Primary Medical Services (GP Practices)

James Gleed Associate Director Commissioning Primary Care

Delegated Commissioning

The CCG took on the needs assessment, service planning and contract management of GP services from 1 April 2018. This is known as ‘Delegated Commissioning’ Prior to this the responsibility sat with NHS England

CCG is responsible for: Decisions about some additional services that GPs provide

Decisions about the establishment of new GP practices (including branch surgeries) and closure of GP practices. Decisions about ‘discretionary’ payments. These new duties will support our aim to develop more integrated out-of-hospital services with primary care at the centre – sometimes known as ‘place-based’ commissioning. The responsibility for practitioner performance and revalidation remains with NHS England.

Some functions remain with NHS England, chiefly:

• Management of the GP revalidation and appraisal process

• Management of individual practitioner performance issues

• Functions in relation to complaints management

The CCG is not responsible for everything

Primary Care Development and Support

• Estates Technology and Transformation Fund (ETTF)

• Support practice applications for the NHSE GP Resilience Programme (GPRP)

• Workforce development, training and education

• Quality Improvement /CQC

• Training admin and clerical staff: ‘Workflow Optimisation’ and ‘Active Signposting’

• £3 per patient ‘Transformation Fund’ (£1.50 in 17-18 and again in 18-19)

• Additional locality funding to enhance seasonal flu vaccination

• CFF £10.10 per patient

• £4 per patient for Extended Access Services: CCG has resisted national push for procurement next year to allow localities to deliver local services through federations

• IT: support to create a single electronic patient record /interoperability and Ardens templates

• Winter pressures funding: extra in-hours appointments and care home ward rounds and flu

• A new local resilience and transformation fund £250K across the CCG 2018-19

• Data and information governance support

General Practice Forward View (GPFV)

NHS England Plan for Primary Care Published April 2016, responding to

challenges in primary care

Investment Improved access High quality care Sustainability

Extended Access Primary Care CCGs are required to commission extended access for 100% of their population by 1 Oct 2018:

• 30 mins per 1000 patients

• Appointments evenings 6:30pm – 8pm Mon – Fri and also at weekends according to local need

• Federated groups of existing practices in each locality delivering the service

• Not just GPs – offer should include other healthcare professionals

• Must advertise service

• Service has now gone live in 4 of the 6 localities =60% coverage

Capacity Required

Locality Practices List Size Reg'd pop / 1,000 x 30 (Hrs/W) /60 mins Reg'd pop / 1,000 x 45(Hrs/W)/60 mins

LLV 75,435 38 57

STV 95,333 48 71

ULV (inclu

HB) 124,540 62 93

SVV (inclu

SB 60,704 30 46

WH 120,270 60 90

NH 115,641 58 87

Total 591,923 296 444

Locality Plans to Improve Flu vaccination rates

•Ordering banners, badges and t-shirts and promoting the flu jab in house with various displays, as well as sharing promotional materials with pharmacies.

•Using MJOG to send targeted text messages to eligible patients.

•Advertising flu clinics in local papers – to including mention of community pharmacies offering vaccines.

•Having a practice Flu champion with whom pharmacist can liaise with regards to matters related to flu vaccination and vice versa.

•Working with district nurses to vaccinate house bound patients and carers and working with midwives.

•Buddying higher performing practices with lower performing practices.

•Putting script messages on prescriptions – to include mention of pharmacies offering vaccines.

Workflow Optimisation

• Involves non-clinical staff safely managing clinical correspondence by working to strict protocols and escalation procedures

• National evidence suggests can solve up to 10% of GPs’ time • Virtually all practices in ENH have undergone training

• Providing refresher training this year

Care Navigation /Active signposting • Currently significant amount of GP time is taken up with non-medical problems

or problems that are people can help with instead

• Upskilling admin and clerical staff to help patients make informed choices to see the right healthcare worker or care agency as quickly as possible. Pathways:

IAPT

Community Pharmacy

School Nursing

Herts Help / Social Prescribing

• Makes best use of existing local services

Online consultation & Technology

• Aim is to create a way for patients to easily and quickly access GP services through a phone app or internet portal

• Experience elsewhere suggests that it can greatly improve service efficiency and access

