The NHS Long Term Plan, GP Contract Framework and Primary Care - - PowerPoint PPT Presentation

The NHS Long Term Plan, GP Contract Framework and Primary Care Networks

Barnet GP Forum Wednesday 10 April 2019 A collaborative event between Barnet CCG, LMC and Barnet GP Federation

AGENDA

Item Presenter Timings REGISTRATION, LUNCH AND NETWORKING 12:30 - 1:00 Welcome and Introductions CCG, Fed, LMC 1:00 - 1:10 NHS Long Term Plan and GP Contract framework Colette Wood, CCG 1:10 - 1:20 Primary Care Networks (PCN) Greg Cairns, LMC 1:20 – 1:40 The Local Barnet Context and Timelines Dr Charlotte Benjamin, CCG Colette Wood, CCG 1:40 - 2:10 Barnet Federation Barnet Federated GPs 2:10 – 2:30 Slido Q&As CCG, Federation, LMC 2:40 – 3:00 BREAK 3:00 - 3:20 Table Discussion Table discussion 3:20 - 4:00 Plenary – Table Feedback (1 - 2 points) Dr Charlotte Benjamin, CCG 4:00 - 4:15 Thanks and close Dr Charlotte Benjamin, CCG 4:15 - 4:20

PAN BARNET EVENT

10 April 2019 12:30pm – 5:00pm The 100 Club, Allianz Park, London, NW4 1RL

Welcome, Aims and Objectives

• To understand Primary Care Networks in the context of wider GP

Contract reforms and the NHS Long Term Plan: headlines and timelines

• Present and discuss guiding principles and options, challenges and
• pportunities related to the formation of Primary Care Networks in

Barnet

• Understand what you need to do –now and in the future
• Identify available support and know how to access it

• In June the Government announced there would be an

additional £20bn a year investment in the NHS by 2023/24

• The Long Term Plan (LTP) was issued 07 January setting
• ut a ten-year strategy and direction of travel for NHS,

focus on prevention, improvement and efficiency and better integrating primary and community care

• National clinical priorities: children and young people,

cancer, cardiovascular disease, stroke, diabetes, respiratory disease and mental health. Primary care has key role in making progress in relevant outcomes areas

• All of England covered by Integrated Care Systems (ICS)

by April 2021, based on foundations built by PCNs – groups of GP practices covering 30–50,000 people approx.

Background and Context

The NHS Long Term Plan and Investment and Evolution – a five-year framework for GP contract outline a coherent national policy and strategic direction for developing primary care, and making it sustainable.

✓ Preparing primary care to play a role in designing and driving a future ICS ✓ More integration of community services with primary care –

• perational model and roadmap must

be clear and agreed. Requires significant transformation ✓ More coherent and aligned arrangements for workforce development, education and training needed ✓ Focus on digital; covers patient self- service, access, consultation methods and better use of data.

• Large funding injection for primary care; much of the funding contingent in participation in

Primary Care Networks (PCNs) via a DES

• PCNs are groups of general practices working closely together, with other primary and community

care staff and health and care organisations, providing integrated services to their local populations.

• PCNs to deliver defined services
• DES service specification released 29th March 2019
• 1. Workforce
• 2. Indemnity
• 3. QOF
• 4. Network

contract DES

• 5. Digital and

access

• 6. New

networked services

• 7. Investment
• 8. Research and

future contract changes

Background and Context

The NHS Long Term Plan and Investment and Evolution – a five-year framework for GP contract outline a coherent national policy and strategic direction for developing primary care, and making it sustainable. Contd..

What we know:

• The new GP contractual framework was announced 31 January; first step towards
• perationalising the Long Term Plan. Framework covers eight areas:

6

Guiding Principles for table discussion

Different forms/ levels of integration and service provision will be required at different levels

Integrated care system alliance of commissioners and providers across health and social care; population based and outcomes focused within a shared budget At-scale primary care provider delivering efficiencies

• f scale and leadership support; providing a voice for

integration across boundaries of care The primary care network geographically contiguous teams of practices caring for 30,000-50,000 people; delivery of data-driven integrated multidisciplinary team based services. The practice continues to provide core services, which are resilient and sustainable; coordination and planning of holistic, personalised, accessible care The person supported by families and local communities; enabled and empowered to access care in a way which works for them, based on ‘what matters’ to them

