Dispensing doctors and the NHS Five Year Forward View Deborah Jaines, Head of Primary Care Policy and Contracts, NHS England
Dispensing Doctors and the NHS Five Year Forward View Deborah Jaines Head of Primary Care Policy & Contracts, NHS England 21 st October 2015
Context Expectations FYFV Opportunities
- Or How should dispensing practices position themselves to flourish in the future?
Context
We could not do without dispensing practices 1,063 practices in 2014 14% of total 3.1m patients in 2014 6% of population
Increased funding in healthcare now finding its way to primary care Primary care share of investment in Health was decreasing NHS England has increased the Primary care share In 2005/06 it had a 10.6% share In 2014/15 over 9 billion invested (Increase of 2.68% over previous year) In 2013/14 it had an 8.2% share In 2015/16 Primary care budgets increased by 4.1% (compared to CCG budgets of 3.4% increase)
Dispensing Doctors - Earnings Earnings have been decreasing for all GPs since the peak of 2005/06. 130,000 125,000 120,000 115,000 110,000 105,000 100,000 95,000 90,000 Income before tax Difference = 15,100 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 Dispensing Non-dispensing Linear (Dispensing) Linear (Non-dispensing)
Investment is increasing Dispensing Doctor benefits 800 700 600 500 400 300 200 100 2012/13 2013/14 2014/15 Fees Medicines Total
Total investment in general practice now over 9 billion 795m Total earning from drugs
Increasing expectations of general practice
Expectations are already high and are increasing Government ambition for 7 day services Patients want to see their GP and quickly Patient dissatisfaction is increasing Patients want to see their GP at a time that suits them and practices are rising to this challenge: Patients are loyal to their local practice and predominantly choose a GP practice based on proximity to home.
5 Year Forward View
The Five Year Forward View Taking existing primary care strengths, we will build a firm foundation for the future and deliver a new deal for primary care by: For that reason, I m very pleased at the progress being made nationally on driving change here to improve the amount and the fairness of funding, giving greater power to local CCGs, training extra GPs, making the profession more attractive, improving premises and IT. We ll feel the benefit of some of those things sooner than others, but they re all welcome, and I m proud to have played a part in creating this momentum. Stabilising core funding for general practice nationally Co-commissioning to shift care from acute to community Improving access to services and supporting new ways of working Expanding number of GPs: recruitment, return to work schemes and retention and investing in other new primary care roles Expanding funding to upgrade primary care infrastructure and scope of services offered to patients New initiatives to provide care in under-doctored areas Building public s understanding that pharmacies and online resources can help them with minor ailments without need for GP or A&E Identifying practical solutions to reduce bureaucracy and reshape appointment demand.
Opportunities for dispensing practices
Opportunities Access Funding Infrastructure & technology Strengthening primary care Quality Workforce New ways of working
Access Funding Access Infrastruct ure & technology Dispensing practices have been integral to the success of the PM s GP access fund and have pioneered innovations in delivery of community service delivery Quality New ways of working Workforce Wave one and wave two are providing a more diverse range of options for patient care, acknowledging not everyone has same needs These needs are being met by delivering services through a broader primary care workforce and different approaches including broader workforce and technology
Prime Minister s GP Access Fund Varying approaches to improving access: opening 8am-8pm on weekdays and weekends; better use of telecare and health apps; more innovative ways to access services by video call, email or telephone, Better use of skillmix (nurse, physio, paramedics, pharmacists) developing more integrated services Wave one 50m 1100 practices 7.5m population Wave two 125m 1400 practices 10.5m population Total of 57 pilots, 18 million population and over 2,500 practices.
