SWL Primary Care at Scale 9 th May 2018 Start well, live well, age - - PowerPoint PPT Presentation

SWL Primary Care at Scale

9th May 2018

Start well, live well, age well

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• Att. 5(i)

What we want to present today

• The SWL case for change; the issues general practice is currently facing, and what

needs to be addressed to move to a thriving future state

• The SWL framework for primary care at scale; our overarching framework which

has been developed and tested bottom up with practices and which all CCGs are working to implement

• Our plans for delivery; setting out the areas we will focus on in 18/19 and why we

have chosen these, how we will oversee delivery, and what will be different in six and twelve months’ time

2

THE CASE FOR CHANGE

3

Primary care now – Surviving?

Workforce:

• Inability to recruit

to most staff groups

• Significant

proportion of SW London primary care staff coming up to retirement age

Estates and IT:

• Many practices
• perating out of poor

estate

• Lack of investment

and fragmentation in IT systems and support

Quality Issues Demand:

• Patient expectations
• Frailty and complexity
• Shift of care from acute to

primary care

Financial:

• Funding not kept pace

with demand

• Rising cost of provision

4

Primary care future – Thriving!

Workforce:

• New roles
• Supported,

empowered workforce

• Feeling valued

Estates and IT

• New commitment to

primary care estate

• Online General Practice
• System interoperability
• Safe sharing of data and

information

Quality of Care, good clinical governance and systems of clinical quality improvement Demand

• Self-management, education,

prevention, social prescribing

• Technology solutions
• Alternative operating models

Financial

• Transformation funding
• Operating at scale to

reduce costs

Resilient general practice,

• perating at scale

and harnessing

• pportunities

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THE SWL FRAMEWORK FOR PRIMARY CARE AT SCALE

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We have developed a framework for primary care at scale in SWL

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Most complex patients Primary care network – 30-50k patients

At scale MDT working with community services and social care – “locality teams” – key mechanism for integrating services

Core general practice unit – 7-10k patients

Sufficient scale to enable safe rotas and cover, and to utilise a skill-mixed clinical team Small enough to retain knowledge of individual patients to ensure clinical efficiency and personalised care

Staff work across these functions, coordinated to ensure continuity for patients

Borough level – 200-400k patients

At scale services to support core primary care e.g. quality improvement Could have a role in coordination of primary care networks

Integrated care system

Primary care at the centre of a wider integrated care system

Primary care “voice” in the ICS through Clinical Leadership, Federations / primary care networks

Management functions– 30k plus patients Provision of back office functions at scale across practices, improving efficiency and reducing costs

This framework will change how primary care works in the future

Current landscape in East Newland*

• Population of 50k served by 8 practices, a

mix of single handers, small practices and

• ne larger practice
• Each individual list-based practices and

partnerships

• Variable access and quality across

practices

• Increased numbers of working age adults

accessing urgent care through ED

• Workforce, morale, recruitment and

estates issues; resilience/failing practice issues

• New risks from private online GP

providers (making current business model unviable)

Future landscape in East Newland

• Population of 50k served by primary care

network, with shared strategy and leadership

• GPs and primary care professionals working

in clinical teams with around 8k population, providing continuity of care

• Locally defined complex patients in MDT
• Patients triaged and treated according to

need, using range of F2F and online tools; all patients get same day access if wanted

• Equitable access to comprehensive service
• ffer across population
• Resilience in model with greater staffing,

leadership and proactive/reactive ability

• GP and primary care workforce have

increased satisfaction and work-life balance; better recruitment and retention rates

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* fictional location!

