Achieving vertical and horizontal
integration: working with partners across
primary, community, social and secondary
care to provide a better level of service to
patients
Sarb Basi, Managing Director,
Vitality Partnership
Realising the potential of primary care
Current Political Context
• Managing Long Term Conditions
• Reducing demand on hospital care (urgent care)
• Shift of care into community settings
• Increased demand for primary care
• Better value from GP contract
• Focus on ‘demonstrating quality’
• NHSE/CCG/PH commissioning intentions
Drivers for change
• Need for greater GP involvement in driving better care…
but can’t wait for commissioning led innovation
• Fragmented general practice infrastructure a barrier to
reducing hospital activity and service redesign
• Poor quality primary care remained largely unchallenged
by commissioners
• CQC will start shutting down poor general practice
• Current GP model unsustainable: economics,
demographics
• Transformation of non-clinical and clinical capabilities is
overdue
Future of Primary Care
• The patient voice at the heart of all provision
• General practice should be the ‘locus of community based
integrated services at scale’
• Specialist expertise is an essential component
of effective integration
• Integrated services to incorporate social care
• Technology is an enabler to manage demand
GP partnerships will be gone in ten
years, says NHS England official
Dr Mike BewickHe also said that he expects each new
provider model to accommodate around
300,000 patients - similar to CCGs
the current organisational structure of
primary care is no longer ‘sustainable’ or
‘desirable’
10 September 2014
Andy Burnham: Why general practice
should move towards a salaried model Shadow health secretary Andy Burnham talks
exclusively to Pulse about why GPs should be
predominantly employed by large health and
social care organisations
17 September 2014
Practice closures set to widen GP
privatisation All new GP contracts will be thrown out to
private providers under APMS, in a move
described as the ‘death knell’ for traditional
practice
09 September 2014
Practice hands contract back after four
partners are forced to resignFour partners in a practice in a deprived area
have been forced to take the decision to resign
and hand back their contract to NHS England
due to problems recruiting partners.
15 September 2014
All quiet on the western front
GP Provider led innovation
• GPs need to lead and own the transformation of General
Practice
• Do not wait for policy or national direction
• The status quo is not an option so lead or work with other
innovators
• Future proof the professional with a proactive and
progressive model NOT from a protectionist approach
• Embrace the future landscape and opportunity to provide
at scale
• Think differently – there is no limit to the possibilities
• Partner with like minded NHS providers
Traditional Practice Model Federations ‘Super Partnerships’
(Sole trader, multi-partners)
Full
Merger/IntegrationCollaborationConsultation
2k – 15k patients 30k – 500k patients 80k + patients
Emerging Models in General
Practice
Size Matters
•District Nurses
•Health Visitors
•Physiotherapists
•Case Managers
•GP practices
•Pharmacy
•Dentist
•Optometrist
•Social Workers
•Health & Well Being
•3rd Sector
•Specialist Services
• Intermediate care
•Mental Health Workers
Secondary Social
CommunityPrimary
Vitality PartnershipVitality Birmingham
• 2009 26k
• 2010 32k
• 2011 38k
• 2012 40k
• 2013 58k
• 2014 68k+
• 2015 150k+
(CCG, 550k)
Vitality Walsall
Vitality Leicester
Vitality London
• 10 mergers
• 21 partners
+ 3 associate
+ 2 fixed share
• 5 PMS and 4 GMS contracts
• £12m+ turnover
• 250+ staff
• NHS specialist services
• Private services
• 13 primary care sites (plus
university sites)
• Integrated IT: EMIS Web across
all sites (except one)
Integrated/Additional Services
• Rheumatology
• Dermatology
• Orthopaedics
• Immunology
• Substance Misuse
• X-ray
• Zero Tolerance
• Physiotherapy
• Podiatry
• Osteopathy
•ENT
•Urology
•Gynaecology
•District Nurses
•Intermediate Care
•Healthy Communities
Collaborative
•Pain Services
•Private Services
Our Horizontal Integration
• Acute and Community Strategic partnerships
• Health and wellbeing services
• Social Care
• Mental health
• Public Health and population management
• 3rd Sector
Vitality Partnership
Innovative Organisational
Dynamic
Provision at scale
Primary Care Demand (1)0
12
34
56
Num
ber o
f con
sulta
tions
per
per
son-
year
19951996
19971998
19992000
20012002
20032004
20052006
20072008
NOTE: Analysis by calendar years
copyright QRESEARCH 2003-2009 (Database version 22)
All clinicians and all locations (England)
QRESEARCH crude consultation rates per person-year
Primary Care Demand (2)0
510
15
Num
ber o
f con
sulta
tions
per
per
son
-yea
r
0-4 y
ears
5-9 y
ears
10-14 y
ears
15-19 y
ears
20-24 y
ears
25-29 y
ears
30-34 y
ears
35-39 y
ears
40-44 y
ears
45-49 y
ears
50-54 y
ears
55-59 y
ears
60-64 y
ears
65-69 y
ears
70-74 y
ears
75-79 y
ears
80-84 y
ears
85-89 y
ears
90+ years
Age band
Males Females
NOTE: Analysis by calendar years
copyright QRESEARCH 2003-2009 (Database version 22)
All clinicians and all locations (England)
QRESEARCH crude consultation rates per person-year in 2008
Digital Vitality – Our Consumers
• 82% of UK population
using broadband to
transact…
• <1% of patients using
the internet to interact
with clinicians!
• Birmingham has
highest penetration of
smartphone use in the
U.K….nearly 30%
more than London..
We have the population
and capability to shift the
balanace of provision to
the web!
Digital Vitality
Digitally enabled transformation of healthcare is not about
systems, data, technology, analytics….or any of the usual
NHS IT/Informatics stuff….
Delivering real change is about changing the business
model, through the power of the internet, to create new
provider models….engaging consumers in new, highly
efficient and scalable ways of actually receiving a service.
IT/Informatics operates at the margins of
healthcare….Digital is the future of healthcare delivery!
Our Digital Operating Model
Our Digital Capability Model
Making it Happen –
www.vitalitypartnership.nhs.uk
Further reading