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Primary Care ProviderMaturity Model

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https://www.myhealth.london.nhs.uk/healthy-london-partnership

About this model

This model has been designed with primary care providers across London to support the development of at scale organisations.

It is a flexible model, built on the premise that there is no single definitive development journey for a primary care provider and that context, local needs and priorities will inform the level of maturity you wish to reach.

It is constructed around nine interdependent workstreams that providers have identified as crucial for delivering the benefits of working at scale. This is the first draft of the model and it will be re-issued to reflect the learning and experience of provider organisations as they develop.

How to use

1 Self assessment

Click on the workstream title to read the description of what a mature organisation is likely to have done in this area. You will be asked to rate your organisation against this description on a scale of 1-5, where:

1 Have not started

2 Beginning to tackle

3 Making good progress

4 All or most activities undertaken

5 Fully embedded

This is to give you a quick overview of your maturity and to help you prioritise development. It is not scientific and should not be used for any other purpose. You might find it helpful to undertake this assessment with your board. You will be able to save your current outcome and compare at a later date.

2 Further development

Click on the workstream description box to take you to a page where you will find:

• A list of recommended activities

• Reading list including links to relevant toolkits

• Case studies

To refresh the model, click below

Or to refresh an individual spoke, click on the workstream icon.

To record the assessment, save the document.

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Primary Care Provider Maturity Model

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Strategy and vision

Structure and form

Workforce

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Leadership

GovernanceProductivity

Communication and engagement

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Strategy and vision

The provider has a clearly and consistently articulated vision of how working at scale achieves improved outcomes. Member practices and patients share the vision and understand how they benefit. The strategy is aligned with local commissioning intentions and the STP and is supported by realistic business plans. The organisation regularly scans the healthcare horizon for new developments and opportunities.

Click here for details on strategy and vision

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Structure and form

The provider has an established and appropriate legal form that enables shared provision of services across GP practices and other primary care and community health providers. It is registered as an NHS/CQC organisation in its own right and is able to bid for and provide an outcomes based contract to deliver population health.

Click here for details on structure and form

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Leadership

The provider has leaders who are trusted, credible and accountable across the healthcare system, including with acute providers. They share learning and good practice to lead change and promote continuous improvement in both quality of care and value for money. They encourage the development of leaders and ‘change agents’ across member practices and there is a succession plan in place.

Click here for details on leadership

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Governance

The provider has an effective governance structure that enables member practices and the local community to hold to account on performance and delivery of strategy. Operations are supported by robust controls, processes and policies to manage risk, e.g. business continuity and compliance with the law, NHS governance standards and ethical practice. There is an effective board with the appropriate mix of skills and experience.

Click here for details on governance

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The provider understands and engages appropriately with local and national stakeholders, using their input to drive decision-making and strategy and co-design services. These include CCGs, providers, member practices, patients, the wider community and national bodies. There are regular and proactive communication outputs using face-to-face, digital and print media as appropriate.

Click here for details on communication and engagement

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Productivity

The provider has implemented efficiency and productivity opportunities from working at scale e.g. IT, estates and other shared functions. It manages resources across the provider to create synergies, reduce cost and maximise value.

Click here for details on productivity

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Finance

The provider manages complex finance and budgetary processes, and complex contractual arrangements across multiple entities. There are appropriate controls to identify and mange safety, reputational, demand and financial risks. The organisation shares risk and systems to manage payment allocations to organisations involved in delivering the contract.

Click here for details on finance

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Workforce

The provider has a shared operating model across the member practices with clearly defined roles and responsibilities, and the right mix of skills. Resources are efficiently shared and there is a succession plan that is regularly reviewed in line with developments. There are clear HR policies (e.g. recruitment, pay, pensions, workforce development).

Click here for details on workforce

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IT and informatics

The provider has standardised information systems and bases decision making on robust shared data that is used to improve local patient care across services. The organisation uses demand data to plan future services and improve the patient experience.

Click here for details on IT and informatics

Has a clearly and consistently articulated vision of how working at scale achieves improved outcomes. Member practices and patients share the vision and understand how they benefit. The strategy is aligned with local commissioning intentions and the STP and is supported by realistic business plans. The organisation regularly scans the healthcare horizon for new developments and opportunities.

Elements of the Maturity Model to look at next:

Structure and form

Leadership

Communications and engagement

In terms of their strategy and vision, a mature at scale primary care provider:

Strategy and vision

Has a clear and succinct vision, shared with member practices and patients, and consistently articulated, of how working at scale achieves improved outcomes. The strategy is aligned with local commissioning intentions and the STP and is supported by business plans. The organisation regularly scans the healthcare horizon for new developments and opportunities.

Strategy and vision


• Develop a vision and strategy for the provider in

the short and long term with member practices.

• Work with the commissioner to understand the

role of the provider in commissioning intentions

and STP.

• Develop and agree a business plan to support

commissioner investment.

• Work in partnership with patients and other

organisations in the health system to achieve a

shared vision and strategy.

• Align the service offer with commissioning

intentions and STP.

