Transforming Primary Care Provider Development 4 th November 2015 01 - - PowerPoint PPT Presentation

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Transforming Primary Care Provider Development 4 th November 2015 01 - - PowerPoint PPT Presentation

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WiFi Login Details Network: Hospitality Password: ovaltine89 Transforming Primary Care Provider Development 4 th November 2015 01 Welcome and Introduction Transforming Londons health and care together 2 Welcome and introduction Liz Wise,

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Transforming Primary Care Provider Development 4th November 2015

WiFi Login Details Network: Hospitality Password: ovaltine89

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01

Transforming London’s health and care together

Welcome and Introduction

2

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Welcome and introduction

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Dr Robert Varnam - Head of General Practice Development, NHS England Liz Wise, Programme Director, Transforming Primary Care, Healthy London Partnership

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Welcome and introduction

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#HealthyLDN @HealthyLDN

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Using your App

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You can download the app by searching for ‘Transforming Primary Care’ in either app or google store Features to enhance your time at the event, such as:

  • Programme and general information
  • Speaker biographies
  • Access to presentations, including the ability to save, email and make notes

alongside them

  • Voting and question submitting
  • Networking functionality
  • Note taking functionality

Through each session you can WiFi Login Details Network: Hospitality Password: ovaltine89 Make Notes Vote Raise a question

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How many Primary Care ‘at scale’ organisations are there in London at this present time?

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  • A. 102
  • B. 17
  • C. 57
  • D. 5

http://www.im- cms.co.uk/application/assets/81/KeypadVotingTimeFilter/KeypadVotingChart.php?Title=12:30:%20Welcome%20and%20introd uctions&ID=14797

Register your vote in the Welcome and Introductions session tab

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Agenda for today

Time Session Speakers

12:30 WELCOME AND INTRODUCTIONS Liz Wise Dr Robert Varnam 12.45 WHY ARE WE COMMITTED TO PROVIDER DEVELOPMENT? Dr Michelle Drage Dr Marc Rowland Dr Robert Varnam 13:25 THE EMERGING PICTURE SO FAR Chris Adams Jeremy Fenwick Dr Judy Roberts 13:55 Q&A 14.15 PROVIDER DEVELOPMENT - TAILORING YOUR LOCAL NEEDS Dr Robert Varnam 14:30

Break

14:45 THE INTELLIGENCE HUB

  • Leadership
  • System wide support
  • Organisational Development
  • Developing Partnerships
  • Regulatory & legal advice

ALL 16:10 Break 16.20 WHAT ARE THE NEXT STEPS?

Greg Cairns Liz Wise

16:50 CLOSING SUMMARY Robert Varnam 17:00 CLOSE

Networking (30 mins)

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02

Transforming London’s health and care together

WHY AR WHY ARE E WE C WE COMMITTE OMMITTED T D TO O PR PROVIDER VIDER DEVEL DEVELOPMENT? OPMENT?

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PR PROVID VIDER ER DEVEL DEVELOPMENT OPMENT

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Dr Robert Varnam - Head of General Practice Development, NHS England Dr Michelle Drage- Chief Executive, London-wide Local Medical Committees

Don’t forget to tweet us at @HealthyLDN #HealthyLDN

Dr Marc Rowland, Chair of the Healthy London Partnership Innovation Group, Co- Chair of the Transforming Primary Care Strategic Oversight Group

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Transforming Primary Care

Strategic Commissioning Framework Pan – London Support Provider Development System wide collaboration

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www.england.nhs.uk

General practice development

Dr Robert Varnam

Head of General Practice Development

@robertvarnam

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www.england.nhs.uk

Collaborative working New models of LTC care Improved access Quality & safety

What are people working towards?

Release capacity

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www.england.nhs.uk

How?

Learning so far…

We’re going to need every component Some of this is very new for us

bit.ly/pmcflessonsvid1 bit.ly/PMCFlessons1

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www.england.nhs.uk

Leadership

Creating shared purpose Strategic planning & partnerships Leading through change Being a leader

Improvement

Patients as partners Processes and systems Using data for improvement Rapid cycle change

Business

Governance Operations management Workforce Business intelligence

General practice development framework

These are interdependent

bit.ly/pmcflessonsvid1 bit.ly/PMCFlessons1

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03

Transforming London’s health and care together

EMERGING PICTURE SO FAR

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EMERGING PICTURE SO FAR

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Chis Adams, Chief Executive , H&F GP Federation

Don’t forget to tweet us at @HealthyLDN #HealthyLDN

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Part 1: What we told practices at the start

Hammersmith & Fulham GP Federation

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Primary care faces a range of challenges and opportunities…..