OUR PLANS FOR DELIVERING THIS CHANGE

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Our plans are based on bottom up engagement with practices and providers

• We believe that primary care at scale will only be successful if it is driven by general practice
• CCGs have invested time and resource in engaging with practices to understand how they want to work together

in the future and how the transformation resource can best support this

• CCGs have tested our emerging framework with a number of local groups and feedback is generally positive;

practices are beginning to recognise there could be benefits of working in this new way

All Croydon GP Networks, Croydon GP Open Meeting (all practices), Croydon Primary Care Commissioning Committee

In addition, there has been engagement at SWL level with London LMCs, the SWL patient reference group, and discussions on primary care through the SWL grass roots engagement programme

Sutton Plenary of Members, Sutton practice managers forum, all locality groups, Sutton practice nurses forum, locality leads meeting, Sutton Primary Care Commissioning Committee, LMC, Sutton Federation Merton CCG clinically led workshops, Merton Federation strategy away days with representation from all practices, Merton practice managers forum, further engagement with CLCH, LA, CEPN, PPGs, Merton Voluntary Services Council Richmond Primary Care Committee, Richmond GP Alliance, Surrey and Sussex LMC Kingston Primary Care Committee, Kingston Council of Members, Kingston GP Chambers, Surrey and Sussex LMC Wandsworth locality forums, Wandsworth whole members forum

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We are not starting from scratch; we have already delivered initiatives which contribute to our primary are at scale vision

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• Six federations that are co-terminus with CCGs; whilst at

varying stages of development they deliver a range of services including extended access, MSK and enhanced care planning

• Most practices are members of their federations, and

there is engagement with membership

• Federations have been established as organisations with a

leadership structure

• All federations have a board of directors, including clinical

and non clinical members

• Information sharing agreements are in place across CCGs

and there are systems in place to support cross borough services such as extended access

• ETTF is supporting development of IM&T systems to

support interoperability

• Purchasing of software licenses to enable cross
• rganisation booking (around access)
• The resilience programme has involved federations/CEPNs

contacting practices to understand their needs and issues

• Local practice manager handbook in development to

support practices managers

• Skill-mix audit and vacancy audit has been completed by a

number of practices across SWL

• Clinical pharmacists working at scale to support changing

skill mix and ways of working

• Work to standardise induction and training packages for

practice nurses

• Wandsworth Federation runs a quality improvement

service to support practices with CQC requirements

• Social prescribing services being piloted in a number of

CCGs

• “Time for Care” programme which is supporting practices

to look at more efficient ways of working

• Workflow optimisation training for practices

Federations IT systems Workforce development Quality improvement at scale

We have self-assessed against our framework and identified the following areas of focus

12 Our engagement has shown that the key part of the framework which needs development is the “primary care networks”. Practices and CCGs have identified the following areas which they are interested in working on in 18/19, to support development of primary are networks: 1) Population based comprehensive care: focussing on the development of locality MDT working, ensuring the primary care networks are working at scale to meet the needs of their population. This is a key mechanism for delivering integrated care 2) Organisational capabilities: exploring opportunities for delivering back office functions at scale across a primary care network. This could involve IT, HR and a range of other admin functions 3) Workforce and wellbeing: understanding the current workforce skill mix, and vacancies, across a primary care network and exploring how the workforce could be deployed differently. Empowering the workforce and supporting them to think about opportunities for working differently, as well as exploring opportunities for at-scale schemes to improve workforce wellbeing

Most complex patients Primary care network – 30-50k patients At scale MDT working with community services and social care – “locality teams” – key mechanism for integrating services Core general practice unit – 7-10k patients

Sufficient scale to enable safe rotas and cover, and to utilise a skill-mixed clinical team Small enough to retain knowledge of individual patients to ensure clinical efficiency and personalised care Staff work across these functions, coordinated to ensure continuity for patients

Borough level – 200-400k patients

At scale services to support core primary care e.g. quality improvement Could have a role in coordination of primary care networks

Integrated care system

Primary care at the centre of a wider integrated care system Primary care “voice” in the ICS through Clinical Leadership, Federations / primary care networks Management functions– 30k plus patients Provision of back office functions at scale across practices, improving efficiency and reducing costs

We have self-assessed against our framework and identified the following areas of focus

13 The areas which practices identified for development through our engagement work align to the areas identified through an internal self-assessment against the SCF development framework. 1) Population based comprehensive care: this is an area of early stage development and therefore an area to ensure we see rapid progress 2) Organisational capabilities: this is an area of early stage development. We see this as a fundamental building block of other areas of the framework and it is therefore important that we make progress on this area in 18/19 3) Workforce and wellbeing: this is an area where work is already more established and can therefore act as a springboard to help move forward at pace. It is also a key challenge for most of our practices so forms a common goal / area of need which can help bring people together We also self assessed at being “early stage” in effective governance and system partnership. However, we feel that progress in these areas will be more difficult until we have some more of the building blocks in place. Development of these areas of the SCF framework are therefore likely to follow in 19/20, which also aligns to the timescale over which wider SWL ICS conversations will be taking place.

