General Practice Forward View Planning Requirements Submission 23 rd December 2016
General Practice Forward View planning - The Challenge of Change NHS Warrington CCG has translated the GP Forward View into key aims and local priorities and as such has developed a detailed local operational plan. Our plans include investment and commitment to strengthening general practice to support the sustainability of primary care, along with identification of priority areas for system transformation. We believe, delivering effective service re-design with focused investment will make significant impact in improving health outcomes for our local population, we call this The Challenge of Change. The CCG believes, that our ambition to make the people of Warrington s lives better is achievable; by working together as a health economy we can improve the way in which care is delivered. The CCG has been developing local plans to strengthen and transform general practice since its inception in 2013. In 2014, following consultation with practices, the CCG published its primary care strategy. The CCG is cognisant that primary care, and in particular, general practice will play a crucial role in the Cheshire and Merseyside STP plans alongside a similar role in the Alliance LDS. 2
The Challenge of Change Why do we need to change? Primary Care Consultation with primary care (in 2014) highlighted that primary care in Warrington was categorised by increasing workload pressures decreasing investment significant variation price per head funding significant variation in service provision between practices. 37% of GPs in Warrington at that time were potentially able to retire over the next few years staff considered that workload was unsustainable and they were dissatisfied with work-life balance. The CCG review concluded that the conventional model of service delivery is under substantial pressure and delivery of the status quo was not sustainable The risks and challenges were recognised by the CCG and a primary care strategy for the sustainability of primary care was developed and published 3
Why do we need to change? Health and Social Care The Challenge of Change The Town of Warrington s health economy faces a series of challenges and opportunities and if not addressed could worsen the health and wellbeing of local people. Some examples of Warrington s population challenges are described below. The population is projected to grow by 9.7% More people will be living longer than expected 27% growth in the numbers of people 65+ years by 2021 and 60% by 2030. Frail older people occupy around 70% of acute hospital beds (with up to 60% of over 65s in our hospital having dementia co-morbidity) Long term conditions currently account for 70% of overall health and social care spend with projected increase related to lifestyle and age profile demographics In addition to this growth in the population, change in the age profile within the population will impact heavily upon health and social care service delivery. As the population ages there will be more people living with health conditions and often multiple needs, placing greater demands upon our health and social care system both in community and hospital care settings 4
Why do we need to change? The Challenge of Change Health and Social Care continued People in Warrington experience a range of worse health outcomes in comparison with similar towns in other parts of the country and when we asked local people about their experiences they pointed out the fragmented nature of health and social care and the disjointed pathways, this is what they told us: we don t know who is responsible for what Waiting on medications takes up a bed for patients being discharged Health and Social care don t communicate with each other; we have to tell different people the same story all the time I want my child to have the right care by the right person and in the right place Dad wanted to come home and we wanted him home, but it took ages Quality of service delivery can also vary significantly, such variations have to be tackled therefore by delivering the acuity model through collaborative working we will work to a future where services are delivered consistently to the highest standard in a fair and sustainable and equitable manner. 5
Our Ambition The Challenge of Change NHS Warrington CCG believes that by working together practices and other service providers can improve the way in which care is delivered and ensure that the people of Warrington s lives are better. Within Warrington the Collaborative Cluster programme is a key enabler to delivering, supporting and strengthening the transformation processes. Our GP Practices have been formed into population cluster sizes of circa 30,000 residents. This model of care was initially funded by the Prime Ministers challenge fund initiative but is now fully supported and integrated by the CCG. To support and lead transformational change through the cluster model the CCG has committed funding for 4 service development managers There are seven clusters across the Warrington footprint; the vision for this model is to significantly change the delivery potential for primary care by creating primary care populations that will serve as a platform for fully integrated services around the registered lists. It will ensure a multi-disciplinary primary care health team which includes secondary care, social care, community providers, public health, mental health and third sector services enabling primary care to be a whole system of integration and co-ordination. 6
The Measure of Success The Challenge of Change We will know that we have improved the Warrington health and social care system when we have achieved. A population base that allows health and social care professionals to integrate in a primary care setting Practices working within a wider team of practices in collaboration, benefiting both workforce and communities Shared care co-ordination resources More ambulatory care available More community based mental health services Shared multi-disciplinary care home services Further scope for self-management and primary prevention support An increased in the number of people having a positive experience of care Reduced health inequalities across Warrington 7
Our Map of the Future - Overview 8
The Vision Acuity/Complexity Model of Care
Delivering on the Vision A schematic maturity model was developed within the primary care strategy for the emerge of a primary care led model for system transformation. To ensure delivery of the model the CCG has included membership engagement as one of the quality requirements within the local enhanced service. To ensure achievement of the quality standard the model was developed wider to include a systematic stepped approach for delivery that ensures each step is followed in order of required sequence. The stepped model is underpinned with a positioning level which enables the CCG to monitor how practices are progressing within each step. The positioning level has been adapted from: Cusick, K (1998). The Systems Engineering Capability Maturity Model: Where to Start? This model will be used to enable NHS Warrington CCG to deliver our vision: Step 1 Leadership Step 2 Improving Local Services Step 3 Creating the vision for the acuity/complexity model Step 4 Delivering the Vision Step 5 At Scale Working The following slides detail the steps and clarify the positioning model.