Examples in rural areas and including dispensing practices Taurus Healthcare Ltd (Arden, Herefordshire and Worcestershire) Together as One Community (North Yorkshire and Humber) Development of 3 Hubs providing services 8-8, 7 days/week Almost half of practices are dispensing doctors Total conurbation of 185,000 Full access to the patient's home practice record Over 2500 of patients seen already responded positively to patient survey Looking for to improve access on Sundays and Bank Holidays. Fully constituted GP federation of 22 practices 17 dispending practices Open for Longer : extended hours clinics in Whitby, Hambleton and Richmondshire Delivery of new models of care, e.g. tender for Whitby community services. Ambitious supported self-care programme Deployment of clinical pharmacists in general practice
Infrastructure Roll out of Primary Care Infrastructure Fund to accelerate investments in GP premises and better use of technology Funding Quality Access Infrastruct ure & technology Workforce New ways of working
Technology Funding Access Infrastruct ure & technology GP Appointment Booking - patients able to book appointments online. Quality Workforce New ways of working Online ordering of prescriptions. Patients can view their full coded medical record, including option for them to download it into third party applications, where required.
GP workforce 10-point plan NHS England, Health Education England, RCGP and BMA GP committee working together to ensure that we have a skilled, trained and motivated workforce in general practice All four organisations have jointly developed GP workforce 10-point action plan Building the Workforce a New Deal for General Practice which sets out various approaches: To recruit new GPs, retain those thinking of leaving and encourage doctors to return to general practice to better meet needs of patients now and in future To develop a range of initiatives to increase number of GPs NHS England investing 10million to kick start initiatives in plan Initial focus has been on GPs, but we are now working on a range of critical measures to support development of other staff including General Practice Nurses and Pharmacists
Pharmacists in general practice First in a number of pilots testing innovative workforce models designed to support general practice as part of the GP Workforce 10 Point Plan Intention is to invest at least 15 million over the next three years to test out this new patient-facing role in which clinical pharmacists have extended responsibility over and above many current ways of working Practices have already suggested that this extended role could include managing care for people with self-limiting illnesses and long-term conditions and have asked that the new team members have the ability to independently prescribe Pilot will be part funded for three years with an expectation that practices will continue with the role into year four and beyond Anticipate that roughly in 250 clinical pharmacists will be involved over this period with the ambition of supporting over 1 million patients GPs and GP practices have been invited to submit applications between 11 and 18 September Announcement of successful proposals next month
New ways of delivering care Access Vanguards New Models of Care Programme. Co-designing services with patients and health and social care system which can be blueprints for NHS (at pace and scale). 38 sites across England. Multispecialty Community Providers (MCPs) and Primary and Acute Care Systems (PACS) both with general practice at the heart. Funding Quality New ways of working Infrastruct ure & technology Workforce More person-centred care supporting people to stay healthy, make informed choices of treatment, manage their conditions and avoid complications.
New general practice contract option Voluntary new contract option to drive integration & new models of care through GP networks/federations delivered at scale Funded with money from the 10 billion additional investment previously announced Reaffirmed commitment to 7 day NHS including access to GP services Key principles: more money for primary care more control for GPs over the way they work more time to care for patients Quality & Outcomes Framework opt-out
Quality CQC Inspection of GP and dental practices and GPhC inspections for community pharmacies ensuring high quality services for patients Development of a wider primary care web tool and GP dashboard for commissioners GP Patient survey 2014/2015 results (published July 2015) conducted with 2.64 million postal questionnaires, published at practice level and used by local people and commissioners to influence how the local NHS develops GP Friends and Family Test provides practices with real time feedback about their patient s experiences. Tell them what is going well, but also help them improve where change needs to happen Funding Quality Access New ways of working Infrastruct ure & technology Workforce
Funding New funding for 2015/16 Funding Access Infrastructu re & technology Primary Care budgets increased by 4.1% compared to CCGs at 3.4% 1 billion - Primary Care Infrastructure Fund is a new four-year investment programme in workforce, technology and infrastructure 125 million - PM Challenge Fund improving access to general practice wave two schemes will further improve access to and build on 50m wave one funding 2014/15. It includes 6m programme to support digital transformation 250 million budget for primary care IT 10 million for measures to tackle recruitment and retention the GP Workforce 10- Point Plan 10 million programme of support for struggling practices to be developed between NHS England and NHS Clinical Commissioners. Quality New ways of working Workforce
Opportunities Access Quality Infrastructure & technology Strengthening primary care Funding Workforce New ways of working
Thankyou