Bromley Primary Care Needs Assessment Findings Dr Agnes Marossy - - PowerPoint PPT Presentation

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Bromley Primary Care Needs Assessment Findings Dr Agnes Marossy - - PowerPoint PPT Presentation

Dec 04, 2023 26 likes •366 views

Bromley Primary Care Needs Assessment Findings Dr Agnes Marossy Dr Agnes Marossy Consultant in Public Health PRIMARY CARE NEEDS ASSESSMENT The aim of the Primary Care Needs PCNA CLINICAL Assessment is to describe both the need for

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Bromley Primary Care Needs Assessment – Findings

Dr Agnes Marossy Dr Agnes Marossy Consultant in Public Health

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SLIDE 2

The aim of the Primary Care Needs Assessment is to describe both the need for primary care and the needs of those delivering primary care in order to inform the development of a sustainable model of primary care in Bromley.

PCNA STEERING GROUP CLINICAL REFERENCE GROUP PRIMARY CARE NEEDS ASSESSMENT

WORKFORCE SURVEY POPULATION DATA QOF & HES DATA EVIDENCE WORKLOAD ANALYSIS ENGAGEMENT

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PCNA Steering Group

  • GP Clinical Directors
  • Bromley GP Alliance
  • CCG Primary Care Team
  • CCG Nurse Lead
  • Director of Organisational

Development PCNA STEERING GROUP CLINICAL REFERENCE GROUP PRIMARY CARE NEEDS ASSESSMENT

WORKFORCE SURVEY POPULATION DATA QOF & HES DATA EVIDENCE WORKLOAD ANALYSIS ENGAGEMENT

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Clinical Reference Group

  • GPs (Partners, Salaried, Locums, Trainee)
  • Practice Nurses
  • Practice Managers

PRIMARY CARE NEEDS ASSESSMENT PCNA STEERING GROUP CLINICAL REFERENCE GROUP

WORKFORCE SURVEY POPULATION DATA QOF & HES DATA EVIDENCE WORKLOAD ANALYSIS ENGAGEMENT

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SLIDE 5

CCG Membership Practice Visits (42/45) Practice Nurse Forum Practice Managers’ Forum Locum/Salaried GP Group Public Engagement BME Groups Learning Disabilities Mental Health

ENGAGEMENT

Mental Health Sensory Impairment Long Term Conditions

WORKFORCE SURVEY POPULATION DATA QOF & HES DATA EVIDENCE WORKLOAD ANALYSIS ENGAGEMENT

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SLIDE 6
  • Continuity
  • Skill Mix
  • Vulnerable Groups
  • Consultation Length

PUBLIC ENGAGEMENT

WORKFORCE SURVEY POPULATION DATA QOF & HES DATA EVIDENCE WORKLOAD ANALYSIS ENGAGEMENT

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Population Access Workforce Integration & Coordination Complex Multimorbid Patients Shift of Care Closer to Home Resilience

PRACTICE VISIT QUESTIONS

Resilience Models of Care Integrated Care Networks

WORKFORCE SURVEY POPULATION DATA QOF & HES DATA EVIDENCE WORKLOAD ANALYSIS ENGAGEMENT

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DISEASE BURDEN HEALTH OUTCOMES POPULATION

PRIMARY CARE NEEDS ASSESSMENT WORKFORCE WORKLOAD

ACCESS MODELS OF CARE RESILIENCE

ASSESSMENT HOME WORKFORCE WORKLOAD

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“Bromley has a higher nurse to patient ratio than London, but an additional 18 WTE nurses (of all types) are needed to reach the same ratio as England.” “In order for Bromley to reach the same ratio as London, an additional 2.7 WTE GPs are needed in Bromley, and to reach the same ratio as England, an additional 13.4 WTE GPs are needed.” CAPACITY GPs WORKFORCE the same ratio as England.” In order to keep up with population growth, we need 1.5 additional GPs per year in Bromley. NEW ROLES NON CLINICAL STAFF PNs

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The annual workforce survey in Bromley

VIEWS ON PARTNERSHIP VIEWS ON LOCUMS CAPACITY

The annual workforce survey in Bromley shows that we lost 1.85 WTE GPs last year.