Context

LES contracts finishing

Offering a wider range of services

CCGs need population coverage

Services shifting

  • ut of

hospital

Integrating primary care with intermediate care and urgent care

Ensuring financial stability

A Federation allows us to address these issues together: Provide more complex services closer to patients Act at scale for a whole population Improve care coordination across settings Enhance access and convenience Capture growth opportunities to provide financial stability

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  • 1. The Federation will be registered as a limited company so that it can contract with CCGs
  • 2. Practices will subscribe and pay for shares
  • 3. Five Board Directors will be elected: three local GP partners, one PM, and one other
  • 4. Other key positions appointed by Board through an election process

How it will work

Governance

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How it will work

Patient and Public Engagement

Social Media

Patients and public Engage & Inform

Surveys

Specific groups Specific topics

Patient Satisfaction

Patients Measuring performance

Complaints & Feedback

Patients Responding to specific feedback

Conditions

Patients with specific long term conditions Pathway and continuity of care

Local Clinical Networks

Patients at specific practices Feedback about local services

Organisational

Patients and public Lay member

  • n Board

Focus Audience

We will use multiple channels to engage patients and the local public in different ways,

  • n different topics, at different frequencies, so that engagement is dynamic and relevant
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How it will work

Founder Member Associate Member Qualifying criteria Located within Borough and subscribe for shares at formation of Federation (member and shareholder) Join at a future date through application to the Federation membership committee (member only) Rights Voting rights in proportion to shareholding Stand for election as a statutory director First refusal to deliver clinical services subject to quality, specified requirements, pricing, and any maximum number of required locations Participate in delivery of clinical services subject to quality, specified requirements, pricing and any maximum number of required locations Participate in clinical education and training Participate in clinical education and training Participate in any future distribution Obligations Support Federation bids, and must not hold shares in a directly competing organisation Support Federation bids and declare any conflicts of interest No membership fees for Founder members An annual membership fee may be levied

All local practices encouraged to become Founder Members See separate Prospectus document for details of the fundraising

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  • 1. Management reports to the Board and is responsible for all day to day operations
  • 2. Initially 1FTE (Chief Executive), further resourcing subject to Board approval
  • 3. Directly employed resource will be minimal (e.g. specialised shared clinical resource)
  • 4. Some activities may be externally shareable to reduce cost (e.g. with other Federations)

How it will work

Management

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  • 1. Federation will contract up to the CCG and contract down to practices for clinical services
  • 2. Federation may contract with third parties for specific support on specific pathways
  • 3. Federation may contract with individual clinicians for specialised support
  • 4. Contracts will include service specifications, usual NHS terms, prices and clinical indicators

How it will work

Contracting

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Members of the Federation will act according to the following principles:

  • 1. Always ensure that patients are the primary concern for all action and decision

making

  • 2. Collaborate with other Federation members and the central team:
  • Sharing resources where this is economic or enhances coverage
  • Work with other members to ensure pathways are delivered effectively and

access is maximised

  • 3. Actively contribute to continuous improvement through service delivery, supporting

central management, knowledge sharing or by any other means

  • 4. Support bids by the Federation to extend the services offered to patients and the

number of patients reached

How it will work

Federation Charter

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Medium term milestones

Establish

  • Federation. Deliver

OOHS portfolio

Oct-14 Apr-15 Oct-15 Apr-16 Oct-16

Clinical benchmarking, continuous improvement and performance monitoring Wider integration with intermediate care and urgent care

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Part 2: Where we are

Hammersmith & Fulham GP Federation

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Out of Hospital Services Contract

