Route Map to the 2020 Vision: A Strategic Assessment of a Health Board s Capability and Capacity to Deliver the 2020 Vision for Primary Care

Context Route Map to the 2020 Vision: A Strategic Assessment of a Health Board s Capability and Capacity to Deliver the 2020 Vision for Primary Care The Route Map to the 2020 Vision for Health and Social Care describes 12 priority areas for action for pursuing the Scottish Government s 2020 Vision for high quality sustainable health and social care services in Scotland. These 12 priorities are described in three domains, often referred to as the Triple Aim : 1. Quality of Care 2. Health of the Population 3. Value and financial sustainability For each of these domains there will be a small number of priority areas for action, often building on existing work and all requiring focussed attention and acceleration if they are to deliver in time for the 2020 Vision to be realised. Primary care is at the heart of the 2020 vision, keeping people healthy in the community for as long as possible. It is a prerequisite for tackling health inequalities, for successful adult health and social care integration and for addressing some of the challenges of unscheduled care. It should promote an integrated and asset-based approach to providing care to patients across the health and social care system, working collaboratively with community facing specialists, local authorities and third sector organisations in communities to unlock solutions hitherto not available to us. In doing this we need to consider the patient journey across the whole health and social care system and across what we currently call in hours and out of hours. Future care in a community setting is crucial to supporting people living with one or more long term conditions, to prevention, to achieving more person-centred care and to delivering on our effective and safe ambitions. The Health and Social Care Management Board and Health Board Chief Executives have recently agreed the 4 key elements necessary for the transformation of primary care, in order to achieve the 2020 vision. Route Map to the 2020 Vision final version Page 1

Those 4 pre-requisites are: A need to develop new models of integrated care that better meet the needs of a changing population and that engages with and meets the needs of the local people; A need to develop a more Scottish GP contract as part of our continuing efforts to deliver excellence in primary care; an immediate period of stability and consolidation in the GMS contract would be an important enabling factor, allowing significant GP involvement in the development of that more Scottish contract, with a clear focus on health and social care integration. A need to continue efforts to improve the quality and usefulness of Primary Care data, as a tool for improvement; and A need for territorial Health Boards to make a medium term assessment of the strengths and weaknesses in delivering the 2020 vision for Primary Care in their area, thereafter developing an implementation plan based on the outcome of that assessment, which would include consideration of the workforce for Spring 2014; this point/step was agreed with Chief Executives at their meeting in April 2013. Purpose and key role of the strengths and weaknesses assessments These assessments will be a central component of health board s Local Delivery Plans and will be a key step in planning this expanded role for Primary Care, both for local and national purposes. Within health boards they will inform the measurable resource shift necessary to innovate and strengthen Primary Care; developing new models of integrated care that will be tested in a supported environment and be quality assured. The assessments should be reflective of the breadth of issues that may arise from the more local approach to strategic planning expected under health and social care integration arrangements. They will also assist the development of approaches to enable the Scottish Government to provide support to health boards in expanding the role of Primary Care, recognising that across Scotland health boards have different priorities, reflecting their geographic and demographic situation, current infrastructure and health needs. The framework provided for assessment facilitates a self-assessment of strengths and weaknesses in local capability and capacity to deliver the 2020 vision for Primary Care. It should form the basis of discussion in setting local priorities and the subsequent relevant shift of resource necessary to equip Primary Care to extend its role in the whole system delivery of the 2020 vision. The assessments will also allow the identification of common themes and will determine any national actions and solutions that require the Scottish Government to support local delivery of the intended outcomes of the 2020 Vision. We actively want feedback. We expect that assessments will developed in conjunction with the relevant primary care professions. Route Map to the 2020 Vision final version Page 2