7

Guiding principles include:

• Place has primacy –practices within PCNs should be geographically contiguous
• Size of networks suggested at 30,000-50,000 population; balancing critical mass and

making professional relationships work

• There should be 100% coverage; CCGs have a role in confirming the full PCN

configuration

• All practices eligible to participate in the PCN DES; weighted Network Participation

Payment of £1.76, (alongside Global Sum)

• Viability of PCN delivery model is key. Current national guidance: could be through lead

practice, GP federation, NHS provider or social care enterprise

• Each network must appoint a Clinical Director
• Level of responsibility involved: e.g. service delivery, workforce, financial management

and governance

• PCNs will want to consider: decision-making, accountability, data sharing, dispute

resolution, HR, finances etc Primary Care Networks: Guiding Principles

Any questions so far?

Slido Questions: https://www.sli.do/ Code: #8680

www.lmc.org.uk

GP Contract Agreement 2019/2020 Primary Care Networks

www.lmc.org.uk

Primary Care Networks

Contract specification:

• Is a DES (Network Contract DES), spec applies to year one
• Accessed by Primary Care contract holder – GMS, PMS,

APMS

• Begins 1 April, requirements apply from 1 July 2019
• Part of larger package re Long Term Plan
• Funding to form and develop PCNs, additional workforce
• PCNs to deliver defined services
• DES specification published 29 March 2019
• CCGs may add contracts for enhanced services to the

Network Contracts DES, in discussion with LMCs and practices

www.lmc.org.uk

What this means

“The Network Contract DES specification must not be varied locally and commissioners are not able to increase or reduce the basic requirements nor reduce the national funding pursuant to this Network Contract DES specification.” “Commissioners and LMCs will need to work closely and in partnership…This will include ensuring any patients with a GP practice not participating are covered, e.g. through a Local Incentive Scheme”

www.lmc.org.uk

Structure and Coverage

Key messages:

• Cover @30-50,000 patients.
• Should be ‘geographically contiguous.
• Can overlap, but must ensure full

population coverage.

• Based on collaboration, relationships

within PCN, with other providers.

www.lmc.org.uk

PCN Governance (i)

• Practices are core members.
• Based on collaborative working, underpinned by

Network Agreement.

• Legal and contractual status.
• Will have a Clinical Director, decided by PCN

(funding based on size).

• PCN decides how funding/workforce deployed,

and who it flows funding to (e.g. sub-contracting)

• Consider VAT/Liabilities issues (BMA PCN

Handbook)

www.lmc.org.uk

PCN Governance (ii)

• CCG confirms PCN configuration.
• CCG confirms network population coverage.
• CCG approves variation to GP contract

(GMS/PMS/APMS).

• PCN to provide services via DES; delivery based
• n Network Agreement.
• PCN makes decisions & determines decision

making processes.

• Collaborative working with other organisations by

invitation (e.g. Community Providers).

www.lmc.org.uk

PCN Establishment

• 29 March – PCN DES Spec, DES guidance, DES registration form,

Network Agreement 19/20 and network contract VAT information note issued.

• 15 May 2019 – initial registration submission (names, list size,

geography, draft Network Agreement, funding arrangements via named lead provider*, named Clinical Director). NB funding via Nominated Payee; must hold primary care contract

• Full signed Network Agreement by 30 June
• 1 July 2019 – Network Contract live.
• 2019 – amended SFE, Regulations in place.

www.lmc.org.uk

PCN Registration

• Initial submission: By 15th May 2019
• Names of proposed member GP Practices
• Practice ODS Codes
• PCN/Practice list size @ 1 January 2019
• Map of geographical area
• Initial Network Agreement
• Single practice/provider to receive funding on

behalf of PCN – Nominated Payee

• 31 May, CCGs confirm PCNs, coverage

www.lmc.org.uk

PCN Network Agreement

‘Mandatory’ Network Agreement will set out:

• How practices will work together.
• Which practice(s) will deliver what.
• How funding will be allocated.
• How new workforce will be shared.
• Patient involvement.
• Any other agreements e.g. pooling of practice funding.
• Data sharing arrangements.
• Conflicts of interest.
• Decision-making, meetings.
• Joining/leaving arrangements.

www.lmc.org.uk

Clinical Director

• Named, accountable CD
• Pay scale nationally negotiated, GP pay scales
• Responsible to PCN members
• Practicing clinician from PCN members
• Collaborate with other PCN CDs
• Strategic/clinical leadership
• Workforce development
• Support service changes and pathways
• Develop relationships
• Shape, challenge wider ICS development
• Selection process as determined by the PCN; i.e.

selection, election

www.lmc.org.uk

PCN Workforce

• New workforce over 5 years; +20,000
• Investment £110m in 2019 to £891M in 2023
• Part-funded @70% recurrently inclusive of ON

costs and as per AFC pay scales; 30% from PCN.