Pop based comprehensive care Systems and information Quality improvement Organisational capabilities Workforce and wellbeing Effective governance System partnerships Mid stage Early stage Advanced stage

These are some examples of what we will deliver in 18/19 to drive change

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• “Working at Scale Conferences” to continue engagement

with practices and reinforce the opportunities of Working at Scale

• Leadership development to support development of primary

care networks and further development of Federations

• Analysis of current General Practice Back Office functions

and development of future integrated Back Office operating model, building on scoping work in 17/18

• Continued development of extended access services to

integrate into wider urgent care system

• Public health profiles produced for primary care networks, to

better understand health needs and identify areas which primary care networks should focus on

• Using the information from the profiles, networks will begin

to identify areas of focus for service development

• Support to ensure profiles are developed and data is shared

in a safe way, compliant with General Data Protection Regulations

• Work with networks to complete workforce mapping and gap

analysis, and develop recruitment and retention plans, aligned to SWL workforce projects

• HR advice and production of standard documents to support

employment across practices

• Continued roll out of clinical pharmacist roles; successful bids

throughout SWL have encouraged practices to start forming networks of collaborative working and provided a foundation for practices to share members of staff across multiple organisations

• Work with lead nurses to explore opportunities for a practice

nurse “bank” to support at scale working

• Legal services to produce MOUs and other documents

required to enable collaborative working across networks

• Programme and Project Managers to facilitate change in

primary care networks and share learning across SWL

• Review of IT Infrastructures, including making safe existing

and new data sharing agreements, compliant with General Data Protection Regulations

• Roll out of Online Consultation services, including video

consultations to help networks manage demand in new ways

• Digital interoperability phase 1 and business case for phase 2

Organisational capabilities and development Population based comprehensive care Workforce Enablers

Detailed CCG level transformation initiatives can be found in Appendix 1

• In SWL we have taken an open and transparent approach to agreeing how the transformation

money will be split across CCGs

• We held a SWL Committee in Common meeting in public on 27th March 2018
• The Committee in Common agreed an approach based on “levelling up” the amount of

transformation funding each CCG will receive in 18/19

• Each CCG will receive £5.41 per head, to deliver extended access services and drive primary care

at scale transformation

• All our funding will be allocated to CCGs to drive our bottom up approach to transformation;

where it makes sense to do so, we will pool funding to make better use of our resources

• SWL are not seeing this transformation money as isolated funding; we are using it to align and

complement other funding sources so that we make progress at pace towards our vision. More information on this can be found in Appendix 2

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The SWL Committee in Common has agreed how the transformation funding will be allocated across CCGs

16 CCCG KCCG MCCG RCCG SCCG WCCG SWL Transforming Primary Care Delivery Group SWL Alliance SMT

• The SWL TPC DG brings together CCGs,

providers, LMC and other stakeholders to drive delivery of the TPC programme

• This forum will provide opportunities for

collaborative working, and will review progress and options for accelerating transformation over the next 12 months

• Spend and delivery will be monitored on an
• ngoing basis by the SWL Alliance SMT

We have the infrastructure and governance in place to deliver our plans

• CCGs will follow local governance

arrangements to oversee the development

• f local plans
• This will support our bottom up approach to

development and implementation

What we will have delivered by month 6 and month 12

Phase 1: Months 1-6

• Practices will recognise the network that they belong to, and understand the demographics of their population
• Networks will have identified their area of focus for development e.g. delivery of back office functions, workforce

planning

• Federations will understand how they can work with their networks to deliver patient improvement initiatives,

and initiatives to support resilience and sustainability of practices

• Local leaders will be identified and have a vision for supporting the delivery of primary care at scale in their

network Phase 2: Months 6-12

• Federations will have an overview of the needs of their networks, both in terms of patients as well as their

practices and primary care staff

• Networks will have identified opportunities for working at scale and have plans in place for these areas; pilots

will have started in some networks

• There will be an infrastructure for federations to deliver activity through networks or practices
• The whole system will be familiar with their local primary care at scale plans