• Scan the horizon frequently for new

developments in healthcare and provider

opportunities

Activities you may wish to consider undertaking:



Strategy and vision

Suggested reading list

• Department of Health and NHS England (2014) Transforming primary care: safe, proactive,

personalised care for those who need it most, https://www.gov.uk/government/uploads/system/

uploads/attachment_data/file/304139/Transforming_primary_care.pdf

• Leinward, P., and Mainardi, C. (2016) Strategy that Works,

http://www.strategyand.pwc.com/strategythatworks

• NHS England (year) Improving general practice: a call to action, evidence pack,

https://www.england.nhs.uk/wp-content/uploads/2013/08/igp-cta-slide.pdf

• NHS England (2014) The Forward View into action: planning for 2015/16,

https://www.england.nhs.uk/wp-content/uploads/2014/12/forward-view-plning.pdf

• RCGP (2013) The 2022 GP: A vision for General Practice in the future NHS,

http://www.rcgp.org.uk/campaign-home/~/media/files/policy/a-z-policy/the-2022-gp-a-vision-for-

general-practice-in-the-future-nhs.ashx

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/304139/Transforming_primary_care.pdf

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/304139/Transforming_primary_care.pdf

http://www.strategyand.pwc.com/strategythatworks

https://www.england.nhs.uk/wp-content/uploads/2013/08/igp-cta-slide.pdf

https://www.england.nhs.uk/wp-content/uploads/2014/12/forward-view-plning.pdf

http://www.rcgp.org.uk/campaign-home/~/media/files/policy/a-z-policy/the-2022-gp-a-vision-for-general-practice-in-the-future-nhs.ashx

http://www.rcgp.org.uk/campaign-home/~/media/files/policy/a-z-policy/the-2022-gp-a-vision-for-general-practice-in-the-future-nhs.ashx

Strategy and vision



Case study: Primary Care Working At ScaleStrategy and vision

Organisation: Haverstock Healthcare

Location: Camden, North London

Practices: 26

Patients: more than 200,000

Background: Haverstock Healthcare was established in 2008 by a small group of GP practices in Camden. The aim was simple; to allow local GPs to form an organisation large enough to compete with global firms bidding for NHS contracts in their borough and to keep services relevant, local and familiar to patients.

The services offered now span the entire spectrum of healthcare, and the breadth of experience that this has brought has enabled Haverstock to develop and deliver new and exciting integrated healthcare solutions that are at the cutting-edge of 21st century medicine and ensure effective, efficient and economical care for patients.

Haverstock Healthcare is now solely owned by 26 NHS GP practices in Camden, representing the care and custody of more than 200,000 patients.

The importance of a clear vision and purpose: Mike Smith, Chief Executive of Haverstock Healthcare, firmly believes that having a strong vision upfront is crucial for an at scale organisation to succeed and get buy-in and engagement from practices.

He encourages organisations to think carefully about why they want to federate – this needs to be a collective decision agreed by all parties.

His key principles for creating a vision are:• it has to be shared both within the organisation and

between stakeholders• it has to be realistic• it has to be future proof• it has to be brief• THINK BIGGER PICTURE.

Haversotck’s vision: is centred around their commitment to working with local partners and providers to guarantee value based healthcare for patients whilst always keeping the traditional values of General Practice. They aim to:

• Preserve the role of the Generalist in patient care• Promote disease prevention and early detection• Provide holistic and pastoral care tailored to a person’s needs• Be the healthcare advocate for the patient and their family

For more information, visit http://www.haverstockhealth.com/

http://www.haverstockhealth.com/

Has an established and appropriate legal form that enables shared provision of services across GP practices and other primary care and community health providers. It is registered as an NHS/CQC organisation in its own right and is able to bid for and provide an outcomes based contract to deliver population health.


Strategy and vision

Governance

In terms of their structure and form, a mature at scale primary care provider:

Structure and form

Has an established and appropriate legal form that will enable shared provision of services across general practices and other primary and community health providers. It is registered as an NHS/CQC organisation in its own right and is able to bid for and prov.ide an outcomes based contract to deliver population health.

Structure and form


• Establish an appropriate legal form that will:

– Enable shared provision of services across

GP practices and other primary and

community health providers.

– Allow continuity of pensionable NHS service

for the workforce

• Identify and agree the functions the provider

will take responsibility for.

• Review the framework of ownership,

governance and management on an

on-going basis.

• Register as an NHS/CQC provider.

• Bid for and provide an outcomes based

contract to deliver population health.




Structure and form


• British Medical Association (year) GP practices. Collaborative GP networks – basic legal structures,

http://bma.org.uk/practical-support-at-work/gp-practices/gp-networks/settingup-a-gp-network

• NHS England (2014) The NHS Five Year Forward View, https://www.england.nhs.uk/wp-content/

uploads/2014/10/5yfv-web.pdf

• RCGP, The King’s Fund, The Nuffield Trust and Hempson’s Solicitors (2008) Chapter 2 “Deciding

on a Federations Legal Structure” within the Toolkit to Support the Development of Primary

Care Federations, http://www.rcgp.org.uk/clinical-and-research/a-to-z-clinical-resources/~/

media/19A1F84B41A04DFE8AAAF2F65FD3D757.ashx

• The Humberside Group of Local Medical Committees Ltd (year) Advice Sheet on GP Federations:

Legal Issues for Consideration, http://www.humbersidelmc.org.uk/uploads/3/7/5/8/37582639/advice_

sheet_-_gp_federations_-_legal_issues_for_consideration_jan_2015.pdf

• The Nuffield Trust and The King’s Fund (year) Securing the future of General Practice,

http://www.nuffieldtrust.org.uk/sites/files/nuffield/130718_full_amended_report_securing_the_

future_of_general_practice.pdf

http://bma.org.uk/practical-support-at-work/gp-practices/gp-networks/settingup-a-gp-network

https://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf

https://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf

http://www.rcgp.org.uk/clinical-and-research/a-to-z-clinical-resources/~/media/19A1F84B41A04DFE8AAAF2F65FD3D757.ashx


http://www.humbersidelmc.org.uk/uploads/3/7/5/8/37582639/advice_sheet_-_gp_federations_-_legal_issues_for_consideration_jan_2015.pdf

http://www.humbersidelmc.org.uk/uploads/3/7/5/8/37582639/advice_sheet_-_gp_federations_-_legal_issues_for_consideration_jan_2015.pdf

http://www.nuffieldtrust.org.uk/sites/files/nuffield/130718_full_amended_report_securing_the_future_of_general_practice.pdf

http://www.nuffieldtrust.org.uk/sites/files/nuffield/130718_full_amended_report_securing_the_future_of_general_practice.pdf