• 1 Social Prescriber 100% NHSE funded.
• 1 Clinical Pharmacist 70% NHSE funded
• Community workforce should be aligned.
• Clinical Director (0.25 WTE per 50K list)
• Funding when in post, actual costs reimbursed
• Also from 2020, PAs, First contact Physio, 2021

First contact Community Paramedics

www.lmc.org.uk

PCN Funding

• £1.50 pp recurrent to PCNs via the NFE (Network Financial

Entitlement).

• Based on yearly population @1 January.
• £1.45 pp for Extended Hours, 30M in Global sum (£1.90 for

extended hrs DES paid in full).

• Network ‘investment & Impact Fund’, £75M in 2020 rising to

£300M by 2024.

• £6 pp from 2021 for Improving Access to go to PCNs or

earlier, where contracts ending before then.

• Existing CCG LCS funding, pending local negotiations and

agreement. NB £1.761 pp Network Participation directly paid to practices via the SFE practice entitlement, not PCN funding!

www.lmc.org.uk

Network Funding Flows

• CQRS sign-up 30 June
• Single bank account
• CD payments monthly from July
• £1.50 paid by end July, backdated to 1

April, monthly afterwards

• Workforce payments monthly in arrears
• Extended Hours paid monthly from July

(1.099 pp from £1.45 for 2019/20)

www.lmc.org.uk

PCN Funding - Overview

www.lmc.org.uk

PCN Service Delivery National Requirements

2019/20;

• Extended Hours DES for whole population, July 2019

2020;

• Structured medication review
• Enhanced health in care homes
• Anticipatory Care
• Personalised care
• Supporting early cancer diagnosis

2021;

• Cardiovascular disease prevention & diagnosis, case finding
• Action to tackle neighbourhood inequalities

Subject to yearly negotiations with NHSE

www.lmc.org.uk

PCNs – Key Questions?

• How do we work together; what are our aims?
• Who do we work with?
• What area do we cover?
• What about existing groupings,

Networks/Localities/Neighbourhoods?

• How can our Federations support the PCN?
• Who makes/how are decisions made?
• What happens to existing support for

localities/networks?

• How do we appoint our Clinical Director?

www.lmc.org.uk

Not forgetting….

• Primary Care Networks are one part of a

wider GP Contract package

• Access review: 111/Urgent Care

developments

• Existing STP/CCG plans re shifting care.
• Existing workforce, workload pressures.

www.lmc.org.uk

Wider GP Contract Offer

• IT & Digital
• Digital-First Providers
• QOF

➢Personalisation ➢Quality Improvement

• Indemnity
• Practice funding & pay
• Other agreements for 19/20
• Reviews to come: Access, V&I, Premises

www.lmc.org.uk

The Contract package on a page

• What general practice gains
• Indemnity state backed scheme
• Pay & expenses uplift each year
• Additional workforce & linked funding
• QOF amendments
• Resources for IT and digital
• What it means
• Workforce expansion
• Workload reduction
• Funding increase, pay uplift
• Autonomy retained
• Leadership role for rebuilt community

team

2 7

What general practice delivers

• PCN creation (2019)
• LTP ambitions (2020 onward) through

additional funding and additional workforce

• Greater digital access (built up)

Stability

• Five year deal, built upon each year
• 2019: build foundations, expand workforce
• 2020 onward: expand workforce further,

reconfigure services

Overall funding in excess of £2.8bn over 5 years, through practices and networks

28

The Local Barnet Context and timelines

29 What have we achieved in the past 12 months in Barnet?

• We have successfully achieved the formation of 7 Care and Health Integrated Networks (CHINs),

providing 99% patient population coverage. This was achieved through the launch of the Infrastructure LCS in October 2018

• The CCG has invested in the programme through the Infrastructure LCS, Plan, Do, Study, Act

(PDSA) cycles and embedding the CCG primary care transformation team into the formation and the development of the networks.