Phase 3: 19/20

• Now that networks are in place, learning from the models across SWL will be shared to accelerate further

implementation and spread of working at scale initiatives

• Improved patient outcomes through practices working collaboratively to address population health issues, and

through reduction in practice variation

• Improvement in staff wellbeing and retention; workforce will feel empowered and supported

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We have thought about what success looks like for commissioners, providers and patients. We have had some initial thoughts about how we will measure success, to ensure we are delivering the expected benefits. This will be further co-produced with practices as each CCG rolls out their transformation initiatives.

Commissioning is on a population health based approach. Providers can deliver services more efficiently through economies of scale Delivery of the high quality proactive, coordinated and accessible care

• Practices are resilient and

sustainable, as a result of collaborative working to manage risks and issues

• The workforce is well supported

and there are opportunities for learning and development, to improve recruitment and retention

• Patients have equal access to high

quality primary care services regardless of the practice where they are registered

• Patients have access to a broader

range of skills in general practice

Commissioner Provider Patient

• Improved CQC performance
• Staff satisfaction survey
• Reduction in administrative

workload

• Improved patient satisfaction
• Improved carer satisfaction
• Increased ability to self manage

Outcome KPIs

• Improvement in patient access
• Improved CQC performance
• Reduction in variation in LTC

management

• Reduction in inappropriate A&E

attendances

We will measure our success to ensure we achieve the expected outcomes

APPENDIX 1 CCG TRANSFORMATION FUNDING INITIATIVES

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Area of focus Amount Progress by Month 6 Progress by Month 12 1 OD Working at Scale Conferences to reinforce the opportunities of Working at Scale. £20,000

• 1. First wave of practices have identified

synergies for Working at Scale.

• 2. First wave of practices providing peer

support to second wave of practices.

• All Croydon practices having had OD support to

develop and deliver Working at Scale

• capability. This will enable greater capacity for

practices to focus on Working at Scale. 2 Backfill for practices who are interested in Working at Scale to attend/engage in meetings with peers in Croydon networks. £30,000

• Established GP champions who will drive

identification of operating model changes in their practices (i.e. skills audit, population health, patient flows etc).

• Implementation of identified Working at Scale
• perating model will have been tested with

lessons learned for Croydon peers. 3

• 1. Recruitment
• 2. Croydon GP Collaborative Staff
• Working at Scale Programme Manager x 2
• Working at Scale Project Officers x 2

£5,000 £210,000

• Advertised, interviewed and recruited

staff.

• Staff in place delivering Working at Scale plans.

4 Accelerating leadership development for the new Croydon Primary Care networks to support Working at Scale (as current network boundaries will change). £25,000

• Agreed new network boundaries and

established new network leaders.

• Network leaders ensuring Working at Scale

plans are delivered at pace. 5 Workforce

• Training/upskilling of current General Practice workforce.

£15,000

• Identification of staff requiring skill mix.
• Skill mix training completed.
• Upskilled clinical care delivery post training

based upon population health 6 Enablers IT Infrastructure

• Enterprise-wide IT platform
• Enterprise-wide telephone solution
• Enterprise-wide EMIS integration
• System-wide interfacing with partners (access/Urgent Care)

£300,000

• Analysis and design of IT infrastructure
• IT infrastructure implemented

Total Investment £605,000

Transformation funding initiatives - Croydon

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Transformation funding initiatives – Kingston

Organisational capabilities Amount Progress by Month 6 Progress by Month 12 1 Engagement with practices - to scope work around sharing back office functions

• Federation to engage with practices to identify at scale back office function
• Initiatives for shared back office functions developed.

£30,000

• Scoping work completed and agreement
• n areas for joint working
• Implementation plan for delivering shared back
• ffice functions in place

2 Implementation of primary care at scale – pilot PCAS initiatives Q2/Q3, workforce development etc.

• Identify initiatives for at scale working based on population health needs
• Develop network plans for implementing PCAS initiatives.