Guidance The areas set out below are to guide consideration of the content of a collated response for each theme and we do not expect responses to cover all of these areas. In all areas you should be clear about the resource shift required. Service Planning: Consider integrated service provision and the current contribution of different professionals including GPs, nursing, AHPs, community pharmacists, dentists, optometrists, community based services, peripatetic specialists to these models of care Analyse evidence of a move from competitive to collaborative teams at interfaces of care within your health board Demonstrate how you have attempted to shift the balance of care and workforce within Primary Care Determine what can be done to better balance the measurement and reporting of outcomes and cut bureaucracy in both managed and independent contractor services Assess access to services, including general practice (consider appointments and registration). Determine what you consider appropriate access to be and what capacity and capability there is to improve access. Determine alignment of National and Local Enhanced Services with local priorities and delivery plans. Determine the extent to which new models can be delivered now, and what barriers or levers might need to be addressed to increase effectiveness (e.g. collaborative place based care (such as federated practices), multi professional working, community engagement and utilisation of community assets, patient flow) Consider to what extent current service planning is based on assessment of population need, understanding of sociodemographic factors and on priorities from the local population s perspective Route Map to the 2020 Vision final version Page 3

Interfaces and Integrated Working: Analyse interfaces o within the primary care team o with the extended community team o between primary and secondary care - front door and back door o with the third sector o with mental health services o with social care o between in-hours and out of hours services Review inclusiveness and effectiveness of local planning to develop successful and efficient integration of services e.g. care networks, use of electronic tools to improve interfaces. Consider to what extent the changing health needs of the population and new ways of working will lead to a greater proportion of shared care (generalist and specialist working together) in a community setting; how will this influence the approach to forming integrated teams and resetting interfaces of care? (e.g. Reshaping Care, Future Hospital report) Infrastructure: Independent Contract administration Digital technology Information management systems Management capacity and capability Organisational and staff development Premises Supplies and procurement Support services Telehealth and Telecare Transport Route Map to the 2020 Vision final version Page 4

Workforce: Consider what is required to move from a competitive to a collaborative workforce Review training to determine if it is fit to support modern practice Determine workforce profiles and the extent to which these are sustainable Consider work- life balance, working patterns, portfolio careers, new roles, skill mix Review the extent of support for continuous professional development, appraisal, revalidation Consider the effect of existing and new professional regulation Consider issues relating to pay and conditions Leadership: Determine the extent of collaboration in support of leadership development e.g. Royal Colleges, National Leadership Unit, NES Consider changing career structures, accountabilities, levels of authority as a consequence of health and social care integration Consider primary care within local, whole-system and national leadership frameworks Consider leadership for improvement and performance Determine existing and future leadership investment Route Map to the 2020 Vision final version Page 5

Data and Improvement: Consider how you use contracts, now and in 2020, to support data extraction. Consider how national level data extracts can support/enhance local level extract Determine what s needed to deliver effective data linkage e.g. primary care and social care, governance of information including the role of NSS Consider standardisation, adoption and spread of reliable systems e.g. DATIX. How will systems need to change to be fit for purpose in 2020? Determine how you use data now and towards 2020 to drive decision making, improvement and performance. For example use of benchmarking, data visualisation, whole-system data sets Consider the existing capability and capacity to deliver continuous quality improvement in primary care Consider the existing capability and capacity for measurement for improvement Review the extent of cultural change needed as we move towards 2020 Determine what will be needed to achieve a tiered level of capability and capacity within primary care as part of the whole system approach to quality improvement. Route Map to the 2020 Vision final version Page 6

