Transforming Primary Care in Greater Manchester

Dr Anne Talbot, Associate Medical Director, Greater Manchester Area Team, NHS EnglandGP Clinical Director, Bolton Community Practice CIC

Aims of the session• Provide context around primary care work in Greater Manchester• Introduce the Primary Care Strategy and Community Based Care

Standards• Hear from two demonstrator sites:

– Middleton GP Practices – Organisations in Partnership– Central Manchester CCG: Making a difference for our whole community

The Case for Change

1,055,959 1,075,025

1,105,464

1,149,174

1,000,000

1,020,000

1,040,000

1,060,000

1,080,000

1,100,000

1,120,000

1,140,000

1,160,000

2009/10 2010/11 2011/12 2012/13

A&E

atten

danc

esGM A&E Attendances

Primary Care Progress• Primary Care Strategy for GM was approved by NHS England in Feb 2014, with wide engagement from GPs,

LMCs and CCGs

• A suite of Community Based Care standards has also been approved and work is taking place to ensure these are agreed, owned and embedded into local CCG visions

• A GM Primary Care Transformation Steering Group has been formed to steer delivery of enabling work streams - including organisational development and workforce led by Health Education England

• Six primary care demonstrator sites have been approved across GM covering a population of 377,000 with a total budget of £2million

• 18 bids submitted to the Prime Ministers Challenge Fund

• Emergence of new provider models in Primary Care and consideration of innovative contracting models (eg Alliance Contracts)

Primary Care Strategy

Multidisciplinary CareIdentification of Long Term Conditions

Best Care PathwaysMedicines OptimisationIntegrated Care Teams

GP as co-ordinator of Care

Involvement in CareAccess to care recordsPromotion of self-care

Primary preventionPatients die in place of their choosing

Access and ResponsivenessDigital Technology; range of access

mediumsContinuity of Care

Increased access to primary care services

Increased Out of Hospital ServicesLocally based enhanced servicesSmooth primary/secondary care

interfaceInter-practice referrals

Quality & Safety

Community Based Care Standards - Rationale

Align Primary care and Integrated care into a coherent offer for out of hospital services that people can understand.

To provide a mechanism for reducing variation across Primary Care and measuring quality

Set future aspirations upon which activity assumptions can be based.

Providing a set of metrics for activity upon which the money flows can be determined

Aim to develop high level standards , outcomes and metrics which reflect those emerging from local plans

To provide a consistent approach across Greater Manchester the quality and commitment to OOH which can be implemented locally

Community Based Care StandardsACCESS AND RESPONSIVENESS

People will have access to professional health and social care advice and triage (assessment) provided 24 hours a day, seven days a week and be directed to the most appropriate service to meet their health or social care needs

Everyone will have access to primary (e.g. GP services) and community care within 2 hours in case of an urgent health need, or within 6 hours if considered needing same day consultation

Everyone with an urgent social care need will have access to social care within 2 hours, those with a less urgent need will be contacted on the same day THE STANDARD WILL DELIVER THE FOLLOWING OUTCOMES WHAT THIS WILL MEAN FOR YOU

People will be able to use primary care as their first port of call when accessing health services People with an urgent health or social care need will have rapid access to primary, community and

social care services Increased satisfaction with access to health and social care services Reduced use of the ambulance service, attendances at A&E and emergency admissions to hospital People will have improved access to NHS Dental and NHS sight test services Carers will feel more supported to continue in their role

Accessing primary care is simpler

and easier than going to A&E You know who to contact and

when, even in a crisis When you need urgent care, you

have rapid access to an appropriate health or social care professional

You have access to health and social care advice 24 hours a day, 7 days a week

You have support to help you access the most appropriate health or social care service to meet your needs

THE STANDARD MAY BE MEASURED IN A NUMBER OF WAYS

Fewer A&E attendances for minor conditions Fewer emergency admissions for conditions that should not usually require hospital admission Better responses to the annual GP Out Of Hours Survey Fewer A&E attendances and admissions to hospital related to long term conditions More people needing social care who receive an initial assessment and advice the same day More people who need social care whose needs are resolved through online services Fewer ambulance journeys to A&E as a proportion of the overall total More carers assessed In development: Measures for the responsiveness of primary care within 2 hours and 6 hours