• The Primary Care Transformation team have worked with the networks, alongside the GP

Federation, supporting the development of a number of clinically led PDSA projects across Barnet.

• The London Borough of Barnet, who jointly lead this programme with the CCG, have developed the

LBB CHIN offer, a document describing council services and pathways, which was shared initially with the Burnt Oak CHIN and then more widely through the CCG Clinical bulletin. The aim is to begin wrapping these services around the primary care networks to provide an integrated health and care

• ffer.
• We have developed Business Intelligence capability through the North East London Information

Exchange (NELIE) which provides Network Insights across a number of areas where can be benchmarked and compared on a borough, network and practice level. You can also drill down to see activity and costs at a practice and individual patient level.

30 We are in a good position in Barnet to implement this national change

Key Practice List size (Feb 19) Care & Health Integrated Network 1 Deans Lane Medical Centre 4257 CHIN One 2 Parkview Surgery 6556 CHIN One 3 Oak Lodge Medical Centre 18472 CHIN One 4 Watling Medical Centre 16207 CHIN One 5 The Everglade Medical Practice 8267 CHIN One 6 Dr Lamba (Colindeep Lane) 8835 CHIN One 7 Wakeman’s Hill Surgery 4675 CHIN One 8 Jai Medical Centre 8303 CHIN One 9 Hendon Way Surgery 8493 CHIN One 10 The Village Surgery 5201 CHIN Two 11 East Barnet HC (Dr Weston & Dr Helbti 3609 CHIN Two 12 East Barnet HC (Dr Peskin/Syed/Hussa 4507 CHIN Two 13 East Barnet HC (Monkman) 3074 CHIN Two 14 St Andrews Medical Practice 10885 CHIN Two 15 Brunswick Park Medical Practice 8548 CHIN Two 16 The Clinic (Oakleigh Rd North) 8934 CHIN Two 17 Friern Barnet Medical Centre 9046 CHIN Two 18 Doctors Lane - Colney Hatch Lane 5425 CHIN Two 19 Longrove Surgery 11327 CHIN Three (a) 20 The Old Courthouse Surgery 8323 CHIN Three (a) 21 Addington Medical Centre 9061 CHIN Three (a) 22 Vale Drive Medical Practice 5555 CHIN Three (a) 23 Gloucester Road Surgery 1802 CHIN Three (a) 24 Derwent Medical Centre 5581 CHIN Three (b) 25 Torrington Park Group Practice 12569 CHIN Three (b) 26 The Speedwell Practice 11440 CHIN Three (b) 27 Wentworth Medical Practice (Ballard L 11404 CHIN Three (b) 28 Cornwall House Surgery 6411 CHIN Three (b) 29 Squires Lane Medical Practice 5796 CHIN Three (b) 30 Lichfield Grove Surgery 6235 CHIN Three (b) 31 Rosemary Surgery 5286 CHIN Three (b) 32 Woodlands Medical Practice 4395 CHIN Three (b) 33 East Finchley Medical Practice 7806 CHIN Three (b) 34 Penshurst Gardens 6639 CHIN Four 35 Millway Medical Practice 18483 CHIN Four 36 Lane End Medical Group 13136 CHIN Four 37 Mulberry Medical Practice 9946 CHIN Four 38 Langstone Way Surgery 7997 CHIN Four 39 St George’s Medical Centre 11116 CHIN Five 40 Hillview Surgery 1876 CHIN Five 41 The Phoenix Practice (Boyne Ave (E836 9987 CHIN Five 42 Dr Azim & Partners 9147 CHIN Five 43 Ravenscroft Medical Centre 7378 CHIN Five 44 Pennine Drive Surgery 8991 CHIN Five 45 Greenfield Medical Centre 6857 CHIN Five 46 Supreme Medical Centre 4357 CHIN Six 47 Mountfield Surgery 5006 CHIN Six 48 Heathfielde 8135 CHIN SIX 49 PHGH Doctors 10941 CHIN Six 50 Temple Fortune Health Centre 7264 CHIN Six 51 The Practice @ 188 7588 CHIN Six 52 Adler & Rosenberg (682 Finchley Road 5846 CHIN Six 53 Hodford Road Surgery 3663 CHIN Six 54 Cricklewood Health Centre(Barndoc H 8493 Unallocated

99% coverage

Barnet GP Practices and Primary Care Network configuration (April 2019)

31 Potential Primary Care Network structures to support the Network DES

Flat Practice Network Lead Provider

GP Provider/Limited Liability Vehicle Super Practice Non-GP Providers

These proposed models have been taken from the British Medical Association (BMA) Primary Care Network Handbook.

