Achieving vertical and horizontal integration: working with partners across primary, community, social and secondary care to provide a better level of service to patients Sarb Basi, Managing Director, Vitality Partnership Realising the potential of primary care
Current Political Context Managing Long Term Conditions Reducing demand on hospital care (urgent care) Shift of care into community settings Increased demand for primary care Better value from GP contract Focus on demonstrating quality NHSE/CCG/PH commissioning intentions
Drivers for change Need for greater GP involvement in driving better care but can t wait for commissioning led innovation Fragmented general practice infrastructure a barrier to reducing hospital activity and service redesign Poor quality primary care remained largely unchallenged by commissioners CQC will start shutting down poor general practice Current GP model unsustainable: economics, demographics Transformation of non-clinical and clinical capabilities is overdue
Future of Primary Care The patient voice at the heart of all provision General practice should be the locus of community based integrated services at scale Specialist expertise is an essential component of effective integration Integrated services to incorporate social care Technology is an enabler to manage demand
All quiet on the western front GP partnerships will be gone in ten years, says NHS England official Dr Mike Bewick He also said that he expects each new provider model to accommodate around 300,000 patients - similar to CCGs the current organisational structure of primary care is no longer sustainable or desirable Andy Burnham: Why general practice should move towards a salaried model Shadow health secretary Andy Burnham talks exclusively to Pulse about why GPs should be predominantly employed by large health and social care organisations 17 September 2014 10 September 2014 Practice closures set to widen GP privatisation All new GP contracts will be thrown out to private providers under APMS, in a move described as the death knell for traditional practice 09 September 2014 Practice hands contract back after four partners are forced to resign Four partners in a practice in a deprived area have been forced to take the decision to resign and hand back their contract to NHS England due to problems recruiting partners. 15 September 2014
GP Provider led innovation GPs need to lead and own the transformation of General Practice Do not wait for policy or national direction The status quo is not an option so lead or work with other innovators Future proof the professional with a proactive and progressive model NOT from a protectionist approach Embrace the future landscape and opportunity to provide at scale Think differently there is no limit to the possibilities Partner with like minded NHS providers
Emerging Models in General Practice Consultation Collaboration Full Merger/Integration Traditional Practice Model Federations Super Partnerships (Sole trader, multi-partners) 2k 15k patients 30k 500k patients 80k + patients
Size Matters Specialist Services Intermediate care Mental Health Workers Social Workers Health & Well Being 3 rd Sector Secondary Social Primary Community GP practices Pharmacy Dentist Optometrist District Nurses Health Visitors Physiotherapists Case Managers
Vitality Partnership Vitality Birmingham 2009 26k 2010 32k 2011 38k 2012 40k 2013 58k 2014 68k+ 2015 150k+ (CCG, 550k) Vitality Walsall Vitality Leicester Vitality London 10 mergers 21 partners + 3 associate + 2 fixed share 5 PMS and 4 GMS contracts 12m+ turnover 250+ staff NHS specialist services Private services 13 primary care sites (plus university sites) Integrated IT: EMIS Web across all sites (except one)
Integrated/Additional Services Rheumatology Dermatology Orthopaedics Immunology Substance Misuse X-ray Zero Tolerance Physiotherapy Podiatry Osteopathy ENT Urology Gynaecology District Nurses Intermediate Care Healthy Communities Collaborative Pain Services Private Services
Our Horizontal Integration Acute and Community Strategic partnerships Health and wellbeing services Social Care Mental health Public Health and population management 3 rd Sector
Innovative Organisational Dynamic Provision at scale Vitality Partnership
Primary Care Demand (1) QRESEARCH crude consultation rates per person-year All clinicians and all locations (England) 0 1 2 3 4 5 6 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 NOTE: Analysis by calendar years copyright QRESEARCH 2003-2009 (Database version 22)
Primary Care Demand (2) QRESEARCH crude consultation rates per person-year in 2008 All clinicians and all locations (England) 0 5 10 15 0-4 years 5-9 years 10-14 years 15-19 years 20-24 years 25-29 years 30-34 years 35-39 years 40-44 years 45-49 years 50-54 years Age band 55-59 years 60-64 years 65-69 years 70-74 years 75-79 years 80-84 years 85-89 years 90+ years Males Females NOTE: Analysis by calendar years copyright QRESEARCH 2003-2009 (Database version 22)
Digital Vitality Our Consumers 82% of UK population using broadband to transact <1% of patients using the internet to interact with clinicians! Birmingham has highest penetration of smartphone use in the U.K.nearly 30% more than London.. We have the population and capability to shift the balanace of provision to the web!
Digital Vitality Digitally enabled transformation of healthcare is not about systems, data, technology, analytics.or any of the usual NHS IT/Informatics stuff. Delivering real change is about changing the business model, through the power of the internet, to create new provider models.engaging consumers in new, highly efficient and scalable ways of actually receiving a service. IT/Informatics operates at the margins of healthcare.digital is the future of healthcare delivery!
Our Digital Operating Model
Our Digital Capability Model
Making it Happen www.vitalitypartnership.nhs.uk
Further reading