future of at scale primary care

#GPforwardview#GPforwardview

What does the future holdfor at-scale primary care?

Dr Robert VarnamHead of General Practice DevelopmentNHS England

@robertvarnam

#GPforwardview

Is there something meaningful for us to do?

What size should we be?

How do we realise the benefits of scale?

What capabilities will we need?

Asking the right questions

#GPforwardview

Multispeciality Community Provider contract

bit.ly/MCPframe1

Virtual MCP Alliance contract, overlaid on existing contracts

Partially integrated Pre-procurement of community services (MCP + GMS)

Fully integratedHybrid: NHS Standard Contract & primary medical servicesSingle, whole population budget for all services coveredNew performance element (replacing CQUIN & QOF) Risk share for acute activity

www.england.nhs.uk @robertvarnam

UK general practice is one of the world’s most comprehensive embodiments of the founding principles of primary care…

Personal care built on a relationship from cradle to grave

Community based responsible for prevention and care of a registered population

Holistic perspective understanding the whole patient not just a disease

Comprehensive skills to diagnose & manage almost anything

Personal and population-orientated primary care is central … if general practice fails, the whole NHS fails. Simon Stevens, General Practice Forward View

First port of call and central point of care for all, for life

www.england.nhs.uk @robertvarnam

Self Care

Broader skillmix

Self management /

social prescribing

Emergencycare

Collaborationwith specialists

At scale

Population wellbeing management and holistic person-centred care provided by a multiprofessional team led by the GP, supported by at-scale collaboration and efficiencies.

#GPforwardview






@robertvarnam

Clarity

Commitment

Agility

Alignment

Priorities

Partnerships

4 400

We need the best of both worlds

What is the ideal size?

#GPforwardview

STP footprint: 300k-2mWorkforce & infrastructure planningLarge scale service reconfigurationMajor partnerships & shifts in priority

MCP: 100-350kOrganisational infrastructure & governanceSpecialist staff & servicesEmployment & career developmentModel design (population management, care models)Strategic partnerships

Hub/Home: 30-60kAcute careLocality-tailored servicesShared MDTPlace of ‘belonging’

Core team: 3-4kCoordinated, complex multidisciplinary careContinuity

#GPforwardview






#GPforwardview

Working at scale: Opportunities for practices

#GPforwardview

Staff pooling• nurses, reception & clerical staff, sessional GPs

Overflow support• phone consultations• access hub (phone +/- face-to-face)• home visiting

#GPforwardview

Purchasing• Indemnity• Supplies• Utilities

Shared functions• Policies & procedures• Procurement• Correspondence management• IM&T (eg support & maintenance, intranet, web, social media)

Specialist functions• HR• Finance• Clinical governance• Business intelligence

#GPforwardview

Planning• Workforce• Infrastructure development• Service reconfiguration• Public health

Provision• Acute care• Community pharmacy• Dentistry• Optometry• Social care• Housing• Welfare• Voluntary sector

#GPforwardview

Traditional healthcare roles• Pharmacists• Specialist nurses• Physiotherapists• MH therapists• Paramedics

Wellbeing workers• Social workers• Care navigators• Health trainers & coaches• Welfare advisors

#GPforwardview

QI expertise

Analytics• Population health analytics• Priority setting• Benchmarking• Realtime measurement

Project management

#GPforwardview

HR

CPD

Career development• Leadership• Mentoring• Service improvement• Research

#GPforwardview






@robertvarnam

Leadership

Creating shared purpose

Strategic planning &

partnerships

Leading through change

Being a leader

Improvement

Patients as partners

Process design

Using data for improvement

Rapid cycle change

Business

Team leadership

Operations management

H R

I T

At-scale working

Governance

Contracts

Workforce

Business intelligence

Capabilities for the future

Interdependent capabilities for leaders & organisations

Robert Varnam

Ops & team management

@robertvarnam

www.england.nhs.uk/gpdp

Local Time for Care programmes• Bespoke 9-12 month

programme to support a group of practices to implement innovations that release time for care.

• Training for reception and clerical staff, for active signposting and document management (£45m over 5 years).

• Funding towards purchasing online consultation systems (£45m over 4 years, from 2017).

• CCG transformational support (£171m over 2 years, from 2017).

General Practice Improvement Leaders• At least 400 free places a

year for three years.

• Skills and confidence in designing and implementing improvements within the practice rapidly and sustainably.

• RCGP Supporting Federations Network and NHS Collaborate (NAPC & NHS Alliance) for leaders of at-scale primary care.

• Funding facilitated peer networking for practice managers of all 7,800 practices, with support to develop professional skills.

• Local showcase events• Web resources• Fortnightly webinars• Network of champions

10 High Impact Actions to release time for care

future of at scale primary care

Healthcare