£30,000

• Scoping work completed and agreement
• n areas for joint working
• Network plans for delivering PCAS initiatives

3 Primary care networks – development of 4 networks aligned to MDT localities, pilot new contract forms, develop performance dashboard

• Exploration of contract models required for PCAS
• Development of dashboard to support PCAS planning

£200,000

• Primary care network 1 of 4 aligned to

MDT locality

• Primary care network 4 of 4 aligned to MDT

locality

• Options for contracting PCAS models shared
• Metrics to be included in dashboard agreed

4 Workforce Strategy – Work with networks to develop recruitment and retention plans, pilot new ways of working across general practices, networks and borough wide, aligned to SWL workforce work

• Skillmix and workforce audit completed
• Gap analysis
• Recruitment and retention plan

£80,000

• Workforce mapping
• Recruitment and Retention plans in place for

19/20 aligned to SWL work

• Gap Analysis of workforce against population

health need 5 Learning and Development - Training to support primary care networks understand PCAS, analyse the data in the performance dashboard, support new ways of working

• Work with federation and CEPN to identify gaps in skills needed for working at

scale

• Commission additional training for working at scale

£40,000

• Training needs identified

Training plans for network 6 Project and Change Management Support - Procurement of expertise, allocation

• f resources, coordination with practices and CCGs, contract support, monitoring

and reporting, evaluation INCLUDE PROJECT MANAGEMENT IN OTHER SECTIONS £25,000

• Strong project management in place, with

progress being made according to plans

• Strong project management in place, with

progress being made according to plans Total Investment £405,000

Transformation funding initiatives - Kingston

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Transformation funding initiatives – Merton

Area of focus Amount Progress by Month 6 Progress by Month 12 1 Governance Refresh MHL Governance to reflect membership mandate and each PCH (Each

• f the four primary care networks)

£25,000

• New integrated governance framework and

board assurance framework

• Identify working groups within each PCN
• Aligned federation board member and clinical

directors within each PCN 2 Comms and engagement Comms and engagement strategy to include all internal and external stakeholders £25,000

• Development of strategy
• Implementation of agreed strategy

3 Workforce Skills gap analysis (Use of STP workforce tool, Eden bridge apex software tool and input from Merton CEPN £25,000

• PCN recruitment and retention plan

(development)

• PCN recruitment and retention plan

(implementation) 4 Workforce Staff bank with subsidiary PCN banks £10,000

• Enhanced staff bank and reduced vacancy and

locum rates (development)

• Enhanced staff bank and reduced vacancy and

locum rates (implementation) 5 Workforce Achieve functional alignment of HR, Health and safety and wellbeing services £10,000

• Consultation with various stakeholders to

agree priorities

• PCN staff handbook, HR policies, Health and

safety and alignment of HR where possible 6 Workforce Development of inter-practice SLAs for the provision of staff/shared staff for an agreed function across PCNs £10,000

• Inter-practice SLAs to support sharing staff

across multiple practice sites. N/A 7 Back office Develop a centralised procurement facility for practices to access £10,000

• Scoping potential opportunities across

Merton

• Development of procurement portal for all

practices

• Agreed process for making new procurement

queries not currently available 9 Population health Develop fit for purpose Health Informatics (e.g. population segmentation data) to identify our population health priorities to develop integrated services for specific cohorts of patients. £10,000

• Population Segmentation Data at 50,000

patient level. i.e. Locality and Borough Level.

• Population Segmentation Dashboard Delivery

10 PILOT: Acute GP Home visiting service. Development of medical model and business case £10,000

• An acute Home visiting GP Service will be

delivered.

• Partnerships will be developed to support early

discharge, intermediate care bed work etc.

Transformation funding initiatives - Merton

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Area of focus Amount Progress by Month 6 Progress by Month 12 11 Service delivery Proactive Care Home Ward Rounds. Back-fill required to develop medical model and business case. £10,000

• Develop business model
• Improved patient experience
• Reduced A&E attendances, LAS conveyances

and LOS.

