Neighbourhoods / Primary Care Networks and Long Term Plan February - - PowerPoint PPT Presentation

Oxfordshire Clinical Commissioning Group

Neighbourhoods / Primary Care Networks and Long Term Plan

February 2019

Oxfordshire Clinical Commissioning Group

Purpose

• This slide deck provides an update on the implications
• f the Long term plan published 7 January 2019 with

specific reference to Primary Care and primary Care Networks

• It takes into account the Operational Planning and

Contracting Guidance and the newly published five year framework for GP contract reform to implement the Long Term Plan

• Content is intended to provide highlights not a full

summary of all content

Oxfordshire Clinical Commissioning Group

Oxfordshire

Oxfordshire Clinical Commissioning Group

City Locality

City Central Neighbourhood total 55,372 City East Neighbourhood total 43,066 City Headington Neighbourhood total 43,391 City North Neighbourhood total 46,983 City East Neighbourhood total 40,824 Locality total As of 01/01/2019 229,636

Oxfordshire Clinical Commissioning Group

City Locality

City North

Summertown Health Centre 17,359 Banbury Road (172) 9,125 Observatory Medical Practice 11,370 Jericho Health Centre (Leaver) 9,129 Neighbourhood total 46,983

City South East

Donnington HC 13,336 Temple Cowley Health Centre 8,098 The Leys Health Centre 10,459 Hollow Way Medical Centre 8,931 Neighbourhood total 40,824

City Central

Beaumont St (19) 16,016 Beaumont St (27) 7,296 Luther Street Medical Centre 490 Beaumont St (28) 5,719 King Edward Street 5,664 Botley Medical Centre 15,718 South Oxford Health Centre 4,469 Neighbourhood total 55,372

City East

St Bartholomews MC 19,603 Bartlemas Surgery 8,760 St Clements Surgery 5,108 Cowley Road Medical Practice 9,595 Neighbourhood total 43,066 City Headington Hedena Health 26,681 Manor Surgery Headington 16,710 Neighbourhood total 43,391 Locality total As of 01/01/2019 229,636

Oxfordshire Clinical Commissioning Group

Vision from Long Term Plan

Achieved by:

• Boosting ‘out of hospital’ care
• Primary care Networks / Neighbourhoods
• Enhanced staffing and expanded community multidisciplinary

teams

• Care home coverage
• Proactive approach to ageing population
• Increased funding with single designated fund
• Significant changes to QOF
• A new shared savings scheme
• Digital first primary care

Fully integrated community based health care

Oxfordshire Clinical Commissioning Group

Contract Reform Headline changes

• Core general practice funding will increase by £978 million a

year by 2023/24

• Increase to global sum, this year, £109m will be invested into

the ‘core practice contract’ - in subsequent years, core funding will increase significantly

• Indemnity costs for all GPs and practice staff will be funded on

top of the global sum increases every year for the next five years

• A Primary Care Networks (PCN) contract will be introduced

from 1 July 2019 as a Directed Enhanced Service (DES) provision of funds will be at PCN level

• 20,000+ additional staff by 2023/24 - Workforce fund (worth

£900m by 2023/24) to fund practice staff to support GPs

• Digital first and improving access focus

Oxfordshire Clinical Commissioning Group

Primary Care Networks

PCNs - the building blocks for integrated care

• Enable the provision of proactive accessible, co-ordinated

and more integrated primary and community care

• Formed around natural communities based on GP

registered lists

• Serve populations of around 30,000 – 50,000 patients
• Small enough to still provide personal care but large enough

to have deeper impact by collaboration

• Collaboration between practices and others in the local

health (community and primary care) and social care system

• Platform for providers of care being sustainable into the

longer term

• Oxfordshire is using the language of neighbourhoods

Oxfordshire Clinical Commissioning Group

New GP contract - PCNs

Primary Care Networks (PCN) contract will be introduced from 1 July 2019 as a Directed Enhanced Service (DES)

• Technically ‘voluntary’, NHS England and the BMA expect

100% take up = 100% of patient population covered

• To qualify for the funding from July 2019, practices will need

to join networks and appoint a clinical lead

• Financial support of £1.50 per patient – in cash not kind
• Financial support given for the clinical lead role (0.25 WTE per

50k population)

• PCNs will have to work towards seven ‘service specifications’

based on the aims of the NHS long-term plan

Oxfordshire Clinical Commissioning Group

Workforce

• Workforce fund (worth £891m by 2023/24) to fund 20,000+

additional practice staff to support GPs

• Additional role reimbursement scheme from 1 July 2019
• Recurrent for 5 years – no taper or increase (AfC linked)
• networks will receive 70% of the funding to employ additional

roles 100% for social prescriber

• Phased approach:
• 2019/20 pharmacists and social prescribers / link workers
• 2020/21 physician associates and first contact physiotherapists
• 2021/22 Community Paramedics
• This is aimed at additional roles – reimbursement will only be

for demonstrably additional people (not fill existing vacancies

• r subsidise existing staff) [exception for some pharmacists]

Oxfordshire Clinical Commissioning Group

Integrated Working

• Delivery of integrated primary and community health will be

supported by integrated multidisciplinary teams to comprise

• f:
• GPs
• Pharmacists
• District Nurses
• Community geriatricians
• Dementia workers
• Physios
• Podiatrists/chiropodists
• Consideration will need to be given to scale and ways of

working

• Data analysis and population health management functions

will be critical to enabling proactive and preventative care

Oxfordshire Clinical Commissioning Group

Significant changes to QOF

QOF reformed to remove ‘unnecessary indicators’, to bring in ‘clinically-proven improvements’ for the management of prevalent conditions

• QOF currently comprises 559 points; 28 indicators worth 175

points (31% of the complete scheme) - will be retired from April 2019

• 101 points will be recycled into 15 more clinically appropriate

indicators over five areas

• NHS England and GPC England have agreed to replace the

current blunt system of exception reporting with a more precise ‘personalised care adjustment

• The remaining points indicator retirement will be used to

create two one year Quality Improvement modules om 2019/20 prescribing safely and end of life care

Oxfordshire Clinical Commissioning Group

Time table for DES introduction

https://www.england.nhs.uk/wp-content/uploads/2019/01/gp-contract-2019.pdf

Oxfordshire Clinical Commissioning Group

Points to consider

• Network arrangements
• Benefits of delivery some aspects of work at scale
• Integration with wider community services including

mental health and social care

• Employing arrangements
• Support and enabling role of Federations
• The network agreement is the formal basis for working

with other community based organisations – wide membership

• PCNs are the building blocks of integrated care
• All network contracts within a CCG will be confirmed at

the same time

Oxfordshire Clinical Commissioning Group

To leave you with

• Some pump priming money to support some of

these initial conversations and discussions

• Working together
• Required infrastructure
• Workforce implications
• Digital opportunities
• Wider content covers much more
• GP salary transparency
• Employer pension contributions
• Personal pensions
• Joining up the urgent and emergency care system
• Digital access and enablement