funding to upgrade primary care infrastructure
● CCGs to have greater access to budget to help them deliver more comprehensive range of services
● Need more GPs in training and new incentives to retain them
● Support GPs in providing more ‘out-of-hospital’ care
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More flexibility to foster innovation
● Support a modern workforce with training and skills
development
● National leadership to allow meaningful local flexibility over
systems and structures which may impede innovation
● Support for diverse solutions and local leadership
● Encourage ‘testbed’ sites for innovation and novel approaches
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Neither one-size-fits-all Nor ‘ let a thousand flowers bloom’
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Opportunities for respiratory disease?
Innovation
Clustering
Staffing
Access
Prevention
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Local level respiratory data● Commissioning for value – data packs for CCGs from NHS E
http://www.england.nhs.uk/resources/resources-for-ccgs/comm-for-value/
● INHALE - database of respiratory information at local level http://www.erpho.org.uk/inhale.aspx
● Compare your care – AsthmaUK – regional level http://www.asthma.org.uk/compareyourcare-reports
● Public health observatory https://www.gov.uk/government/organisations/public-health-england
● Academic health science network? http://www.emahsn.ac.uk/emahsn/national-map.aspx
● Children’s and young people’s network?
● Public health in local authorities
● Pharmaceutical adviser
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What is important nationally?● NHS outcomes framework / Public health outcomes framework
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/256456/NHS_outcomes.pdf
● CCG Outcomes indicator set (CCG OIS) http://www.england.nhs.uk/wp-content/uploads/2013/12/ccg-ois-1415-at-a-glance.pdf
● Wales - National Respiratory Delivery Plan (May) http://wales.gov.uk/docs/dhss/publications/140429respiratoryen.pdf
● England - COPD/asthma Outcomes Strategy https://www.gov.uk/government/publications/an-outcomes-strategy-for-people-with-chronic-obstructive-pulmonary-disease-copd-and-asthma-in-england
● NICE/ BTS/SIGN guidelines
● NICE/BTS Quality standards http://www.nice.org.uk/guidance/published?type=QS
● Respiratory Atlas of Variation http://www.rightcare.nhs.uk/index.php/atlas/respiratorydisease/
● National reports:
● All party parliamentary group report into asthma deaths (June) http://www.blf.org.uk/Page/APPG-on-Respiratory-Health
● National Review of Asthma Deaths (May) https://www.rcplondon.ac.uk/projects/national-review-asthma-deaths
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