Structure and form



Case study: Primary Care Working At ScaleStructure and form

Organisation: Alberta Health Services

Location: Alberta, Canada

Structure: 106 acute care hospitals, five stand-alone psychiatric facilities, 8,471 acute care beds, 23,742 continuing care beds/spaces and 208 community palliative and hospice beds, 2,439 addiction and mental health beds plus equity partnership in 42 primary care networks.

Number of staff: over 108,000 employees

Number of patients: more than 65,000

Background: Canada’s first province-wide, fully integrated health system was established on May 15, 2008 and is responsible for delivering health services to the over four million people living in Alberta, Canada’s fastest growing province.

New models of primary care have been in place since 2003 to support this integrated model and encourage patients to maintain their health in the community. The main strategic aims of Primary Care in Alberta is to:

• Enhance the delivery of care to ensure all patients can access familiar care, fast.

• Enable cultural change for patients, encouraging them to think about their health differently

• Be the building blocks for change by altering the way primary care is organised, particularly at a system-wide level

Structure and Form: The structure of Primary Care in Alberta is split into two team-based approaches than enable care in the community:

1. Primary Care Networks: Established in 2003, these are physician-led multi-disciplinary teams. They consist of doctors and other health providers such as nurses, dieticians, and pharmacists who work together to provide primary care to patients. There are 42 Networks with approximately 3,800 physicians and the full-time-equivalent of 1000 other health care providers.

They were established to improve the direct access to frontline healthcare and work to achieve 5 goals:

1. Increase access to primary care

2. 24 hour services

3. Increase the emphasis on health promotion and sickness prevention, and care of patients with complex problems

4. Improve co-ordination with acute care

5. Facilitate the greater use of multi-disciplinary teams

Benefits realised so far have included reduced emergency room admissions; reduced wait time; comprehensive patient education programmes; a more skilled workforce.

2. Family Care Clinics: Introduced in Alberta more recently in 2012, Family Care Clinics are local, team-based primary health care delivery organisations that provide individual and family-focused services that are tailored to meet the health needs of a community. The idea is that an individual will have access to the same clinical team (where possible) for their entire life-span. Reference: http://www.albertahealthservices.ca/about/about.aspx; http://www.health.alberta.ca/services/primary-health-care.html

Has leaders who are trusted, credible and accountable across the healthcare system, including with acute providers. They share learning and good practice to lead change and promote continuous improvement in both quality of care and value for money. They encourage the development of leaders and ‘change agents’ across member practices and there is a succession plan in place.


Strategy and vision

Governance

Communications and engagement

Workforce

In terms of their leadership, a mature at scale primary care provider:

Leadership

Has leaders who are trusted, credible and accountable across the healthcare system, including with acute providers. They share learning and good practice to lead change and promote continuous improvement in patient care and value for money. They encourage the development of leaders and ‘change agents’ across member practices and there is a succession plan in place.


Leadership

• Establish a board with an appropriate balance

of skills and knowledge to enable delivery of

the provider’s strategy.

• Establish strong and experienced leadership

to build trust and engagement with member

practices and the community.

• Provide clinical leadership to inform service

delivery and quality improvement.

• Establish accountability for delivery and

operational management.

• Anticipate and manage changing environments

effectively to improve performance of the

provider.

• Develop and grow future leaders at all levels,

identifying successors for the provider.

• Identify and develop ‘change agents’ within

member practices.

• Share learning and good practice in order

to lead change and promote continuous

improvement in patient care across the

healthcare system.

• Be recognised as credible within the local

healthcare system.


Leadership




• Department of Health, DCLG, Local Government Association and NHS England (2015) How to…lead

and manage Better Care Implementation, http://www.local.gov.uk/documents/10180/5572443/How+

to+lead+and+manage+Better+Care+implementation/90f695ae-a5f5-4596-bcec-345483ec8304

• NHS Leadership Academy (2014) Healthcare Leadership Model,

http://www.leadershipacademy.nhs.uk/resources/healthcare-leadership-model/

• The King’s Fund (2011) The future of management and leadership in the NHS – No more heroes,

http://www.kingsfund.org.uk/publications/future-leadership-and-managementnhs

• The King’s Fund (2011) The role of leaders in high performing health systems,

http://www.kingsfund.org.uk/sites/files/kf/roles-of-leaders-high-performing-health-care-systems-ross-

baker-kings-fund-may-2011.pdf

• The Leadership Academy (2013) Towards a new model of Leadership, http://www.leadershipacademy.

nhs.uk/wp-content/uploads/2013/05/Towards-a-New-Model-of-Leadership-2013.pdf

• 10 Principles of Strategic Leadership, http://www.strategy-business.com/article/10-Principles-of-

