Securing the Future of General Practice Harrow LMC

1. Securing the Future of General PracticeHarrow LMC Dr Michelle Drage, CEO 29 January 2014

3. Core Values of General Practice Basic Building Blocks of Excellent General Practice • The registered list - individuals and practice population • Expert generalist care of the whole patient • The consultation as the irreducible essence of delivery • Take into account socio-economic and psychological determinants of disease and the inverse care law • The therapeutic relationship • Deliver safe, effective long term and preventative care, balanced with timely episodic care by promoting access to relationship continuity • Advocacy and confidentiality • Sufficient consultation time • Sufficient numbers of GPs, nurses and practice staff per 1000 weighted patients • Right premises • Right technology • Right extended Primary Health Care Teams centred around the practice or networks of practices • Right connections and communications across services • Flexibility to innovate locally Commissioning for General Practice and Primary Care in London • Improve access to GPs and their Primary Health Care Teams by reducing bureaucracy, freeing up consultation time and adding more clinical staff • Improve support for GP and practice Primary Health Care Team delivery through integrated care centred around practices • Support more training and practices for General Practice Nurses • Use contractual mechanisms to support all of the above plus networks of practices and collaboration • Re-route funding from secondary care to support all the above by stopping A&E seeing and admitting non-emergencies • Get back to basics of service delivery: move away from models that are aimed at developing an alternative provider market. www.lmc.org.uk

4. The registered list - individuals and practice population Expert generalist care of the whole patient The consultation as the irreducible essence of delivery Take into account socio-economic and psychological determinants of disease and the inverse care law The therapeutic relationship Deliver safe, effective long term and preventative care, balanced with timely episodic care by promoting access to relationship continuity Advocacy and confidentiality Core Values of General Practice www.lmc.org.uk

5. Sufficient consultation time • Sufficient numbers of GPs, nurses and practice staff per 1000 weighted patients • Right premises • Right technology • Right extended Primary Health Care Teams centred around the practice or networks of practices • Right connections and communications across services • Flexibility to innovate locally Basic Building Blocks of Excellent General Practice www.lmc.org.uk

6. Improve access to GPs and their Primary Health Care Teams by reducing bureaucracy, freeing up consultation time and adding more clinical staff Improve support for GP and practice Primary Health Care Team delivery through integrated care centred around practices Support more training and practices for General Practice Nurses Use contractual mechanisms to support all of the above plus networks of practices and collaboration Re-route funding from secondary care to support all the above by stopping A&E seeing and admitting non-emergencies Get back to basics of service delivery: move away from models that are aimed at developing an alternative provider market. Commissioning for General Practice and Primary Care in London www.lmc.org.uk

7. Basic Building Blocks of Excellent General Practice Core Values of General Practice Commissioning for General Practice and Primary Care in London Extended PHCT MDT Social Services Hospital Care www.lmc.org.uk

8. What shall we integrate this week? www.lmc.org.uk

9. Turn the whole process on its head CommissionFORgeneral practice & primary care www.lmc.org.uk

10. … to deliver • Better outcomes for patients • Reduced A&E / Hospital attendances • Enhanced integrated care across health, social and mental health care settings • Improved quality of patient services • Maintenance of high quality generalist healthcare service with relationship continuity at its heart • Cost effective care www.lmc.org.uk

11. Invest in general practice, primary, community & social care……. www.lmc.org.uk

12. ……free up hospitals to do what they should do www.lmc.org.uk

13. Londonwide LMCs support • Campaign • Engagement with NHSE to shape agenda • Surveys • Brokering relationships beyond the CCG • Policy & Influence • Securing the future of general practice in London

14. Londonwide LMCs Support • Investment fund for general practice to operate more effectively but more importantly the support services that help general practice function eg community services, social care, mental health and pharmacy • Keep the existing structure as it is proven that it works well and is admired internationally • Review primary care development that includes the development of collaborative working and allows the whole system to operate more efficiently www.lmc.org.uk

15. Case for change • Health and Social Care Act • Procurement • Choice and Competition, AQP • Transformation; system changes with LAs, H&WBs &PH, • “Shaping a Healthier Future” • Lack of investment/disinvestment • General Practice is being challenged as the provider of choice

16. Key Issues • Legal • Governance • Financial • HR • Services • Conflicts of interest • Patients

17. GPs as Providers • Maximise opportunities • Why collaborate – shared vision • What do we want to achieve through collaboration • Cost; benefits • What level of collaboration • Management, shared costs/functions • Primary Medical Services – quality/coverage • Service providers; procurement/AQP

18. Organisation • What does this mean for you? - Existing collaborative models • Networks; Federations • Super Partnerships • CIC • Social Enterprise • LLP • CLS/CLG • Cooperatives

19. Development Programme • Collaborative programme for GPs • Working with CCGs to meet their needs • Practical tools for practices to meet commissioning/provider priorities • Legal input • Locally focussed - practical tools - How? What? Why? When? • Local outcomes – Collaborative working is a solution not a problem

20. Practical Toolkit Guidance for set up and sustainability that includes: • Core contract protection • Legal framework • Network setup • Company Formation • Engagement with stakeholders • Workforce • Premises • Service Contracts/Procurement • Technical guidance and examples of process infrastructure • Individual practical support

21. GP Providers Working Together www.lmc.org.uk