patient partnerships - new approaches in england

@robertvarnam

Dr Robert VarnamHead of general practice development, NHS EnglandGP, The Robert Darbishire Practice, Manchester

@robertvarnam

Patient partnershipAn international perspective

@robertvarnam

Patient partnershipAn international perspective

bit.ly/160728partnerships

@robertvarnam

Improving quality

Our successes: Data-driven approach Peer review Incentives for quality

Room for improvement: Culture of unease Focus on outcomes as well as inputs Focus on patient perspectives as well as professional Non-peer review Multi-morbidity, complex care & collaborative care

@robertvarnam

Massive shifts…

• Population needs (LTCs)

• Societal expectations

• Technology

@robertvarnam

Population

Community

Care

Three arenasfor new partnerships

@robertvarnam

Population

Community

Care

Three arenasfor new partnerships

@robertvarnam

bit.ly/nhs5yfv

Shifts / rebalancing…

• From treatment to wellbeing• From professionals to people• From hospital to community

@robertvarnam

Shifts / rebalancing…

• From treatment to wellbeing• From professionals to people• From hospital to community

New Zealand Health Strategy 2016

@robertvarnam

Population arena

• Shift of investment towards prevention

• Partnerships across society

• Coproduction of priorities with citizens

@robertvarnam

Population arena

• Shift of investment towards prevention

bit.ly/GPAF1voxpops1

@robertvarnam

Population arena

www.nhscitizen.org.uk

@robertvarnam

Population arena

startool.org

@robertvarnam

Population

Community

Care

Three arenasfor new partnerships

@robertvarnam

Population

Community

Care

Three arenasfor new partnerships

@robertvarnam

Community arena

• Coproduction of priorities with citizens

Wave one Wave two

57 schemes2,500 practices18m patients

bit.ly/PMCFresources1

Prime Minister’s GP Access Fund

@robertvarnam

Community arena

• Coproduction of priorities with citizens

• Asset-based community solutions

eg GP Access Fund in SloughOpen town meetings (lots of GP concerns) – almost instant benefits… different priorities local champions patient-run services

@robertvarnam

Community arenaOther resources…

How are practices engaging differently with the population

• bit.ly/GPAF1ppe1

The GP Access Fund• bit.ly/GPAFresources

Leading inter-practice change• vimeo.com/album/3133652

@robertvarnam

Population

Community

Care

Three arenasfor new partnerships

@robertvarnam

Population

Community

Care

Three arenasfor new partnerships

@robertvarnam

Care arena…

Patient-led transactions

Informing patients

Improving access

New consultation paradigms

Care planning & coordination

Personal budgets

Patient training

@robertvarnam

Care arena…Patient-led transactions• Patient Online: book appointments, request repeat

prescriptions

www.england.nhs.uk/ourwork/pe/patient-online/

@robertvarnam

Care arena…Informing patients• NHS Choices: information about symptoms, conditions and

treatments

• Patient Online: access to your medical record

www.nhs.uk

www.england.nhs.uk/ourwork/pe/patient-online/

www.dynamichealthsystems.co.uk

www.digitallifesciences.co.uk

@robertvarnam

Care arena…Improving access• Demand-led systems

• Phone consultations

• e-consultations

bit.ly/GPAFresources

@robertvarnam

Care arena…New consultation paradigms• Self monitoring

• Group consultations

• Assessing patient activation

• Coaching

bit.ly/GPcapacitynet2

www.getflorence.co.uk

bit.ly/NHSE-PAM1

youtu.be/p47H6kVF0IU

youtu.be/_uHFIJhWSxU?t=4m36s

www.dynamichealthsystems.co.uk

@robertvarnam

Care arena…Care planning & coordination• Incentives for practices

• Social prescribing

• Very multidisciplinary teams

bit.ly/GPcapacitynet8

waystowellness.org.uk altogetherbetter.org.uk

bit.ly/2ac6laU

www.coalitionforcollaborativecare.org.uk

@robertvarnam

Care arena…Personal budgets• For social +/- health care

www.nhs.uk/personalhealthbudgets

@robertvarnam

Care arena…Patient training• Expert Patients Programme

• COPD

• Diabetes

• etc

selfmanagementuk.org

www.blf.org.uk

www.dafne.uk.com

@robertvarnam

eg GP Access Fund

@robertvarnam

Care arena…

Patient-led transactions

Informing patients

Improving access

New consultation paradigms

Care planning & coordination

Personal budgets

Patient training

@robertvarnam

Population

Community

Care

Three arenasfor new partnerships

@robertvarnam

How does it feel?

What next?

How?

So …

@robertvarnam

How does it feel?

Innovative+ Great … obviously− Threatening … obviously

Power shift+ Empowering− Abrogation of responsibility

Demedicalising+ Appropriate− Loss of role

We’ve begun

…

there are differing

perceptions

@robertvarnam

What next?• Sustain innovations• Spread innovations• Address inequity• Embed / normalise

How?• Grow evidence of benefit• Understand conditions for success • Inc training capacity• Change patient expectations• Align incentives & payment