Delivering on the Vision Step 1 - Leadership Creating a shared purpose Strategic planning & partnership Leading through change Being a leader Adopting a team approach Acting with integrity Understanding all aspects of the healthcare system and NHS Intelligence Clusters formed for defined populations Clusters formed into population sizes of 30,000 Terms of reference developed for clusters Building personal relationships with colleagues Selecting a nominated Chair Gathering intelligence from patient surveys, CQC reports, service user engagement, internal Practice issues & Public Health cluster profiles Analyse information from a range of sources on performance Use evidence and intelligence to identify options Use information to challenge existing practice and processes
Step 2 Improving local services Intelligence led improvement Critical evaluation Encouraging improvement & innovation Facilitating transformation Making decisions Rapid cycle change Applying knowledge & evidence Understanding the current skill mix Question the status quo Develop creative solutions to transform service and care Identify general practice improvements and create solutions through collaborative working Address local population issues and make improvements Achievement on the requirements of the Warrington Local Enhanced Service Develop a plan to set the direction of travel to deliver the Primary Care Strategy and local improvements Test and evaluate new service options Maximising achievements in own clusters Sharing responsibility for delivery
Step 3 Creating the vision for the acuity/complexity model Influencing the vision of the wider healthcare system Work in partnership with others in the healthcare system to develop the vision Developing the strategy Team leadership Communicate ideas and enthusiasm about the future of collaborative working Operations management Understanding finances Developing skill mix Actively engage with colleagues and partners/ stakeholders about the future Scan and analyse the full range of factors that will impact on the cluster Create the vision for collaboration that reflects the core values of the NHS and CCG Understand other providers agendas, motivations and drivers to develop integration which is sustainable Identify and mitigate uncertainties associated with integration Create implementation plans that are deliverable Patient rep involvement when developing new cluster project/services Test and evaluate new service options against acuity model Risk assessments completed
Step 4 Delivering the vision Framing the vision Implementing the plans Appropriate skill mix Integrated with social care, mental health, community services and third sector etc. Developing skill mix Social Workers/Health Visitors embedded with clusters and operational pathways in situ Community Provider embedded with clusters and operational pathways in situ Mental Health embedded with clusters and operational pathways in situ Third sector relationships matured and working Risks revisited and with mitigation concluded Acuity model working productively Continuous monitoring, evaluation and improvement model delivering expected outcomes Consolidate back and middle office functions
Step 5 At scale working Making delivery systematic Business intelligence Governance Contracts Shared workforce Cohesive integrated provision across populations of 30,000 Establish a climate of transparency and trust discussing results and issues openly Monitor and evaluate outcomes, making adjustments to ensure sustainability of plans Sharing of supplies/orders across clusters Shared IT platform across cluster Shared management, administration and back office functions Delivering out of hospital services
Delivering on the Vision - Positioning Level Positioning Level adapted from: Cusick, K (1998). The Systems Engineering Capability Maturity Model: Where to Start? 16
Making delivery systematic Business intelligence Governance Contracts Shared workforce Cohesive integrated provision across populations of 30,000 Establish a climate of transparency and trust discussing results and issues openly Monitor and evaluate outcomes, making adjustments to ensure sustainability of plans Sharing of supplies/orders across clusters Shared IT platform across cluster Shared management, administration and back office functions Delivering out of hospital services Framing the vision Implementing the plans Appropriate skill mix Integrated with social care, mental health, community services and third sector etc Developing skill mix Social Workers/Health Visitors embedded with clusters and operational pathways in situ Community Provider embedded with clusters and operational pathways in situ Mental Health embedded with clusters and operational pathways in situ Third sector relationships matured and working Risks revisited and with mitigation concluded Acuity model working productively Continuous monitoring, evaluation and improvement model delivering expected outcomes Consolidate back and middle office functions Influencing the vision of the wider healthcare system Work in partnership with others in the healthcare system to develop the vision Developing the strategy Team leadership Communicate ideas and enthusiasm about the future of collaborative working Operations management Understanding finances Developing skill mix Actively engage with colleagues and partners/stakeholders about the