R f i G l P ti dReforming General Practice and improving health in Walesimproving health in Wales

Paul Myres, Chair RCGP Walesy

Policy Forum for Wales, Cardiff 14 May 2015

RCGP Vision

A world where excellent person-centred care in general practice is

at the heart of healthcare

RCGP

The RCGP aims to improve the quality of healthcare by ensuring the highest standards forhealthcare by ensuring the highest standards for general practice, the promotion of the best health outcomes for patients and the public and byoutcomes for patients and the public and by promoting GPs as the heart and hub of health servicesservices

RCGP Core Values

•Consider patients as peopleConsider patients as people

•Be moved by their suffering

•Assist them on difficult and life h i jchanging journeys

The NHS

Th NHS f ll h d tThe NHS performs well when compared to other similar health systems on measures of continuity, communication and patient engagementg g

Patient centred care RCGP 2014Patient centred care RCGP 2014

NHS GPs provide:

• Comprehensive• Cost-effective• High qualityg q y• Widely respected• Generalist healthcare services

• GPs make the NHS safe, fair and value forGPs make the NHS safe, fair and value for money

The NHS in 2015- the system

Demand exceeding supplyDemand exceeding supplyFragmentation of carePoor continuity of careArtificial divides between health, social, primary and secondary careT h f i li t h liTo much focus on specialisms….not enough on generalismNot enough use of e-healthUnacceptable health inequalitiesUnacceptable health inequalitiesAnd…..

NHS in 2015 - Patients

• Living longerMore obese• More obese

• More morbidities• Reduced social support• Higher expectationsHigher expectations• More unequal care needs

The NHS in 2015 – General Practice

Increased workloadReduced share of NHS budgetUnpopular specialtyWTE workforce reducingWTE workforce reducingWaiting times increasing

Investment in PHC in Wales•Total NHS spend by primary and secondary care

•Source: Kathrin Thomas with the Program Management Unit, Public Health Wales

GP funding as a share of NHS expenditure in Wales10 0%

8.6% 8.8%8.4%

8.2% 8.0% 7.8% 7.8% 7.8% 7.8%8.0%

10.0%

6.0%

2 0%

4.0%

0.0%

2.0%

2004-05 2005-06 2006-07 2007-08 2008-09 2009-10 2010-11 2011-12 2012-13

Source: NHS Wales (Programme Budget), HSCIC, ONS, HM TreasuryNote: GP funding figures are for total investment in GPs, excluding dispensing and reimbursement of drugs. Social care funding has been stripped from calculation of total NHS expenditure.

Fall in general practice funding in Wales, 2009/10 to 2012/13 (2013/14 prices)

439,591 434,353 430,383 428,060 426,324

400 000

500,000

300,000

400,000

200,000

-

100,000

2009-10 2010-11 2011-12 2012-13 2013-14

Source: NHS Wales (Programme Budget), HSCIC, ONS, HM TreasuryNote: GP funding figures are for total investment in GPs, excluding dispensing and reimbursement of drugs.

2009-10 2010-11 2011-12 2012-13 2013-14

•Source: Kathrin Thomas, Public Health Wales, data from StatsWales

COMRES POLL 2015 (headlines)

1 Th l t ti b k d i t t ith GP h did fi d th ?1. The last time you booked an appointment with your GP, how did you find the process?One in three (35%) not able to book appointment within a week

2. Do you think your ability to see your GP will stay the same, improve or decline over next 5 years?Half of adults surveyed ((50%) believe this will stay the sameHalf of adults surveyed ((50%) believe this will stay the sameOnly 4% of adults believe this will improve

3. Do you agree/disagree that waiting times in Wales are a national crisis?Over half of adults (63%) believe waiting times are a national crisisOver half of adults (63%) believe waiting times are a national crisis

4. The Welsh Government has announced a one-off £40m investment in primary careMajority (63%) believe most of the funding should go to frontline GP services

The NHS

• Evidence suggests that the health service is failing to deliver patient centred carefailing to deliver patient centred care consistently – both in the context of general practice and the wider health and care systempractice and the wider health and care system

• Patient centred care 2014

Primary Care Plan Feb 15 - WGPrimary Care Plan Feb 15 WG

Planning care locallyImproving access and qualityImproving access and qualityReducing inequalitiesE i kill d kfEnsuring a skilled workforceProviding strong leadership

Primary Care Plan

Prevention early interventionPrevention, early interventionCoordinated care, closer working between primary secondary and communityprimary, secondary and communityActive involvement of public, patients and carersPlanning at community level (25,000 to 100,000)Prudent healthcare

Prudent Healthcare

Do no harmTreat the greatest need firstCarry out the minimum appropriate interventionCarry out the minimum appropriate interventionMainly do what only you can doC i t tl l id b d di iConsistently apply evidence based medicinePromote equityCo-produce

QOF – does it still have a place?

Quality Improvement or PerformanceQuality Improvement or Performance managementTick box or aide memoireTick box or aide memoireDriver for change or a distractionPatient or doctor centredSingle issuegPerson or population health

A Patient Voice

A system where “I can plan my care with people who work together to understand me and my carer(s)work together to understand me and my carer(s), allow me control and bring together services to achieve the outcomes important to meachieve the outcomes important to me

N ti l i 2013National voices 2013

Patients in 2022 will expect

Easy access to health informationFlexibility to access registration, consultations, health records and treatment remotelyA t b t li tAssessment by expert generalistTo be shown respect & dignityLonger consultation timesLonger consultation timesBetter communication between GP & specialistTo relate to a team who knows themTo share decision makingChoice

The GP in 2022 willBe an expert generalist physicianStructure care around multi morbidity as well asStructure care around multi-morbidity as well as individual conditionsBe independent advocates for patientsBe independent advocates for patientsAct as gatekeeper and navigator ensuring effective resource utilisationresource utilisationWork as part of a generalist team & take on extended roles in specific areas of care public health androles in specific areas of care, public health and education Lead service planning & quality improvementLead service planning & quality improvement

The 2022 General practice team is likely toto

Work as a community-led, flexible, integrated MDTWork in a federationWork in a federation Work in purpose-built premises with clinical & diagnostic servicesOffer a variety of appointments – content, length, remotey pp , g ,Monitor, understand & manage inappropriate variability Work with specialists, 3rd sector, private & NHS providers to deliver care in a integrated & coordinated mannerInclude other community-based generalist professionals working both in & out of acute & intermediate care facilities ? Primaryboth in & out of acute & intermediate care facilities. ? Primary care nursesWork with care coordinators

We need

More GPsMore GPsMore GPsMore GPs

Spending longer with their patients & communitiesSpending longer with their patients & communitiespatients & communitiespatients & communities

With longer trainingWith longer training

We need

Wider skill mixWider skill mixWider skill mixWider skill mix

More community engagementMore community engagement

Premises fit for purposePremises fit for purpose

RCGP Wales Priorities

Sustained investment restoring the shortfallgImprove recruitment, returns and retentionContinuity of CareContinuity of CareExpand the General Practice FamilyPromote dignityImprove EOLCpSupport patients with dementia and carersImprove the working life of GPs and their teamsImprove the working life of GPs and their teams

“I t t h“I want to see someone who cares what happens to me”cares what happens to me