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Primary Care DevelopmentProgramme

Governing Body Meeting in Public6th May 2015

Dr Hasnain AbbasiPrimary Care Clinical Lead

Primary Care Development• Introduction:

• Clinical Lead: Dr Hasnain Abbasi, GP• SRO: Andrew Parker, Director Primary Care Development• Programme Lead: Therese Fletcher, AD Primary Care

• Dr Justin Hayes, GP Federation Director SW Locality• Sandra Connolly, GP Federation Director North Locality • Michele Izzo, GP Federation Director SE Locality

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AGENDA

• Context – the journey, what’s worked well?• Primary Care Development London Strategy 2015/16• Primary Care Transformation – Emerging Leaders

• GP Federations• Local Care Networks

• Co-Commissioning• GP Delivery Framework 2015/16

• Prime Ministers Challenge Fund • NHS Services Specifications• Primary Care Education Strategy

• Workforce Development in Primary Care• GP IT – DXS – Windows 7

• Primary Care Development - looking forward

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Context – The Journey

• Primary Care Development Programme – ‘Super Enabler’• Project Initiation Document developed April 2014 and refreshed 2015• The specific objectives of this project are to:

– Enable Primary Care to deliver an increased range of services to patients and integrate with other services on a population health basis

– Reduce variation in access and quality for local populations

– Deliver demonstrable benefits in terms of quality and value for money

– Make primary care a more attractive place to work

– Drive innovation and achieves both local and national strategic objectives

– Reduce inappropriate GP Referrals

– Case Manage frequent users of services

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What’s worked well during 2014/15 (1)• Delivered on programme ambitions

• Increased engagement across key stakeholders

• Successful in using pump priming monies from GSTT Charity and Health Education South London

• Development of the Winter Hubs

• Had some success in reducing variation particularly across GP initiated first out-patient referrals through the GP Delivery Framework, top quartile work during 2014/15.

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What’s worked well during 2014/15 (2)

• Development of the Community Education Provider Network – new nurses in Lambeth

– Developed our Nurse Leadership across the borough

• Opportunity to work across organisational boundaries and in particular with colleagues from the Children and Young Persons Health Partnership

• Increase in the uptake of Holistic Health Assessments across our localities

• Closer working with colleagues from Southwark

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Primary Care Development Strategy2015/16

Transforming Primary Care is a concept that is rapidly gaining momentum as a key priority area in the NHS both nationally and across London. Two important publications underpin the reforms in Primary Care:

– NHS 5 Year Forward Review. Published by NHSE and PHE and launched by Simon Stevens in October 2014, The importance of the registered patient list and the need for greater investment

– Better Health for London, the London Health Commission. Launched in October 2014 and contains recommendations specific for general Practice

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Primary Care Transformation• Case for Change ‘Call to Action for General Practice’• Emerging Leaders Programme• GSTC Funding• Phase 1 – Programme of Leadership (April to Oct 2014)

• Phase 2 – Developing new ways of working (Oct to Date)

• Phase 3 – Implementing new models of care (June onwards)

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GP Federations

• Each Locality in Lambeth– registered their GP Federation with companies house– agreed their legal status and governance frameworks– currently completing a robust due diligence – this process includes work to prepare each GP Federation for CQC

registration

• Developing Mission Statement• Developing Communications Strategy

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South East Locality (1)

• South East Lambeth Health Partnership – 15 practices serving113,000 patients.

• Company Number 0943497

• www.selhp.org.uk

• “Working In Unity For A Healthy Community”

• Four Directors at present, plans to recruit patient Directors.

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South East Locality (2)• In addition to our clinical pilots, practices keen to share

back office functions. We are committed to Mayor of London’s Healthy Workplace Charter – the Federation has procured an employee wellbeing package for all practices.

• Practices in Vassall & Coldharbour wards sending reps to meeting on 21st May of Southwark & Lambeth Early Action Commission with Vassall & Coldharbour Forum to jointly find ways to improve quality of life for residents and to prevent a range of social and health problems.

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South East Locality (3)• Good engagement with high attendance at Gen

Practice Locality events.• Next event is joint General Practice / Community

Pharmacy meeting on 18th May 15.• Enjoying increasing work with patients/community

groups/vol sector.