• Improved partnership working between

providers 12 Service delivery Same day access model across pilot sites £20,000

• Work with current provider, CCG and

practices to agree pilot sites and new model

• Begin pilot of first PCN site for same day access

13 Workforce Delivery of the Merton Clinical Pharmacist Programme. Back-fill required supporting with mobilisation. £9,000

• Agree SLAs and working groups
• Begin implementation

14 Leadership Upskill practice managers to support PCAS £28,000

• 8 places (2 per PCN) for practice managers to

undertake a 1 year diploma in advance primary care management

• Completion of 12 month advanced diploma

15 PILOT: Develop and deliver a PCN primary care based integrated paediatric & geriatric clinics. Back-fill required for stakeholder engagement, to develop medical model and business case. £30,000

• Scoping and working up PCNs
• Begin stakeholder engagement and develop

medical model business case 16 OD Member practice engagement in at scale working – including facilitation for working groups and stakeholder engagement £97,000

• Begin cycles of engagement with practice managers and clinicians to ensure there’s buy-in to at

scale working 17 Back office Legal, HR and finance advice - enable delivery of all workstreams and support the development of MHL as a PCAS provider organisation £25,000

• Identify projects, working groups and practice

groups.

• Agree partnerships between PCNs, Federation

and CCG

• Continued support from HR, Finance and legal

firms to enable delivery and management of PCAS services Total Investment £354,000

Transformation funding initiatives - Merton

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Transformation funding initiatives – Kingston

Area of focus Amount Progress by Month 6 Progress by Month 12 1 Implementation of primary care at scale – pilot PCAS initiatives Q2/Q3, workforce development etc.

• Identify initiatives for at scale working based on population health needs
• Develop network plans for implementing PCAS initiatives.

£20,000

• Scoping work completed and agreement
• n areas for joint working
• Network plans for delivering PCAS initiatives

2 Workforce Strategy – Work with networks to develop recruitment and retention plans, pilot new ways of working across general practices, networks and borough wide, aligned to SWL workforce work

• Skillmix and workforce audit completed
• Gap analysis
• Recruitment and retention plan

£90,000

• Workforce mapping
• Recruitment and Retention plans in place for

19/20 aligned to SWL work

• Gap Analysis of workforce against population

health need Total Investment £110,000

Transformation funding initiatives - Richmond

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Transformation funding initiatives – Sutton

Area of focus Amount Progress by Month 6 Progress by Month 12

1

Leadership Establish Programme Office Building on the successes of the Sutton Health and Care at Home programme, we would want to engage PPL Consulting to set up and run the Programme Office £100,000

• Detailed programme plans in place
• Business case setting out plans to mainstream

at scale projects in 2019/20

2

Workforce Development Delivery team (2 x B8A) responsible for working with practices to identify and pilot at scale projects £130,000

• Appointed 2 Delivery Managers
• Identified projects to mainstream based on

initial pilots

3

MDT Development Case manager nurse (2 x B7) – in addition to the 2 x B7 in existing contract. This is to drive forward MDT working across all localities. £115,000

• Appointed additional nurses, 4 in total to

lead proactive MDTs

• Developed the Sutton Health and Care
• ptimum model for MDT working across Sutton

Health and Care bringing together the proactive and at Home work programmes

4

Workforce Development Engagement by GP Federation £20,000

• Proposal developed for shared staffing at

scale

• Proposal developed for shared business

services with delivery plans in place

5

Organisational Development Commission expert support to show case what has been achieved elsewhere through exemplar sites. £50,000

• 2 Engagement Workshops delivered with

commitments to pilot new ways of working eg spirometry hubs

6

Contract Development Legal guidance regarding contracting options £20,000

• Scope opportunities for MCP contracting

model

• Options for contracting forms considered by

Governing Body

7

MDT Development Operational support for integrated cross-organisational working (2 x B5) £80,000

• Administrative support to MDT process
• Effective MDTs operating in each locality

8

Patient & Public Engagement Communication and engagement £20,000

• Testing patient and staff experience of

new projects

• Reshaping delivery based on feedback and

recommendations presented to inform the business case Total Investment £535,000

Transformation funding initiatives – Sutton

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Transformation funding initiatives – Wandsworth

Area of focus Amount Progress by Month 6 Progress by Month 12 1 Workforce Development and Retention £45,000

• Develop (in conjunction with CEPN) a

diverse recruitment and retention strategy.