Strategic-Leadership

http://www.local.gov.uk/documents/10180/5572443/How+to+lead+and+manage+Better+Care+implementation/90f695ae-a5f5-4596-bcec-345483ec8304

http://www.local.gov.uk/documents/10180/5572443/How+to+lead+and+manage+Better+Care+implementation/90f695ae-a5f5-4596-bcec-345483ec8304

http://www.leadershipacademy.nhs.uk/resources/healthcare-leadership-model/

http://www.kingsfund.org.uk/publications/future-leadership-and-managementnhs

http://www.kingsfund.org.uk/sites/files/kf/roles-of-leaders-high-performing-health-care-systems-ross-baker-kings-fund-may-2011.pdf

http://www.kingsfund.org.uk/sites/files/kf/roles-of-leaders-high-performing-health-care-systems-ross-baker-kings-fund-may-2011.pdf

http://www.leadershipacademy.nhs.uk/wp-content/uploads/2013/05/Towards-a-New-Model-of-Leadership-2013.pdf

http://www.leadershipacademy.nhs.uk/wp-content/uploads/2013/05/Towards-a-New-Model-of-Leadership-2013.pdf

http://www.strategy-business.com/article/10-Principles-of-Strategic-Leadership

http://www.strategy-business.com/article/10-Principles-of-Strategic-Leadership



Leadership

Case study: Primary Care Working At ScaleLeadership For the past 2 years, Guy’s and St Thomas’ charity have been funding an innovative primary care development programme for ‘emerging leaders’ in Southwark and Lambeth.

This group of GPs and practice managers are driving change and transforming the way primary care is delivered in the boroughs, supported by NHS Lambeth and Southwark Clinical Commissioning Groups (CCGs). On their website, they say:

“At the heart of the programme is the idea that by having a strong collective voice and delivering new primary care models ‘at scale; care can be better integrated, more efficient and effective, and provide a better experience for patients.

The programme is supporting GPs and practice managers to have protected time and headspace in order to develop the skills necessary to lead change, create and manage large federations of practices, and introduce innovative new ways to improve care for people locally. These ‘emerging leaders’ are not only spearheading change to general practice locally, but also influencing other major health and care programmes, bringing the perspective and views of primary care to the forefront.”

https://www.gsttcharity.org.uk/what-we-do/our-impact/stories/primary-care-development

How has leadership development supported your organisation?“It has enabled me to think more corporately... we are trained as clinicians to start off with and we don’t necessarily have the corporate skills to lead or to try and spearhead an organisation… the programme itself has given us the tools to be able to do that”Dr Martin IU, Director of Improving Health Limited, GP Principal at Nunhead Surgery

“My organisation… have massively benefitted from me having a wider perspective, a wider understanding of the bigger picture that we are working in… I’ve been able to help them [my staff] and support them in ways that I wouldn’t have known how to before, and give then an understanding of what the focus is outside of the practice so that we are able to position ourselves in a way that we are ready for change”.Tilly Wright, Director of QHS GP Federation, Practice Manager and Partner at Villa Street Medical Practice

How has the programme supported your own development? “The course helps me to understand the wider system and how it can be influenced and changed… The most important thing that I’ve learnt about leadership is to be collaborative, not to see things in terms of ‘fighting against systems’”Dr Justin Hayes, Director and Chair of Lambeth Healthcare Limited, GP Partner at Valley Road Surgery.



Has an effective governance structure that enables member practices and the local community to hold to account on performance and delivery of strategy. Operations are supported by robust controls, processes and policies to manage risk, e.g. business continuity and compliance with the law, NHS governance standards and ethical practice. There is an effective board with the appropriate mix of skills and experience.

In terms of their governance, a mature at scale primary care provider:


Structure and form

Leadership

Governance


Governance

• Develop and agree fundamental organisational

policies and procedures e.g. conflict of interest.

• Agree and communicate the governance

structure for the provider, that enables

members to hold it to account in performance

and operation of its strategy.

• Establish a process for election of leadership

and recruitment of the provider workforce.

• Implement policies and procedures to enable

the effective running of the provider e.g.

business continuity policy and compliance with

NHS Governance standards, and ethical practice

• Operate an effective governance process to

facilitate collaborative decision making with

wider stakeholders in the healthcare system.

• Encourage the local community to hold the

provider to account through well established

governance forums.


Has an effective governance structure that enables members and the local community to hold it to account in its performance and delivery of strategy. Operations are supported by robust controls, processes and policies to manage risk, e.g. business continuity and compliance with the law, NHS governance standards and ethical practice. There is an effective board with an appropriate mix of skills.


Governance


• Capsticks LLP (2014) Developing boards and senior teams: the how to do it guide,

http://www.good-governance.org.uk/wp-content/uploads/2014/02/developing-boards-and-senior-

teams-the-how-to-do-it-guide.pdf

• Capsticks LLP, GP Federation Checklist – Practical considerations,

http://www.capsticks.com/assets/Uploads/RE14.pdf

• RCGP, The King’s Fund, The Nuffield Trust and Hempson’s Solicitors (2008) Chapter 3 “Governance”

within the Toolkit to Support the Development of Primary Care Federations,

http://www.rcgp.org.uk/clinical-and-research/a-to-z-clinical-resources/~/


• The Good Governance Institute and Healthcare Quality Improvement Partnership (2014)

Good Governance Handbook,

http://www.good-governance.org.uk/good-governance-handbook-publication/

http://www.good-governance.org.uk/wp-content/uploads/2014/02/developing-boards-and-senior-teams-the-how-to-do-it-guide.pdf

http://www.good-governance.org.uk/wp-content/uploads/2014/02/developing-boards-and-senior-teams-the-how-to-do-it-guide.pdf

http://www.capsticks.com/assets/Uploads/RE14.pdf



http://www.good-governance.org.uk/good-governance-handbook-publication/

Has an effective governance structure that enables members and the local community to hold it to account in its performance and delivery of strategy. Operations are supported by robust controls, processes and policies to manage risk, e.g. business continuity and compliance with the law, NHS governance standards and ethical practice. There is an effective board with an appropriate mix of skills.