  • 18 services; 31 locations; 451 delivery points
  • F&A plans down to service by practice, by month
  • 119 payment & KPI reports; 81 data quality reports
  • Practices receive 90% of price, Federation central costs covered by 10%
Practice name-lead ABPM Anticoag Monitoring Anticoag Initiation Case Finding, Care Planning & Case Management Complex Common Mental Health Management Complex Wound Care Diabetes (Level 1) Diabetes (High Risk) Diabetes (Level 2) ECG Homeless Near Patient Monitoring Phlebotomy Ring Pessary Simple Wound Care Spirometry Testing Transfer of Care: Severe and Enduring Mental Illness Ashchurch Surgery - Winayak K 65 44 16 80 41 119 72 46 21 1,307 10 90 66 6 Ashville Surgery - Aras SF 124 88 31 149 8 220 134 268 86 30 2,428 18 167 123 12 Bridge House Centre for Health - Das B 33 39 19 57 34 144 22 627 43 32 3 Brook Green Medical Centre - Wingfield D 139 111 47 186 93 60 275 167 12 268 107 47 3,044 18 208 153 14 Brook Green Surgery - Slater L 53 37 14 61 36 91 55 268 35 15 998 68 50 5 Canberra Centre for Health 47 36 11 54 32 79 48 172 31 6 872 7 60 44 Cassidy Road Medical Centre - Dellaportas CI 57 72 106 64 41 13 1,165 9 80 59 Fulham Cross Medical Centre - Hussain Z 30 34 18 50 30 19 549 38 28 3 Hammersmith Surgery - Fernandes PFR 115 76 34 140 67 64 207 125 12 80 39 2,276 18 156 115 10 Lillie Road Health Centre - Jefferies S M 37 23 10 45 25 67 41 2 26 12 738 5 51 37 4 Lilly Road Surgery, - Blair G 96 69 26 113 51 64 167 101 9 65 34 1,842 13 126 93 8 North End Medical Centre - Wilson P 209 146 60 259 104 60 383 232 11 273 163 59 4,260 28 290 213 17 Palace Surgery - Mangwana B 59 69 39 103 62 40 1,265 78 57 5 Park Medical Centre - O'Gallagher D 107 73 32 129 57 190 115 7 74 33 2,142 17 144 106 8 Richford Gate Medical Centre - Koppel JI 124 88 39 151 72 223 135 11 94 40 2,520 19 169 124 13 Sailsbury Surgery - Muthiah RN 19 22 32 20 13 7 358 25 18 Sands End Clinic - Lawley GC 101 68 26 122 57 56 180 109 6 144 70 30 1,987 16 136 100 10 Shepherds Bush Medical Centre - Badat AA 43 30 12 50 73 44 36 13 808 56 41 Sterndale Surgery - Elliott C 58 40 16 71 30 105 64 15 1,247 9 79 58 The Bush Doctors - Samji F 142 99 38 176 81 60 261 158 12 268 101 45 2,983 19 197 145 13 The Fulham Centre for Health 85 53 100 148 89 268 58 1,575 10 112 82 The Fulham Medical Centre - McNicholas T 87 57 25 105 55 155 94 5 268 60 34 1,709 11 117 86 6 The Lilyville Surgery - Evans Mal 71 62 27 118 56 60 174 106 5 68 28 1,982 14 132 97 6 The Medical Centre (Ollgar Close) - Kukar RK 82 49 20 96 143 86 63 1,717 108 79 The Medical Centre, Dr Jefferies & Partners - Jeffer 158 113 58 216 96 53 319 193 5 268 131 49 3,568 22 241 178 15 The New Surgery - Miller S 42 19 77 46 113 69 6 51 21 7 86 63 4 The Old Oak Surgery - Anyiam-Osigwe 51 75 45 29 8 826 57 42 Westway Surgery - Dasgupta S 43 51 75 46 15 831 9 57 42 White City Health Centre - Dandapat R 46 54 14 53 79 48 10 165 38 17 944 6 60 44 White City Health Centre - Mirza NS 21 12 4 24 36 22 165 22 629 27 20 White City Health Centre - Uppal GS 81 96 83 141 86 165 62 1,775 107 79 In Year Volume 2,331 1,469 578 3,008 1,049 590 4,446 2,695 113 3,105 1,732 632 48,969 284 3,362 2,474 163