TEMPLATE Note: The following template may be helpful in constructing your response. We expect your response to cover all relevant strategic themes and the resource shift identified. NHS Board: NHS Lanarkshire Strategic Theme: Service planning Consideration: Current Service Strengths NHS Lanarkshire is committed to a process whereby it will support a more integrated approach to service delivery within a community setting. Though there is evidence of good progress in this respect, there is recognition that in order to be ready to deliver the 2020 Vision of health and social care, a transformational approach is now necessary to ensure that primary care modernises in such a way as to be ready to meet the challenges of a changing patient demographic and needs. Of the work already taken forward, there are particular strengths in: The introduction of an Integrated Community Support Team as a test in East Kilbride locality, leading to closer working between community nursing, AHPs, social care Current Barriers to Achieving the Future Vision The future vision of primary care needs to be fully shaped and clearly articulated to all stakeholders before commencing; this requires careful planning and dedicated time for those tasked with doing so. In both the 2009 and 2012 Primary Care Workforce Surveys, NHS Lanarkshire has the lowest ratio of GP sessions per 10000 population. This level of 51 sessions per 10000 population compares to a national average of 63 sessions per 10000 population. Improving this ratio through expansion of the GP workforce will take significant investment in practices, relies on availability of the workforce but is an important element of increasing the overall capacity of primary care, especially in the management of complex frailty and multi-morbidity. Proposed Local Interventions NHS Lanarkshire has commenced a refreshment of its primary care strategy to ensure that it will be capable of fulfilling its contribution to the route map to the 2020 vision of health and social care.; this will incorporate pre-requisites necessary to deliver policy intention, learning from successful tests of change already underway and from important publications such as The King s Fund s Securing the Future of General Practice. Through implementation of the GMS contract 2014/15, work around improving access to primary care will accelerate with the introduction of new QOF indicators designed to facilitate this. Begin discussions with general practice and other key stakeholders to investigate and introduce new models Necessary resource shift identified As part of the Change Fund linked to the Reshaping Care for Older People Lanarkshire received between 7m and 8m in each of the four years of the fund. A key aim of this programme of work has been to develop capacity and capability within primary and community care settings across all care sectors to safely treat and care for older people thus reducing reliance on in-patient care. As the demand for beds has reduced the objective in the final year of the plan (2014/15) is to redirect resources in to the established primary and community care services to sustain these models of care. The actual level of resource shift will be agreed within 2014/15. Further work around the whole system service strategy will inform how resources should be deployed in future years to achieve the best balance between community based Route Map to the 2020 Vision final version Page 7

and GPs. The model is now being rolled out across South Lanarkshire. The team in EK are currently undertaking PDSA work around a shared care model between ICST, GP practices and consultant geriatricians to enhance existing provision. Use of independent optometrists to provide acute eye care, leading to high quality care from an appropriate specialist and freeing more time in general practice and eye clinics for other purpose. Use of Care Homes LES to improve the quality and consistency of care to residents of care homes, leading to better outcomes for patients and the health system, and high patient and staff satisfaction. Prescription for Excellence shows us the direction for travel for pharmacy. Locally, NHS Lanarkshire has experience in several of the areas of delivery, including pharmacist prescribing, good relationships with GPs, poly-pharmacy review, care homes and work with social care services. It is reasonable to suggest that general practice is experiencing an increase in workload that finds it saturated; further transfer of the locus of care will be difficult to achieve without freeing up capacity, but much of general practice funding relies on contractual, and particularly QOFrelate work being carried out. A method of freeing up capacity to participate in testing new models of care without compromising practice income is necessary to ensure full practice engagement. Increased emphasis on partnership working between professions, and harmony between different independent contracts. Rebalancing care away from institutional settings where it is both desirable from a patient perspective and safe from a clinical practice point of view requires Scottish Government support to remodel aspects of acute care provision including agreement to reduce bed numbers to reflect changing demand of care that are person centred, address the complex needs of those with multi-morbidity and result in improved outcomes for patients and their carers through closer integrated working across primary and acute care teams, social care and voluntary organisations. Assist independent contractors to maximally configure their workforce to meet demographic and illness demands, and facilitate a movement towards collaborative place based care. Initiate work to develop strong therapeutic partnerships between key professionals in primary care, such as GP and community pharmacy. Strengthen links between community nursing and general practice, with particular regard to the learning from ICST and ASSET pilots. Review the configuration and delivery of the Out of Hours service to ensure a high quality and sustainable service that meets the needs of Lanarkshire s population Improve intelligence about how the healthcare system works together, and the understanding of data so that it can be used to make interventions focussed by need and designed to bring about and evidence and in-patient provision and between prevention and early intervention and the need for acute clinical treatment and care. The actual value of any resource shift will only be identified once the service models have been agreed and workforce and wider resource plans linked to these have been fully established. Route Map to the 2020 Vision final version Page 8