future Scan and analyse the full range of factors that will impact on the cluster Create the vision for collaboration that reflects the core values of the NHS and CCG Understand other providers agendas, motivations and drivers to develop integration which is sustainable Identify and mitigate uncertainties associated with integration Create implementation plans that are deliverable Patient rep involvement when developing new cluster project/services Test and evaluate new service options against acuity model Risk assessments completed - Creating a shared purpose Strategic planning & partnership Leading through change Being a leader Adopting a team approach Acting with integrity Understanding all aspects of the healthcare system and NHS Intelligence Intelligence led improvement Critical evaluation Encouraging improvement & innovation Facilitating transformation Making decisions Rapid cycle change Applying knowledge & evidence Understanding the current skill mix Clusters formed for defined populations Clusters formed into population sizes of 30,000 Terms of reference developed for clusters Building personal relationships with colleagues Selecting a nominated Chair Gathering intelligence from patient surveys, CQC reports, service user engagement, internal Practice issues & Public Health cluster profiles Analyse information from a range of sources on performance Use evidence and intelligence to identify options Use information to challenge existing practice and processes Question the status quo Develop creative solutions to transform service and care Identify general practice improvements and create solutions through collaborative working Address local population issues and make improvements Achievement on the requirements of the Warrington Brand Develop a plan to set the direction of travel to deliver the Primary Care Strategy and local improvements Test and evaluate new service options Maximising achievements in own clusters Sharing responsibility for delivery Positioning Level adapted from: Cusick, K (1998). The Systems Engineering Capability Maturity Model: Where to Start? 17
Effective Access to Wider Whole System Services By working together we can improve the way in which care is delivered, not just hospital care but in GP practices, mental health services and social care. Work to reshape some care services is already underway integrated health and social care is an emerging reality and there is work being undertaken on how we better deliver care in our communities Together we are improving health and social care in Warrington (January 2016) Mr Derek Warrington Derek is an 82 year old man with COPD and heart failure. He has rheumatoid arthritis and dementia and unable to perform personal care tasks. Propensity to wander out of the house, leave the gas on unlit and cannot be left alone. Derek had a holistic assessment undertaken of his needs at the same time as Anne. Derek was allocated the same care coordinator as Anne to help her access the health & social care system as Derek s main care giver. Derek receives outreach support for his dementia from 5 Boroughs Partnership. Recently he was suffering from a urinary tract infection which made his confusion worse. The care coordinator pulled in additional support from the collaborative care team, who put a package of care together to enable him to be managed at home. Derek didn t have to go into hospital and continues to enjoy his time at home with Anne his wife. 18
Right Care, Right Place, Right Time 19
Health & Social Care governance structure to support Collaborative Clusters 20
Investment - Local Enhanced Services to support the Warrington Brand The Warrington Brand of Primary Care will define the quality of provision and enable every citizen to get a common offer of care irrespective of their registered practice. The local enhanced services will strengthen and transform general practice. The specifications will ensure:- Collaborative working across primary care to deliver a range of projects to transform care delivery Core access standards that meet best practice Where appropriate, ambulatory care pathways to be managed in Primary Care Practices to work with the CCG s Medicines Management team to deliver consistent prescribing practice Membership engagement to deliver maturity of the collaborative clusters Increase identification and early treatment of lifestyle related health problems Effective Referrals utilising the Warrington Referral Assistance Gateway Improvement in the quality of care and access for patients with a mental health issue, dementia or a learning disability A Diagnostic bundle offered in Primary Care to include ECGs, spirometry, ambulatory blood pressure readings, 24hr ECGs and phlebotomy A risk stratification tool is implemented and used to support complex patients Increased access for appointments across all GP Practices The intended impacts of the new enhanced services include : Supporting sustainability and viability of primary care Promoting multi agency working resulting in potential efficiencies Reducing acute sector activity Focusing resources for maximum benefit and return on service investment Contributing to pro-active care, improved wellbeing and quality of life Reducing reliance on reactive primary care / community service provision by pro-active interventions Promoting patient self-care Reducing long term care needs 21
