developing the primary care home and available support dr...

Developing the primary care home and available support

Dr James Kingsland OBE, NAPC President,and John Pope, NAPC CEO.

The session will cover

© 2017 National Association of Primary Care

• Primary care home in context• A re-cap of the model• Support for sites and

enablers• Our focus in 2017/18

About the National Association of Primary CareThe National Association of Primary Care (NAPC) is a national membership organisation representing and supporting the interests of all healthcare professionals, both clinicians and managers, working across the breadth of Primary Care.

The NAPC is recognised as an organisation that is shaping the future of healthcare delivery, enabling our membership to continue to provide world-class patient centred healthcare.

•3000 – Practice Managers & Practice Members (via PMN network)•77 – GP Federations, covering population of 15 million•57 – Pharmacy members•NPCN Network – 300 members on database, National Thought Leaders•Nurses Voice Network – cohort of 6 senior nurses from across the country•Innovation Network, Primary Care Navigators –90 trainees from across pharmacy and general practice

We support solutions based primary care development for whole population integrated care.


• Patients’ first point of contact with the health and social care system

• Provides the majority of our preventative and curative health needs, health promotion and care monitoring requirements

• Personalised approach rather than disease focused•• Comprehensive services delivered by multi-professional teams focus on population health needs

• Co-ordinates the integration of care in partnership with patients and care providers

Our definition of primary care


Core characteristics of a Primary Care Home

Whole population health management

An integrated, multi-disciplinary workforce

Financial drivers aligned with the health needs of the whole population

Focus on 30,000 – 50,000 people

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Four core characteristics of a Primary Care Home

An integrated, multi-disciplinary workforce

• The NAPC definition of an integrated workforce is a team of 100-150 people drawn from an existing workforce comprising:

- healthcare workforce (e.g. primary, community, mental health, palliative care and appropriate specialist care teams)

- social care workforce

- voluntary and charitable workforce, patient groups and community assets.

• The PCH provides the environment and conditions for effective team working to deliver the Triple Aims whilst also improving staff satisfaction.

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A combined focus on personalisation of care with improvements in population health planning, provision and outcomes

• Balancing the provision of personalisedcare, responsive to the needs of individuals with population health planning and provision

• Focus on health and social needs, including the social determinants of health

• Focus on people who share characteristics within a population rather than a disease

• Implies proactive, preventative care, for healthy and chronically ill people

• It especially means thinking about the health of people who are not accessing care regularly.

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Four core characteristics of a Primary Care Home

Financial drivers aligned with the health needs of the whole population

•The aim is for the PCH model to have responsibility whole population budget formulated on the needs of the registered list of 30,000 – 50,000 patients, built around the constituent GP practices involved

•The level of whole population funding will be dependent on the needs of the population and the scope of services that is agreed through local commissioning arrangements

•The details of how the PCH will take on a whole population budget is being developed in conjunction with the NCM programme.

The provision of care to a registered population size of 30,000 to 50,000 people

•We know that an ‘optimum’ size for a workforce to be truly integrated and effectively utilise local resources is 100-150 (the ‘Dunbar’number*)

•From the modeling work NAPC has done, this size of workforce is able to maximize the delivery of population health outcomes to a place based registered population size of 30,000 – 50,000

•At this size the PCH is the “right size to scale”and the “right size to care”.

*Dunbar, R. (2010). How Many Friends Does One Person Need? Dunbar’s Number and Other Evolutionary Quirks. Faber & Faber.

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PCHs are a key enabler for stabilising Primary Care

The 30-50k population of a PCH, as well as being the right size to care, provides a ‘sweet spot’ for professional collaboration and team work bringing associated benefits for the future development of Primary Care:1.Encourages practices to morph and seek economies of scale e.g. practice management, admin and triage.2.Disparate units of Primary Care coalescing into more robust units – will make it easier for the whole ‘system’ to engage with each other.3.Freedom to act within a whole population budget releases and encourages innovation and opportunities for personal and professional growth leading to an increased ability to attract and retain staff.4.Multidisciplinary Teams will release more time for GPs.5.Allows real delivery of benefits faster and a development escalator


NAPC will support the adoption and development of the PCH model

NAPC’s role is to:

•Support local engagement: Align stakeholders within the system by acting as the honest broker

•Support site development of the characteristics of the PCH model

•Assure the adoption and maturity of the PCH model

•Support sites and system stakeholders to evaluate the outcomes delivered by the model

•Promote understanding and spread the PCH model across aspirant sites and key system stakeholders.

