General practice forward view, Lewisham CCG

#GPforwardview#GPforwardview

Dr Robert VarnamHead of General Practice DevelopmentNHS England

@robertvarnam

www.england.nhs.uk/gpfv

bit.ly/161013lewisham

#GPforwardview

The problems

#GPforwardviewwww.england.nhs.uk/gpfv

#GPforwardview

Overall new investment is a minimum extra £2.4 billion pa by 2020/21

£9.6

billion/year 2015-16

£12 billion/year

2020-21

14% real terms increase vs 8% for the rest of the NHS (plus CCG increases)

One off Sustainability and Transformation package >£500M over 5 years

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Extra £33m included in 2016/17 contract

Already actioned

Repeat winter payments scheme for

OOH in 2016

Payment to all practices (weighted) Apr 17 & 18 based on

average indemnity increases

Work on new scheme for OOH support with BMA

Next steps

GP Indemnity Review Group to look at cover for new members of the workforceand other more radical options

Longer term

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Make GP attractive again

Expand the Medical Workforce

Encourage Recruitment

Retain GPs for longerReduce workload

Bursaries in under-doctored areasInduction & refresher scheme

Retainer Scheme Leadership training opportunitiesMulti-disciplinary Training Hubs

Flexible career schemesCareer coaching for senior GPsMental Health support services

Work with medical schoolsIncreased training places250 Post-CCT fellowshipsMajor campaignsCSU Marketing support International recruitment

5,000 Net WTE doctors in general practice by 2020/21

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Develop the workforce5,000 additional staff by 2020/21

• Major new practice nursing review underway

• £15M to be invested

NURSES

• 3,000 new mental health therapists• Focus on longterm physical conditions

MENTAL HEALTH

Training 1,000 physician associates by 2020• Regulatory and indemnity

enablers

PHYSICIAN ASSOCIATES

£6m of new support over 4 years• Expanded national network• Professional development

PRACTICE MANAGERS

Current £31m to pilot 470 pharmacists in >700 practices, • Plus new £112m for additional

1,500 pharmacists by 2020 (a pharmacist / 30,000 patients)

• Clinical pharmacists in 111 hubs

PHARMACISTS

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• Estates and Technology Fund - prioritisation and pipeline

• Project management support to speed up delivery

• 100% reimbursement of premises costs (rather than up to 66%)

• Fund £7M Stamp Duty for NHS Property Services tenants

• Compensate VAT where the landlord has chosen to charge VAT

• Transitional funding for significant rises in facilities costs

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Interoperability

Online and telephone

consultation systems

Summary care record in all pharmacies

Approved Apps library and

buying framework

Improve uptake of Patient

Online

Wi-Fi services in practices for

patients and staff

Improve payment systems, GP2GP, EPS,

e-discharges, ERS, Advice & Guidance

Accelerate self-care and patient

activation

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Simplify reporting and regulationStreamline payment systemsMove away from micro-incentives

Greater specialist support

Self-help and GP Online

Better sign posting• Care navigation• Social prescribing• Minor ailments• Remote triage/care• Open access AHPs

Reformed 111/Urgent Care

Collectiveworking and MCP contract

GP PRACTICE

Community services

Changes to

Standard Contract

HOSPITAL

Access hub

Demand Management

WORKLOAD

Practice Resilience ProgrammeTen High Impact ActionsDevelopment Programme

Tools to measure & plan workReceptionist & clerical training

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Multispeciality Community Provider contract

• CCG-commissioned. • Organic process. • 10 – 15 year contracts.• Population >100,000 (neighbourhood units 30-50k)

bit.ly/MCPframe1

Virtual MCP Alliance contract, overlaid on existing contracts

Partially integrated Pre-procurement of community services (MCP + GMS)

Fully integratedHybrid: NHS Standard Contract & primary medical servicesSingle, whole population budget for all services coveredNew performance element (replacing CQUIN & QOF) Risk share for acute activity

#GPforwardviewwww.nhsalliance.org/making-time-in-general-practice/

[email protected]

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Self-rating by GPs

5,128 consultations [email protected]

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10 High Impact Actions to release time for careSpreading knowledge of innovations that release GP time and improve care for patients. Practical evidence from practices throughout England who have demonstrated ways to make better use of staff time.

• 24 regional GPFV roadshows• 30 local High Impact Actions showcase events• Web resources (60 and growing)

• Fortnightly webinars• Network of experts

www.england.nhs.uk/gpdp

Ongoing programme to identify and capture robust and practical case studies, adding to the evidence base and implementation guides.

bit.ly/gpcapacityforum

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Time for Care programmes• Bespoke 9-12 month programmes to support groups of practices to

implement innovations that release time for care.

• Open to all 7,800 practices in England. Registrations received from practices in 35% of CCGs in first 3 months. Expected total of 200 local programmes to run over three years.

• Evidence indicates most practices can expect to release 10% of GP time through programme.

• Each programme designed to align with existing local initiatives.


Time for Carechange programmes

Can be aligned with new transformational funding:

• Training for reception and clerical staff, for active signposting and document management (£45m over 5 years).

• Funding towards purchasing online consultation systems (£45m over 4 years, from 2017).

• CCG transformational support (£171m over 2 years, from 2017).


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General Practice Improvement Leaders programme• Training for clinicians and managers in service redesign and

change leadership. Creating at least 400 free places a year for three years.

• Focus on techniques for designing and implementing improvements within the practice rapidly and sustainably.

• Learn-while-doing approach gives immediate as well as longer term benefits.

• First two cohorts (60 staff) launched Oct 2016, next four almost full. Supporting staff from LMCs, federations and practices.

Fundamentals of change and improvement (2-day session)

Human dimensions of change (2 x 1-day sessions)

Facilitation skills (2 x 1-day sessions)

Primary care improvement community

Learn-while-doing

• Funding the RCGP Supporting Federations Network. 750+ members, 3 national events a year, 6 webinars, growing library of online resources.

• Funding NHS Collaborate (NAPC & NHS Alliance) network for leaders of at-scale primary care. Bi-monthly face-to-face networking, aiming to grow to 200 members in next year.

• Funding facilitated peer networking for managers of all 7,800 practices, with support to develop professional skills.



#GPforwardview

www.england.nhs.uk/gpfv


www.nhsalliance.org/making-time-in-general-practice/england.nhs.uk/ourwork/gpfv/gp-indemnity/

england.nhs.uk/ourwork/gpfv/resilience/bit.ly/MCPframe1

General practice forward view, Lewisham CCG

Health & Medicine

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