Outline Primary Care Strategy Primary Care Commissioning Committee

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Outline Primary Care Strategy Primary Care Commissioning Committee 25 June 2019

Outline Primary Care Strategy Primary Care Commissioning Committee 25 June 2019

Strategic Vision • Our aim is to have sustainable and comprehensive general practice, as

Strategic Vision • Our aim is to have sustainable and comprehensive general practice, as a cornerstone of the wider NHS system, working collaboratively to improve population health and wellbeing and reduce health inequalities. Our delivery model to achieve is predicated upon comprehensive general practice working within PCNs, based around the registered list, maximising digital and workforce opportunities working with wider partners. • Approach – protect & build on strengths of general practice, provide a unified vision shared & owned by practices, LMCs, CCGs and external partners. • Priorities • • • Sustainable General Practice – working collectively within PCNs Workforce & Leadership Development Consistent, equitable, high quality services to patients Supporting quality improvement as well as sustainability & efficiency Continued & Equitable Investment Workload Management Integrated In & Out of Hours Access Digital solutions to support the future model of care Consistent approach to development of Estate On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG

Priority 1 - PCNs Wyre Forest x 2 South Worcestershire x 6 On behalf

Priority 1 - PCNs Wyre Forest x 2 South Worcestershire x 6 On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG Redditch & Bromsgrove x 3

Priority 1 - PCNs PCN – Localities Herefordshire On behalf of: NHS Redditch and

Priority 1 - PCNs PCN – Localities Herefordshire On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG

Priority 2 - Workforce 25% Herefordshire and Worcestershire M&E 80% 15% 60% 10% 40%

Priority 2 - Workforce 25% Herefordshire and Worcestershire M&E 80% 15% 60% 10% 40% 5% 20% 0% Cumulative distribution of GPs (excluding registrars) 100% 20% Proportion of GPs (excluding registrars) 120% 0% 20 -2425 -2930 -3435 -3940 -4445 -4950 -5455 -5960 -6465 -6970 -7475 -7980 -8485 -90 Age band • GPs per 1000 patients - The current national average for a GP FTE is 0. 57 per 1000 patients. The range for our CCGs varies between 0. 45 - 0. 51. • GP recruitment – there a number of GP practices in our area who have GP vacancies and are unable to fill these posts- we need to focus on recruitment and supporting newly qualified GPs in their first years in practice. • There is a significant amount of GPs planning to retire in the next 3 years- we need to focus on retaining their skills within general practice.

Priority 2 - Workforce • Herefordshire and Worcestershire GPFV Workforce Plan was developed and

Priority 2 - Workforce • Herefordshire and Worcestershire GPFV Workforce Plan was developed and approved in 2018, focusing on three workforce themes in particular; • Theme 1: Developing Supply • Theme 2: Up-skilling Staff • Theme 3: Developing New Roles • This update reviews progress since the plan was developed. • Primary Care Quarterly Workforce Survey is a notable achievement to support local workforce intelligence and targeted support • Primary Care Workforce representation across STP; Local Workforce Action Board, Workforce and Organisational Development Action Group • GP Recruitment and Retention Group On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG

GP Retention and Recruitment GPFV Workforce Clinical Lead • First Five Mentor Register and

GP Retention and Recruitment GPFV Workforce Clinical Lead • First Five Mentor Register and Network • Building Relationships with VTS trainees • GP portfolio roles GP trainees and ‘first fives’ • Mentoring and Coaching • Flexible working opportunities • GP portfolio roles Mid-career: salaried GPs; locums; partners • National GP retainer • Mentoring and Coaching • GP portfolio roles ‘Wise fives’ Over-arching actions to address retention • • • Rebuilding the reputation of general practice Focus on benefits of growing the wider general practice workforce Workload Professional development (including education of other professionals) Indemnity On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG

GPs Theme 1: Developing Supply Practice Nurses • Working towards increasing GP training capacity

GPs Theme 1: Developing Supply Practice Nurses • Working towards increasing GP training capacity and trainee numbers • GP Trainers pilot commencing June 2019 • Attendance at VTS meetings to outline options post completion • First Five Network development • GP Training Practices have increased by 2 since Aug 2018, 64% of practices are training practices • GPs in Training – increase of 3 WTE since Sept 2016 • Training Hub offering high quality Practice Nurse training • Increase pre-registration and nurse training placements • Three General Practice Nurse mentors working across the STP • Strong links with University of Worcester Practice Education Facilitators • Increase of 3 new student placements in 2018 72 70 68 66 64 62 60 58 56 Sep-15 Sep-16 Sep-17 Sep-18