Care Redesign / Transformation To support the maturity and the acuity model the CCG will ensure that our community services, provided by Bridgewater Community Healthcare NHS Foundation Trust, will :- Restructure their services around practice populations and continue development of the acuity model Redesign and integrate the urgent care primary care model to include GP Out of Hours, Extended Access and the Acute Visiting Service Review and re-specify the Care Home Support Service The CCG commits to: Commission high quality clinical assessment, care and treatment services Reduce reliance on secondary care services (as the main component of healthcare provision) Work across organisational boundaries to deliver integrated models of care Utilise telehealth/ telecare and integrated IT solutions to maximise efficiency The Impact of these changes will : Increase consistency and quality of service provision Promote multi agency working and resulting potential efficiencies Reduce acute sector activity (and transfer into a community setting if demand requires) Enable proactive management of complex care home residents thus reducing demand on other services Contribute to improved wellbeing and quality of life Maintains people safely in their home environment wherever possible 22
Care Redesign People may live in a Care Home for short or long periods. For many people, it is their sole place of residence and so it becomes their home, although they do not legally own or rent it. There are two types of Care Homes (Care Home With Nursing and Care Home Without Nursing). The CCG will enhance the care home support offered by : Reviewing, redesigning and re-specifying the Enhanced Care Home Support Service including but not limited to Single Point of Access (SPA) Embedding support for care home residents across other care pathways e.g. end of life care and other community services Undertaking a comprehensive skills audit to match skill sets to identified service needs to ensure maximisation of available resources Exploring integration with other developing service models, for example GP OOHs, Extended Access and Out of Hospital services sector Delivering a multi disciplinary team approach including medicines management and social care The Impact of these changes will ensure: Proactive care for care home residents resulting in optimal management Reduction in avoidable poly-pharmacy Increased capacity within Primary Care to allow focussed management of complex patients Increase the quality of care in the Care Home Sector by identifying and addressing development and capability gaps 23
Investment Transformational support 2017/18 and 2018/19 from CCG allocations NHS England requires CCGs to plan to spend a total of 3 per head as a one off non-recurrent investment commencing in 2017/18 for practice transformational support, as set out in the GPFV. NHS Warrington CCG, with a population size of 218,376 the expected sum available is detailed below; for clarity the CCG intends to invest this sum across the two years of 2017/18 and 2018/19. Period Funding Allocation 2017/18 /19 655,128 The CCG will invest this funding against the following schemes but at time of submission does not have the full detail available: Active Signposting Social Prescribing Supporting Self Care 24
Investment Online general practice consultation software system NHS England has allocated 45 million funding for this programme (over three years) to be deployed from 2017/18. The allocation to NHS Warrington CCG will be Period Funding Allocation 2017/18 55,788 2018/19 74,868 To ensure that the CCG delivers to the outlined specification the CCG will ensure that this project is included in the work plan for the Primary Care Development Group. This group, will ensure that delivery is in line with the specification and required monitoring arrangements. 25
Investment Training care navigators and medical assistants for all practices NHS England has allocated 45 million funding for this programme (over five years) to commence from 2017/18. The allocation to NHS Warrington CCG for the next three years will be Period Funding Allocation 2017/18 18,707 2018/19 37,426 2019/20 37,434 To ensure that the CCG delivers to the required specification the CCG and to support collaboration with the our partner CCGs across our STP and LDS this project is included in the work plan for the Primary Care Development Group. This group, will ensure that delivery is in line with the specification and required monitoring arrangements. 26
Investment General Practice Resilience Programme The 40 million non-recurrent funding for the General Practice Resilience Programme as announced in the GPFV has already begun to be deployed. Five practices submitted applications and the outcomes of these are detailed below: Practice Stretton Medical Centre Outcome 20,000 awarded to support Capacity and demand management Mentorship and coaching Buddy with a high performing practice Folly Lane Medical Centre Westbrook Medical Centre Chapelford Health Centre Causeway Medical Centre No funding awarded however we have been informed that there will be a centrally funded diagnostic allocation for:- Capacity planning, Recruitment, and Work force planning. No further details yet released 27