Outcome focused care plans are in place for all long-term and complex patients at home. Over 5000 anticipatory care plans are also in place across NHS Lanarkshire, developed in close cooperation between patients, carers, nurses and GPs. Respiratory MCN have developed and circulated to all GP practices guidance and information on COPD Anticipatory Care Planning, this includes rescue medication and monthly information to practices relating to their patient usage in preceding 12 months. improvement; Develop deeper understanding of needs through closer working with Public Health and Information Management to determine areas of priority and any variation in population need between localities.. Establish a multidisciplinary implementation group that will assist in the delivery of the intentions of Prescription for Excellence. Introduction of ASSET team to test delivery of acute Care of the Elderly services in a community setting showing close working between GPs, community nursing, specialist services and social care. Joint development of pathways to support improved models of care eg AF / DVT / Falls Introduction of musculoskeletal service, delivered by physiotherapy Route Map to the 2020 Vision final version Page 9

in partnership with NHS24 and leading to direct and improved access for patients. Audit of over 65 admissions to hospital to better understand influence of specific disease processes (eg COPD/HF), reasons for admission, patient journey and discharge processes. Use of enhanced services (such as Diabetes, Near Patient Testing, DMARD) to promote shift in locus of care from acute to primary care) Use of enhanced service to test extended winter opening hours at festive weekend in general practice Introduction of enhanced service for general practice to facilitate training and gain experience in continuous quality improvement to support introduction of Interfaces and Integration SPSP-PC. The introduction of the integrated community support team has demonstrated that it is possible to have excellent interfaces of care within the extended primary care team, and across a number of general practices without reliance on an attached model. Key professional within this model include community General practices tend to work as small organisations and need development to work more closely together. Overcoming the resistance to this type of working by providing reassurance about income and the governance of care will be an important step to achieving this. NHS Lanarkshire and it s Local Authority partners have agreed to establish integrated adult and health social services through the Body Corporate Model. Transition Boards will be fully operating through 2014 to lead and manage the change programme linked to this transformation. Within these plans it is Resource shifts will be determined on an on-going basis as part of the whole system strategic plans and will be supported through the Joint Strategic Commissioning process that will be implemented for all community care groups including Older People; Mental Health; Learning Disability; and Substance Misuse as a key aspect of Route Map to the 2020 Vision final version Page 10

nursing, AHPs, social care and GPs. Similarly, the ASSET team has demonstrated that using specialist Care of the Elderly teams in the community setting leads to good integration of care and improved outcomes for patients. Interface between acute hospitals community services has been assisted by the introduction of discharge HUBs within each acute hospital site which provide a multi-disciplinary/ agency approach to discharge planning. The ICST and ASSET play a proactive role in supporting the work of team in the HUB and assessment wards on acute sites. There is an electronic system in place which identifies community care managed patients at the point of admission to hospital, this allows the community team to link immediately with acute colleagues and the patients GP to ensure a timeous return home. General practice has worked closely with carers representative groups in North and South Lanarkshire to ensure improved visibility and care for their members. This has resulted in exemplary identification of carers and a structured assessment of their health needs through an enhanced service developed with input from these groups. Within practices effective communication and continuity of care overseen by one professional is becoming more difficult due to parttime working and portfolio careers. There is a perception amongst many practices that communication with community nursing is more difficult due to the use of alignment and geographic working.. Ensuring that communication and co-operation is optimised is essential and the ICST approach has been shown to be beneficial in this respect. Formal clinical communication from acute care has been poor but is improving face to face contact between acute care and primary care clinicians is now rare other than for clinicians in management roles, and this must be improved so that relationships that involve greater understanding of roles and trust can be developed. This same process of achieving greater understanding of roles and trust between independent contractors in primary care must also be achieved in order to fulfil the intentions of policy documents such as Prescription for Excellence. intended to strengthen the links within primary and secondary health care to ensure that service models reflect the aspirations of patients to receive care at home or in the community where this it at all possible. As part of this programme it is intended to include the acute care of older people within the Health and Social Care partnerships. This change is expected to support improvements in the pathway of care and to enable resources to be input to the most appropriate place to support the patients care journey. Establish three site interface groups, jointly led by clinical directors from each of the hospitals and primary care, to take local ownership and action of issues that arise in relation to interfaces of care around each of the hospital sites. The acute clinical strategy and primary care strategy are simultaneously being refreshed. In order to maximise the benefit of this, it is necessary to ensure a joined up, whole system approach and those responsible for each strategy will ensure that communication and engagement enables this to happen. Focus pathway work to improve high risk pathways of care for patients with long term conditions, identified through the over 65 audit, with an initial focus the work of the Integrated Health and Social Care Partnerships. Route Map to the 2020 Vision final version Page 11