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North Locality (1)

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• North Lambeth Practices Limited• 3 elected directors• Articles of Association & Shareholders Agreements

being signed this week• Recruiting Managing Director in cooperation with

other federations• Appointed a local manager as contractor to support

due diligence and business development

North Locality (2)• Engagement from all 12 practices

• 6 weekly locality meetings• Series of workshops to ensure collective input

• Governance • Performance Management• New ways of working• Communications strategy

• Reached HHA target for locality with all North practices participating and examples of cross-practice working

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North Locality (3)• Current projects Lambeth-wide

• GPDF• PMCF• CEPN

• Current projects North• CYPHP outpatient clinics in all practices• Primary Care Navigators • Portuguese Community Project• Shared back office functions

• Federations represented at key meetings

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• 20 (all) practices engaged.

• Leaders/Directors engaged with healthcare community. Articulate voice cf token rep. (LCN, SLIC, CYPHP)

• Innovation and system transformation in our sights.

• Meeting objectives PC development project.

• Ready to be first choice provider.

Local Care Networks – Key Aims• The Local Care Networks are based on local networks

focused on the health and social care needs of local communities – encompass the ‘patient voice’

• They will support our 5 year Strategy that Incorporates the six elements of our Vision (patient centred, prevention focused, integrated, consistent, innovative, deliver best value)

• To act as a vehicle to develop and transform the highest quality health and social care across Lambeth

• The Local Care Networks provide an opportunity for true integration with all key providers, including the voluntary sector and local patient groups.

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Primary care working within LCN’s

Update from the Local Care Networks CLG

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Local Care Network Our Unique selling point

Strong Patient/Public engagement in Lambeth The Patient “Voice” is captured through

Healthwatch LambethLambeth Patient and Participation Group (PPG) NetworkVoluntary Sector OrganisationsCharities, Faith Groups,

To build on this established relationship, Community Hubs will be at the heart of each Local Care Network in Lambeth

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Community Hubs

Community Hubs

Community Hub Vision (1)

• The Community Hub is a way of really understanding what local people need from services and support. There is a focus on sharing and learning, and a recognition that each of the three hubs will reflect local differences whilst having a consistent approach to positive health and wellbeing

• The Community Hub is responsible for the actions it takes. It is an important mechanism to support the Local Care Networks to tackle the balance of power

• The Community Hub reaches out to and is assessable to everyone.  It is versatile and accommodating. People feel it is for them.

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Community Hub Vision (2)• The Community Hub is about signposting and sharing information.

It helps people connect about health and wellbeing issues that are important to them, their family and their community. It’s not just about having meetings but about creating  a sense of community

• The Community Hub is not just a talking shop, it creates waves and breaks down the barriers between primary, community and secondary care services and between commissioners and providers. It influences and get things done

• There is work required now to provide some practical solutions as to how we co-produce achievement of this vision and ensure it is a critical friend to commissioners/providers

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Local Care Networks

• The LCN Development Groups are keen to pursue innovative pilots across their respective localities including:– Increased provision of Holistic Assessments/Integrated Care

Management and Community Multidisciplinary Team review using cross-practice support

– On-going work with the Children and Young People's project, which focuses on Asthma and Epilepsy pathways

– Review Long Term Conditions pathway for patients with co-morbidity

– Social Prescribing (use of SAIL/Age UK)– Community Asset Mapping– Complex Dressings Clinics – Locality Geriatrician

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Co-Commissioning • Overall aim is to create a joined up, clinically led commissioning system

which delivers seamless, integrated out of hospital services based around the needs of local populations

• Programme of Engagement took place during 2014/15 including locality discussions and an all practice Webinar to agree what level of Co-Commissioning to embark upon during 2015/16

• NHS Lambeth CCG submitted their proposal to enter into Joint commissioning Arrangements during 2015/16

• In March 2015 NHS England confirmed their approval of the proposal including governance arrangements that support a Committee in Common between South East London CCGs and NHS England. The Committee in Common is due to have its inaugural meeting in June

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GP Delivery Framework 2015/16

• During 2014/15 the CCG contracted with each practice in Lambeth to provide the GP Delivery Framework  

• Conflicts of Interest panel have agreed the GP Delivery Framework 2015/16 can be commissioned through the three GP Federations

• Final Service Specifications for the frameworks individual components will be reviewed at the Primary Care Programme Board meeting in May 2015 and a recommendation made to the Joint Committee in Common

• To ensure there is no delivery gap, the CCG has rolled over the existing contractual arrangement with practices until the contractual framework has been approved by the Joint Committee in Common, which is scheduled to meet in early June.