Governance

Case study: Primary Care Working At ScaleGovernance

Organisation: Suffolk GP Federation

CEO: David Pannell

Board structure: Board with 10 GPs, 3 PMs and CEO

Type of company: Not for profit Community Interest Company

Number of practices: 64

Financial ask of practices: 30p per patient one off investment – no further obligation

Background: Suffolk GP federation was formed in April 2013 to:– Support and strengthen Primary Care and CCG objectives– Share practice resources to increase efficiency and

maintain sustainability– Share the burden of increased clinical workload and reduced

income to general practice – Maintain workforce challenges in recruitment and retention

The groups’ first successful service in 2009 was a non-obstetric community ultrasound service available to most of East Suffolk, cutting waiting times from six weeks to a fortnight. Since then, cardiology and urology intermediate clinics have been launched, additional practices have joined the federation and in 2014 they successfully bid to manage the diabetes service in North East Essex. In 2015, the federation became a Wave 2 Prime Ministers’ Challenge Fund provider offering extended primary care access.

The Suffolk GP Federation has an integrated and robust approach to governance.

Their Members’ Agreement sets out the objectives of the Federation, the obligations of members, the composition of the Board, relationship between the Board and Members and how Members join and leave.

Their integrated approach combines corporate, financial and clinical accountability and enables equality of input from clinical and non-clinical sources for the purposes of delivering recognisably high standards of care.

Please see http://suffolkfed.org.uk/who-we-are/governance/ for more information.

10 Steps to a successful business plan: David Pannell, CEO, has come up with 10 questions to ask yourself when creating a business plan for your at scale organisation:

1. What is your strategy?2. What is your ‘elevator pitch’? (a one minute speech on the

strategy and vision of your federation)3. What is the offer? (to practice and patients)4. What will you DO as a federation?5. How will you manage the start up phase?6. How will you fund yourself sustainably?7. How will you build a relationship with the CCG?8. Do you really want to bid for contracts?

This is time consuming and costly.9. What do you need to think about longer term?10. How will you communicate with members?

http://suffolkfed.org.uk/who-we-are/governance/

Understands and engages appropriately with local and national stakeholders, using their input to drive decision-making and strategy and co-design services. These include CCGs, providers, member practices, patients, the wider community and national bodies. There are regular and proactive communication outputs using face-to-face, digital and print media as appropriate.


Strategy and vision

Leadership

In terms of their communication and engagement, a mature at scale primary care provider:



Understands and engages appropriately with local and national stakeholders, using their input to drive decision-making and strategy and co-design services. These include CCGs, providers, member practices, patients, the wider community and national bodies. There are regular and proactive communications using face to face, digital and print media as appropriate.


• Develop and use an ‘elevator pitch’ to

communicate the vision and purpose of the

organisation and the benefits for members.

• Develop and implement an engagement plan

for the provider, identifying: – CCGs in your area – Providers in your area – Practices within your provider – Other NHS bodies – Patients – Wider public

• Communicate and engage with patients,

and external and internal stakeholders to

meet their needs and expectations.

• Use the outcomes of engagement to inform

decision-making and strategy.

• Co-design services with the local population

and stakeholders.

• Implement innovative approaches to

engagement and communications, learning

from success and good practice.






• NHS Networks (2012, 2013 and 2014) Smart Guides to Engagement,

https://www.networks.nhs.uk/nhs-networks/smart-guides

• RCGP, The King’s Fund, The Nuffield Trust and Hempson’s Solicitors (2008) Chapter 4

“Involving Patients and the Public” within the Toolkit to Support the Development of Primary



https://www.networks.nhs.uk/nhs-networks/smart-guides






Name: Simon Brake

Role: Chief Executive of Coventry and Rugby GP alliance

Organisation: Coventry and Rugby GP Alliance

Population coverage: 100%

Number of patients: 480,000

Background: Three years ago GP’s in Coventry saw the need to work together to protect the future of Primary Care and to ensure that it was able to adequately deliver good, safe, effective services to the local population.

A small federation was formed in Coventry and then a successful Prime Ministers Challenge Fund bid enabled the federation to expand across Coventry and Rugby CCG area, covering 480,000 patients.

Biggest challenge: Getting a disparate and broad group of people engaged and helping them to realise the benefits of federating. To agree shared aims and objectives, governance and support structures, ways to distribute resources and clinical projects to focus on.

How it was overcome: The federation spent a lot of time at the beginning working through the vision of the organisation and getting the right governance structures in place. It was a collaborative approach that allowed all practices to have their say and take ownership. They have found that the best way to sustain this engagement has been through regular communications with practices through a variety of mediums, such as fortnightly newsletters, site visits and quarterly update and planning meetings that are open to all practices. It has been very important to integrate practices into the Coventry and Rugby GP alliance whilst enabling them to have a degree of site specific autonomy.

For more information, please email [email protected]

Case study: Primary Care Working at ScaleCommication and engagement

CEO: Simon Brake

Organisation: Coventry and Rugby GP Alliance



Background: Three years ago GPs in Coventry saw the need to work together to protect the future of Primary Care and to ensure that it was able to adequately deliver good, safe, effective services to the local population.

A small federation was formed in Coventry and then a successful Prime Ministers Challenge Fund bid enabled the federation to expand across Coventry and Rugby CCG area, covering 480,000 patients.

Biggest challenge: Getting a disparate and broad group of people engaged and helping them to realise the benefits of federating. To agree shared aims and objectives, governance and support structures, ways to distribute resources and clinical projects to focus on.