BACK

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VIEWS ON PARTNERSHIP VIEWS ON LOCUMS CAPACITY

BACK

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Salaried GPs

Too Few Applicants

  • Practices don’t know how to

access the trainee cohort

  • Competition from posts at

access hubs and UCC

  • High indemnity fees

Difficulty in retention

  • Excessive workload
  • Causes GPs to resign
  • Practices protect salaried GPs

from workload to retain them.

  • Salaried GPs not willing to be on call
  • Salaried GPs not willing to be on call
  • Only want to work 4 to 6 sessions

per week

  • Want a mentor

Don’t develop the full range of GP skills

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SLIDE 13

VIEWS ON PARTNERSHIP VIEWS ON LOCUMS CAPACITY

BACK

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The annual workforce survey in Bromley shows that we lost 1.13 WTE ANPs whilst gaining 2.95 WTE PNs relating to an overall increase of 1.83

NURSE RECRUITMENT CAPACITY

WTE PNs relating to an overall increase of 1.83 WTE Nurses last year. Alongside that there was a loss of 1.37 WTE HCAs

BACK

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NURSE RECRUITMENT

ISSUES INNOVATIONS Retirement of longstanding experienced nurses Nurses as mentors Small pool of practice nurses In house training of nurses

CAPACITY

BACK

Hospital nurses not aware of practice nursing Student nurse placements in practices Terms & Conditions not standardised and less attractive than in secondary care. Use of a training contract with commitment for nurse to stay in practice Lack of training courses Higher rates of pay

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WORKFORCE

Key Issues: Insufficient number of GPs and nurses Lack of skill mix Competition between local services for GPs and Competition between local services for GPs and nurses Undesirable workload and work life balance

OVERWHELMING WORKLOAD

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WORKLOAD

Much is spoken about General Practice workload, chiefly about it increasing and becoming unmanageable, but what exactly are we talking about? Under the GP Contract, GPs must provide a service to manage a registered list of patients. This includes manage a registered list of patients. This includes consultation, treatment, onward referral for investigation and extended primary care services such as prevention, screening, immunisations and some diagnostic services. GPs also help to ensure effective coordination of care for their patients with other NHS services, social care and health services outside the NHS.

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WORKLOAD

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WORKLOAD

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WORKLOAD

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WORKLOAD

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WORKLOAD

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WORKFORCE

We are at the point where the issues of AND

INSUFFICENT CAPACITY

AND are creating an unsustainable future for Primary Care in Bromley and we therefore need to do something transformational…

OVERWHELMING WORKLOAD

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OPTIONS

  • Take a long

time

  • Often fail on

premises

  • Retain

Partnerships

  • Retain

Premises (at

STATUS QUO OPERATING AT SCALE

MERGERS/TAKEOVERS COLLABORATION

premises issues Premises (at least in the short term) Who will be

LAST MAN STANDING?

  • Financial Considerations/ Ownership
  • Exit Strategy
  • ?Attractiveness to new partners
  • Current state/capacity

PREMISES

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THE TRADITIONAL MODEL… GP PARTNER PRACTICE

SALARIED & LOCUM GPs PHYSICIAN ASSOCIATE PRACTICE NURSE

MANAGER

RECEPTIONIST/ OTHER ADMIN ROLES SALARIED & LOCUM GPs ADVANCED NURSE PRACTITIONER CLINICAL PHARMACIST HCA ASSOCIATE MEDICAL ASSISTANT

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THE NEW MODEL

ANP

PHYSICIAN ASSOCIATE Snr CLINICAL PHARMACIST

GP E MANAGER

NAVIGATOR

PRACTICE NURSE

HCA

CLINICAL PHARMACIST

MEDICAL ASSISTANT

PRACTICE M

RECEPTIONIST MEDICAL SECRETARY

CARE NA

TRAINING & SUPPORT

HEALTH COACH

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TARGETED UNIVERSAL SERVICES

Immunisation Screening NHS Health Checks LD HCs SMI HCs Lifestyle Management Sexual Health