JOINT COMMITMENTS

Greater Manchester health and social care commissioners give you the following commitments We will ensure that there is excellent access to primary, community and social care services across all

parts of Greater Manchester Children between 0-5 years will be able to access primary care services appropriate to their need the

same day We will promote the use of different communication methods and technology for accessing services

(e.g. using smart phones)

You give GM the following commitments

People will have access to professional health and social care advice and triage (assessment) provided 24 hours a day, seven days a week and be directed to the most appropriate service to meet their health or social care needs

Everyone will have access to primary (e.g. GP services) and community care within 2 hours in case of an urgent health need, or within 6 hours if considered needing same day consultation

Everyone with an urgent social care need will have access to social care within 2 hours, those with a less urgent need will be contacted on the same day WHAT THIS WILL MEAN FOR YOU

Accessing primary care is simpler

and easier than going to A&E You know who to contact and

when, even in a crisis When you need urgent care, you

have rapid access to an appropriate health or social care professional

You have access to health and social care advice 24 hours a day, 7 days a week

You have support to help you access the most appropriate health or social care service to meet your needs

Primary Care Demonstrator SitesSix demonstrator communities are trialling innovative solutions in Primary Care across GM – commenced in Nov/Dec 2013, covering a population of 377 000 with combined budget of £2million:

- Bolton CCG: Care Homes & GP weblinks- Bury GP Federation: A Healthier Radcliffe- Central Manchester CCG: Making a difference for our whole community- Heywood Federation: Pilot in integrated care- Middleton GP practices: Organisations in Partnership- Stockport CCG: Development of Integrated hub

Commissioning robust formal evaluation of benefits realisation to aid future commissioning and prioritisation

Summary• Delivery and assurance regarding the future responsiveness, capacity and

capability in Primary Care, is critical to the wider health and social care reform programme

• Recognise that improved access needs more than just extending hours face to face …. and should include improved responsiveness with new ways of working embracing digital technology

• Recognition of the importance of continuity of care and balance of improved access and responsiveness

• Our challenge is to develop the current and future Primary Care workforce, IT, estates and new contracting models to meet the needs of a reformed health & social care system…..but also an opportunity?

Middleton GP practices: Organisations in Partnership

Dr Mohammed Jiva, GP

Bid Oversight

Bid

GP AccessA&E DeflectionEarly Hospital

Discharge

GP Access Ext Opening (Evening/weekend)

DISHI Diary

IT IntegrationWebcam (GP, DN, Pharmacy)

GP / MH /DN Clinics

Data Intelligence Software : Health Information diary

DISHI Diary

DISHI Diary

DISHI Diary

DISHI Diary

DISHI Diary

Access to Medical Records

GP Medical Records (40,000)

7*GP Practices

(Edit)

AED (View only)

DN (View only)

Patient Pathway

Attend A&E

Inappropriate

DISHI Diary

Attend A&E

Appropriate

DISHI Tracker

Data Intelligence Software :Health Information Tracker

DISHI Tracker

DISHI Tracker

Virtual Ward25 beds (2000pt/bed)

Patients own home

Proactive GP Care

Summary

Bid

GP Access

A&E Deflection

Early Hospital

Discharge

Thank you

mohammed.jiva@nhs.net

Central Manchester CCG: Making a difference for our whole community

Dr Ivan Benett, GP and Clinical Director,

Central Manchester CCG

Responsive Access• Emergency requests responded to within 20 minutes• Requests for same day appointments clinically triaged

within 60 mins• Urgent GP Care within 2 hrs• Sameday GP Care within 6 hrs

Availability• Increase GP availability - Available in all 4 localities• 8am-8pm weekdays and 3 hours per day on

weekends - 96 appointments per week per locality• Will be able to take appointments from A&E, OOH

and eventually direct from patients• So far more than 700 patients have attended

Primary Care Manchester Ltd• Development of General Practice Provider Organisation • Primary Care Manchester representing 35 practices• Have enabled improved cross practice working and supported

the development of new ways of working.• Will continue to support equity of service provision across CCG

footprint.

Increased Out of Hospital Services• GP led in-reach service has started supporting a

smooth primary/secondary care interface• Consultant advice lines available in 6 specialities

– more in development

Questions