There are currently 5 proposed models for the delivery of the Network DES specification and networks may start with one structure but change structures as relationships mature. 2019/20 is the developmental year for the networks across the country.

The practices in the network would jointly sign up to the network agreement, which would record the fact that contracts relating to the functions and workforce of the PCN are jointly entered into by all practices and that the liability arising from it are jointly split between them. The practices in the network would jointly sign up to the network agreement, which would record the fact that contracts relating to the functions and workforce of the PCN are entered into by a specific lead practice (different lead practices could be identified to lead on differing thing The member practices would continue to employ their normal staff and provide their core GMS services, but the provider entity would be subcontracted to deliver services required by the DES, and employ the range of staff necessary to do so. These services would be funded by the monies received via the DES As a single entity the super-practice would need to create an internal ‘network’ amongst its constituent sites, with each ‘neighbourhood’ of practices operating as a mini network in

• themselves. The super-practice would be the nominated payee and would then supply support and

resources to its constituent neighbourhoods Practices may wish to ally themselves with another local healthcare provider from the start, such as a community trust, which through signing up to the network agreement alongside the GP practices can provide network-level services on behalf of the PCN.

32

Example Primary Care Networks RAW List Size Network Engagement Funding (£1.76/h) Network Payment (£1.50/h) Extended Hours Funding (£1.45/h) Extended Access Funding (£6/h from Apr 2020) Total Funding Network 1 84,065 £147,954 £126,098 £121,894 £504,390 £900,336 Network 2 59,229 £104,243 £88,844 £85,882 £355,374 £634,343 Network 3(a) 36,068 £63,480 £54,102 £52,299 £216,408 £386,288 Network 3(b) 76,941 £135,416 £115,412 £111,564 £461,646 £824,038 Network 4 56,201 £98,914 £84,302 £81,491 £337,206 £601,913 Network 5 55,352 £97,420 £83,028 £80,260 £332,112 £592,820 Network 6 52,800 £92,928 £79,200 £76,560 £316,800 £565,488 Totals 420,656 £740,355 £630,984 £609,951 £2,523,936 £4,505,226

How much per head investment is going into the Barnet Primary Care Networks?

If our current CHIN configurations were to be the Primary Care Networks, the indicative investment would be as follows:

£0 £200,000 £400,000 £600,000 £800,000 £1,000,000 Network 1Network 2 Network 3(a) Network 3(b) Network 4Network 5Network 6

Indicative Primary Care Network Funding

Extended Access Funding (£6/h from Apr 2020) Extended Hours Funding (£1.45/h) Network Payment (£1.50/h) Network Engagement Funding (£1.76/h)

33 How much workforce investment is going into the Barnet Primary Care Networks?

Example Primary Care Networks RAW List Size Network Administration Clinical Director Clinical Pharmacist (70% funded) Social Prescriber (100% funded) Total Funding Network 1

84,065 £105,000 £48,131 £37,810 £34,113 £225,054

Network 2

59,229 £75,000 £34,279 £37,810 £34,113 £181,202

Network 3(a)

36,068 £45,000 £20,267 £37,810 £34,113 £137,190

Network 3(b)

76,941 £105,000 £48,131 £37,810 £34,113 £225,054

Network 4

56,201 £75,000 £34,279 £37,810 £34,113 £181,202

Network 5

55,352 £75,000 £34,279 £37,810 £34,113 £181,202

Network 6

52,800 £75,000 £34,279 £37,810 £34,113 £181,202

420,656 £555,000 £253,645 £264,670 £238,791 £1,312,106

£0 £100,000 £200,000 £300,000 Network 1 Network 2 Network 3(a) Network 3(b) Network 4 Network 5 Network 6

Primary Care Networks - Workforce Investment

Network Administration Clinical Director Clinical Pharmacist (70% funded) Social Prescriber (100% funded)

If our current CHIN configurations were to be the Primary Care Networks, the indicative investment would be as follows:

34 What are the key dates for the Primary Care Networks and the new Network DES?

The following outlines key imminent deadlines/milestones: PCNs to have submitted the initial completed ‘Network Contract Directed Enhanced Service (DES) Registration Form’, by email with the subject header ‘Primary Care Network Registration’, to Barnet CCG Primary Care Team via barccg.barnetccgprimarycare@nhs.net by 15th May 2019. Between 16th May 2019 and 31st May 2019, Barnet CCG will confirm and approve all Network Areas in a single process that ensures that all patients in every GP practice are covered by a PCN and that there is 100% Barnet CCG GP practice registered population coverage. After Barnet CCG confirmation has been received and prior to 30th June 2019, each GP practice in a PCN will sign-up to the Network Contract DES through the Calculating Quality Reporting Service (CQRS).

By 30th June 2019, PCNs must confirm to Barnet CCG Primary Care Team that the fully completed

Network Agreement has been signed by all PCN member GP practices and that the GP practices have entered into the appropriate data sharing (and, if relevant data processor arrangements) to support delivery of extended hours access services from 1st July 2019. This includes submitting completed ‘Network Contracted Directed Enhanced Service – Network Agreement Schedules’ to Barnet CCG Primary Care Team via barccg.barnetccgprimarycare@nhs.net. PCNs commence delivery of the Extended Access DES from 1st July 2019.

1 2 3 4 5

35 Additional Roles Reimbursement Scheme- Wider Workforce

• 20,000 plus new workforce over five years; investment £110m in 2019 to £891m in 2023
• Part-funded: 70% recurrently; 30% from PCN.
• One social prescriber (link worker) 100% NHSE funded.
• One clinical pharmacist 70% NHSE funded
• Community workforce should be aligned.
• Clinical Director (0.25 WTE per 50,000 list)
• Also from 2020, Physician Associates, first contact physios, 2021 first contact community paramedics

36 There are a number of documents available for practices

Resource Resource Link / Document Network Contract Directed Enhanced Service – Contract Specification 2019/20 https://www.england.nhs.uk/publication/network- contract-directed-enhanced-service-des-specification- 2019-20/ Network Contract Directed Enhanced Service – Guidance for 2019/20 in England https://www.england.nhs.uk/publication/network- contract-directed-enhanced-service-des-guidance- 2019-20/ Network Contract Directed Enhanced Service (DES) Registration Form https://www.england.nhs.uk/publication/network- contract-directed-enhanced-service-des-registration- form/ Network Contract Directed Enhanced Service – Mandatory Network Agreement (April 2019) https://www.england.nhs.uk/wp- content/uploads/2019/03/mandatory-network- agreement.pdf Network Contracted Directed Enhanced Service – Network Agreement Schedules https://www.england.nhs.uk/wp- content/uploads/2019/03/network-agreement- schedules.docx The Network Contract DES and VAT https://www.england.nhs.uk/wp- content/uploads/2019/03/network-contract-des-and-vat- information-note.pdf Primary Care Networks: Frequently Asked Questions https://www.england.nhs.uk/gp/gpfv/redesign/primary- care-networks/pcn-faqs/ An Introduction to Quality Improvement in General Practice https://www.england.nhs.uk/wp- content/uploads/2019/03/an-introduction-to-quality- improvement-in-general-practice.pdf British Medical Association (BMA) Primary Care Network Handbook https://www.bma.org.uk/- /media/files/pdfs/collective%20voice/committees/gpc/gpc% 20england/pcn%20handbook.pdf?la=en

37 GP Federation

Barnet GP Federation

Barnet Primary Care Networks

THIRD SECTOR

EMPLOYEE HEALTH AND WELLBEING

DENTIS T

Leadership and Governance Your Primary Care Network will need to have robust leadership and governance arrangements in place Population Health and Care Models Your Primary Care Network will need to understand the health needs of your local population and develop integrated models of care Engaging People and Communities Your Primary Care Network will need to engage and involve teams coming together to provide integrated care across your network Care Teams and Clinical Governance Your Primary Care Network will involve teams coming together to provide integrated and shared care Managing Resources Your Primary Care Network will need to manage resources to make them efficient and effective Working Together Your Primary Care Network will have to collaborate to deliver integrated care to your local population

Your Primary Care Network

30,000-50,000 Patients

WHAT SUPPORT DOES YOUR PRIMARY CARE NETWORK NEED? SERVICES Which services? When? From whom? PEOPLE (CEPN) Which people? When? From whom? SUPPORT What support? When? From whom?

