The Adventures of General Practice in Primary Care Land David - - PowerPoint PPT Presentation

The Adventures of General Practice in Primary Care Land

David Wingfield General Practitioner Chairman of Hammersmith and Fulham GP Federation Hon Senior Lecturer Imperial College

Or ……. A Hammersmith and Fulham response to a national challenge

Primary care as a speciality

• All of medicine in one professional discipline

– Updating knowledge

• Whole population
• Urgent care and long term condition

management But also …

• Personal holistic care

Organisational dilemmas

• GP Business realities

– independent contractor status – Regulation – Working in and running it – Crises through lack of business skill – HR and skillmix – Gp accounts and business models

• NHS costs- Commissioner pressures to contain

cost, increase access and maintain quality

Some good news:-

• Teaching and quality
• Audit and quality
• Research and quality
• Patient focus to all we do

Further education

Collaborative research

• WelReN funding for a research nurse agreed
• IT available to connect to all clinical records

and to conduct patient level searches

• Potential for NIHR and other research across

the 200,000 registered patients in Hammersmith and Fulham

Today's adventures

• Clinical Commissioning Group strategy and the

Primary care home

• GP Federations as change management
• rganisations
• The new business model and Super Practices
• Accountable care

Hammersmith and Fulham Clinical Commissioning Group strategy and the Primary care home

This document explains the what, why, and how of primary care will improve in Hammersmith and Fulham

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What happens now Our ambition is to harness the energy and ideas of people who deliver and receive care in Hammersmith and Fulham to create a system that works seamlessly for everyone in the borough. This document explains in very practical terms how the changes will benefit patients as well as GPs and other practitioners.

The new approach to providing care in Hammersmith and Fulham will particularly benefit people, including many older people, who rely on a wide range of services

Our headline objective is for accountable – that is end-to-end - care for Hammersmith and Fulham in 2019. Within the limited resources we have, we are aiming for steady but material improvement over coming years. These will be based on sustainable changes in how local GPs and other primary care practitioners work with each other and other services provided across the borough. The end result will be a local care system that uses the collected expertise and compassion of all of our local care organisations to deliver the health and wellbeing outcomes we and our residents want. Dr Tim Spicer Chair, Hammersmith and Fulham CCG Dr David Wingfield Chair, Hammersmith and Fulham GP federation

Our approach is based upon what local people have told us they expect from their services

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A range of people provide my care but they all work together, communicate effectively, and have clear roles that I

• understand. Together, they provide

me with seamless care My GP and his or her colleagues are linked in closely to all the

• ther people and organisations

who provide care for me and support me in other ways I can access care easily and in the way most convenient for me, either in person or by using

• technology. If continuity of care is important to me,

I have this too If I have a care plan, it is developed with me and then used right across all the relevant people who provide me with care My practice works with other organisations to support me to maintain my physical and mental wellbeing – as well as to support me when I am ill My practice is my first point of contact with the local health and care system and provides the network of support for the majority

• f my care needs

More of my care needs can be delivered within primary care, without the need to visit hospital I am supported to understand my condition and to manage more of my own care – but I know where to get support when I need it I have a clear say in how my care is delivered and can access different services by using my personal budget Through my practice’s Patient Participation Group, I can continue to shape how care is provided in my community I am cared for as a whole person rather than a series

• f conditions

I can access the right skills from GPs across my local area – meaning I get the specialist primary care that I need People in Hammersmith and Fulham have been clear about their expectations from local health and care services. The statements below reflect these ambitions and what the CCG and GP federation intend all people in the borough to be able to say about the care they receive. These are based on Wsic and reflect the specifics of the primary care home. What local nuances do we need to work in?

The local approach to primary care will be based around the needs of the different population groups in Hammersmith and Fulham (1)

The CCG and GP federation will respond to local health needs with a population-based approach. This means that they will look at the combined needs of whole groups of people, based on age (such as older people or working-age adults) or health and wellbeing status (such as mostly healthy people or people with complex conditions). This approach helps providers to ensure that services that people need are wrapped around them in a co-ordinated way. As the chart opposite shows, the North West London CCGs are already thinking of their Local Services transformation in terms of how they meet the needs of different groups of people, for example:

• Self-care support, based on different age groups’

needs

• Improving intermediate care and expanding

common discharge arrangements People have different wants and needs depending

• n age and health status. The chart on the page

next shows how some of these needs will be met.