Investment Funding for reception and clerical staff training, and online consultation systems Funding for this is allocated equally between all CCGs on a capitated basis. The CCG has agreed with the CCGs in the Alliance LDS that this funding will be pooled. The primary care development group is collaborating with member practices to advise on how practices in Warrington consider that this funding will be best spent. The group will ensure that spending is Developed in consultation with member practices Aligned to other development activities and strategies Is innovative Is ring-fenced The allocation for NHS Warrington CCG is Year Allocation 2016/17 19,000 2017/18 19,000 2018/19 TBC 28
Investment/ Improved Access Funding to improve access to general practice services As a successful pilot site for the Prime Minister s Challenge Fund NHS England has indicated that the CCG should plan to receive 6 per weighted patient in 2017/18 and in 2018/19. The CCG is investing this funding in services including extended access, enhanced care home support, and demand reduction schemes in Primary Care that collaboratively will: Provide 45.84 minutes of additional GP capacity per 1000 population (based on a population size of 212,000) that is delivered outside of core primary care contracted hours and that does not include capacity delivered via the extended hours DES. Have pre-bookable appointments delivered within a maximum of 48 hours of request and same day appointments. Have 18 hours of pre-bookable and same day appointments delivered from one central hub co-located with GP Out of Hours and community nursing teams, with pharmacy also on site. Have capacity to flex should demand arise Have same day appointments available via 111 Advertises their services to patients Release GP time During 2017/18 the CCG, working with the provider, primary care and secondary care urgent care services, will enhance the service to Implement the GP appointment utilisation tool Extend/enhance advertisements of the service Review access to the service for primary care amenable patients attending Accident and Emergency Departments 29
Practice Infrastructure CCGs are required to have clear local estates and digital roadmaps that deliver against the requirements set out in the recent guidance (local Estates Strategies, A framework for commissioners and GP IT operating model) Estates The CCG developed its Strategic Estates Plan in partnership with member GP practices at the end of 2015 and was subsequently approved and published by the CCG in March 2016. The core elements of the plan focus on utilisation of existing estate to deliver changes in clinical services and delivering improved or expanded primary care facilities where there are current or future capacity shortfalls. The CCG is working closely with planning colleagues at Warrington Borough Council to ensure health facilities develop to meet demand due to rapid population growth caused by new housing which will deliver and average of 830 homes a year through to 2030. An all party joint strategic estates group is in place to develop and monitor plans. Currently the CCG is supporting primary care with 5 estates schemes planned through the Estates Technology and Transformation Fund in addition to another 6 developments through alternative capital routes. These are on top of annual business as usual GP capital improvement grants. In 2016/17 there has also been significant progress with utilisation of current estate most notably the establishment of integrated GPOOH and extended access service in LIFT premises at Bath St. In addition the CCG is an active member of the Alliance LDS estates and facilities group which is responding to future service delivery requirements of the STP. 30
Practice Infrastructure CCGs are required to have clear local estates and digital roadmaps that deliver against the requirements set out in the recent guidance (local Estates Strategies, A framework for commissioners and GP IT operating model) GPIT The Warrington Digital Roadmap is lead by the Executive Director of Warrington and Halton NHS Trust who is also strategic IMT lead for Warrington CCG. The Warrington Digital Roadmap lead chairs The Alliance LDS Informatics Steering Group to ensure the plans within Warrington meet the aims of the local delivery system (The Alliance) whose plans report up into the STP submission. A single lead for The Alliance, within the CCG and main Acute lead ensures a single IMT vision for Warrington effectively enabling the key projects to support integration within the borough and wider into The Alliance. In many ways Warrington s starting position differs to the remaining STP, mainly due to its geography central to the Cheshire, Liverpool and Manchester conurbations and in particular in Primary Care due to the predominant use of TPP as the clinical system of choice. Warrington has made good progress in the development of GPIT in recent years including practices on a single COIN shared infrastructure, roll out of GP Wi-Fi which is due for completion early 2017, development of mobile clinical solutions via the Prime Ministers Challenge Fund and the evaluation of future tele-health technology through trials with commercial partners. Current GPIT capital bids look to build and develop this work while creating more mobile capacity to allow flexibility within primary care workforce. 31
