Transforming Primary Care. Dr Julie Hales Transformation Director, Modality Partnership (Vanguard Programme Director)

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1 Transforming Primary Care Dr Julie Hales Transformation Director, Modality Partnership (Vanguard Programme Director)

2 The Modality Partnership At a Glance 19 mergers 95,000 patients 37+ partners 1 and 2 care contracts 300+ staff single org. 24 primary care sites Integrated IT: EMIS Web Single Partnership partners own shares of the organisation One model of care Corporate structure Executive team manage day to day GP Partnership Board to oversee governance Modality Population Growth

3 Federation vs Partnership Federation Collaboration between multiple practices May be informal or a legal entity, e.g. LLP, CIC, Ltd Co Informally or formally established organisational structures with management teams funded by member practices GMS provided by member practices Enhanced services / specialist services provided by federation May share back-office functions Using organisational scale to achieve economies Individual practices retain own identity Potential for conflicts when bidding for services Examples: Midlands Health Network, New Zealand Tower Hamlets, UK Partnership Full legal merger between practices Corporate style legal entity is the partnership Single Management team Core services, enhanced services, specialist services, community services, private services Share back office functions Single scaled organisational infrastructure to expand scope of primary care provision. Single legal entity to hold all contracts or legal sub-divisions Potential loss of individual practice autonomy Quality Improvement through peer review process Examples: Modality Partnership, Birmingham Whitstable Medical Practice, Kent

4 The Modality Platform Enhanced Access Channels Website Re-design Click First Access NHS symptom checker NHS 111 call back Skype consultations Real time patient feedback NHS F&F Test Self help E consulting Centralised call centre Modality Partnership Modality Model of Care The Modality Platform EMIS Web Standardised clinical templates Map of Medicine Standardised referral templates Population Health planning Premises Standardisation Specialist Services MDTs Care Plans Change Management Business Development Central Administration Function HR Package (induction/appraisals) Governance package (reporting metrics) Finance Package (financial reporting and forecasting) Group Purchasing Single Secretarial Team Training

5 Service Improvement: Patient Access Online via the website Via Skype In person By Phone Via a mobile device

6 Service Improvement: Service Availability and Quality Our Clinical Contact Centre Up to 1,300 calls answered every day, serving over 46,000 patients Average call waiting time is 45 seconds Average call duration has reduced from 10 minutes down to 2 minutes Demand for appointments has stabilised throughout the day, reducing the morning rush Patients call their surgery number Clinical capacity increased by 10% DNA (Did Not Attend) Rate reduced by 72%

7 So has it made a difference? I wasn t sure about the changes when we started but now my job and the patient experience is so different. The queues are gone and I feel much more in control of how we manage appointments its much less stressful and so much better for patients. They get to choose how and when they see their doctor and they love the new service. Marjorie our receptionist at Handsworth Wood Medical Centre who now runs the Clinical Contact Centre

8 Building the Evidence Base The Results So Far 72% reduction in DNAs...equates to an additional two full time SGPs worth of appointments at no additional cost 10% increase in within day activity meeting unmet demand within the resources already available Our initial results are very promising and we are continuing our evaluation and continuous improvement of our services and our platform by working with independent evaluation partners such as The Nuffield Trust. 70% of patients are consistently being dealt with remotely without having to come in to practice e Average consultation time reduced to under 5 mins (for the remote consultations) 70% of patients say that the new access system is better than before (1000 patient in house survey) 100% of clinicians would not go back to old system Reduction in A&E attendances of around 5-10% (range - % differs across practices)

9 Multi-Specialty Community Provider (MCP) Background NHS 5 Year Forward View (Oct 14) New Models of Care - Vanguards 4 GP-Led MCPs Integrated Care Delivery in the Community: ü ü ü ü ü ü Co-ordinate and oversee the care of the population across the continuum of services Provide 7 day access to services e Provide seamless transition between service, remove silos and gaps in care Empower residents to take responsibility for their own care and wellbeing Focus on prevention and understanding risk/patient segmentation Provide services close to home designed to reduce/minimise acute care utilisation

