Primary Care A whistle stop David Levy Sept

Primary Care A whistle stop David Levy Sept 2018 www. england. nhs. uk

Gearing of investment across the system www. england. nhs. uk 2

The future: 2015 - 2028 ICare Community Care www. england. nhs. uk Social Care Primary Care General Hospital University/ Specialist Facilities 3

Published 2015 www. england. nhs. uk/gp Primary Care remains a priority in the Long Term Plan 20. 12. 16

Primary Care • A spectrum of small to larger independent sector providers- that “cannot be allowed to fail” • • Patient focused IT much better than most hospitals • Under intense pressure • • • Nimble, can change fairly quickly Can reconfigure services within months (c/w hospitals) Can innovate at pace 5

UNDER INVESTMENT WORKFORCE CHALLENGES The problems UNFUNDED WORK RISING DEMAND BUREAUCRACY INADEQUATE INFRASTRUCTURE #GPforwardview

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Overall new investment is a minimum extra £ 2. 4 £ 9. 6 £ 12 2015 -16 billion/year 2020 -21 billion/year billion pa by 2020/21 14% real terms increase vs 8% for the rest of the NHS (plus CCG increases) One off Sustainability and Transformation package >£ 500 M over 5 years #GPforwardview

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Stabilise and Improve Resilience Vulnerable Practices Scheme • £ 10 m to support 900 identified GP practices in difficulty, 2016 • Permissive approach e. g. no matched funding • Diagnostic and improvement support for 600 practices Practice Resilience Programme • £ 40 m four year programme over 4 years • Similar permissive approach to individual and groups of GP practices • £ 16 M 16/17 then £ 8 m each year for next three years #GPforwardview

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Expand the Medical Workforce 5, 000 Net WTE doctors in general practice by 2020/21 Encourage Recruitment • • • Medical schools Health Education England increasing training places 250 Post-CCT fellowships First 5 Portfolio careers International recruitment Make GP attractive again • • • Reduce workload 10 High Impact changes Induction & Refresher scheme Bursaries in under-doctored areas Retainer Scheme Leadership training opportunities Training Hubs Resolve Indemnity issues Improve appraisal processes Retention • • • Flexible career schemes Career coaching for GPs GP Health Service #GPforwardview

Only 21% of GP trainees want to work full time once they complete their training

Develop the workforce 5, 000 additional staff by 2020/21 NURSES • Support with return to work • Improved practice placements • £ 15 M to be invested PRACTICE MANAGERS • Expanded national network • £ 6 M on development PHARMACISTS Current £ 31 m to pilot 470 pharmacists in >700 practices, • Plus new £ 112 m to extend by a pharmacist per 30, 000 patients • For an additional 1, 500 pharmacists by 2020 • Clinical pharmacists in 111 hubs PHYSICIAN ASSOCIATES PARAMEDICS & PHYSIOS • 1000 to be trained • Regulatory and indemnity enablers MENTAL HEALTH • New Care Models • 3000 Therapists for long-term physical conditions #GPforwardview

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Estates • Estates and Technology Fund • £ 1 B over 3 years • Estates and IT • Fund £ 7 M Stamp Duty for NHS Property Services tenants #GPforwardview

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Extended access to primary care • Appointments available in evening and weekends • National coverage by end of Sept 2019 • Has resulted in creation of Primary Care hubs and greater sharing of patient information for care across Hub 19

Delivering the extended access mandate commitment by 1 October 2018 - CURRENT • Refreshing NHS Plans for 2018 -19 (published February 2018) requires provision of extended access to GP services, including at evenings and weekends, for 100% of the population by 1 October 2018. • 64% of the country already has seven day access (GPFV Monitoring return May 2018). www. england. nhs. uk 20

10 High Impact Changes: 3 year programme at practice level • Sustainable Improvement Team • Two top programmes: • Productive workflows- smarter not harder • 70% reduction in some doctors admin work • Develop QI expertise 21

Primary care networks • 30 -50, 000 population • Good for patients, good for staff, improves sustainability • Guide in draft but surveys suggest 80%+ coverage already, 800+ PCNs • Part of new NHS architecture • Driving rapid redesign of patient care pathways 22

What’s happening now? • • • Multidisciplinary care provided- “see who you need to see” Different care models: calls, skype, email, GPs act as “Primary care consultants”- longer appointments Care in the community, with MDT meetings, including secondary care doctors, to discuss patients, with: • Diabetes, CKD, Frail patients… Results: • Improving patient care and outcomes • Reducing OP referrals and admissions • Upskilling primary care teams