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General practice development framework

Dr Robert VarnamHead of General Practice Development

@robertvarnam

Work in progress

Version dated 29/07/15

Health & wellbeing-promoting care

‘Right access’ Consistently high qualityHolistic, personalised, proactive, coordinated care

Comprehensive, joined-up care for a registered population,shaped around them in the community

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‘Wider primary care, at scale’

bit.ly/nhs5yfv

Phone first.

Community diagnostics.

Practice based paramedics.

Pharmacy first.

Web consultations.

Primary care led urgent care centre.

Minor injury service.

Physio first

Direct specialist advice.

Condition management training.

Shared records.

Care coordination.

Hospital in-reach.

Care home ward rounds.

Virtual ward.

Primary care-employed specialists.

Social prescribing.

Travelling health pods.

Peer-led walking groups

Health coaching.

Befrienders.

Schools outreach.

Community development.

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Work areas

Quality• safety• effectiveness• experience

Access

Proactive

Self care

Coordinated

Secondary / specialist care

Care & support

Community services

Pharmacy

Diagnostics

CCG AT LA

Improvement

Care models

Larger scale

Participationin wider system

Collaboration

Collaboration

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Leadership

Creating shared purpose

Strategic planning & partnerships

Leading through change

Being a leader

Improvement

Patients as partners

Processes and systems

Using data for improvement

Rapid cycle change

Business

Governance

Operations management

HR

Business intelligence

Capabilities

EnablersInnovation spread

Policies & permissions

Contracts & incentives

InfrastructureProductive federation

Transparent measurement

General practice development framework

eg releasing capacity

PMCF 1+2

Access programme

Workforce

Releasing capacity

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Capability building

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Good ideas and intentions are not sufficient. It will be necessary to build capabilities for transformation, improvement and innovation in primary care.

• Some communities already have primary care leaders skilled in facilitating innovation and improvement. However, they are in the minority. We therefore wish to support the creation of a wide range of high quality, relevant development offers. Our goal is that, in time, every local network of practices has in-house expertise in service redesign, improvement and change leadership.

Need for capability-building

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• Gaps in every enabler & capability• Historic underinvestment• Ad hoc culture• Unconscious incompetence• Independence• Anti-academic• Lack of capacity• Superhero innovation

Development challenges

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• Capabilities > consulting• Learn while doing• Build around a patient-facing purpose

• Purpose > function > form• Use ‘pull’ for capability-building

• Something for everyone• Reach every ‘level’ & ‘corner’• Multi channel• Options: educational functional

• Awaken, train, mentor, coach [not necessarily in that order]

• Recognise the gap• Ensure transformational learning

• Use existing networks• …and develop them

Capability building principles

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The supplier market

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Selection of good offers for some needs But v limited capacity for some

Many one dimensional suppliers Easy to omit some needs

Consultancy >> capability-building More problematic in some areas than others

No ‘case manager’ Where to start? How to pull it all together?

The supplier market