Integrated Day Services have been established in North Lanarkshire and allow for an integrated approach to assessment and care for people with dementia, linking closely with primary care. The skills of the main providers of care and treatment are pooled and shared to enable the service to adjust to these changing needs and respond quickly and appropriately resulting in a smoother journey for the person through services; a reduction in crises through early intervention and identification; a person centred approach across the agencies and improved personal outcomes; a faster response to changing needs; a reduction in duplication of assessments and Increased staff confidence The introduction of Integrated Addiction Services across North Lanarkshire now means that those who need help with an alcohol and/or drug problem, can go straight to their local IAS who will arrange for them to see the worker best placed to help them and arrange involvement of other professionals including doctors, psychologists and occupational therapists, as part of an holistic care package. on patients with COPD and heart failure. An event will be held on the 6 th February, involving senior leaders from across the organisation, to reflect on the performance year 13/14 and inform and support the delivery of priorities for 14/15. Improve communication by: Spread use of ekis and the electronic portal as a way of ensuring the availability of timely and accurate patient information at the time of assessment; implement the Closing the Gap initiative to improve the timeliness and quality of information contained within the discharge summary; test and implement structured admission template to provide improved information when patients are admitted to hospital. The creation of One Door Access to mental health adult services has facilitated quicker and more Route Map to the 2020 Vision final version Page 12

appropriate response from the range of professionals in a CMHT including access to Psychological Therapies. A social prescribing programme titled Well Connected has been established providing access to telephone based CBT, Biblio-therapy, Occupational Therapy Community Clinics, self-help information, Stress Control Classes and socio-economic intervention (benefit advice, employment, exercise, volunteering arts and culture, learning). Community Mental Health Team (CMHT) hours have been extended to evenings and weekends enabling GP referral for intensive support at these crucial times. In North Lanarkshire agreement has been reached with partners from all sectors through the Reshaping Care for Older People Programme to introduce a Locality Response Team that will provide a 24/7 approach to multi-agency, multi-professional assessment of needs matched with a rapid response to support people to stay at home. These teams will also contribute to reduced A&E and Out of Hours attendances, hospital admissions and expedite safe and effective discharge planning. Route Map to the 2020 Vision final version Page 13

Infrastructure There is one current GP IT system Vision used by 96 practices out of 98. Electronic document transfer has been implemented across general practices and a clinical portal has undergone successful testing in key long term conditions. Testing of Vision 360 has taken place, and it is the intention that this will now roll out to further practices. NHS Lanarkshire retains a budget for improvement grants for practices who own their premises, and though applications have reduced in number, there have been new awards made that have led to improved premises for the delivery and extension of care in general practice eg Cadzow Health Centre. NHS Lanarkshire has a property and asset management strategy in place to ensure that existing estate is managed and maintained in a fit for purpose condition. The property and asset management strategy also supports assessment of changing needs for estates within community and acute hospital settings. From this priority plans around capital developments are made. This is especially important as service demand changes in line with demographic shifts and the development of new models of care. There is a primary care property Currently, the GP contract is too focused on single diseases and needs to be adapted in such a way as to allow practices to focus more on complex areas, such as multimorbidity and health inequalities, where GPs generalist skills are best deployed. This need not be about incorporating a transactional element to enable this, as there should be greater influence on professionalism, but it is time consuming work and the contract needs to enable practices to spend the necessary time on these issues. The current GP contract core working hours pose problems for other parts of the system, particularly ED and OOH. Consideration should be given to extending the core GP working hours, whilst acknowledging that this would be extremely unpopular with the present weary GP workforce. There is a need for alignment between the independent contractors contracts, particularly GP and community pharmacy. At present, some teams are not colocated within the same premises. Co-location enables the face to face communication between teams which enhances collaborative working. IT is currently fragmented with general Review of the current working environment in out of hours and the logistics associated with the management and administration of the service are an important component of the review that the service will undergo. As a result of boundary changes the transfer of practices in Camglen locality will lead to further practices using EMIS and though there is likely to be a service level agreement with NHS GGC in relation to continuing support for these practices, it will be desirable for support staff to build experience with these systems. There is a need for improved IT links between in hours GP, out of hours GP, community nursing and acute care. Exploring how best this can be achieved, for example by spread of the use of the clinical portal or implementation of Vision 360, will be an important facet of better communication across the interfaces of care. There has been approval of three large infrastructure projects that will improve health premises in Primary Care and work will commence on new health centres that will serve East Kilbride, Kilsyth and Wishaw. NHS Lanarkshire will participate in the Route Map to the 2020 Vision final version Page 14