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Prime Ministers Challenge Fund• The GP Federations with support from NHS Lambeth CCG have

been successful with their PMCF bid and have been awarded £3.4m investment funding.

• Developed the plans to make primary care consistently accessible and responsive to patients’ needs

• In addition to creating extra capacity for appointments it will enable proactive care for our frail adult population and reduce avoidable admissions to hospital.

• Together we will also be developing new ways of accessing primary care using new technologies

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Prime Ministers Challenge Fund Contd/…

• The bid responds to what our membership, local people and patients have told us about urgent access to primary care. We know from asking local people that they want services with: improved access to care for both urgent and routine needs; joined up services and care and a flexible service to suit their needs

• Lambeth GP Federations have an ambitious vision of making general practice consistently accessible and responsive to patients’ needs

• Making this vision a reality will involve a huge amount of work, and we are delighted to have the Challenge Fund to help successfully deliver our joint vision

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Primary Care NHS Service Specifications

• In November 2013 Transforming Primary Care in London: General Practice a Call to Action, was published which examined challenges facing primary care and outlined the case for change

• In response Lambeth Health Watch, Lambeth PPG Network and the CCG held a collaborative event in June 2014, to start discussions on how we can improve services in General Practice and reduce health inequalities. There is a follow up event scheduled for 10th June 2015

• 3 NHS Service Specifications launched in November 2014 for wider public engagement to transform primary care

• Strategic Commissioning Framework for Primary Care Transformation in London approved earlier this year for implementation

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NHS Service Specifications

Proactive Care – supporting and improving the health and wellbeing of the population, self-care, health literacy, and keeping people healthy

Accessible Care – providing a personalised, responsive, timely and accessible service

Coordinated Care – providing patient centred, coordinated care and GP-patient continuity

Strategic Commissioning Framework for Primary Care Transformation in London. Better health for London: A New Deal for General Practice. London CCGs. NHS England. November 2014

Primary Care GP IT• DXS system: can enable a reduction in GP First Out-patient

referral to secondary care and provide a consistent process for referral and the use of clinical checklists• QIPP specialties uploaded and DXS is fully operational

• Centralised function went live in February 2015

• Local Healthcare providers including our acute trusts are aware of this new system

• Comprehensive library of clinical content has been developed

• Practice usage reports will be run on a monthly basis to establish utilisation rates across Lambeth practices

• Windows 7 – Update

• Local Unified Record - update

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Primary Care Education Strategy

• The Strategy will be refreshed in 2015/16 with an emphasis on looking at non-clinical as well as clinical education in Lambeth

• Training Brochure published and updated on a regular basis by the Primary Care Development team

• There is now an opportunity to have additional PLTs throughout the year (increase from 4 to 8)

• Evaluation underway of training available during 2014/15• This links to ongoing development of our CEPN in Lambeth

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Workforce Development in Primary Care

Development of CEPN – 6 key roles:1.Increasing community placements

2.Readiness to receive and manage CPPD funding

3.Workforce development initiatives

4.Managing the scope of the network

5.Workforce planning/future workforce

6.Inter-professional learning

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What Lambeth CEPN is doing now• Creation of an entity to based within a GP federation that will handle GP VTS • Supporting localised workforce planning for primary care• Creation of a hub and spoke network for multi-professional education based around

LCNs• Creating Multi-professional action learning sets• Addressing the workforce need for new nurses through an innovative project

which has taken on 10 new nurses in phase one already and a further 10 this year

• Preparing for nurse revalidation and implementing a system to provide appraisal, revalidation and workforce planning support to the whole primary care network

• Using apprenticeships to increase a more locally focussed recruitment of HCA’s• Stakeholder engagement to create a community of education across Lambeth's multi

and non professional network• In the near future CEPN’s will hold funding for some undergraduate medical

placements to allow us to make more local decisions on where these placements need to be

Primary Care Development Looking Forward• Embed on-going transformation supported by more ambitious IT support in Primary

Care• Focus on Pharmacy during 2015/16 – more integrated work with Community

Pharmacy to support urgent care, patients with long term conditions, and health promotion. Shared training with general practice.

• Advanced Care Planning (Multiple long term conditions)• Children and Young People - asthma and epilepsy pathways• Reducing variation (peer support/review)• Co-Commissioning – influence local priorities• Increase screening uptake• Prevention – every contact counts• Enhanced access – 7 day working aligned to NHS specifications; Proactive,

Accessible and Coordinated care - PMCF• Pre-Diagnosis

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Questions?

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