Delivery Structures across NCL

ICP – Pan-borough or Hospital Geography Health & Social Care Partnership Business Analytics / Contract management GP Federation – Pan-borough Management infra-structure / Service management / Population Health Enhanced access / Specialist workforce /Integration Agreement Primary Care Networks – Geographical Community alignment / Social prescribing LTC management / MDT Approach GP Practice – GMS Contract Health promotion / Diagnosis / Disease management

Networks of 30-50,000 patients

Federation Roles

Supporting GP Practice and Networks

Offering back office functions and support Joining up workforce capabilities Brokering collaboration conversations

Delivering PC Services at Scale

Providing access hubs Managing / Governing network multidisciplinary teams e.g. elderly, paediatrics, LTC Employing shared staff e.g. pharmacists, care home visiting

Representing at ICP

PC leadership in ICP Delivering joined up population health at the most appropriate scale Aligning community teams, community facing consultants

Just some of the successes so far…

GP Federation Infrastructure EAS Hubs Research

• Board Governance Structure –

clinical/financial governance strong

• Underpinned BI Dashboards
• Pensions, NI and Premises
• IT/BI Capability/Clinical Auditors
• Service, Operational and Programme Leads
• Trusted and represent all practices
• Communications/HR/Contracting (LMC

Law)

• 48,000 appointments
• Stable workforce
• Nurse appointments (smears)
• Low DNA rates
• Same day/routine appointments
• Populate EMIS directly with discharge

summary and refer on

• 48/52 practices signed up – 42 active
• 15000 patients screened
• 6000 patients taking part in research locally
• Total number of new studies undertaken in

Barnet 185

• LTCs, Cancer and MH key research areas
• £36k paid out to practices

Practice Support/Membership Offer Anti-coagulation GP FED/CEPN – Workforce Development

• Blue Stream Academy
• Blue Stream Federation Portal
• Dene Healthcare (Buying Consortium)

mobilised

• DPO Service & GDPR
• QOF Prevalence
• New Telephone system
• Expanding further in coming year
• Mobilised new service
• Estimated value: £300k (plus start up costs)
• 133 patients already contacted
• Clinical staff in place and equipment bought
• Clinics commenced
• Clinical Governance in place
• Workforce Development
• Workforce Retention
• I-GPs
• Clinical Pharmacists
• Non-Clinical Training – reception booklets
• DQIST Diabetes Training
• Productive General Practice
• BRAD Group

Federation is your organisation – can be developed into what you need for the next stage of the journey?

Membership Engagement - Dates for the Diary

Primary Care Networks – Planning for the Future 1st May 2019 What do you want from us and how can we help? LMC/CEPN/BFG CHINs Steering Group 8th May 2019 Submission to NHS E of the Clinical Directors 15th May 2019 NCL Event for Clinical Directors – success, enablers and what next 29th May 2019

Questions from the Room and Slido

Slido Questions: https://www.sli.do/ Code: #8680

46 Discussion – Practice Perspectives

Other questions? What conversations have you already had? Share your thoughts…

Discussion on tables:

• What are our aims?
• How do we work together?
• Who do we work with?
• What area do we cover?
• What about existing groupings, Networks/Localities/Neighbourhoods?
• How can our Federation support the PCN?
• Who makes/how are decisions made?
• What happens to existing support for localities/networks?
• How do we appoint our Clinical Director?
• What support do we need?

47

PCN DES Agreement published (29 March) PCN DES Specification published (29 March) NCL Practice events (until early April) Further practice communications by 11 April Practices confirm PCNs (before 15 May) CCGs confirm PCNs (by 31 May) PCN DES goes live (1 July 2019)

Next Steps and Contacts

For more information: https://www.england.nhs.uk/gp/gpfv/investment/gp-contract/ https://www.england.nhs.uk/wp-content/uploads/2019/01/gp-contract-2019.pdf Or contact: barccg.barnetccgprimarycare@nhs.net HCCH.NCLSTP@nhs.net Greg.Cairns@lmc.org.uk

Thank You & Close

Dr Charlotte Benjamin, Barnet CCG