How it was overcome: The federation spent a lot of time at the beginning working through the vision of the organisation and getting the right governance structures in place. It was a collaborative approach that allowed all practices to have their say and take ownership. They have found that the best way to sustain this engagement has been through regular communications with practices through a variety of mediums, such as fortnightly newsletters, site visits and quarterly update and planning meetings that are open to all practices. It has been very important to integrate practices into the Coventry and Rugby GP alliance whilst enabling them to have a degree of site specific autonomy.

Has implemented efficiency and productivity opportunities from working at scale e.g. IT, estates and other shared functions. It manages resources across the provider to create synergies, reduce cost and maximise value.


IT and Informatics

Workforce

Finance

In terms of their productivity, a mature at scale primary care provider:

Productivity

Has implemented efficiency and productivity opportunities from working at scale e.g. IT and estates and other shared functions. It manages resources across the provider to create synergies, reduce cost and maximise value.

Productivity


• Identify efficiency and productivity

opportunities from working at scale e.g.

IT and estates and other shared functions.

• Define which services will be shared within

the provider and which should remain within

the autonomy of individual practices e.g.

HR, IT, payroll.

• Develop and agree an implementation

plan for services to be shared across the

provider, including service specifications

and evaluation metrics.

• Manage resources across the provider to create

synergies, reduce cost and maximise value.

• Analyse and balance long term clinical and

financial considerations in implementing

performance improvement initiatives.



Productivity



• NHS Alliance (2015) Making time in General Practice, http://www.nhsalliance.org/wp-content/

uploads/2015/10/Making-Time-in-General-Practice-FULL-REPORT-01-10-15.pdf

• RCGP, The King’s Fund, The Nuffield Trust and Hempson’s Solicitors (2008) Chapter 10

“Sharing Back Office Functions” within the Toolkit to Support the Development of Primary



http://www.nhsalliance.org/wp-content/uploads/2015/10/Making-Time-in-General-Practice-FULL-REPORT-01-10-15.pdf

http://www.nhsalliance.org/wp-content/uploads/2015/10/Making-Time-in-General-Practice-FULL-REPORT-01-10-15.pdf



Productivity



Case study: Primary Care Working at ScaleProductivity

Name: Jonathan Steel

Role: Partner of member practice

Organisation: G-Doc in Gloucestershire

Number of practices: 83


Background: G-Doc formed 15 years ago in response to the requirement to scale up out of hours services. Access to Prime Minister’s Challenge Fund has since enabled the federation to bring practices together from across the region.

Issues faced during formation: Huge challenge to persuade practices to come on board as there is no immediate benefit.

Need to ensure long term value of joining the federation is worthwhile for all members and that this is communicated clearly.

Greatest success : Through working together, G-Doc practices have been able to provide extra services, improve efficiency at a practice level and maximise benefits for patients.

They now provide out of hours services for patients and have more recently introduced ‘choice plus’ appointments, delivered out of community hospitals or practices on a rota basis. Patients that need to be seen on the same day but their practice can’t fit them in can go to these clinics that are held across the region. It has been a great achievement to establish the network and fill the rotas with doctors that are largely part of the practices already.

Another success story has been the introduction of social prescribing, for patients who have far greater needs than a GP can help with. A social prescriber sits within a cluster of practices and links in to all the community assets available, helping to take patients forward rather than using a medical model for the problem. These three initiatives are taking a lot of the day to day pressures off practices, releasing capacity and improving the work/life balance for GPs and the practice workforce.

The real-time benefits realised by these initiatives has encouraged more practices to join the organisation.

Manages complex finance and budgetary processes, and complex contractual arrangements across multiple entities. There are appropriate controls to identify and mange safety, reputational, demand and financial risks. The organisation shares risk and systems to manage payment allocations to organisations involved in delivering the contract.

In terms of their finance, a mature at scale primary care provider:


IT and Informatics

Workforce

Productivity

Finance£

Manages complex finance and budgetary processes and complex contracting arrangements across multiple entities. It has appropriate controls to identify and mange safety, reputational, demand and financial risks and shares risk and systems to manage payment allocations to organisations involved in delivering the contract.

Finance£


• Establish appropriate controls to identify and

mange safety, reputational, demand and

financial risks.

• Identify key sources of income and expenditure.

• Establish the funding structure.

• Manage and actively mitigate risks through

early action and identification.

• Identify the cost base along a whole health and

social care pathway and/or population group.

• Negotiate incentive agreements for

gatekeeping functions and cost savings across

shared services.

• Manage complex finance/ budgetary processes

and complex contracting arrangements across

multiple entities.

• Share risk and systems to manage payment

allocations to organisations involved in

delivering the contract.



Finance£



• RCGP (2016) Commissioning – What is it and what’s my role? Online course, http://www.rcgp.org.uk/

learning/online-learning/ole/commissioning-what-is-it-and-whats-my-role.aspx

• The King’s Fund (2014) Commissioning and contracting for integrated care, http://www.kingsfund.

org.uk/publications/commissioning-contracting-integrated-care

http://www.rcgp.org.uk/learning/online-learning/ole/commissioning-what-is-it-and-whats-my-role.aspx

http://www.rcgp.org.uk/learning/online-learning/ole/commissioning-what-is-it-and-whats-my-role.aspx

http://www.kingsfund.org.uk/publications/commissioning-contracting-integrated-care

http://www.kingsfund.org.uk/publications/commissioning-contracting-integrated-care

Finance£



Case study: Primary Care Working At ScaleFinance

Organisation: Canterbury District Health Board, New Zealand

Location: A single organisation that operates across 13 different locations

Population: c.150,000

Background: In New Zealand, the District Health Board for Canterbury, the south island’s largest and most populous region, has been engaged on a transformational journey for more than nine years.

