The Burning Platform

Evolving a New Model for General Practice

Financial Constraint

Workforce Crisis

Increasing Demand

How many patients are registered with the Hurley Group?

15,000 20,000

25,000 31,000

41,000

55,000

75,000

95,000

2006 2007 2008 2009 2010 2011 2012 2013

6.3 times

increase

How many minor illnesses and injuries do we treat a year?

35,000

130,000 140,000

180,000

205,000

2006 2007 2008 2009 2010 2011 2012 2013

4,615 a week

25 35

55

100

170

210

232

272

2006 2007 2008 2009 2010 2011 2012 2013

How many in our team?

2.5%

4%

2%

1%

11%

4%

4%

11% 2%

59%

40% 25%

29%

% of borough’s

urgent care

% of borough

registered with Hurley

es

Our growth strategy working?

Pub Hea

Contract Reviews

Recruitment Issues

Low Morale Cuts

Practice Failures Revalidation

KPIs

PCT meltdown

Rising Patient Demand

Increasing Regulation Values

CQC Rising Patient

Demand

Reduced Funding

NHS Reforms

PMS Reviews

Network Services in the new financial year

1. Diabetes (Care Package)

9. Cancer screening (NEW)

2. NHS Health Checks (Care Package) 10. Healthy Lifestyles (NEW)

3. Imms and Vaccs (Care Package) 11. Sexual Health (New)

4. Hypertension

12. Anti-coagulation (enhanced)

5. CVD: Secondary Prevention (New) 13. Minor surgery & Aftercare (enhanced)

6. COPD (New)

14. Phlebotomy (enhanced)

7. PBC (redesigned)

15. Vulnerable Adults (New)

8. Drug and Alcohol (New)

16. Children 0-5 (New)

Docklands Medical Centre

Barkantine

Island Medical

Island Health Healthy Island

Partnership

The 36 Tower Hamlets practices have formed 8 geographic networks 14

6

5

*

1 2 3

4

5

6

8 Health E1

9

10 Albion

LAP 2. Spitalfields and Banglatown, Bethnal Green South 8

9

10

7

LAP 1. Weavers, Bethnal Green North, Mile End and Globe Town

1 Strouts Pl

2 Bethnal Green

3 Pollard Row

4 Blithehale

7 XX place*

5 Mission

6 Globe Town

11 12

15

13

16

14

11 Shah Jalal

12 Tower

13

LAP 3. Whitechapel, St. Duncan’s and Stepney Green

14

Spitalfields

Varma

Stepney 17

18

19 Grove Surgery 22 St. Stephen’s

LAP 5. Bow West, Bow East

20 Tredegar

21 Harley Grove

23 Ruston Street

19

24

21 22

20

23

24 Merchant Street

25 St Paul’s Way

26 Stroudley Walk

LAP 6. Mile End East, Bromley by Bow

27 Nischal

25

26 27

28

29

30

31

32

28 Limehouse 30 Chrisp St

LAP 7. Limehouse, East India Lansbury

29 Selvan 31 All Saints

32 Aberfeldy

33 Barkantine 35 Island Health

LAP 8. Millwall, Blackwall and Cubitt town

34 Docklands 36 Island Med Ctr 33

34

35

36

17 St Katherine’s Dock

18 Wapping

LAP 4. St. Katharine’s and Wapping, Shadwell

16 Jubilee St

15 East One

LAP 4

LAP 3

LAP1

LAP 2

LAP 6

LAP 5

LAP7

LAP 8

7’ Bromley by Bow

* Estimated registered population, calculated as ½ of Bromley-by-Bow and XX place combined list Source: http://www.towerhamlets.gov.uk/data/in-your-ward; Allocation practice to LAP as per Team Analysis (Aug 2008); Number of

patients per practice based on LDP data (Jan 2009)

Grow to Survive • Challenging financial climate • Bigger is better for economies of scale • Ability to flex resources across the whole organisation • Ability to protect our teams more • Maintain this critical mass as many contracts time limited Grow to Invest • People are our greatest asset • Growth enables our nurturing talent programme • Career progression opportunities for all • Our ambition is to become London's employer of choice

Grow to Make a Difference • Best care to the most deprived communities • Being larger gives us influence • Scope to innovate and develop Primary Care

Why Grow? Is bigger better?

The Journey?

General Practice is sub-scale

Limited mechanisms to enlarge to scale e.g. procurement, M&A and Federating

1. Have to do more with less 2. New skill mix and technologies

3. Commissioners Quality Conundrum 4. New models for true involvement

The roll up to

come….

• Independents for decades but….

• Enlarging Independent Contractors

• The FT possibility • Meaningful Federations