5 Year Forward view and what it means for General Practice

Dr Helen Mead FRCGPVice Chair & Council RepresentativeLeicester Faculty RCGP

• Thanks to Dr Tim Ballard Vice Chair RCGP for slides

• I also work for Health Education East Midlands (HEEM), a part of Health Education England (HEE). Any views expressed here, while informed by this work, are my own and not the view of HEE or HEEM

Acknowledgements & disclaimer

Where are we starting from?

1. 10 years under-investment in general practice

2. Failure to develop the workforce in general practice

3. The Five year Forward View – Building the New Deal

4. Building the workforce – the 10 point plan

English General Practice

today

• Around 1.2m patients seen every working day

• 340-370 million consultations per year (300m in 2008)

• Increase in workload, static funding and falling resource is bringing general practice to its knees

Funding of UK general practice

General practice funding has fallen by 8% across Britain in real terms since 2005/06 – at a time when the rest of the NHS budget has grown by 18%

Source: RCGP analysis

Rising Demand Between 1995 and 2008, the number of consultations in General Practice rose by 75% to more than 300m. A sharp increase in consultations for those over 65 has contributed to this

Not enough GPs: The general practice workforce crisis

The rise in numbers and complexity

“Epidemiology of Multimorbidity” – Lancet, May 2012

https://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf

• “a collaborative vision which describes the blueprint for the future of the NHS. It was published as a critical intervention after the political party conferences but before the publication of manifestos, to ensure that the voice of the NHS is heard”

Adlington K, Finn R, Ghafur S, Smith CR, Zarkali A

On behalf of the FMLM National Medical Director’s Clinical Fellows 2014-15

What is it?

• “NHS will take decisive steps to break down the barriers in how care is provided”– Primary and secondary care– Physical and mental health– Health and social care– Support for patients with multiple health

conditions not single diseases

Five Year Forward View

• “radical upgrade in prevention and public health”– NHS will back hard hitting national campaigns

• “patients will gain far greater control of their own care”– Including shared health and care budgets

Five Year Forward View

• “England is too diverse for a ‘one size fits all’”– But we must not let “a thousand flowers bloom”

Five Year Forward View

• Other underlying principles– Integration of OOH/emergency services– New models to allow smaller hospital to remain

viable– Midwifery led services– More care for those in Care Homes– Continuation of list based Primary Care– Ability to flex terms and conditions locally– More technology

Five Year Forward View

In principle• Care designed round the needs of the

patient rather than the needs of the system

• The Coalition of Collaborative Care

What does this actually mean?

• In practice• Refocus on prevention

– General/targeted/employment/workplace health– Locally led & driven e.g. DevoManc

• Empowering patients– Access to care records– Group based education (with voluntary sector)– Increased patient choice

What does this actually mean?

• Engaging communities– Supporting carers– Encouraging volunteers– Stronger partnerships with 3rd sector– The NHS as an employer

What does this actually mean?

• Exploring new ways of working– Multispecialty Community Providers

• a multidisciplinary team of clinicians from both primary and secondary care, GP, outpatient and ambulatory care services

– Primary and Acute Care systems• Fully integrated primary and secondary care, via a

single provider for GP, hospital, community and mental health services.

What does this actually mean?

• For you– Networks and Federations

What does this actually mean?

• Networks and Federations, Networks and Federations, Networks and Federations, Networks and Federations, Networks and Federations, Networks and Federations, Networks and Federations, Networks and Federations, Networks and Federations, Networks and Federations

• Why are Federations & Networks part of the answer?

• Enable Professional Control• Keep the traditional patient facing feel of GP• Demonstrate the will to tackle variability• Control Segmentation• Control the way we work with Secondary Care

• For you– Networks and Federations– More work – More connections– Need for a different workforce– Risk of a competitive marketplace for personnel– Increasing privatization/3rd “sectorization”

What does this actually mean?

• For you– Networks and Federations

• Herding cats• Skill sets

– More work • Moving care from secondary to primary care• Prevention initiatives• Co-ordination

– More connections• Direct working with trusts, 3rd sector, home care

What are the specific challenges?

• For you– Need for a (different) workforce

• Workforce planning• GP recruitment/retention crisis• Need for clinical leadership

– Risk of a competitive marketplace• Local variation in terms & conditions

– Increasing privatization/3rd “sectorization”

Challenges ?

• Federate & Network – engage locally• Use Co-Commissioning• The Whole systems Integrated Care

Toolkit• Building the workforce – the new deal for g

eneral practice• Making time to keep in touch

Potential “solutions”

The Future?

The Future?

Progress is impossible without change, and those who cannot change their minds cannot change anything

George Bernard Shaw

The Future