PCH programme functions

Local Support(Advisors/Coaches/Facilitators)

PCH Development Support

Engagement and spread

PCH Model and Best Practice

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Engagement Population Health Data and Needs

Development of PCH Service

Models

Development of PCH

Workforce and Culture

Alignment of strategic and

financial drivers

Evidence and evaluation

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B

C

D

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Local Support(Advisors/Coaches/

Facilitators)

Local support model, aligned with STPs, will coach and facilitate the PCH site development journey

1• Each PCH is encouraged to

develop its own approach and focus, building on the 4 key characteristics.

• Working with the Rapid Test Sites, we have observed 6 emerging elements in the development journey.

• These elements are iterative and not always chronological.

• As sites begin their journey we encourage them to notice what they are learning and put that learning into practice for each new iteration.


The NAPC PCH Programme will facilitate three levels of PCH assurance and evaluation

PCH Model and Best Practice

3a Programme Level Assurance

Self Assurance and evaluation– PCH Site Level

b

National Level Evaluationc


Aware Engaged Advocate

KeyStakeholder

Groups

Engagement and spread

Developing the right level of Primary Care “pull” in the system by making it easy for PCH sites to ‘want’ to implement the model

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Objectives•To embed the understanding within the healthcare system that the Primary Care Home model is a credible and sustainable delivery vehicle meeting the triple aims of the Five Year Forward View

•To inspire the right behaviours and actions within the health care network to building advocates of PCH

•To ’make it easy’ for aspirant local health networks to want to implement the PCH model


Primary Care Home support

Core team is here to support you through your PCH journey:

•Advice, concerns – NAPC’s team of experts •Population health•Workforce design•Training - new Advanced Primary Care Management Diploma •Communications – shared learning •Primary Care Navigation


Advice and support from NAPC’s team

Please get in touch with NAPC core team in the first instance if you need any advice:

•Dominic Frankis – PCH Programme Manager•Catherine Hill – Programme Office Lead•Sally Kitt, Chief Operating Officer•Marcus McAlister, Chief of Staff •Caroline Thomsett, Communications Lead•Katherine Andrews, Primary Care Navigation

We have a PCH field team who can also support you:•Becky Meadows (Midlands and East)•Dr Mark Davies (North)•Andy Mullins (South West)•Dr Steve Laitner (London and South)•Dr Johnny Marshall•Clare Simpson (workforce)


Webinars, events, conferences

The NAPC team will be running a series of webinars and events on a range of topics, such as logic models and population health

We will be at number of conferences coming up – please join us: Ø11-12 September - Health and Care Innovation Expo, Manchester Ø18-19 October – NAPC’s annual conference, Best Practice, Birmingham NEC


Training – new diploma launching October

• Advance Primary Care Management Diploma• One-year course starting in October • For managing and developing primary care at

scale for the NHS • Leading the transformation of primary care

and developing new models of care


• Practices: 25% - 50% of patient contact with GPs would be better provided by an alternative professional

• Staff: more appropriate use of each team member’s skills and increasing job satisfaction for receptionists.

• Patients: patients have a shorter wait to get the right help and it is easier to get an appointment with the GP when they do need it

Primary Care Navigation Programme


We can provide tailored training for your frontline staff:

• to signpost people to local community resources• to empower people to manage their personal needs • to reduce their reliance on GPs

We typically work with:

• receptionists• health care assistants• pharmacy assistants.

Primary Care Navigation Programme



Support to PCH sites

Visit us atwww.napc.co.uk/primary-care-home@NAPC_NHS #primarycarehome


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