10 Our MCP Vision and Mission Statement Based on our registered population, our collective vision is to develop a true population health model that provides the right services by the right team at the right time and place based on individual needs and acuity Together, we will: Increase access to our services and ensure the right care and support at the right time and place by the right professional team, delivered in the way people want according to their needs Working Together Together, we will: Make the best use of available resources and work c together to provide integrated and seamless care closer to home Harness our collective skills, capabilities and expertise to deliver excellent quality and experience and value across the system and improve long-term outcomes of our population 10

11 Operating Platform: Required Capabilities Our operating platform is an integrated suite of capabilities, powered by business intelligence and interoperable systems, continuously refined to manage risks and deliver optimal care needs for the population Provision Service Delivery Care Coordination Wellness, Prevention & Community Resilience Enhanced Primary Care 24/7 Single Point of Access Referral Facilitation Care Management Acute Interface Care Coordination Coordinate and oversee the clinical provision of care across the continuum of health care services Business Intelligence & Technology System Configuration Population Health Risk Stratification Well Low Risk Moderate Risk High Risk People engagement and empowerment Service & Pathway Redesign Provider Mix & Care Model Design BCC / BSMHFT Modality BCHC SWBH Prevent unplanned hospitalisation and avoidable admissions Manage goals, empower, prevent avoidable decline, and treat in least restrictive setting Population Health Apply proven health management principles to deliver the right services by the right team at the right time and place based on individual needs and acuity Commissioning Contracting Management Transformation Execution Provider Contracting Outcomes Monitoring Financial Management Communications and Engagement Workforce and Organisation Development Programme Management Outcomes and Financial Accountability Provide measured outcomes relating to individual experience and population cost and health and bear financial risk for the health care needs of Modality s registered population 11

12 New Care System Ecosystem Interventions Framework Wellness, Prevention & Community Resilience Enhanced Primary Care Care Management Acute Interface Self-Care Enablement Hospital at Home 24/7 Single Point of Access Healthy Communities Enhanced Primary Care (Physical & Virtual) Specialist Services (Outpatients) Condition Management Complex Case Management Nursing Home / Residential Care Advanced Illness Interim Bed Intermediate Bed Sub-acute Care Acute Inpatient Front Door A&E Referral Facilitation Bed Management (Discharge Planning) 24/7 Single Point of Access 12

13 New Care System Ecosystem Interventions Framework Wellness, Prevention & Community Resilience Enhanced Primary Care Care Management Acute Interface Self-Care Enablement Hospital at Home 24/7 Single Point of Access Healthy Communities Enhanced Primary Care (Physical & Virtual) Specialist Services (Outpatients) Condition Management Complex Case Management Nursing Home / Residential Care Advanced Illness Interim Bed Intermediate Bed Sub-acute Care Acute Inpatient Front Door A&E Referral Facilitation Bed Management (Discharge Planning) 24/7 Single Point of Access 13

14 Team Compositions (1/3) GP ANP/PA Practice Nurse Core EPC Care Team HCA GP/ANP EPC Leads Care Management Oversight 3,500 population Moderate-risk patient Care Coordinator* Frail patient Wellbeing Coordinator Advanced illness patient Care Coordinator* EPC Care Management Team Shared Resource Care Coordinator* Most complex patients Care Manager Wellbeing Coordinator Care Management Team 10,500 population Prescribing Pharmacist Mental Health Community Nurse/Therapist Care Navigator District Nursing Senior Social Worker Therapies e.g. Physio Mental Health ANP Extended EPC Team Community-based Team *Care coordinator delivers services across EPC and complex care, with different caseload assumptions based on patient complexity: WTE loads need to be tested against demand 14

15 Team Composition MDT:EPC (2/3) Complex Case Management MDT EPC Team 1 EPC Team 2 EPC Team 3 3,500 Patients 3,500 Patients 3,500 Patients 10,500 Patients 15

16 Questions? Dr Julie Hales Transformation Director Modality Partnership