• Develop an online sessional GP pool

enabling practices to source sessions directly reducing agency spend and maintaining a consistent temporary workforce

• Develop standardised recruitment,

induction, and training materials supporting a positive and structured experience for the candidate at the outset

• Implementation of agreed strategy
• Agile working implemented at PCNs level
• Develop a practice manager preceptorship

programme to support new practice managers 2 Project Management Programme management lead role to manage project documentation. This will incorporate the workforce SME role plus governance and BI SMEs. £143,000

• Employment of 1 Programme manager/SME to lead governance and project assurance
• 2 SME workstream leads – workforce and & BI

3 Working Groups Practice representatives who will be responsible for reviewing, recommending, and implementing the agreed solution. £30,000

• Identified working group members
• Clear evaluation process and TOR
• Implementing agreed plan with identified

working group members 4 Practice Protected time Back fill hours (based on patient capita) for practices to enable PCAS discussions / specialist support e.g. facilitators. £107,500

• Develop PCN plans collectively with PCN

members

• Initiating plans as PCNs
• Identifying areas of clinical focus
• Engaging with members of PCN and federation
• Working with all stakeholders – including LMC,

CCG etc 5 Quality system Quality system expertise and systems (policies, procedures, etc) which will require significant oversight / administration support. £50,000

• Standardised policy and procedure

directory

• Establish the governance framework
• Ensuring agreed policy and procedure directory

and governance framework are being implemented

• Explore local apprach to DNAs and entry into

PC via other NHS pathways

Transformation funding initiatives - Wandsworth

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Area of focus Amount Progress by Month 6 Progress by Month 12 6 Legal & Finance Advice External professional advice and guidance (e.g. contracts). £17,500

• Identify projects, working groups and

practice groups.

• Agree partnerships between PCNs,

Federation and CCG

• Continued support from Finance and legal firms

to enable delivery and management of PCAS services 7 Procurement Development of centralised purchasing, directory of suppliers, etc £10,000

• Directory of suppliers
• Identify procurement vehicle to support

delivery of PCAS

• Develop working relationships with NHS agency

EG NHS property service, NHS pensions etc. in conjunction with SWL HCP 8 Nurse Training – workforce Nurse training development £20,000

• Develop 5 year plan in accordance with

GPN 10-point plan

• Identify specific staff who want to

develop

• Developing new out-of-hospital pathways with

a greater range of nurse-led services available to patients in a nearby practice. Eg epilepsy, diabetes, etc 9 GP Network Pilots Business Intelligence, back office and diabetes hub pilots £20,000

• Create a GP network to enable non-

participating clinical correspondence practices to be supported by participating clinical correspondence practices to deliver the solution.

• Scope BI
• Diabetes hubs go-live
• BI roadtesting – working with PCN to evaluate

the data 10 GP Network - Leadership and Governance GP networks leadership structure and a robust governance framework £94,500

• Exploring the challenges faced by

practices at PCN level

• Develop a leadership structure which

includes existing structures identifying the gaps which require new or increased resource

• Establish a strategy that is clinically-led,

informed by system engagement and includes SMART objectives where appropriate

• Strategy is available and understood

throughout the organisation

• Identify any recurrent funding needs and how

this will be me Total Investment £537,500

Transformation funding initiatives - Wandsworth

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APPENDIX 2 OTHER FUNDING SOURCES SUPPORTING PCAS

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Funding source How this is supporting primary care at scale