TOTAL CONTRACT VALUE PRA £30,818 £326,099 £83,882 £266,858 £168,372 £12,118 £149,734 £67,738 £20,467 £111,404 £25,266 £27,647 £133,540 £16,546 £33,831 £90,048 £44,654 £1,609,022 TOTAL CONTRACT VALUE FEDE £3,424 £36,233 £9,320 £29,651 £18,708 £1,346 £16,637 £7,526 £2,274 £12,378 £2,807 £3,072 £14,838 £1,838 £3,759 £10,005 £4,962 £178,780

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Federated Working Transform Primary Care

  • Population-based services:

Service model changes

  • Inter-practice referrals/bookings
  • patient experience
  • Shared accountability for aspects of performance
  • quality
  • cost efficiency
  • Make progress on community service integration:
  • skill mix
  • Ophthalmology

“Super-partnership”

  • MSK
  • Cardio-respiratory

“Back office shared services”

  • Memory
  • Workforce Development / CPEN
  • Deliver PMCF programme
  • Whole Systems Integrated Care

Goals: what are we trying to achieve in terms of change?

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Federation Priorities HENWL Funding Total £126k T&T Funding PMCF funding for practices Transform Primary Care OOHS Transform clinical delivery Patient Engagement New Revenue Sources: Community Ophthalmology Community Memory Research CIS 10p per patient Oct-15 £20k Central operations and governance £145k Outbound call pilot £15k On-line accounts £20k HealthWatch commissioned to support practices Funding to support CIS referrals £15k Back Office: Phase 1 £61k Support partnership consolidation £34k Process Vision Timeline Execution Whole Systems Disease Management Pilot £TBC Preparatory work on ACO creation New Part 2 funding £65k Central support: weekend service

Current Funding: Training

OOHS clinical training £32k Reception training £10k Nurse training £30k Practice Manager HR training £6k HCA training £17k

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Federation Priorities HENWL Funding Total £126k T&T Funding PMCF funding for practices Transform Primary Care OOHS Transform clinical delivery Patient Engagement New Revenue Sources: Community Ophthalmology Community Memory Research CIS 10p per patient Oct- 15 £20k Central operations and governance £145k Outbound call pilot £15k On-line accounts £20k HealthWatch commissioned to support practices Funding to support CIS referrals £15k Back Office: Phase 1 £61k Support partnership consolidation £34k Process Vision Timeline Execution Whole Systems Disease Management Pilot £TBC Preparatory work on ACO creation New Part 2 funding £65k Central support: weekend service

Current Funding: PMCF revenue streams

OOHS clinical training £32k Reception training £10k Nurse training £30k Practice Manager HR training £6k HCA training £17k

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Federation Priorities HENWL Funding Total £126k T&T Funding PMCF funding for practices Transform Primary Care OOHS Transform clinical delivery Patient Engagement New Revenue Sources: Community Ophthalmology Community Memory Research CIS 10p per patient Oct- 15 £20k Central operations and governance £145k Outbound call pilot £15k On-line accounts £20k HealthWatch commissioned to support practices Funding to support CIS referrals £15k Back Office: Phase 1 £61k Support partnership consolidation £34k Process Vision Timeline Execution Whole Systems Disease Management Pilot £TBC Preparatory work on ACO creation New Part 2 funding £65k Central support: weekend service

Current Funding: Transition & Transformation budget

OOHS clinical training £32k Reception training £10k Nurse training £30k Practice Manager HR training £6k HCA training £17k

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Federation Priorities HENWL Funding Total £126k T&T Funding PMCF funding for practices Transform Primary Care OOHS Transform clinical delivery Patient Engagement New Revenue Sources: Community Ophthalmology Community Memory Research CIS 10p per patient Oct- 15 £20k Central operations and governance £145k Outbound call pilot £15k On-line accounts £20k HealthWatch commissioned to support practices Funding to support CIS referrals £15k Back Office: Phase 1 £61k Support partnership consolidation £34k Process Vision Timeline Execution Whole Systems Disease Management Pilot £TBC Preparatory work on ACO creation New Part 2 funding £65k Central support: weekend service

Current Funding: Whole Systems Funding

OOHS clinical training £32k Reception training £10k Nurse training £30k Practice Manager HR training £6k HCA training £17k

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Part 3: What we have learned