• Have recruited a project management team and are now planning project kick-off

• Key to the project will be service users and GP practices, is imperative to implement a product that is user friendly and will be used

• Other pockets of innovation across ENH such as the use of video consultation in the Integrated Urgent Care Service (NHS 111). We aim to learn from pilots and spread good practice

GPFV Transformation Fund

CCGs’ GPFV Transformation non- recurrent monies are being utilised to achieve the following

Stimulate development of

at scale providers

Implementation of 10 high impact

actions

Secure sustainability in General Practice

Training/ development

The monies are being used to support and develop localities to work on their Extended Access offer, e.g. supporting GPFV events/ workshops/ collaborative

working

Active Signposting (Care Navigation), support self-care, new consultation types, Social Prescribing and other CCG

specific training e.g. HVCCG Practice Managers Masterclasses etc

Enabling sustainability by being able to work in collaborative arrangements.

Training and development of current healthcare staff.

GPN: Hertfordshire and West Essex STP

Update on GPN 10 Point Plan

1.Celebrate and raise the profile of

General Practice nursing. - Developing a Primary Care Workforce and Education Network (CEPN) website

2.Extend Leadership and Educator

Roles

- Extended leadership and educator roles developed through locality and STP networked CEPN’s and the introduction of GPN Nurse Tutor and GP Locality workforce

leads.

- Nurse Tutors across STP: ENHCCG x 6 8hrs; HVCCG x 4 3 x 8hrs /1 x 16hrs; WECCG x 3 8hrs

- In ENHCCG a Primary Care Nurse Co-ordinator Post oversees the work of the Tutors.

- HVCCG are developing the Practice Nurse Coordinator role in their area to develop the shared approach and address the key areas for future development

collaboratively

3.Increase pre reg placements in GP

- ENHCCG: 3 Half-day mentorship courses developed to increase the number of nurses who need an update

- 28 general practice pre-registration student placements as at Jan 18

- Introduction of a welcome letter and the establishment of a 1-day CCG Taster Session for student nurses- Funded places secured with local HEI for mentorship

preparation training to facilitate increased student placements

- As at January 2018 a total of 9 pre-registration student placements had taken place in practices across HVCCG.

4.Establish Inductions and

Preceptorship

- Nursing in General Practice: Fundamentals Programme developed by University of Hertfordshire in Jan 17

- As at Jan 18 a total of 20 nurses had attended or were booked on the Foundation Course in ENHCCG and 1 nurse in HVCCG.

5.Improve access to return to work

programmes

- As at January 2018 a total of 7 RTP nurses had been placed in ENHCCG and 1 in HVCCG.

- Vision that numbers will increase in CCGs during 18/19 with the implementation of Nurse Tutors in HVCCG and WECCG and in response to the planned National

Campaign.

6.Embed and deliver a radical upgrade

in prevention

- Aim is to ensure that every patient encounter is productive, with particular emphasis on management of obesity and anti-microbial resistance

- Nurse Tutor Network will support practice nurses with the use of the PHE All Our Health learning platform.

7.Access to educational programmes

ENHCCG: TNA of Nurses undertaken in November 2016 and relevant courses secured and CPD for Practices Nurses across E & N Herts.

ENHCCG have provided over 350 funded course places for Practice Nurses during 17/18

ENHCCG produces a monthly training flyer for practice nurses, HVCCG produce a newsletter for Practices

- Specialist Nursing Degree for Practice Nurses to develop nurses with advanced nursing skills has been actively promoted.

- HEE funding has been obtained by CCGs for Independent Prescribing courses and Long Term Conditions Management Diplomas in Asthma, COPD, and Diabetes.

8.Increase Access to clinical academic

careers and ANP

- Advanced clinical practice will be promoted to support an increase in the no. in primary care.

- Work collaboratively with HEE to promote and develop roles.

- Existing Practice Nurses encouraged through RCN credentialing to become accredited Advanced Nurse Practitioners.

9.Develop Health Care support workers

and Nursing Associates career pathway

- ENHCCG in the process of securing the EQUIP 5 day Healthcare Assistants Course for those new to the role.

- Development of an Apprenticeship Framework for all primary care staff

10.Improve retention - Working collaboratively through promotion of general practice as a good place of employment for practice nurses and HCSWs through various initiatives.

Any Questions?