strategy group in place to continue to assess changing needs in primary and community care and to ensure that priority areas for development are flagged up in the Capital Investment Group. practice, community nursing, acute and OOH all using different clinical IT systems which do not communicate well. Furthermore, some of these systems are not easily auditable (e.g. need for manual searches for care home data in both TrakCare and Adastra) United 4 Health study that will investigate the effectiveness of telehealth solutions in the care of people with COPD. There is currently a lack of quality improvement support in primary care and the capacity and capability around this must be increased. Workforce NHS Lanarkshire continues to have good uptake of training positions in general practice and a number of practices who participate in this training. There are already a number of areas in which collaborative working occurs. For example, the ICST in East Kilbride and Strathaven involves collaborative working between nursing, AHPs, general practice and social work. In both East Kilbride and Strathaven and Cambuslang/Rutherglen localities, community pharmacy liaison groups exist, enabling a better understanding between pharmacies, GPs and NHS Lanarkshire prescribing staff. As previously detailed, there are fewer sessions of GP time per 10000 population in Lanarkshire than elsewhere in Scotland; improving this ratio by expanding the GP workforce will take substantial investment, ringfenced for this purpose, and availability of trained GPs. Maintaining adequate numbers of appraisers to fulfil the obligations around GP appraisal remains a challenge. It would be helpful to have a review of, and national, or at least regional, consistency in the approach, to payments to independent contractors working within managed services. The general practice workforce is weary due to workload and frequent changes of contractual targets. Review the configuration and delivery of the Out of Hours service to ensure a high quality and sustainable service that meets the needs of Lanarkshire s population. This will have a particular focus on the requirement necessary to ensure a sustainable model and workforce plan, recognising the challenges that are being faced in Lanarkshire and elsewhere in securing appropriate clinical cover during the out of hours period. Additional investment in the supporting infrastructure to be able to meet the requirements of GP appraisal and revalidation has been identified as a priority. Develop a programme of events and educational meetings that will promote more collaborative working between professionals in primary care and There will be continuous assessment of workforce requirements using the relevant tools, especially where these have been mandated by Scottish Government. All service model reviews will include the need for the numbers and skills and competencies of different staff disciplines to ensure that the new models can be delivered in accordance with the quality ambitions for the NHS in Scotland. It is not possible to quantify resource implications at this time this will however become evident as work on the whole system service strategy is concluded. Route Map to the 2020 Vision final version Page 15

There is a need for greater training in general practice and in community nursing on older people s medicine and nursing. In addition, there is a need for increased training on management of polypharmacy and multimorbidity. between primary, acute and social care. There is a need to increase the capacity and capability in improvement methodology and the use of PDSA within the community. Leadership NHS Lanarkshire has invested in strategic leadership in Primary Care by sending several senior clinical leaders on the national Delivering the Future leadership programme and they contribute in local and national roles. There has also been a senior leader who has undertaken the Fellowship in Patient Safety. Organisational Development within NHS Lanarkshire run leadership course in conjunction with the national leadership unit at NES. One CD in primary care and at least one Senior Nurse in primary care have attended the Leading for the Future course. There is not yet a critical mass of primary care clinical leaders at a practice and community team level who have understanding and training in adaptive leadership and quality improvement. Greater access for these clinicians to training packages on leadership will be necessary to support the implementation of transformational approaches to care across primary care. Identify key opinion shapers from within the clinical communities and support them to be able to make a meaningful contribution and access to development opportunities. Ensure that an appropriately resourced structure of clinical leadership is able to contribute fully as part of the new health and social care partnerships. RCOP work has benefitted from a Route Map to the 2020 Vision final version Page 16