CARE HOME S ACUTE LTCs

MINOR ANP

Active Signposting in Active Signposting in practices and online

MAJOR

CPs/PNs/HCAs/Health Coaches Monitoring Review

  • Std. Management

Medication Review

HOUSEBOUN

BROMLEY NEW MODEL

Based on 30-50,000 patients STREAMING

ONLINE CONSULTATIONS ONLINE CONSULTATIONS

RESOURCES: RESOURCES: £££ and people

CLINICAL LEADERSHIP QOF across the network or across whole area

Sexual Health Contraception Dressings DIAGNOSTIC SERVICES: Phlebotomy ECG Ambulatory BP

E SERVICE

ANP Paramedic PA

OUND

GROUP GROUP CONSULTATIONS REMOTE DIGITAL MONITORING

CARE NAVIGATOR/HEALTH COACH/MEDICAL ASSISTANT

GP

Admin shared across the network utilising WORKLOAD FILTERING

QUALITY ASSURANCE

GP and Nurse ROTATIONAL AND PORTFOLIO posts, encompassing Access Hubs, community, general practices and UCC

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SLIDE 28

“Refocusing of the GP role as expert medical generalists with a focus on undifferentiated presentation, complex care and whole system quality improvement and clinical leadership”

CLINICAL LEADERSHIP QUALITY ASSURANCE

PARTNERS SALARIED LOCUM

GP / PRIMARY CARE CONSULTANT

GP RETIREE PROGRAMME MENTORING NEW GPs & NEW SKILL MIX PORTFOLIO & ROTATIONAL POSTS

These roles will include practice work as well as Access Hubs/UCC/OOH. Thereby reducing competition to recruit into these roles

VERSATILE GP

Bromley network of locums Access to training & support Online platform for matching Different ways of working (e.g. remote) Clearly defined packages/contracts

CREATING SUSTAINABILITY

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SLIDE 29
  • !

" "

  • #$%
  • &'(

) )

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NHS Long Term Plan and GP Contract Reforms

Primary Care Networks (30 to 50,000 population) Additional Roles Network DES Network DES Expanding digital access for patients

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Additional Roles

Clinical Pharmacists (2019) Social Prescribing Link Workers (2019) Physician Associates(2020) First Contact Physiotherapists (2020) First Contact Physiotherapists (2020) First Contact Community Paramedics (2021) 70% reimbursement for five years, 100% for social prescribing link workers

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Digital Improvements

Access to online and video consultation for all patients by April 2021 Online access to full medical record by April 2020 Electronic ordering of repeat prescriptions and electronic repeat dispensing from April 2019 Electronic ordering of repeat prescriptions and electronic repeat dispensing from April 2019 25% of appointments bookable online by July 2019 Up to date and informative online presence for practices by April 2020

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Network Specification

  • 1. Structured medications review and
  • ptimisation
  • 2. Enhanced health in care homes
  • 3. Anticipatory care
  • 3. Anticipatory care
  • 4. Personalised care
  • 5. Supporting early cancer diagnosis
  • 6. CVD prevention and diagnosis
  • 7. Tackling neighbourhood inequalities
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Non-Clinical Workforce Clinical Skill Mix GP Support

Care Navigation / Social Prescribing / Health Coaches Active Signposting Workload Filtering Nursing / ANP Versatile GP GP Training Capacity Transitional GP – ‘First Fives’ Clinical Pharmacists Physician Associates Nursing Associates First Contact Physios Paramedics End-of-Career GP Support PM Support & Training Online Consultations

Primary Care Transformation Programme

Organisation Development PCN Development Workforce Development GP Support Cascading Good Practice

Combining Back Offices Legal Advice Peer Support Networks Super User Networks Academic Half Days Chislehurst & Woodlands Penge Collaboration Crays Collaboration Established Forums Crown Medical Digital Transformation

Leadership Development