Back in 2007, Canterbury was a health system that was under pressure and beginning to look unsustainable, with a growing and aging population. Its main hospital in Christchurch was regularly entering a state of ‘gridlock’ and the case for change was accelerated further when the 2011 earthquake damaged hospital buildings.

Canterbury’s main aims were that:

• people should be empowered to take responsibility for their own health and well-being

• patients should be cared for in their homes and communities where possible

• when people need complex care, it should be timely and appropriate.

To support these goals, over the years the Canterbury health system has implemented a large array of initiatives, including:

• Health Pathways, created by hospital doctors and GPs together

• Acute Demand Management System aimed at preventing hospital admissions

• Community Rehabilitation Enablement and Support Team

• Falls Management

• Medication Management

• Expansion of 24 hour general practice

• Electronic Request Management System

• Electronic Shared Care Review Record

Financial model: Adopting a mantra of ‘One system, one budget’ has been a key enabler for Canterbury.

“What we have tried to do is not focus on the marginal edge of money that we have not got, and not worry about the million we are short. Rather we have tried to say ‘we have $1.4bn here, and how we use it is what matters.”

Dr Nigel Millar, Chief Medical Officer

Funding is on a population basis and an alliance contract was introduced, providing non-governmental and for-profit providers with a degree of certainty about their income and margins, subject to performance, while removing fee-for-item-of service contracts that were driving expenditure upwards.References: Canterbury -Timmins & Ham 2013 The quest for integrated health and social care A case study in Canterbury, New Zealand. Available at: http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/quest- integrated-care-new-zealand-timmins-ham-sept13.pdf

Has a shared operating model across the member practices with clearly defined roles and responsibilities, and the right mix of skills. Resources are efficiently shared and there is a succession plan that is regularly reviewed in line with developments. There are clear HR policies (e.g. recruitment, pay, pensions, workforce development).


Leadership

IT and Informatics

Finance

Productivity

In terms of their workforce, a mature at scale primary care provider:

Workforce

Has a shared operating model across the organisation, with clearly defined roles and responsibilities and the right mix of skills. Resources are efficiently shared and there is a succession plan which is regularly reviewed in line with developments. There are clear HR policies (e.g. recruitment, pay, pensions, workforce development)

Workforce


• Develop an operating model for the provider,

including defined roles and responsibilities.

• Appoint key personnel.

• Implement compliant pay and pensions

solutions for the workforce.

• Identify key workforce requirements to enable

recruitment of future roles.

• Review workforce requirements regularly and

take action in line with an agreed workforce

and succession plan.

• Co-create an operating model across the

provider, including estates, workforce and

communications.

• Provide appropriate learning and development

opportunities for the workforce.




Workforce


• Centre for Workforce Intelligence (year) In-depth review of the General Practitioner Workforce,

http://www.cfwi.org.uk/publications/in-depth-review-of-the-gp-workforce

• Health Education England (2015) Primary care workforce commission, https://www.hee.nhs.uk/our-

work/hospitals-primary-community-care/primary-community-care/primary-care-workforce-commission

• NHS England (2016) GP Forward View, https://www.england.nhs.uk/wp-content/uploads/2016/04/

gpfv.pdf

• RCGP, The King’s Fund, The Nuffield Trust and Hempson’s Solicitors (2008) Chapter 5 “Engaging

the Wider Primary Care Workforce” within the Toolkit to Support the Development of Primary



• The King’s Fund (2013) NHS and social care workforce: meeting our needs now and in the future,

http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/perspectives-nhs-social-care-

workforce-jul13.pdf

• The Nuffield Trust (2014) Is general practice in crisis?

http://www.nuffieldtrust.org.uk/publications/general-practice-crisis

http://www.cfwi.org.uk/publications/in-depth-review-of-the-gp-workforce

https://www.hee.nhs.uk/our-work/hospitals-primary-community-care/primary-community-care/primary-care-workforce-commission

https://www.hee.nhs.uk/our-work/hospitals-primary-community-care/primary-community-care/primary-care-workforce-commission

https://www.england.nhs.uk/wp-content/uploads/2016/04/gpfv.pdf

https://www.england.nhs.uk/wp-content/uploads/2016/04/gpfv.pdf



http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/perspectives-nhs-social-care-workforce-jul13.pdf

http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/perspectives-nhs-social-care-workforce-jul13.pdf

http://www.nuffieldtrust.org.uk/publications/general-practice-crisis



Workforce

Case study: Primary Care Working at ScaleWorkforce

Name: Jeremy Fenwick

Role: CEO

Organisation: Battersea Healthcare



Background: Battersea Healthcare formed in 2010 as a way to protect GP income, take advantage of the shift of the care agenda and to move care out into the community.

Workforce challenge: Four years ago, Battersea Health took the opportunity to become a Community Education Provider Network (CEPN) on behalf of Health Education South London (HESL). They sent out GP practice surveys to do a stock take on training needs and discovered three main issues:

1 There was an ageing practice nurse workforce

2 There was a large disparity in training opportunities between practices

3 There were limited training opportunities for practice management

They went back to Health Education South London with their results and worked with them to develop tailored training solutions to meet the needs of local providers.

What happened next?

A GP practice nurse recruitment and training programme was set up to drive the practice nurse recruitment and retention agenda. This programme encourages nurses into GP practices and will enable them to experience varied placements over multiple primary care settings.

Non-training practices were offered the opportunity to ‘buddy up’ with training practices to share knowledge and resources. There was an overwhelming response to this initiative and practices are in the process of being paired up. The idea is to create training networks where people can work together and become stronger.

