David Colin-Thom é

1. David Colin-Thomé National Clinical Director for Primary Care GP, Castlefields, Runcorn Visiting Honorary Professor, M.C.H.M, Manchester University

2. Primary Care • GPs and their staff • Dentists • Pharmacists • Optometrists • Community Nurses

3. General Practice Traditional • Personal Care • Co-ordination of Care • Continuity of Care • Longitudinal care • “Gate Keeper”

4. The P.M.’s Principlesfor the NHS • National Framework of Standards and Accountability • Devolution to the Local Level • Improved Rewards and Conditions of Employment (Flexibility, Incentives, Rewarding Success, Shedding Bureaucracy) • More Choice, More Contestability

5. NSFs • Clinical Priorities for the NHS • Tackles areas of under performance • Evidence based clinical recommendations • Addresses all aspects of Anticipatory care • Quality framework for the whole care system • All apply to Primary Care

6. PCT Manager of the local NHS

7. FOR PATIENTS • Choice • Voice • Control of their Care

8. “Diversity and Plurality are Government Policy” Secretary of State for Health

9. PCTs supported by NatPaCT New GP Contract (GMS) PMS (PDS, LPS) Other contracts Appraisal GPwSIs Medicines Management Collaborative Primary Care Collaborative N&AHPSI OOH R&R Primary Care Development

10. A New Primary Care • Access • Self Care • Modern Clinical Professionals • Modern General Practice • Integrated Care • Intermediate Care / Ambulatory Care • The Public’s Health • A New Public Management

11. NHS Direct Community Pharmacy GP Surgeries Community Premises Walk-in Centres Hospital Other Providers Rapid Access

12. Self-Care – the informed patient • NHS Direct Online • Other Interactive software • Digital TV • The expert patient

13. New GMS • Practice based • Services – Essential, Additional and Enhanced (National,Direct or Local) • 4 Domains of Quality (Clinical, Organisational, Additional Services and Patient experience) • Infrastructure, Aspiration and Rewards • Can opt out of OOH

14. Primary Care Nursing • First Contact • Care of chronic conditions • Improving the health of the public • Prescribing • Referring • NwSI

15. Modern Pharmacy • Information Resource • Walk in Services • Medicines Management • Anticipatory Care including CDM • New Primary Care Provision

16. What is “Intermediate Care”? • Those services that do not require the resources of a general hospital, but are beyond the scope of the traditional primary care team. These services can include ‘substantial care’ for people with complex needs. • This can also be described as Ambulatory Care

17. New PMS • Where is PMS plus? • New Organisations (LPS, other PC contractors) • Extended Contracts into the Hospital • The Broader Public Health • Local Accountability • Models for future iterations of GMS

18. What is “Integrated Care”? • Integrated care and disease management are often used interchangeably, as the aim is to provide a systematic, multi-agency approach. IC applies to all health care interventions but DM principally applies to chronic illness.

19. Clinical Resource Management • Case Management • Assertive outreach • Secondary to Ambulatory shift • Clinical Appropriateness • Expert Patient

20. “Medical costs rise to equal the sum of all private insurance and Government subsidy” Aaron Wildavsky’s Law of Medical Money

21. Hospital Re-Design • Out-Patients • Day Case Surgery • Orthopaedic scoping • DTCs • REC • Configuring Small Hospitals • Private Sector

22. Social Gradient Stress Early Life Social Exclusion Work Unemployment Social Support Addiction Food Transport Health Care in Context