dr paul twomey partnership council nov 2013 primary care opportunities set in the context of...

Dr Paul Twomey

Partnership Council Nov 2013

Primary Care Opportunities Set In the Context ofReconfiguration

OVERVIEW

•New System:CommissioningDevelopment / SustainabilityQA / Performance Management

HOW DO WE ?

•Focus GP Practice

GP PRACTICE Challenges / Opportunities / Threats

Strategic Reviews:

•Shift secondary Community

•7 / 7 and 8 to 8 Working• > Scrutiny (keogh + CQC)

•Issues re recruitment + moral

GP PRACTICE Challenges / Opportunities / Threats

‘WE’ NEED:

•Consistent quality primary care:for patients - focus primary care experienceFor system to evolve - reconfiguration

- effective utilisation + release of resources

GP PRACTICE Challenges / Opportunities / Threats

HOWEVER

•Essential to describe ‘What is Consistent Quality Primary Care’

•Headroom to enable and deliver change

•Super-saturated Sponge

Standard operating policies and procedures for primary care

Primary medical services assurance framework

UTILISING A DIFFERENT ENVIRONMENTPrimary Care Focus Area Team

CCG Executive

GPPractice

Primary Care Professional

GP Practice

as a Provider

PRIMARY CARE STRATEGY

• Office GP Practice

• Full range of primary care services through the working day

 • Collaborative approach (federal model/other providers). 

11

RESPONSIBLE OFFICER FUNCTION

To make available to their constituent doctors a quality assured Appraisal programme which is Fit for Purpose. 

Supported by the Clinical Governance Framework which will provide suitable developmental opportunities

MEDICAL REVALIDATION

• First cycle 3 ¼ years

• ¼ Year 0 = 14 %

Residual cohort

• Year 1 - 20 %

• Year 2 - 40 %

• Year 3 - 40%

• Focus: Fitness for Practise vs Fitness for Purpose

Total Recommendations 177  (14%)

North Yorkshire 67 (10%) 

Humber 104 (27 - 10%) 

Deferments   4 4

GMC Actions   2 2

Reflections

INFORMATION FOR GP PRACTICE

GP HIGH LEVEL INDICATORS

• Secondary Care Activity

• QoF

• Prevalence LTC

• Exception Rate

• Prevention / Immunisations

• Medicines Management

• Patient Experience

OUTCOME STANDARDS 27

• Ca Management • AF Management

- Common Ca- Survival Rates 1 year - Prevalence- Emergency Admission

• Smoking Management

• Childhood Immunisation < 2 yrs • LTC Management

• Flu > 65 years

• Patient experience

- Prevalence- Admission rates- Some key QoF indicators

CLINICAL GOVERNANCE FRAMEWORK

CHARACTERISTICS OF QUALITY GENERAL PRACTICE • Holistic and evidence based approach to patient care• Continuity of care• Positive GP practice : patient relationship• Appropriate management of risk• Attention to detail• Good communication with patients and other health care

professionals• Appropriate skill mix• Education• Strong leadership• Support from secondary care colleagues• Quality IT support

Delivered by culture and system

HOW CAN WE CULTIVATE HIGH QUALITY PRIMARY CARE?

•Nurture current resources to build on strengths

•Promote new growth

•Consider hybrids

•Pruning

•Commissioning and design

NEXT STEPS ?

SYSTEMS FOR QUALITY GP PRACTICE• The Team

induction (int / ext) mentoringintegrated training programmeindividual team PDP well-beingskill mixcommunicationguidance

SYSTEMS FOR QUALITY GP PRACTICE• Service Delivery

8 am – 6.30 pmMonday Friday

access to whole team as clinically requiredfocus patient Objectivessupported by MDTs / complex case managementseamless relationship with community services

SYSTEMS FOR QUALITY GP PRACTICE

• Collaboration (spectrum)

• Focus primary care centre well-being service delivery capacity

• Bring / share enable• Build on good characteristics• Achieve 3 Rs

ACTION PLAN • Focus on what we value GP practice to deliver

(call to action)Health & Wellbeing Boards describe & supportPublic Health consistent good GP practice

•Bring / share to enableback office and clerical staff

•Medical Leadership

Focus Primary Care Centre

ACTION PLAN SUMMARY

COMMISSIONING OF GP PRACTICE

• Synergy of :

Core + (Area Team) = 9 clinical sessionsLocal enhanced services (HWBB)Resource identified from reconfiguration

ACTION PLAN SUMMARY

GOVERNANCE

3 steps:

•Conversation engagement sign off (AT)

ownership delivery

(CCG led) - local community•Consensus

•(AT / CCG /

Link / HWBB)

ACTION PLAN SUMMARY

KEY ACTIONS

• Consistent quality GP practice

NOWMonday - Friday 8.00 am – 6.30 pm

Integrated into wider community service

transparent

patient sees single service

SOON7 / 7 8 am – 8 pm build on characteristics of good GP practice

COMMISSIONING

• Minimise safety netting

• Utilise ITF (protection of PMS)

SERVICE DELIVERY

Timescalesre impact

• Unplanned admissions

Timely Discharge NOW

• LTCs 2 – 5 yrs

• Well-being 5 – 10 yrs

RECRUITMENT / RETENTION

• ACT NOW

change environment / culture well-being > relationship with Med Students and Drs in training

Year 4 5 yr sliding programme (training + Collab) Last 5 years Initial focus GPs but then broaden