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 organisations • The new business model and Super Practices • Accountable care
Hammersmith and Fulham Clinical Commissioning Group strategy and the Primary care home
1 2 3 4 5 This document explains the what , why , and how of primary care will improve in Hammersmith and Fulham Our headline objective is for accountable – that is end-to-end - care for What happens now Hammersmith and Fulham in 2019. 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. 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 This document explains in very practical terms how the changes will practitioners work with each other and other services provided across the benefit patients as well as GPs and other practitioners. 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 Dr David Wingfield Chair, Hammersmith and Chair, Hammersmith and Fulham Fulham CCG GP federation The new approach to providing care in Hammersmith and Fulham will particularly benefit people, including many older people, who rely on a wide 1 ‘Does the Primary Care Home make a difference? Understanding its impact’ (NAPC, 2017) range of services
1 2 3 4 5 These are based on Wsic and reflect the specifics of the primary care home. What local nuances do we need to work in? Our approach is based upon what local people have told us they expect from their services 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. My practice works with other organisations to I can access care easily and in the way most support me to maintain my physical and mental convenient for me, either in person or by using wellbeing – as well as to support me when I am ill technology. If continuity of care is important to me, I have this too I am supported to understand my If I have a care plan, it is developed with me and condition and to manage more of then used right across all the relevant people my own care – but I know where who provide me with care to get support when I need it My practice is my first point of A range of people provide my care but contact with the local health and My GP and his or her colleagues More of my they all work together, communicate care system and provides the are linked in closely to all the care needs effectively, and have clear roles that I network of support for the majority other people and organisations can be understand. Together, they provide of my care needs who provide care for me and delivered me with seamless care support me in other ways within primary care, I have a clear say in how my without the care is delivered and can access need to visit I am cared for as a Through my practice’s Patient different services by using my hospital whole person Participation Group, I can continue to personal budget rather than a series shape how care is provided in my of conditions community I can access the right skills from GPs across my local area – meaning I get the specialist primary care that I need
1 2 3 4 5 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 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. common discharge arrangements People have different wants and needs depending on age and health status. The chart on the page next shows how some of these needs will be met.
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
1 2 3 4 5 The CCG and GP federation are now planning for the optimum configuration of primary care homes in Hammersmith and Fulham 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. Illustrative configuration for October 2017 May 2017
Integrating primary care into a single organisation CCG NHS Services R&D HEE funding Aligning GP and Community Services GP Practices Community nursing and Urgent care Intermediate therapies care Mental health All CLCH, GP, Community mental health and urgent care services. C£40-50m OOHS CEPN
Primary care development roadmap Federation Plus- integrated = primary and community care GP Federation facilitating coherent GP integration + across a borough GP Partnership merger or functional alignment , + providing organisational capability to deliver Primary Care Home 30-50k joint projects partial NHS + budget holders/shadow Traditional General Practice , dispersed, but loosely arranged in networks 16
Hammersmith and Fulham GP Federation as a change management organisation
Hammersmith & Fulham GP Federation Work Streams Summary Apr17-Mar18 4 strategic priorities……….. Out of Hospitals Accountable Primary Care Workforce Development Clinical Service Care Transformation Ceommunity education Delivery Development Provider Network (CEPN) Funded By…… Trading Income Whole Systems HENWL Grants 10% of c.£2.5m T&T £250k PMCF £500k £50k c. £500k contract
Hammersmith & Fulham GP Federation Work Streams Summary Apr17-Mar18 Federation Board OOHS Practice Delivery Reporting and Contract Monitoring Capacity & Configuration Governance & Safety Quality Improvement Expand Portfolio Population Coverage Clinical staffing CIS, UCC, Practices (hosted and bank) Research NIHR Hub [new] Funding Source Trading Income
Hammersmith & Fulham GP Federation Work Streams Summary Apr17-Mar18 Programme Manager Federation Board Transformation Dave Sellers (part time) Shared Services Phase 1 Rollout Workflow Rollout Patient Care Plan tool PMCF Extend MESH to C&W More MJOG campaigns Merger Support Services Clinical Governance On-line engagement Funding Stream T&T PMCF
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