Hammersmith & Fulham GP Federation

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  • There needs to be a clear reason to start
  • Write a prospectus
  • First who then what: get a strong chairman, someone to run it,

and elect a GP Board

  • Run it like a start-up
  • Communicate lots and lots and lots
  • Build a good working relationship with the CCG
  • Expect difficulties
  • Have a clear plan for the first 12 months
  • Help practices to address the core business
  • Don’t get distracted with multiple priorities and projects
  • Don’t use any software that isn’t SaaS

Key Lessons

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  • Establishing a CIC to host the local CEPN
  • Flipping the resource triangle
  • Practice Nurse audit
  • HCAs and the Care Certificate
  • GP fellows for urgent care and undergraduate teaching
  • Careers event 9 September
  • Testing software platform for training and competence reporting
  • Use Federation as employment vehicle for multi-site clinicians
  • Board development
  • Build out clinical governance
  • Quality improvement focus, e.g. diabetes network

Workforce Agenda

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Thank you chris.adams6@nhs.net 07785 501952

Hammersmith & Fulham GP Federation

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EMERGING PICTURE SO FAR

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Jim Fenwick, Chief Executive, Battersea Healthcare CIC and Wandsworth CEPN

Don’t forget to tweet us at @HealthyLDN #HealthyLDN

Dr Judy Roberts, Director, Education and CEPN Lead, Battersea Healthcare CIC and Wandsworth CEPN

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Federation@ Wandsworth

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Introduction

Jim Fenwick | Chief Executive, Battersea Healthcare CIC and Wandsworth CEPN Dr Judy Roberts | Director, Education and CEPN Lead, Battersea Healthcare CIC and Wandsworth CEPN  Why we created a federation  Original development  Original contracts  Further contracts  Future developments  Future support needs

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Why we created a federation

 Threat to GPs in 2008  5 original federations  Ltd vs. CIC  Early projects (imms/Wandle extra/QMH Polyclinic)  PCT seed money

Putney

Roehampton

Central BTF

Battersea

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Original development

 Lots of legal advice and admin required  3 federations merger  CCG development and distraction for GPs  CIC to remove conflicts of interest  Able to keep localities

Putney

Roehampton

Battersea Healthcare CIC

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Original contracts

 2 pilots for outpatients – dermatology and MICAS  Included triage of all referrals  80% of tariff  Dermatology using Dermatology consultants, registrars and GPSIs  MICAS using Sports and Exercise Medicine consultants, Extended Scope Physios and GPSIs  Better patient experience  Lower wait times

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Further contracts

 CEPN – Initial model for HESL  LES contracts through CCG tender (Long-term conditions and Diagnostics)  CCG preference for single contract (with 100% coverage)  Open procurement

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Future developments

 Access – 8:00 – 8:00, 7 days  MCP Model  CEPN Expansion  Public Health

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MCP and CEPN Model:

Primary care providers working together Stakeholders:  40 GP Practices  1 CCG  1 Acute Hospital (plus 3 more in close proximity)  1 Community Services Provider  1 OOH/111 Provider  1 Mental Health Trust  1 Public Health Department  1 Hospice  14 Care Homes  60 Pharmacies  400 Charities  ? Carers  375,000 Patients

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Future support needs

Local

 CCG

Regional

 Commissioning collaboratives  South London or London wide

National

 NHS wide

Local

 Workforce and COI

Regional

 IM&T and estates

National

 NHS pensions for LES work  IM&T and estates

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Q&A

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Chis Adams, Chief Executive , H&F GP Federation

Don’t forget to tweet us at @HealthyLDN #HealthyLDN

Jeremey Fenwick, Chief Executive, Battersea Healthcare CIC and Wandsworth CEPN Dr Robert Varnam - Head of General Practice Development, NHS England

Session Host

Dr Marc Rowland, Chair of the Healthy London Partnership Innovation Group, Co- Chair of the Transforming Primary Care Strategic Oversight Group

Q&A Host

Dr Judy Roberts, Director, Education and CEPN Lead, Battersea Healthcare CIC and Wandsworth CEPN

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04

Transforming London’s health and care together

TAIL AILORING ORING YOUR L OUR LOCAL OCAL NEEDS NEEDS

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INTELLIGENCE HUB

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  • There are 10 tables themed around our development support offer
  • Spend 10 mins on each table to discuss your development needs and share

experiences

  • Each table has a facilitator and subject matter expert(s)

Tips for the Intelligence Hub

  • Discuss the importance of each topic
  • Gain a clearer understanding of your organisational needs and resources available

to you

  • Feedback any gaps in support and ways you would like support to be delivered
  • Use the Self assessment tool to start mapping out your learning and development

& shape a tailored offer

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Intelligence Hub

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System Wide Support Group 1 & 7 Regulatory & Legal Group 2 & 8 Organisational Development Group 10 & 4 Developing Partnerships Group 6 & 5 Leadership Group 9 & 3

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Which Table Topic Is Your Top Organisation Priority?