Practice Infrastructure GPIT continued.. The Warrington LDR sits within the wider LDR shared by the Alliance. Active involvement in the LDS and STP steering groups to ensure the following digital themes are built into the Warrington plans, 1. Sharing an Information Sharing / Governance Framework 2. Digital Maturity of all Health and Social Care Providers (including Primary Care Digital Transformation) 3. Rationalisation of systems in and out of hospital with a long term (5-10 year) view to single systems when contractually possible. 4. Interoperability between systems through a connected borough based set of data stores. 5. Upscaling of Assistive Technology into Health Cities as part of council growth plans. 6. Advanced Analytics / Population Health through extending CSU data repositories. 7. Consolidated infrastructure (Wireless, Active Directory and collaboration tools) at LDR level and ultimately STP connectivity between LDRs where clinical services overlap such as cancer. 32
Workforce Planning - Background NHS Warrington CCG continually monitors workforce numbers across the CCG to ensure that planning in collaboration with NHS England is robust and fit for purpose. By way of background: GP numbers in Warrington have fallen in recent years to 124 headcount and 95 WTE* Nationally Warrington is in the worst quartile for GPs: patient ratio with a ratio of one full time GP:2188.29 the national average is 1:1 680** If benchmarked to the national average per 100 weighted patients then Warrington is under-doctored by 29 GP In line with timescales the CCG will refresh the local survey information in early 2017. * Warrington Practice Survey 2014 ** NHS National GP Workforce task force Nov 2014 33
Workforce Planning Strategic Implementation Plan The CCG Workforce Strategic Implementation Plan aims to ensure that the CCG focuses on the current and future workforce when planning service transformation and redesign. With a focus on out of hospital care, recruitment and retention issues with traditional roles and more people living with complex health and social care needs the CCG must to look at innovative ways of developing the workforce with appropriate skills and knowledge to ensure they meet the current and future demands of Warrington s health & social care economy. Within the plan is a specific objective to develop and implement a plan to address the sustainability of the General Practice workforce. The assessment of the current skill mix will be analysed against the required skill mix for alternative roles in primary care and plans will be formulated to bridge any gaps to ensure full collaboration with partners in accordance with the maturity model. This will enable the CCG to understand the education and training needs of our current workforce and be able to support General Practice to develop new workforce models that will help address the gaps in the number of GPs across Warrington. To support this objective and begin to work up more detailed plans the CCG is undertaking a project to look to develop a cluster based workforce model using the population centric workforce model. The project has engagement from LA, mental health & community providers as well as primary care. 34
Workforce Planning Strategic Implementation Plan The following outcomes are planned from the project : Numbers and types of practitioners will be identified to meet the demands of the GPFV with detailed plans Assess knowledge & skills required Position of the current workforce to identify any gaps with service provision. New roles will be identified as well as understanding the demand for of more traditional roles. The CCG aims to develop and maintain relationships with Health Education North West, Local Education Boards, Higher Education Institutes and Deanery in order to inform and influence future curricula and roles to support future models of care and ways of working. The CCG is working with local HEI and HENW to increase access to primary care of pre-registered students and support the development of assistant practitioners. 35
Action Plan Timeline for Workforce Planning 2017/18 Apr 17 May 17 Sept 17 Sept 17 Mar 18 Mar 18 Apr 18 Sept 18 Mar 19 Mar 19 Explore the utilisation of apprenticeship framework to increase the number of apprenticeships within primary care Establish baseline for workforce data across all practices Implement pilot for cluster based staffing model across one cluster Evaluate the student nurse in practice work Evaluate practice pharmacy services Evaluate pilot cluster based staffing model and agree next steps Roll our cluster based staffing model Profiling of skills within primary care administrative workforce to identify skills gaps and develop options/proposals for new roles or new ways of working Development of standardised competency framework for all staff groups commencing with HCAs Explore how clusters become training cluster for GP training and wider multi professional students 36
Workforce Planning Clinical Pharmacist Pilot The Clinical Pharmacist Pilot is currently being rolled out across Warrington and is led by Warrington Health Plus. The funding allocated to this project is 2.4m over the next 3 years (17/18 to 19/20) which includes an NHS England contribution of 0.6m. To date the pilot has : Successfully recruited 13.2 WTE with only 0.8 WTE remaining for recruitment Band 7 Posts: 9 individuals already in post, 3 individuals commencing in early January Band 8a Posts: 4 individuals already in post, 1 individual commencing early January 20 Practices are currently receiving support from band 7s. 8 Nursing Homes are being supported by band 8as. MDT processes currently being discussed for 3 care homes Memorandum of understanding defined by WHP and shared with GP Practices Whilst still in the early stages positive initial feedback has already from Practices. Two practices have reported how well the pharmacists have fit into the team, both pharmacists have initially been focusing on discharge reviews which appears to be working well, one Pharmacist is establishing a hypertension clinic from January. 37
Workforce Planning Mental Health The CCG was invited and subsequently successful in bidding for central funds to develop integrated IAPT services with Primary Care. Funds will cover backfill staff for the remaining 2016/17 and 2017/18 at which point funding of extra staff will revert to the CCG. Four therapists will integrate into primary care to work with practices for patients presenting with primary mental health related concerns. CCG commissioners will work to develop a system of robust reporting KPIs to ensure a positive outcomes for patients. Development work will include planning for delivery at cluster level which supports the integrated IAPT services objective as well as the GP Forward View of mental health practitioners within primary care this will be executed through the local enhanced services to ensure that the ability to access services to patients in Warrington is standardised and in line with the Multispecialty community provider (MCP) models of care. The CCG has also commissioned an MUS pilot (Medical Unexplained Symptoms) which involves a Consultant Clinical Lead Psychologist working in primary care to develop pathways for people with MUS and skilling up staff to be able to deal with people presenting with MUS. 38
Workforce Planning Assistant Practitioner Apprenticeships Apprenticeships provide routes into a variety of careers in the NHS and are an excellent opportunity to earn, gain work experience and achieve nationally recognised qualifications at the same time. Assistant practitioners are employees within healthcare that work alongside other health professionals such as nurses, doctors, healthcare assistants and therapists. Working with our practices we will assess appropriate work environments to ascertain which type of apprenticeships are appropriate. We will then ensure that assistant practitioner placements are designed to work in either a specific field such as nursing or to be an assistant to several departments in a hybrid role. The aim will be that the employees become specialists in their job role and end up studying further to work higher up in their field e.g. choosing to study a degree in midwifery or nursing. 39
Workforce Planning Whole System Approach Workforce Development Plans set out future ways of working and include the development of multi-disciplinary teams, support for practice nursing and establishing primary care at scale. The CCGs Collaborative Care Board intends to commence project scoping for a collaborative care model. Early conversations have agreed to pilot the care model in the South cluster. The model will utilise risk stratification to identify rising risk patients and will provide a vehicle for care co-ordination that includes integrated social care, community services, the acute trust, public health, mental health and third sector services. The Board has agreed for two managers to lead the project, which will include developing primary care pathways in the community with specialist consultants from the acute trust supporting the relevant pathways in a community setting. Key aspirations for this model include:- Health and social care professionals to integrate in a primary care setting Practices work within a wider team of practices in collaboration, benefitting both workforce and communities Has shared co-ordination resources Has rapid access diagnostics Has more ambulatory care Has more community based mental health services Has shared multi-disciplinary care homes services Provides more scope for self-management and primary prevention support Separates acute and complex care, manages complex care with MDT input around the cluster model 40
Time for Care Programme Following the publication of the NHS England plans to establish a new national development programme for General Practice Time for Care. Preparation is underway to submit the formal application form in 2017. The Senior Commissioning Manager for Primary Care will take the lead for this piece of work. Formal engagement with member practices took place during November 2016 to identify and agree the areas that practices wish to champion and support for care redesign programmes. The areas to be pursued are Active Signposting Social Prescribing Supporting Self Care The CCG plans to re-visit the areas of focus prior to the formal submission of expression of interest to ensure the focus remains inline with work priorities. 41
Communications & Engagement Strategy Consultation with all GP Practices pre-primary care strategy Formal 90 day public consultation on the primary care strategy Cluster Development sessions being held with all clusters maturing your cluster, the challenge of change December 2013 January 2014 August 2015 Nov 2015 April 2016 Jan March 2017 Consultation led to the development of primary care GP Clusters Consultation events on the local enhanced service 42