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Source: NWL Local Services team. The cost, spend, and activity information at the bottom of the chart is based on data from a group of Hammersmith and Fulham practices in 2013/14.

Primary Care Medical Home

Working at scale we can provide all the long term or acute services for our patients napc.co.uk/primary-care-home

• A cluster of GP practices working to common systems

and goals rapid learning and up-scaling of activity

– GP and community trust contracts not altered – 30-50k Registered population- to allow consistent personalised

experience of care

• Integrated diverse workforce
• Aligned financial drivers. Unified capitated NHS

budget- Risk management

• Extended range of services- particular risk groups

DRAFT 26 Jan 2017 David Wingfield

The CCG and GP federation are now planning for the optimum configuration

• f primary care homes in Hammersmith and Fulham

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The CCG and GP federation will now begin to work with practices to develop the current network system into the best configuration of primary care

• homes. This will be completed by October 2017 and will be based on a series of considerations, including existing collaborative relationships, common

challenges, and an appropriate mix of practices’ readiness to lead the development process. The maps below show, on the left, the current three primary care homes and practices not part of a primary care home and, on the right, an illustrative future configuration. The practices names for each number are in the appendix.

May 2017 Illustrative configuration for October 2017

Intermediate care GP Practices Mental health Community nursing and therapies Urgent care CEPN All CLCH, GP, Community mental health and urgent care services. C£40-50m OOHS R&D HEE CCG NHS Services funding

Integrating primary care into a single organisation

Aligning GP and Community Services

16

Traditional General Practice, dispersed, but loosely arranged in networks Primary Care Home 30-50k joint projects partial NHS budget holders/shadow GP Partnership merger or functional alignment, providing organisational capability to deliver GP Federation facilitating coherent GP integration across a borough Federation Plus- integrated primary and community care + + = +

Primary care development roadmap

Hammersmith and Fulham GP Federation as a change management

• rganisation

4 strategic priorities………..

Out of Hospitals Clinical Service Delivery Accountable Care Development Primary Care Transformation Workforce Development Ceommunity education Provider Network (CEPN)

Hammersmith & Fulham GP Federation Work Streams Summary Apr17-Mar18

Funded By……

Trading Income 10% of c.£2.5m contract Whole Systems £50k T&T £250k PMCF £500k HENWL Grants

• c. £500k

Practice Delivery Population Coverage OOHS Clinical staffing

(hosted and bank)

Governance & Safety Capacity & Configuration Funding Source

Trading Income

CIS, UCC, Practices Reporting and Contract Monitoring

Hammersmith & Fulham GP Federation Work Streams Summary Apr17-Mar18

Quality Improvement Expand Portfolio Federation Board Research NIHR Hub [new]

Federation Board Transformation PMCF Funding Stream

PMCF

Programme Manager

Dave Sellers (part time)

Shared Services Phase 1

Rollout Workflow Rollout Patient Care Plan tool Extend MESH to C&W More MJOG campaigns

On-line engagement

Hammersmith & Fulham GP Federation Work Streams Summary Apr17-Mar18

T&T

Merger Support Services Clinical Governance

Caroline Durack Programme Manager Funding Stream Federation Board Accountable Care System Development

Alliance Contract

MCP development with CLCH and WLMHT Implement Models of Care

Paediatrics Ambulatory care Frail Elderly

Develop Informatics Function

Hammersmith & Fulham GP Federation Work Streams Summary Apr17-Mar18

WSIC

Primary Care Home roll out

Funding Stream

HENWL HENWL annual allocations Nursing Workforce modelling & redesign Run all clinical training including OOHS H&F Community Education Provider Network Practice manager and reception training Workforce development Apprenticeships Care Certificate GPN Programme Physician Associates

Fellows Training for all staff groups

Hammersmith & Fulham GP Federation Work Streams Summary Apr17-Mar18

H&F CEPN Steering Group

Education Hubs

8 Hubs (+3 in 17/18) Pharmacy, AHPs, & Other

GP upskilling

Federation Board Care management and navigation

The new business model and Super Practices

H&F Partnership

Primary care for the 21st Century

HFP is a new GP super-practice

Created 3 April 2017 by a three way merger

Overview

Mission & Values Patient Driven Lifelong Learning The underpinning professional values that the

