Att. 5(i) SWL Primary Care at Scale 9 th May 2018 Start well, live well, age well 1
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? Demand: Financial: Patient expectations • Funding not kept pace • Frailty and complexity • with demand Shift of care from acute to • Rising cost of provision • primary care Workforce: Estates and IT: Inability to recruit • Many practices • to most staff groups operating out of poor Significant • estate proportion of SW Lack of investment • London primary and fragmentation in care staff coming IT systems and up to retirement support age Quality Issues 4
Primary care future – Thriving! Demand Financial Self-management, education, Transformation funding • • prevention, social prescribing Operating at scale to • Technology solutions reduce costs • Alternative operating models • Estates and IT Workforce: Resilient general practice, New commitment to • New roles operating at scale • primary care estate Supported, • and harnessing Online General Practice • empowered System interoperability • opportunities workforce Safe sharing of data and • Feeling valued • information Quality of Care, good clinical governance and systems of clinical quality improvement 5
THE SWL FRAMEWORK FOR PRIMARY CARE AT SCALE 6
We have developed a framework for primary care at scale in SWL Integrated care system Primary care “voice” in the ICS through Clinical Leadership, Primary care at the centre of a wider integrated care system Federations / primary care networks 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 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 Most complex patients Management functions– Staff work across these 30k plus patients functions, coordinated to Provision of back office ensure continuity for patients functions at scale across practices, improving efficiency and reducing costs 7
This framework will change how primary care works in the future Future landscape in East Newland Current landscape in East Newland* Population of 50k served by primary care Population of 50k served by 8 practices, a • • network, with shared strategy and mix of single handers, small practices and leadership one larger practice GPs and primary care professionals working • Each individual list-based practices and • in clinical teams with around 8k population, partnerships providing continuity of care Variable access and quality across • Locally defined complex patients in MDT • practices Patients triaged and treated according to • Increased numbers of working age adults need, using range of F2F and online tools; • accessing urgent care through ED all patients get same day access if wanted Equitable access to comprehensive service Workforce, morale, recruitment and • • offer across population estates issues; resilience/failing practice Resilience in model with greater staffing, issues • leadership and proactive/reactive ability New risks from private online GP • GP and primary care workforce have • providers (making current business model increased satisfaction and work-life balance; unviable) better recruitment and retention rates * fictional location! 8
OUR PLANS FOR DELIVERING THIS CHANGE 9
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 Wandsworth locality forums, Richmond Primary Care Committee, Wandsworth whole members forum Richmond GP Alliance, Surrey and Sussex LMC 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 Kingston Primary Care Committee, Council Kingston Council of Members, Kingston GP Chambers, Surrey and Sussex LMC All Croydon GP Networks, Croydon GP Open Meeting (all practices), Croydon Sutton Plenary of Members, Sutton practice Primary Care Commissioning Committee managers forum, all locality groups, Sutton practice nurses forum, locality leads meeting, Sutton Primary Care Commissioning Committee, LMC, Sutton Federation In addition, there has been engagement at SWL level with London LMCs, the SWL patient reference group, 10 and discussions on primary care through the SWL grass roots engagement programme
We are not starting from scratch; we have already delivered initiatives which contribute to our primary are at scale vision Federations IT systems • Six federations that are co-terminus with CCGs; whilst at • Information sharing agreements are in place across CCGs varying stages of development they deliver a range of and there are systems in place to support cross borough services including extended access, MSK and enhanced services such as extended access care planning • ETTF is supporting development of IM&T systems to • Most practices are members of their federations, and support interoperability there is engagement with membership • Purchasing of software licenses to enable cross • Federations have been established as organisations with a organisation booking (around access) leadership structure • All federations have a board of directors, including clinical and non clinical members Workforce development Quality improvement at scale • The resilience programme has involved federations/CEPNs • Wandsworth Federation runs a quality improvement contacting practices to understand their needs and issues service to support practices with CQC requirements • Local practice manager handbook in development to • Social prescribing services being piloted in a number of support practices managers CCGs • Skill-mix audit and vacancy audit has been completed by a • “Time for Care” programme which is supporting practices number of practices across SWL to look at more efficient ways of working • Clinical pharmacists working at scale to support changing • Workflow optimisation training for practices skill mix and ways of working • Work to standardise induction and training packages for practice nurses 11
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