Resilience Programme Practice support delivered at scale by federations and CEPNs. Scoping of back office functions and workforce needs across vulnerable practices, and development of at scale solutions. Medical Assistant and Care Navigator Training Programmes designed and delivered at scale across boroughs to standardise processes to facilitate collaboration across practices. Care navigation being offered at a network level in some areas. Online consultation Initiatives are being sourced for delivery at scale, with primary care leading on developing the appropriate solutions for their population Provider Development Funding (GPFV £3ph) Supporting at scale working in a variety of ways including; development of social prescribing models, at scale clinical pharmacy team, health education and coaching, at scale Quality Improvement services Locally commissioned services LCSs are also being used to support at scale working e.g. over the next 6 months one CCG will be commissioning practices to work at scale to deliver education programmes, and commissioning an at scale respiratory diagnostic service Commissioning approaches For example, Kingston Medical Services brings together locally commissioned services into a single contract which supports at scale working. Wandsworth CCG have commissioned an MCP, which is led by the Federation. In Sutton CCG, there is a PMS Premium KPI for Locality Development Scheme which means every practice is contracted to actively participate in development of at scale plans and delivery of MDTs

29 In SWL, we are not seeing the transformation money as an isolated funding source. We are using other funding sources to drive delivery of primary care at scale, to ensure all our resources are supporting the same strategic vision. This table gives some examples of other funding sources supporting primary care at scale.

We are using other funding sources to support primary care at scale

APPENDIX 3 HOW OUR FRAMEWORK ALIGNS TO SCF NEXT STEPS

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SCF development framework area How will primary care networks support delivery of this SCF area? How will borough level services support delivery of this SCF area? Pop based comprehensive care Clinical leadership has responsibility for performance, patient outcomes and reducing clinical variability across all practices. Consistent clinical pathways, administrative processes and appointment type mean that all populations experience the same quality of access and care

• Practices in a PCN will align their

processes

• PCNs will plan and design MDTs

based on their combined workforce and population need

• Wider skill mix across PCN will

give patients options around appointment type to better meet need

• Borough level responsibility to

analyse population health

• utcome information
• Support planning and delivery
• f care to meet patient need

Systems and information Comprehensive, accurate and real time data reflecting patient needs, performance, quality and

• utcomes is available at different scales of the
• system. Information is the basis for operational

delivery, including workflow optimisation, capacity planning and demand management

• PCNs receive information on

performance to support workforce planning from borough level analytics

• Analyse and interpret

information on patient needs, performance, quality and

• utcomes to make

improvements. Quality improvement Patient centred QI methodology and approach is embedded within the culture, practiced by all staff across all practices. Continuous improvement of the quality, safety and efficiency of services takes place as part of every day operations as well as transformation projects

• Practices in a PCN will work with

borough level provider to engage

• n quality improvement and

make continual improvements to services

• There will be a borough level

approach to quality improvement, engaging with practices through PCNs

Our framework aligns to the SCF development framework

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SCF development framework area How will primary care networks support delivery? How will borough level services support delivery? Organisational capabilities Fully formed business capabilities, constituted of robust systems and processes and resourced by professional experts. Legal advice, procurement and financial expertise is readily available to support service development and contractual decisions

• Alignment of back office

functions across PCNs to ensure practices have access to legal, financial expertise etc NA Workforce and wellbeing Policies, procedures and contracts are consistent, so that all staff are treated and supported equitably. This is reinforced by specialist HR expertise, able to advise and support staff in areas such as appraisal, work plans, pay and performance HR also works with senior leaders to plan to workforce needs of the

• rganisation and implement a recruitment and

retention strategy to meet them

• Practices in a PCN will align their

policies and procedures

• Workforce planning across a PCN

to support efficient use of resources and retention of staff

• Understands the workforce and

skillmix of practices and coordinates activities relating to recruitment and retention and staff wellbeing Effective governance Robust governance structures are in place and understood by shareholders and stakeholders. A multidisciplinary, highly skilled executive team is in place with representation from each practice / network.

• The PCNs will have a clear

relationship with the leadership teams of the borough level

• rganisations
• Multidisciplinary organisation
• that represents the needs of

their practices and population, and has the mandate to work in this way System partnerships Having coalesced into a well formed, mature

• rganisational form, the leadership team is

empowered to speak with a strong voice on behalf of all constituent practices with an ICS. Acts as a leader

• f population health and care alongside system

partnership, including informing the work of commissioners

• The PCNs will have a clear

relationship with the leadership teams of the borough level

• rganisations
• Mandate from practices to

represent them at system level forums and in ICS discussions

Our framework aligns to the SCF development framework