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  • A. Leadership & Organisational Development
  • B. System Wide Support
  • C. Developing Partnerships
  • D. Regulatory & Legal

http://www.im- cms.co.uk/application/assets/81/KeypadVotingTimeFilter/KeypadVotingChart.php?Title=14:45:%20The%20In telligence%20Hub&ID=14803

Register your vote in the Intelligence Hub session tab

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05

Transforming London’s health and care together

WHAT ARE THE NEXT STEPS?

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NEXT STEPS

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Liz Wise, Programme Director, Transforming Primary Care, Healthy London Partnership Greg Cairns, Director Primary Care Strategy, London-wide Local Medical Committees

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www.lmc.org.uk

Provider Development: What Are The Next Steps?

Greg Cairns

Director of Primary Care Strategy, Londonwide LMCs

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www.lmc.org.uk

GP Networks – fact or fiction?

  • Significant activity
  • Significant challenges
  • Future Models, MCPs –

risks/opportunities?

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www.lmc.org.uk

Addressing the Challenges

  • 1. Not involved – don’t want/need to do it
  • 2. We need a Federation; how do we do it?
  • 3. We’ve got a federation, what next; how do we

maintain momentum; ensure we’re sustainable; future proof?

  • How many; who; where; achievements to date?
  • Commissioner & Federation behaviour
  • Capacity - time, skills, interest, leadership
  • Maintaining GP core values and identity
  • Governance, decision making
  • NHS Pensions!!
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www.lmc.org.uk

Deliverables (i)

  • Strategic partnerships, influencing and

delivery

  • Shifting sands – intelligence and analysis
  • Share good practice and new models of

delivery

  • Provide updates and hold London wide

events

  • Effective system leadership
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www.lmc.org.uk

Deliverables (ii)

  • Focus on practical; doing it right!
  • Road Map for successful delivery
  • Work with GP Provider groups to develop tailored support
  • Workshops/Events:
  • London / SPG / Borough / Federation
  • Peer Support; Shared Learning
  • Practical Support/Guides/Experts:
  • Procurement, bidding
  • Governance, decision making
  • Financial planning/modelling
  • Workforce development
  • Continue to support @15 Federations
  • Influencing commissioners – federations (at scale provision) a must

to achieve transformative agenda?

  • Links with Educational Commissioners, providers, incl

LETB/CEPN/LEAD

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NEXT STEPS

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Provider Toolkit: supports provider organisations to develop, and to understand their requirements in order to grow. Support includes;

  • Toolkit
  • Case studies
  • Self Assessment
  • Learning needs analysis
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Support Leadership Development

62 A new provider is being procured to offer a wide range of learning and development opportunities This also includes an initiative to support 10 individuals (clinicians and non-clinicians) from each Strategic Planning Group in the following ways:

A wide range of transformational development packages will be available to empower participants to devise their own bespoke learning and development programme, underpinned by joining a diverse Action Learning Set.

Action Learning Master classes Guest speakers Strategy days Topic events Executive coaching Online initiatives Publications Networking Train the trainer Leadership style Topic action learning

Transformational development packages

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Support local area development

Local delivery

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  • We will work closely with you to plan your programme of support
  • You will benefit from the LMC and the Transforming Primary Care team working

together to deliver local workshops and events

  • We will share good practice and new models of delivery
  • Provide updates and hold London wide events

We are also going to develop a programme for commissioners

  • Commissioner development support – identifying provider readiness, creating

action learning sets that focus on realising the benefit of co-commissioning, developing new contract models that are population based, underpinned with new financial models, sharing emerging contract models and specifications.

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Transforming London’s health and care together

Summary and Close

64

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Thank You

england.londonprimarycaretransformation@nhs.net