• rganisation works to

A clinical model with patients at the centre A commitment to continuing professional and

• rganisational enrichment and support

Specialisation Generalism The principle of holistic care and continuity

• f care, and the maintenance of those

principles over time Allowing primary care to engage with complex community care and every clinician being able to follow their interests

42,000 patients 3 sites in H&F 88 staff 17 Partners

Clinical Model

UNIVERSAL PRIMARY CARE

Complex Children and Families Complex Medicine EOLC, Care Homes, Frail Elderly

Complex Mental Health, PD, Substance Dependency

Specialisati

• n

Clinical decision support Teaching & Research

Michele Davison

Exec Board

All Partners

Overall business leadership Culture, values & ethos

Sarah Douglas

Exec Board Corporate Lead: HR and people Site Lead: North End

David Wingfiel d Jo Huddy

Exec Board Corporate Lead: Finance Site Lead: Bush

Anna Wilson

Exec Board Corporate Lead: Business Development

Pamini Ledchumykant han

Exec Board Corporate Lead: Clinical Governance & Quality Exec Board Corporate Lead: NHS Strategy Site Lead: Brook Green

Partner responsibilities and Executive Board

Finance Lead

Finance & accounting Supply chain Property Insurances Legal Bank Company secretarial

Operatio ns Lead

Service availability and delivery HR operations Training IT & Telephony BCP Recruitment Patient Experience Processes & procedures Occupational Health

Quality Lead Contract s Lead

Clinical quality Safety and audit Clinical governance CQC Information governance Safeguarding HR infrastructure Organisational development Marketing & PR Health & Safety Contract management Revenue maximisation External relations Data analysis Project management Bids

Marta Cabrera Daniella Rubio Stephen Weller Sena Shah

Integrated senior management team

Pamini Ledchumykantha n

Clinical quality & governance Clinical performance and safety Appraisal & revalidation

• versight

Clinical education framework Complaints, incidents and audit Best practice Quality improvement

Clinical Leads

Diabetes Mental Health TBC

Pharmac y Lead Nursing, HCA & Therapy Lead

Clinical quality and governance Workforce planning & development Service development Mentoring Policies and procedures

Quality Lead

Clinical quality Safety and audit Clinical governance CQC Information governance Safeguarding HR infrastructure Organisational development Marketing & PR Health & Safety

Sena Shah

Clinical quality and governance Workforce planning & development Service development Mentoring Policies and procedures

Comprehensive clinical governance infrastructure

Accountable care

33

Hammersmith & Fulham: working in partnership and contributing to NWL’s Sustainability and Transformation Plans

34

Accountable care – let’s simplify…

Patient experience Commissioner and provider interface

35

Accountable care – H&F is an ideal size

36

Our ambition

• The Hammersmith and Fulham Integrated Care

Programme is a formal partnership launched in January 2016

• We will provide:

– high quality care to defined outcomes, for the whole population. – Good patient experience of health care – cost effective care within a budget, – This is the “triple aim” (Institute for health improvement)

• This is what an ACP means to us and today is about

further engagement with commissioners

37

Hammersmith and Fulham Health and Care Partnership Board Steering Group Outcome measures Governance development

Programmes & Projects Finance/Contracting

What we have done so far

Patients at all levels of our Governance

CEOs/Directors/GPs Lay board member: Janis Cammell OBE Directors/Senior managers/GPs Patients and lay reps: Maria Connolly Trish Longdon Olivia Freeman Ian Lawry (SOBUS) Lydia Hodges (Carers Network) Led by lay members

38 Primary and Community Care alignment

Jan 2017 April 2017 April 2018 Jan 2018 Oct 2017 April 2019

Alignment complete ACP goes live- 5y+ contract basis

Agreement to form aligned Primary Care services

Our next steps

Timeframe

ACP whole budget accountability Agreement with CCG to develop ACP ACP shadow year Primary Care Home integrated provision

Data gathering Service co-design Run new service elements with continuous evaluation Roll-out to

• ther PCHs

Primary Care home established

Questions

Davidwingfield@icloud.com 07711141638

Culture and strategy,

• patients first,
• care for our workforce,
• Education and training
• robust business model with diversification

beyond core nhs commissioned budgets