There are now quarterly events where practices come together and discuss training opportunities and build relationships, looking at how to educate staff in SWL and work together.


Workforce


Case study 2: Primary Care Working at ScaleWorkforce

Organisation: City and Hackney Confederation

CEO: Laura Sharpe

Population coverage: 43 practices, 100% coverage


Background: City and Hackney Confederation have been operational for 18 months. The organisation is split into 4 localities, with each having a GP clinical lead on the board. The organisation has impressive practice engagement and each practice pays a membership fee to the Confederation that covers the cost of the board. They currently hold 15 contracts including end of life, long term conditions, smoking cessation, mental health and cervical cytology and are in the process of bidding for more.

Workforce challenge: As City and Hackney Confederation developed into a more mature organisation, contracted to provide a wider range of services, a problem became apparent with pensionable income. If a CCG is contracted directly with a

practice then the income is pensionable. However, if the CCG is subcontracted through the Confederation then the practice income is not pensionable. This was clearly a huge issue.

In April 2015, the Confederation board asked the practices to take a leap of faith and accept this problem for a year whilst they tried to reach a solution. Because the Confederation had good relationships with the practices, they agreed to this deal and gave the board until April 2016 to find a solution. If unsuccessful, they would consider dissolving the organisation.

What did they do? The leaders of the Confederation immediately went to NHS England and warned them of the problem, asking them for support. Because NHSE are encouraging the formation of at scale providers, they had a responsibility to help find a solution to this workforce issue. City and Hackney worked with NHSE, the Pensions Agency, The Department of Health, policy makers and lawyers to resolve the problem. After months of meetings and consultations, NHSE published a consultation document on changing the law. Despite a limited response from only six organisations, demonstrating the current lack of visibility of the problem, the law was changed effective 1st April 2016 (Statutory Instrument 245). This is a great success story for City and Hackney and it now means that subcontracting income is pensionable to partners of the practices for all at scale providers nationwide. There are strict rules to adhere to however, such as a signed mandated sub-contract has to be in place between the Confederation and the practice.

Has standardised information systems and bases decision making on robust shared data that is used to improve local patient care across services. The organisation uses demand data to plan future services and improve the patient experience.


Workforce

Finance

Productivity

In terms of their IT and informatics, a mature at scale primary care provider:

IT and informatics

Has standardised information systems and bases decision making on robust shared data which is used to improve local patient care across services. It analyses and uses demand data to plan future services and improve the patient experience.

IT and informatics


• Analyse the level of need, compatibility of

data systems and key quality indicators across

member practices.

• Develop an implementation plan to enable

sharing of information systems and data across

the provider.

• Develop an information governance policy to

facilitate sharing of data across the provider in

an appropriate form.

• Standardise information systems and share data

across the provider.

• Base decision making on robust shared data

which is used to improve local patient care

across services.

• Use demand data to plan future services and

improve the patient experience.



IT and informatics



• Healthy London Partnership (2015) Provider Development Support Toolkit,

Digital maturity and Transformation – see slide 43,

https://www.myhealth.london.nhs.uk/healthy-london/primary-care/resources


IT and informatics



Case study: Primary Care Working At ScaleIT and informatics

Organisation: Modality Partnership

Location: Sandwell and Birmingham, UK

Structure: A single GP organisation that operates across 13 different locations

Number of staff: around 250

Number of patients: more than 65,000

Background: The vision for the Partnership originated in 2009, when the partners from Handsworth Wood Medical Centre and Laurie Pike Health Centre merged to create the Modality Partnership, an organisation that aimed to be a single GP provider with a five-year strategic business plan to develop a range of integrated services in primary care.

Since then, Modality have been joined by eight more practices, forming the GP super-practice - an organisation that combines the advantages of small practices working closely in local communities with the medical and technological opportunities that come from being part of something bigger.

Together, Modality Partnership are dedicated to:

• delivering exceptional patient care

• providing patients with greater access to care through a choice of locations

• developing and sustaining a learning environment

• being recognised as an employer of excellence

• demonstrating excellence in all business practices

• providing and seizing opportunities for business growth.

IT & Informatics: Modality Partnership have pioneered the use of digital technology to improve healthcare.

In 2014, they formed a partnership with digital healthcare company, Digital Life Sciences.

The Modality Partnership and Digital Life Sciences won funding from the Prime Minister’s Challenge Fund to pilot a new way of using digital technology to improve healthcare.

Together they are creating a new online service which makes it possible for patients to access their GPs or nurses using instant messaging or Skype.

They ultimately aim to enable patients to access their healthcare team between 8am and 8pm, 7 days a week to help better manage our patients in the community.

Patients can now use the Modality app to see practice information and manage appointments.

Reference: https://www.modalitypartnership.nhs.uk

https://www.modalitypartnership.nhs.uk

http://www.haverstockhealth.com/

Other useful resources

• RCGP support for federations, www.rcgp.org.uk/clinical-and-research/our-programmes/supporting-federations.aspx

• For more information about how the Londonwide Local Medical Committee can support your organisation then please email [email protected]

• Resources from the Transforming Primary Care team within Healthy London Partnership, https://www.myhealth.london.nhs.uk/healthy-london/primary-care/resources

For more information about Healthy London Partnership: www.myhealth.london.nhs.uk/healthy-london-partnership

Designed by

http://www.rcgp.org.uk/clinical-and-research/our-programmes/supporting-federations.aspx

http://www.rcgp.org.uk/clinical-and-research/our-programmes/supporting-federations.aspx

mailto:info%40lmc.org.uk?subject=



http://www.myhealth.london.nhs.uk/healthy-london-partnership

http://www.uscreates.com

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