The Adventures of General Practice in Primary Care Land David Wingfield General Practitioner Chairman of Hammersmith and Fulham GP Federation Hon Senior Lecturer Imperial College
Or. A Hammersmith and Fulham response to a national challenge
Primary care as a speciality All of medicine in one professional discipline Updating knowledge Whole population Urgent care and long term condition management But also Personal holistic care
Organisational dilemmas GP Business realities independent contractor status Regulation Working in and running it Crises through lack of business skill HR and skillmix Gp accounts and business models NHS costs- Commissioner pressures to contain cost, increase access and maintain quality
Some good news:- Teaching and quality Audit and quality Research and quality Patient focus to all we do
Further education
Collaborative research WelReN funding for a research nurse agreed IT available to connect to all clinical records and to conduct patient level searches Potential for NIHR and other research across the 200,000 registered patients in Hammersmith and Fulham
Today's adventures Clinical Commissioning Group strategy and the Primary care home GP Federations as change management organisations The new business model and Super Practices Accountable care
Hammersmith and Fulham Clinical Commissioning Group strategy and the Primary care home
1 2 3 4 5 This document explains the what, why, and how of primary care will improve in Hammersmith and Fulham What happens now Our ambition is to harness the energy and ideas of people who deliver and receive care in Hammersmith and Fulham to create a system that works seamlessly for everyone in the borough. This document explains in very practical terms how the changes will benefit patients as well as GPs and other practitioners. Our headline objective is for accountable that is end-to-end - care for Hammersmith and Fulham in 2019. Within the limited resources we have, we are aiming for steady but material improvement over coming years. These will be based on sustainable changes in how local GPs and other primary care practitioners work with each other and other services provided across the borough. The end result will be a local care system that uses the collected expertise and compassion of all of our local care organisations to deliver the health and wellbeing outcomes we and our residents want. Dr Tim Spicer Chair, Hammersmith and Fulham CCG Dr David Wingfield Chair, Hammersmith and Fulham GP federation The new approach to providing care in Hammersmith and Fulham will particularly benefit people, including many older people, who rely on a wide range of services 1 Does the Primary Care Home make a difference? Understanding its impact (NAPC, 2017)
These are 1 based 2 on 3 Wsic 4 and 5reflect the specifics of the primary care home. What local nuances do we need to work in? Our approach is based upon what local people have told us they expect from their services People in Hammersmith and Fulham have been clear about their expectations from local health and care services. The statements below reflect these ambitions and what the CCG and GP federation intend all people in the borough to be able to say about the care they receive. My practice works with other organisations to support me to maintain my physical and mental wellbeing as well as to support me when I am ill I can access care easily and in the way most convenient for me, either in person or by using technology. If continuity of care is important to me, I have this too I am supported to understand my condition and to manage more of my own care but I know where to get support when I need it If I have a care plan, it is developed with me and then used right across all the relevant people who provide me with care My GP and his or her colleagues are linked in closely to all the other people and organisations who provide care for me and support me in other ways Through my practice s Patient Participation Group, I can continue to shape how care is provided in my community A range of people provide my care but they all work together, communicate effectively, and have clear roles that I understand. Together, they provide me with seamless care I am cared for as a whole person rather than a series of conditions More of my care needs can be delivered within primary care, without the need to visit hospital My practice is my first point of contact with the local health and care system and provides the network of support for the majority of my care needs I have a clear say in how my care is delivered and can access different services by using my personal budget I can access the right skills from GPs across my local area meaning I get the specialist primary care that I need
1 2 3 4 5 The local approach to primary care will be based around the needs of the different population groups in Hammersmith and Fulham (1) The CCG and GP federation will respond to local health needs with a population-based approach. This means that they will look at the combined needs of whole groups of people, based on age (such as older people or working-age adults) or health and wellbeing status (such as mostly healthy people or people with complex conditions). This approach helps providers to ensure that services that people need are wrapped around them in a co-ordinated way. As the chart opposite shows, the North West London CCGs are already thinking of their Local Services transformation in terms of how they meet the needs of different groups of people, for example: Self-care support, based on different age groups needs Improving intermediate care and expanding common discharge arrangements Source: NWL Local Services team. The cost, spend, and activity information at the bottom of the chart is based on data from a group of Hammersmith and Fulham practices in 2013/14. People have different wants and needs depending on age and health status. The chart on the page next shows how some of these needs will be met.
Primary Care Medical Home Working at scale we can provide all the long term or acute services for our patients napc.co.uk/primary-care-home A cluster of GP practices working to common systems and goals rapid learning and up-scaling of activity GP and community trust contracts not altered 30-50k Registered population- to allow consistent personalised experience of care Integrated diverse workforce Aligned financial drivers. Unified capitated NHS budget- Risk management Extended range of services- particular risk groups DRAFT 26 Jan 2017 David Wingfield
May 2017 Illustrative configuration for October 2017 1 2 3 4 5 The CCG and GP federation are now planning for the optimum configuration of primary care homes in Hammersmith and Fulham The CCG and GP federation will now begin to work with practices to develop the current network system into the best configuration of primary care homes. This will be completed by October 2017 and will be based on a series of considerations, including existing collaborative relationships, common challenges, and an appropriate mix of practices readiness to lead the development process. The maps below show, on the left, the current three primary care homes and practices not part of a primary care home and, on the right, an illustrative future configuration. The practices names for each number are in the appendix.
Urgent care Integrating primary care into a single organisation Aligning GP and Community Services R&D CCG NHS Services funding HEE GP Practices Intermediate care Community nursing and therapies Mental health All CLCH, GP, Community mental health and urgent care services. C 40-50m OOHS CEPN
Primary care development roadmap = Federation Plus- integrated primary and community care + GP Federation facilitating coherent GP integration across a borough + GP Partnership merger or functional alignment, providing organisational capability to deliver + Primary Care Home 30-50k joint projects partial NHS budget holders/shadow Traditional General Practice, dispersed, but loosely arranged in networks 16
Hammersmith and Fulham GP Federation as a change management organisation
Hammersmith & Fulham GP Federation Work Streams Summary Apr17-Mar18 4 strategic priorities.. Out of Hospitals Clinical Service Delivery Accountable Care Development Primary Care Transformation Workforce Development Ceommunity education Provider Network (CEPN) Funded By Trading Income 10% of c. 2.5m contract Whole Systems 50k T&T 250k PMCF 500k HENWL Grants c. 500k
Reporting and Contract Monitoring Hammersmith & Fulham GP Federation Work Streams Summary Apr17-Mar18 Federation Board OOHS Practice Delivery Capacity & Configuration Governance & Safety Quality Improvement Expand Portfolio Population Coverage Clinical staffing (hosted and bank) CIS, UCC, Practices Research NIHR Hub [new] Funding Source Trading Income
Hammersmith & Fulham GP Federation Work Streams Summary Apr17-Mar18 Federation Board Transformation Programme Manager Dave Sellers (part time) PMCF Shared Services Phase 1 Rollout Workflow Rollout Patient Care Plan tool Extend MESH to C&W More MJOG campaigns Merger Support Services Clinical Governance Funding Stream On-line engagement T&T PMCF
Hammersmith & Fulham GP Federation Work Streams Summary Apr17-Mar18 Federation Board Caroline Durack Programme Manager Accountable Care System Development Alliance Contract Implement Models of Care Paediatrics Ambulatory care Frail Elderly MCP development with CLCH and WLMHT Primary Care Home roll out Develop Informatics Function Funding Stream WSIC
Hammersmith & Fulham GP Federation Work Streams Summary Apr17-Mar18 Federation Board H&F Community Education Provider Network H&F CEPN Steering Group HENWL annual allocations Workforce development Apprenticeships Care Certificate GPN Programme Physician Associates Fellows GP upskilling Training for all staff groups Run all clinical training including OOHS Workforce modelling & redesign Nursing Practice manager and reception training Pharmacy, AHPs, & Other Care management and navigation Education Hubs 8 Hubs (+3 in 17/18) Funding Stream HENWL
The new business model and Super Practices
H&F Partnership Primary care for the 21 st Century
HFP is a new GP super-practice Created 3 April 2017 by a three way merger
Overview Mission & Values The underpinning professional values that the organisation works to Patient Driven A clinical model with patients at the centre Lifelong Learning A commitment to continuing professional and organisational enrichment and support Generalism Specialisation The principle of holistic care and continuity of care, and the maintenance of those principles over time Allowing primary care to engage with complex community care and every clinician being able to follow their interests
17 Partners 3 sites in H&F 42,000 patients 88 staff
Clinical Model Complex Children and Families Complex Medicine Complex Mental Health, PD, Substance Dependency EOLC, Care Homes, Frail Elderly UNIVERSAL PRIMARY CARE Specialisati on Clinical decision support Teaching & Research
Partner responsibilities and Executive Board Michele Davison Exec Board All Partners Overall business leadership Culture, values & ethos Pamini Ledchumykant han Exec Board Corporate Lead: Clinical Governance & Quality Sarah Douglas Exec Board Corporate Lead: HR and people Site Lead: North End Jo Huddy Exec Board Corporate Lead: Finance Site Lead: Bush Anna Wilson David Wingfiel d Exec Board Corporate Lead: NHS Strategy Site Lead: Brook Green Exec Board Corporate Lead: Business Development
Integrated senior management team Finance Lead Operatio ns Lead Marta Cabrera Finance & accounting Supply chain Property Insurances Legal Bank Company secretarial Stephen Weller Service availability and delivery HR operations Training IT & Telephony BCP Recruitment Patient Experience Processes & procedures Occupational Health Quality Lead Contract s Lead Sena Clinical quality Safety and Shah audit Clinical governance CQC Information governance Safeguarding HR infrastructure Organisational development Marketing & PR Health & Safety Daniella Contract management Rubio Revenue maximisation External relations Data analysis Project management Bids
Comprehensive clinical governance infrastructure Pamini Ledchumykantha n Quality Lead Clinical quality & governance Clinical performance and safety Appraisal & revalidation oversight Clinical education framework Complaints, incidents and audit Best practice Quality improvement Sena Clinical quality Safety and Shah audit Clinical governance CQC Information governance Safeguarding HR infrastructure Organisational development Marketing & PR Health & Safety Clinical Leads Nursing, HCA & Therapy Lead Pharmac y Lead Diabetes Mental Health TBC Clinical quality and governance Workforce planning & development Service development Mentoring Policies and procedures Clinical quality and governance Workforce planning & development Service development Mentoring Policies and procedures
Accountable care
Hammersmith & Fulham: working in partnership and contributing to NWL s Sustainability and Transformation Plans 33
Accountable care let s simplify Patient experience Commissioner and provider interface 34
Accountable care H&F is an ideal size 35
Our ambition The Hammersmith and Fulham Integrated Care Programme is a formal partnership launched in January 2016 We will provide: high quality care to defined outcomes, for the whole population. Good patient experience of health care cost effective care within a budget, This is the triple aim (Institute for health improvement) This is what an ACP means to us and today is about further engagement with commissioners 36
What we have done so far Patients at all levels of our Governance Hammersmith and Fulham Health and Care Partnership Board Steering Group CEOs/Directors/GPs Lay board member: Janis Cammell OBE Directors/Senior managers/gps Patients and lay reps: Maria Connolly Trish Longdon Olivia Freeman Ian Lawry (SOBUS) Lydia Hodges (Carers Network) Outcome measures Governance development Finance/Contracting Programmes & Projects Led by lay members 37
Our next steps Timeframe Jan 2017 April 2017 Oct 2017 Jan 2018 April 2018 April 2019 Primary and Community Care alignment Agreement to form aligned Primary Care services Alignment complete Primary Care Home integrated provision Primary Care home established Data gathering Service co-design Run new service elements with continuous evaluation Roll-out to other PCHs ACP whole budget accountability Agreement with CCG to develop ACP ACP shadow year ACP goes live- 5y+ contract basis 38
Questions Davidwingfield@icloud.com 07711141638
Culture and strategy, patients first, care for our workforce, Education and training robust business model with diversification beyond core nhs commissioned budgets