range of senior clinician engagement in planning, development, implementation and evaluation of the various work-streams. Data and improvement NHS Lanarkshire has been implementing improvement methodology and SPSP-PC across a wide front; currently 80 practices are implementing care bundles in a high risk area (DMARD therapy) and there is evidence of strong participation in the improvement indicators within the Quality and Outcomes Framework. An enhanced service designed to support the implementation of the trigger tool in 2012/13 has been reviewed by an NES Associate Adviser and important learning points for the system that were identified by this process have been collated and fed back using educational meetings. NHS Lanarkshire has reviewed its approach to dealing with adverse incidents in Primary Care. As part of this review, a new group has been commenced, reporting through the recognised Quality structures, whose purpose is to assure the actions and learning that arise from undertaking critical incident reviews. There is an experienced team of people working on data and More information on GP workforce, GP workload and GP practice capacity would be helpful to enable practice planning. It would be helpful if practices did not have to record just as much diseasespecific data as this is time consuming. However, it would be important to maintain the recording and monitoring of key measures for a number of disease areas, such as CHD and diabetes. At present, it is not possible to access data easily from TrakCare or Adastra for certain groups, e.g. care home residents. A solution that is practical and simple for practices and community teams to record and present data, so that it can also be aggregated is urgently needed to support them in doing improvement work. National funding that is intended to support Quality and Improvement work should be recurrent and not on an annual basis so that this will allow substantive appointments to be made. Improved understanding of data through use of better techniques of data display, developing use of dashboards, and the spread of SPSP- PC will encourage better use of data. Identify further data developed by Public Health, and strengthen its use as part of the strategic planning process to inform prioritisation of services both at a locality level and as part of the review of primary care strategy NHS Lanarkshire has strengthened its approach to learning from adverse events; there is a need to ensure that learning from independent contractors is captured as effectively as those in the managed service and that this is shared across the system. The key learning points will be collated and shared within units, using vehicles for communication such as locality clinical fora and safety newsletters, building on the process used to feedback learning from the Trigger Tool enhanced service NHS Lanarkshire has an established e Health Strategy Group which oversees the assessment of changing information and information system needs. This group will play a key role in assessing the impact that changing service models and the move to integrated health and social care structures will have. From this agreement will be reached on the investments required to provide the best information systems to support effective clinical delivery and information management. Route Map to the 2020 Vision final version Page 17

information technology. This has proved invaluable in supporting the provision of data to practices for reflection as part of the Closer Working LES and then subsequently the Quality and Productivity domain of QOF. What support / facilitation / action does the health board consider is necessary at a national level in order to address the challenges that you have identified during the consideration of the above themes?: Whilst much of the strategic planning and service redesign work will be taken forward through partnership groups within NHS Lanarkshire and with Community planning partners it will be beneficial to continue to work with the National Primary Care Strategic Forum to ensure that there is appropriate linkage across independent contractor groups and that there continues to be good alignment between national policy, local strategies and service delivery in keeping with national targets and standards. It would be helpful if a central mechanism of support and facilitation was identified so that learning from Primary Care development and new models of care across Scotland is shared, and assistance given to unblocking impediments to progress. Part of this approach may be establishing a means of assisting collaboration between Boards in addressing some of the broader national issues that relate to creating the appropriate infrastructure, leadership and improvement capability in taking this work forward. Equally, continued support from JIT on the reshaping care and Integration of adult health and social care is welcomed. Further to this it is imperative that national work on capital planning and e-health strategies reinforce the intention to enhance community based service capacity and capability. Route Map to the 2020 Vision final version Page 18