DRAFT PRIMARY CARE

COMMISSIONING STRATEGY

Primary Care Commissioning Committee

1st November 2017

Contents

• National guidance on the development of

primary care and general practice

• Sutton approach to date

• Timescale and process for finalising the

Sutton CCG Primary Care Strategy

2

Primary care now

– surviving?

3

Primary care future

– thriving

4

National Policy

GP Forward View

– Care Redesign• Extended access

• Online consultations

– Workload• 10 High impact actions

• Practice Resilience

– Workforce• Clinical pharmacists

• Care navigators and Medical assistants

– Practice Infrastructure• Improved estates

• Improved use of digital technologies

5

10 High impact actions

6

10 point action plan for

General Practice Nursing

7

London Strategy

• 17 Primary Care Specifications:

– Proactive Care

– Accessible Care

– Coordinated Care

8

Sutton’s Draft

Primary Care Strategy

Sutton CCG’s Primary Care Strategy identified 4

priorities for primary care:

• Sustainability

• Healthy Communities

• New Ways of Working

• Improved Access and Experience

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Sustainability

• Policy drivers and long term trends point

towards ‘primary care at scale’

• Central capacity should be

complementary to existing model of

general practice

• At a borough level this could mean

triage, referrals, roving GP, telephone

and online consultations, etc.

• Larger primary care health centres as

focal point for locality based services

• Development of more specialised

support for most complex patients

(Sutton Health and Care)

H E A L T H C E N T R E

GP GP GP

Enabling This:

• Subcontracting between practices,

federation & health centres

• Sharing of patient records

• Shared employment models

• Consolidation and collaboration of

administrative functions

Locality Collaboration

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Other Community Services

Healthy Communities

• Significant untapped potential of

community assets for generating health

• Approximately 20% of demand in primary

care driven by social rather than health

needs (local & national evidence)

• Primary care referrals into Sutton

council’s advice and liaison service for

assessment via Social Prescribing

• Better use of volunteer capacity

(championed by Patient Participation

Groups and Sutton Volunteer Centre) for

signposting and to lead social

interventions

• Better use of community pharmacies to

signpost (health champions) and to

deliver some interventions

Enabling this:

• New approach to commissioning

third sector organisations

• Ongoing training of workforce for

social prescribing

• Better data to understand local

variation in wider determinants of

health11

New Ways of Working

Enabling This:

• Increase training via multi-

professional training hubs

• Commissioning levers to be

identified

• Recruitment drive reinforcing the

benefits to living and working in

Sutton

GP

Practice Nurse

Healthcare Assistant

Core Team

Extended Team

Integrated MDT

• Core practice team as fundamental

building block

• Diversify the primary care team to

utilise a higher proportion of skilled

nurses, healthcare assistants,

pharmacists to free up GPs for more

complex care

• Divert some activity to extended teams

(with a locality footprint)

• Integrated multi-disciplinary team-

working to improve cross-organisational

patient-centred care

• Embed multidisciplinary training &

development (e.g. trainers groups) and

move to a model where trainees deliver

capacity12

Improved Access &

Experience

• Reinforce continuity via core practice

teams

• Offer ‘one stop’ type clinics

• Help navigate complex health

management via care navigators

• Primary care referrals into Sutton

Council’s advice and liaison service

• Move towards a single point of access

for primary care for booking

appointments, viewing records, and

telephone/online consultations

• Continue to promote digital access

• Support self-care and self-

management

Telephone & Web Based

Support

Healthy Living Apps

Health Coaching &

Peer Support

Group Consultations

& Clinics

Assistive Home Based

Support

SpecialisedLocalityClinics

UrgentCare Hubs

Single Point of Access

Enabling This:

• Implementing care coordinator role

• Training for staff in influencing

health behaviours

• Commissioning levers for

centralised clinics 13

What is being delivered in 2017/18?

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New primary care model signposting patients to reduce unnecessary usage of primary and secondary services

New primary care model greatly increases numbers of patients that can be seen for minor ailments; reduced A&E attendances, 111/Out Of Hours

New contract models increasing access to services in primary care, reducing secondary care elective activity

Comprehensive model of multi-disciplinary team-working supporting complex patients to avoid emergency admission and facilitate discharges

Transformation

workstreams 2017 - 2019

• Extended Access

• Social Prescribing

• MDT Locality Model

– “Sutton Health and Care”

• Patient Education

• Help Yourself to Health

• National Diabetes Prevention

Programme (NDPP)

• Releasing Time for Care

Programme

• Pharmacists in General Practice

• Health Champions

• Development of Care Navigators

and Medical Assistants

• iPlato

• GP TeamNet

• Skype for Business

• Mobile working

• Wifi for GP Practices

• E-consultations

• Sutton Integrated Digital Care Record (IDCR)

• Kinesis

• Docman Upgrade

• Patient Online

• Premises Developments

• Community Education Provider Network (CEPN)

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What will be different?

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Integrated Teams

Collaborative working and proactive case management of

the most complex patients

Primary Care Team

GP as expert generalist within a multi-disciplinary team

Access

Shorter waiting times

Easier to see GP when needed

Experience

Patients feel better supported to manage their health and

know how to access help when they need it

Sustainability

Stable workforce, increased staff satisfaction, digital

innovations

Next steps

• Engage with stakeholders on the current draft strategy

– Carshalton Locality October 2017

– Sutton and Cheam Locality November 2017

– Wallington Locality November 2017

– LBS Scrutiny Committee October 2017

– Patient Reference Group January 2018

• Primary Care Commissioning Committee - November 2017

• Governing Body approval - January 2018

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