Theme 2: Up-skilling Staff Developing Skill Mix Up-skilling Nurses Up-skilling the Non-clinical Workforce Practice

Theme 2: Up-skilling Staff Developing Skill Mix Up-skilling Nurses Up-skilling the Non-clinical Workforce Practice Manager Training and Development Developing Wider Skills

Theme 3: Developing New Roles ANP FTE Pharmacist FTE Physio FTE 08/18 12/18 HF

Theme 3: Developing New Roles ANP FTE Pharmacist FTE Physio FTE 08/18 12/18 HF CCG 21. 38 23. 11 7. 99 1. 00 RB CCG 6. 56 5. 56 6. 73 7. 17 SW CCG 29. 56 27. 54 22. 70 WF CCG 15. 39 16. 33 6. 4 Emergency Care Paramedic FTE Practitioner FTE Physician Associate FTE 08/18 12/18 . 83 3. 37 2. 66 1. 00 . 72 2. 72 0 0 0 . 99 0 2. 87 3. 51 21. 61 0 0 0 0 1. 00 5. 41 0 0 0 . 99 • Supporting the introduction of Social Prescribers and additional Clinical Pharmacists within PCNs • Training Hub to support existing Physician Associates within the preceptorship programme in General Practice • Increase Nurse Associates and Apprenticeship roles within PCNs

Investment and Achievements Scheme Delivery GP fellowships (HEE funding) No successful applications, re-advertise 19/20

Investment and Achievements Scheme Delivery GP fellowships (HEE funding) No successful applications, re-advertise 19/20 via VTS schemes GP portfolio (£ 106 k) 5 GPs recruited to a range of portfolio roles in Dermatology, Diabetes, Stroke, Elderly Care and ED. Significant interest from a range of GPs (early, mid, late career) Evaluation undertaken by GP Fellow, University of Worcester GP with Extended Roles Currently validating and aligning to Elective Care priorities to future training investment GP retainer (national scheme) 10 GPs joined during 18/19 First 5 mentor network (£ 50 k) On Target, GP lead recruited and Mentors recruited TERS scheme (national scheme) Success in Hereford, to be implemented GP Trainers (£ 70 k) 5 GP Trainers appointed to support GP Training Capacity Clinical Pharmacists (national scheme) Successful, 10 WTE due to commence during Q 1 19/20 from latest wave Physician Associates / PA Preceptorship scheme (HEE) Early success, need to increase numbers Nursing 10 point GPN plan STP GPN strategy Increase in nurse training numbers (3 in last 10 months) 9 EOIs from Practices to host placements (working with Worcester University GPN Facilitator and GPN Leads/Mentors Strategy to be approved by PCCC in May 2019 GP Recruitment and Retention Total investment £ 226 k

Next Steps for 19/20 Single Point of Access Named Clinical Leadership GPFV Workforce Clinical

Next Steps for 19/20 Single Point of Access Named Clinical Leadership GPFV Workforce Clinical Lead First Five Clinical Lead Practice Nurse Leads Training Hub GPN mentors, Ambassadors for emerging roles Medical Education and Peer Support Networks GP Recruitment and Retention Transition from trainee to General Practice Design of new roles Support in first five years Awareness and access to opportunities Implementation of Medical education in primary care model / Medical School developments Mentoring Increased Training capacity -Training Hubs Matching roles with system need Building on local initiatives to build scalable solutions to agreed standards in partnership with STP ICS HEE On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG

Priority – Digital On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire

Priority – Digital On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG

Priority - Estates • Primary Care Estates Strategy – 30 June On behalf of:

Priority - Estates • Primary Care Estates Strategy – 30 June On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG

Priority -Investment • PC Allocation – Short-fundedRisk • Commitment to £ 11 per head

Priority -Investment • PC Allocation – Short-fundedRisk • Commitment to £ 11 per head for delivery of local PCEHOF 1 April 2020 • GPFV Spending Plan agreed by NHSE • Need More • Workforce • Estates

Next Steps & Timetable • THIS IS AN OUTLINE! • NHSE – 24 June

Next Steps & Timetable • THIS IS AN OUTLINE! • NHSE – 24 June • PCC Cttee – 25 June • NHSE Response – 30 June • GP Provider Board & Practice Engagement – June – October • STP Executive - October On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG