The future of GP services

Hull Clinical Commissioning Group My City My Health My Care The future of GP services Hello and welcome to NHS Hull Clinical Commissioning Group s first My City, My Health, My Care newsletter. This newsletter has been produced to share information about developments taking place within primary (GP) care services in Hull. We hope that you find it useful. Why do GP services need to change? The demand on general practice in the UK has intensified in recent years compounded by a number of factors that include an ageing population, increasing numbers of people with complex conditions, initiatives to move care from hospitals to the community and rising public expectations. General practice has experienced: a rising demand for appointments - 20% rise in the last ten years; an increase in number of complex patients requiring (hospital) tests and care coordination which needs more administrative support; an increase in care being provided out of hospital meaning responsibilities have passed from specialists to GPs; numbers of GPs in training falling with many training places unfilled; recruitment and retention challenges for clinical staff, including GPs, practice nurses and practice managers; more than 60% of GPs over 50 reporting that they are likely to leave direct patient care in the next five years. In addition to this, NHS funding for primary care has seen a real-terms decrease since 2009/10 and currently only accounts for 8.5% of the health budget. General Practice in Hull can The city of Hull covers an area of The quality and suitability of GP approximately 34 square miles. Hull premises also varies across the city with currently has 50 general practices with some patients being seen and treated in patient list sizes ranging from 1,388 to modern healthcare centres and others in 18,073 (see map on page 4/5). premises less suited to deliver the range GP Practices in Hull tend to be smaller of medical services a community needs. (have fewer patients) than the average A number of practices in Hull have in England, however, the number of already seen the opportunity of merging patients per GP is much higher in Hull with other practices, increasing patient than in the rest of Yorkshire and the base and practice income to invest in Humber and England (see graph page 2). additional services for patients. These This presents a number of challenges could include minor surgery or sexual for practices locally in recruitment and health services. retention of clinical staff, not just GPs The benefit of sharing staff can also be a and in their ability to be flexible to meet significant factor. Larger practices the demand for appointments. Inside also be better prepared to respond positively to current and future NHS policy as set out in the NHS Five Year Forward View, which includes expanding and strengthening primary and out of hospital care. Our Blueprint for GP practice by Supporting local practices Your wider Estates and Get Primary Care in Hull 3 location and size 4-5 to release time for GP care 6 practice team 7 premises 8 involved 8

What do we mean? Primary care Primary care is a term used to describe the first contact point of care for patients, typically GP services, community pharmacy, community optometry or dentistry. Out of hospital care A term used to refer to health care given in the community, at the patient's home or in a community assessment centre. STP Every local health and care system must develop a five year Sustainability and Transformation Plan (STP). Local Clinical Commissioning Groups, health providers and councils are part of the Humber, Coast and Vale STP which is submitting plans to improve health and wellbeing, transform quality of care delivery and ensure sustainable finances over the next five years. Find out more at www.hullccg.nhs.uk Primary Care Blueprint The Blueprint is a strategic document that aims to ensure patients in Hull have access to high quality and sustainable primary (GP) care. The Blueprint has been developed with, and signed off by, the GPs in Hull. It encourages practices to work collaboratively with neighbouring practices. How many patients do you think a GP looks after? General Practice in Hull 2700 2500 2300 2100 1900 1700 1500 NHS Bradford and Districts CCG NHS Airedale, Wharfdale and NHS Wakefield CCG 40% Average number of patients per GP NHS Wakefield CCG NHS Leeds South and East CCG NHS Greater Huddersfield CCG NHS Hambleton, Richmondshire and Whitby CCG Average number of patients per GP NHS Leeds North CCG NHS Leeds West CCG NHS Sheffield CCG NHS Doncaster CCG NHS Bradford City CCG NHS Vale of York CCG NHS North Kirklees CCG NHS East Riding of Yorkshire CCG NHS Calderdalee CCG NHS Harrogate and Rural District CCG NHS Rotherham CCG NHS Bassetlaw CCG NHS Scarborough and Ryedale CCG NHS North Lincolnshire CCG NHS North East Lincolnshire CCG England Average General Practice in Hull NHS Hull CCG NHS Barnsley CCG On average, a GP in Hull has 2500 patients compared to a national average of 1690. This is the second highest of the 23 CCG s in Yorkshire and Humber region. Only 9% of Hull practices have a list size of 10,000 or more patients compared to Yorkshire and Humber average of 31%. 60% of practices in Hull have a list size of less than 6000 patients whereas in the Yorkshire and Humber area this is nearer 37%. % of practices 35% 30% 25% 20% 15% 10% 5% 0% Less than 2,000 2,000-4,000 4,000-5,000 5,000-6,000 6,000-10,000 10,000 + Hull Local CCG s 2 Practice list size

My City My Health My Care Our Blueprint for Primary Care NHS Hull CCG is committed to transforming primary care in a way that is sustainable; has a workforce with a mix of skills to deliver modern day primary care; embraces the latest technology; and is a rewarding place to work for health professionals. The CCG s primary care Blueprint, which GPs as commissioners supported, sets out a compelling case for practices to come together to tackle the challenges faced by primary care and to deliver services at a larger scale across our city. Delivery of the Blueprint requires sustainable, high quality primary care being at the centre of out-of-hospital services. In the development of our Primary Care Blueprint we considered the following questions: Do we make use of new technology to make access to health care easier and more convenient? Does the current model fit with modern lifestyles? Is the model flexible enough? Does the current model meet the needs of the people of Hull? How do we successfully align with national policy moving towards practices being open longer hours and at weekends? Introducing a new model of primary care will provide a solid foundation from which a range of out of hospital services will be provided to support the delivery of the Sustainability and Transformation Plan (STP). In doing so we will ensure Hull patients have access to sustainable and high quality general practice services. We know we cannot do this alone. We are working closely with primary care workforce and will be involving patients and the public to shape how this is delivered. Read the full Primary Care Blueprint (October 2015) at www.hullccg.nhs.uk What will this mean for me as a patient? A practice with a larger patient base has the potential to provide a much wider range of medical services for its local population and employ a wider range of healthcare professionals (see page 7). Practices who work together have the potential to offer more flexibility for patients, for instance the ability to offer appointments at an alternative surgery if there is no capacity. You will also be able to register for online services which will enable you to book appointments and order prescriptions. Dr Ros Davies, New Hall Surgery, Hull and Clinical Lead for North 2 Group: North 2 is a group of five GP practices, providing care to 52,300 people in Hull. We are choosing to work together to improve the care we provide for our patients. By working as a group we hope to bring together our strengths and skills so that all our patients benefit. We are exploring new ways of working together to enable more flexibility and access, and to provide a wider range of services. General Practice is facing some of the biggest challenges and changes in its history. By facing these opportunities together we will be able to give the very best care we can to our local community in the years ahead. 3

17 16 Nu m Pr ber ac Na tic m e e GP Practice by location and size 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 14 17 49 15 1 2 6 7 3 5 4 20 16 19 23 22 11 8 9 23 17 18 19 20 21 22 23 24 18 28 13 25 12 31 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 26 45 29 17 10 47 30 34 35 46 44 27 37 21 22 43 38 45 41 28 40 46 42 32 36 39 22 41 42 33 4949 50 48 50 41 43 44 45 46 47 48 49 50 0-4,999 patients 5,000-9,999 patients JAMES ALEXANDER PRACTICE 7163 DR A KUMAR-CHOUDHARY'S PRACTICE 3417 GOODHEART SURGERY 4558 DR KV GOPAL'S PRACTICE 1963 ORCHARD 2000 - BRANSHOLME 2455 DR GT HENDOW'S PRACTICE 2513 NORTHPOINT 3121 FAITH HOUSE SURGERY 7560 NEW HALL SURGERY 9561 THE AVENUES MEDICAL CENTRE 6196 DR COOK BF 3684 THE NEWLAND GROUP 15097 NEWLAND HEALTH CENTRE 5979 DR R RAUT 3500 SUTTON PARK MEDICAL PRACTICE (DR RAUT) 1388 DR RK AWAN AND PARTNERS (ORCHARD 2000) 6045 HAXBY GROUP 12093 DIADEM MEDICAL PRACTICE 12036 DR GS MALCZEWSKI'S PRACTICE 2089 SUTTON MANOR SURGERY 7358 NEW GREEN SURGERY 4049 EAST HULL FAMILY PRACTICE 18073 LONGHILL HEALTH CARE CENTRE (DR SHAIKH) 5233 DR G DAVE'S PRACTICE 3179 DR GM CHOWDHURY'S PRACTICE 2376 HOLDERNESS HEALTH OPEN DOOR 1608 CHP LTD - MARFLEET 3495 MARFLEET GROUP PRACTICE 14563 HAXBY - BURNBRAE PRACTICE 4849 CHP LTD - SOUTHCOATES 3027 EAST PARK PRACTICE 3630 THE QUAYS MEDICAL CENTRE (CHCP) 2958 RIVERSIDE MEDICAL CENTRE (CHCP) 2616 KINGSTON MEDICAL GROUP (CHCP) 7220 DR MUSIL J AND DR QUEENAN PJ 5914 STORY ST PRACTICE & WALK IN CENTRE 1491 CLIFTON HOUSE MEDICAL CENTRE 9282 WOLSELEY MEDICAL CENTRE 7008 WILBERFORCE SURGERY 3089 ST ANDREW'S (DR MACPHIE, RAGHUNATH & PARTNERS) 2578 THE OAKS MEDICAL CENTRE 7312 ST ANDREW'S (DR AS RAGHUNATH AND PARTNERS - KOUL) 1648 HASTINGS MEDICAL CENTRE 1749 THE CALVERT PRACTICE (CHCP) 2563 KINGSTON HEALTH (HULL) 8967 NEWINGTON (CHCP) 7983 THE SPRINGHEAD MEDICAL CENTRE 16467 ST ANDREWS GROUP PRACTICE 6167 BRIDGE GROUP 9021 SYDENHAM HOUSE GROUP PRACTICE 7814 10.000+ patients 4 Pr ac Li tic st e* Si ze MyCity My Health My Care *As at 30/06/2016 5 CHCP - City Health Care Partnership

What s happening to support local practices and release time for GP care? The General Practice Forward View (GPFV), published by NHS England in April 2016, sets out a plan, to stabilise and transform general practice. The GPFV sets out some high impact changes that could free up GP time to care. These changes are likely to be the focus for any future investment in primary care as they are seen as important to delivering a sustainable service into the future. In response to the GPFV here are some of the developments that we are exploring for Hull: 1. Active signposting/ Care navigators The role of practice receptionists as Care Navigators is already being explored in West Wakefield. The role has the potential to break down the automatic assumption that a GP appointment is the best place to go for any problem by signposting to more appropriate solutions for people s needs. The online consultation platforms askmygp and webgp offer 24/7 access and could act as platforms for managing demand and capacity across groups of practices. We expect that funding will be made available nationally to support the training and development of practice staff to undertake these new roles. 2. New consultation methods Two Estates and Technology Transformation Fund (ETTF) bids are progressing in response to local interest in piloting the use of digital technology. These proposals include the use of online consultation to enable people to electronically access guidance and advice from their GP. This will speed up access to safe, efficient care, whilst at the same time reducing practice workload. If the bids are successful the new online platform will be available for approximately 50% of patients across the city. One of the proposals also includes a system that allows patients to book, cancel, check or change appointments at any time, night or day using their telephone. It is anticipated that the system will help practices extend reception opening hours; ease the pain of early morning congestion; and manage, improve and ease telephone access. The CCG is keen to see if these systems can deliver on real benefits for patients and practices, so we will be looking to pilot these innovations irrespective of the ETTF bids. 3. Developing the team A Hull Primary Care Workforce Strategy was developed in March 2015 and is currently being refreshed as part of the STP out of hospital care workstream. The CCG has supported practices to employ clinical pharmacists by mirroring the recent NHS England scheme. We were delighted that two practices in Hull were successful and a further twenty practices have submitted expressions of interest in being involved in the CCG scheme. We are exploring the potential of Physician Associates (PA) who support doctors in the diagnosis and management of patients. They are trained to perform a number of roles including: taking medical histories, performing examinations, diagnosing illnesses, analysing test results, and developing management plans. They work under the direct supervision of a doctor. 4. Social prescribing CCG resources have been identified to commission an integrated, citywide social prescribing and general advice service. A service specification has been developed which builds upon the experience of pilot social prescribing services that are operating in a small number of practices and the current advice service provided in general practice by the Citizens Advice Bureau. We would expect the new service to begin in 2017. Together with Hull City Council adult social care services we are exploring the potential links between the service and the plans being developed for a prevention, early intervention and community resilience service. 5. Support for self-care Support for self-care is a key element within the community services contract with City Health Care Partnership including urgent care, condition management, intermediate care, and rehabilitation services. It is vital that people are supported to take more responsibility for their own health.

Effective treatment by the wider GP practice team A GP works with a team of health professionals and other staff within the GP practice. This can include highly experienced practice nurses, nurse practitioners, physician associates and practice pharmacists. Recognising that there is high demand for GP appointments, some practices are able to direct patients towards other healthcare professionals within the practice team to free up valuable GP time. For instance: Irene is 88. She is visiting her GP because she is feeling dizzy and has recently started on hypertension medication in addition to her medication for diabetes. In a larger practice, as an alternative to seeing her GP, Irene could see the practice pharmacist who would take her blood pressure, check her other medication through a medicines use review (MUR) and alter her medication as appropriate. She also sees the nurse practitioner who is able to discuss her diet and give her a flu jab. Natalie has brought her one year old daughter to the doctor because she has a slightly raised temperature and a rash around her mouth with lots of saliva. Natalie thinks her daughter may be teething. As an alternative to seeing her GP, Natalie sees the Practice Pharmacist who assesses the child, confirms that she is teething and prescribes paracetamol suspension. She then refers Natalie to the health visitor for further advice on teething and feeding. Rob is 41 and has shingles. He visits his GP with a rash on his lower back and is generally feeling unwell. Rob is offered an appointment with one of the other health care professionals in the practice, which could be nurse practitioner or physician s associate (see page 6), who examines him, assesses whether there is any need for anti-viral medication and advises him on pain relief. Steve comes in to see his GP because he is experiencing low mood and is feeling tired all the time following recent loss of his mother. All practices in Hull have access to a social prescribing scheme where people can be supported effectively by non-medical services in the community. The care navigator at Steve s local practice (see page 6) books him an appointment with a local organisation offering social prescribing and a support plan for him is agreed. Integration of primary care and community services 7 My City My Health My Care Improving the care of people in care homes is a priority and the development of an integrated care home service involving primary care, community nursing, specialist geriatrician and medicines management is being explored. In addition, some focused work is underway with some practices in Hull to promote integration of community services with primary care services. This could be extended to include other services such as mental health and social care across the city.

GP estates and premises The CCG has engaged local organisation Citycare to review all of the existing primary care properties to determine each property s compliance with current healthcare standards and identify future capacity requirements against the current growth in demand. The work has been undertaken across each of the current eight localities. Practices will have the opportunity to discuss draft reports and the findings with Citycare and the CCG. The Estates reviews will provide the evidence for the development of bids against the NHS England Estates and Technology Transformation Fund (ETTF). Recent Healthwatch Kingston upon Hull observation visits acknowledge the variation in buildings which house GP practices in the City, from purpose built health centres housing multiple practices, to converted houses which are used as surgeries by single practices. You can read the reports relating to the Enter and View observation visits to all GP practices at www.healthwatchkingstonuponhull.co.uk We recognise the importance of engaging with people to understand their needs in relation to primary care and to set out the case for change in primary care. We started this process in May 2016 with a citywide meeting involving Patient Participation Groups. A special Peoples Panel Survey has asked 3600 people across the city about their experiences with general practice, factors they take into consideration when choosing a new practice or choosing to stay with their current GP practice and how they prefer to book appointments. There will be wider engagement over the coming months to capture as many different patient and public views as we can. To support this engagement, the My City, My Health, My Care toolkit will be available to help practices and other community groups facilitate discussion with patients. The toolkit will contain printed materials, slide presentation, guidance and resources to support group discussion. For virtual groups there will be a link to a digital questionnaire/survey. Community groups and practices will be guided as to how all the information will be gathered and returned to the CCG. The toolkit will be available for practices on the CCG portal and will be widely available for community groups and partners. You can find out more information and get a copy of the toolkit from December via HullCCG.ContactUs@nhs.net or 01482 344700. Contact Us We are really keen to ensure that stakeholders are kept up to date on primary care developments and have the opportunity to ask questions or make suggestions on how we can deliver the transformation of primary care and ensure patients in Hull have access to high quality and sustainable primary medical care services now and in the future. Please contact us using the following emails Geoff.Day@nhs.net Philip.Davis@nhs.net Nikki.Dunlop@nhs.net My City My Health My Care November 2016 Hull Clinical Commissioning Group NHS Hull Clinical Commissioning Group 2nd Floor, Wilberforce Court Alfred Gelder Street Hull HU1 1UY T: 01482 344700 E: HULLCCG.contactus@nhs.net Web: www.hullccg.nhs.uk Twitter: @NHSHullCCG