Transforming Primary Care Provider Development 4th ... · PDF fileTransforming Primary Care...

Transforming Primary Care

Provider Development

4th

November 2015

WiFi Login Details

Network: Hospitality Password: ovaltine89

01

Transforming London’s health and care together

Welcome and Introduction

2

Welcome and introduction

3

Dr Robert Varnam - Head of General Practice Development, NHS

England

Liz Wise, Programme Director, Transforming Primary Care, Healthy

London Partnership

Welcome and introduction

4

#HealthyLDN

@HealthyLDN

Using your App

5

You can download the app by searching for ‘Transforming Primary Care’ in

either app or google store

Features to enhance your time at the event, such as:

Programme and general information

Speaker biographies

Access to presentations, including the ability to save, email and make notes

alongside them

Voting and question submitting

Networking functionality

Note taking functionality

Through each session you can

WiFi Login Details

Network: Hospitality Password: ovaltine89

Make Notes Vote Raise a question

How many Primary Care ‘at scale’ organisations

are there in London at this present time?

6

A. 102

B. 17

C. 57

D. 5

http://www.im-

cms.co.uk/application/assets/81/KeypadVotingTimeFilter/KeypadVotingChart.php?Title=12:30:%20Welcome%20and%20introd

uctions&ID=14797

Register your vote in the Welcome and Introductions session tab

http://www.im-cms.co.uk/application/assets/81/KeypadVotingTimeFilter/KeypadVotingChart.php?Title=12:30: Welcome and introductions&ID=14797




Agenda for today

Time Session Speakers

12:30 WELCOME AND INTRODUCTIONS

Liz Wise

Dr Robert Varnam

12.45 WHY ARE WE COMMITTED TO PROVIDER DEVELOPMENT?

Dr Michelle Drage

Dr Marc Rowland

Dr Robert Varnam

13:25 THE EMERGING PICTURE SO FAR

Chris Adams

Jeremy Fenwick

Dr Judy Roberts

13:55 Q&A

14.15 PROVIDER DEVELOPMENT - TAILORING YOUR LOCAL NEEDS Dr Robert Varnam

14:30 Break

14:45

THE INTELLIGENCE HUB

• Leadership

• System wide support

• Organisational Development

• Developing Partnerships

• Regulatory & legal advice

ALL

16:10 Break

16.20 WHAT ARE THE NEXT STEPS?

Greg Cairns

Liz Wise

16:50 CLOSING SUMMARY Robert Varnam

17:00 CLOSE

Networking (30 mins)

02


WHY ARE WE COMMITTED TO

PROVIDER DEVELOPMENT?

8

PROVIDER DEVELOPMENT

9


England

Dr Michelle Drage- Chief Executive, London-wide Local Medical

Committees

Don’t forget to tweet us at @HealthyLDN

#HealthyLDN

Dr Marc Rowland, Chair of the Healthy London Partnership Innovation

Group, Co- Chair of the Transforming Primary Care Strategic Oversight

Group

Transforming Primary Care

Strategic Commissioning Framework Pan – London Support

Provider Development System wide collaboration

www.england.nhs.uk

General practice

development

Dr Robert Varnam Head of General Practice Development

@robertvarnam

www.england.nhs.uk

Collaborative

working

New models of

LTC care Improved access Quality & safety

What are people working towards?

Release capacity

www.england.nhs.uk

How? Learning so far…

We’re going to need every component

Some of this is very new for us

bit.ly/pmcflessonsvid1

bit.ly/PMCFlessons1

www.england.nhs.uk

Leadership

Creating shared purpose

Strategic planning & partnerships

Leading through change

Being a leader

Improvement

Patients as partners

Processes and systems

Using data for improvement

Rapid cycle change

Business

Governance

Operations management

Workforce

Business intelligence

General practice development framework

These are

interdependent

bit.ly/pmcflessonsvid1

bit.ly/PMCFlessons1

03


EMERGING PICTURE SO

FAR

15

EMERGING PICTURE SO FAR

16

Chis Adams, Chief Executive , H&F GP Federation


#HealthyLDN

Part 1: What we told practices at the start

Hammersmith &

Fulham GP Federation

Primary care faces a range of challenges and opportunities…..

Context

LES contracts finishing

Offering a wider range of services

CCGs need population coverage

Services shifting out of

hospital

Integrating primary care

with intermediate

care and urgent care

Ensuring financial stability

A Federation allows us to address these issues together:

Provide more complex services closer to patients Act at scale for a whole population Improve care coordination across settings Enhance access and convenience Capture growth opportunities to provide financial stability

1. The Federation will be registered as a limited company so that it can contract with CCGs 2. Practices will subscribe and pay for shares 3. Five Board Directors will be elected: three local GP partners, one PM, and one other 4. Other key positions appointed by Board through an election process

How it will work Governance

How it will work Patient and Public Engagement

Social Media

Patients and public

Engage & Inform

Surveys

Specific groups

Specific topics

Patient Satisfaction

Patients

Measuring performance

Complaints & Feedback

Patients

Responding to specific feedback

Conditions

Patients with specific

long term conditions

Pathway and continuity of

care

Local Clinical Networks

Patients at specific

practices

Feedback about local

services

Organisational

Patients and public

Lay member on Board

Focu

s A

ud

ien

ce

We will use multiple channels to engage patients and the local public in different ways, on different topics, at different frequencies, so that engagement is dynamic and relevant

How it will work

Founder Member Associate Member

Qualifying criteria

Located within Borough and subscribe for shares at formation of Federation (member and shareholder)

Join at a future date through application to the Federation membership committee (member only)

Rights Voting rights in proportion to shareholding

Stand for election as a statutory director

First refusal to deliver clinical services subject to quality, specified requirements, pricing, and any maximum number of required locations

Participate in delivery of clinical services subject to quality, specified requirements, pricing and any maximum number of required locations

Participate in clinical education and training Participate in clinical education and training

Participate in any future distribution

Obligations Support Federation bids, and must not hold shares in a directly competing organisation

Support Federation bids and declare any conflicts of interest

No membership fees for Founder members An annual membership fee may be levied

All local practices encouraged to become Founder Members

See separate Prospectus document for details of the fundraising

1. Management reports to the Board and is responsible for all day to day operations 2. Initially 1FTE (Chief Executive), further resourcing subject to Board approval 3. Directly employed resource will be minimal (e.g. specialised shared clinical resource) 4. Some activities may be externally shareable to reduce cost (e.g. with other Federations)

How it will work Management

1. Federation will contract up to the CCG and contract down to practices for clinical services 2. Federation may contract with third parties for specific support on specific pathways 3. Federation may contract with individual clinicians for specialised support 4. Contracts will include service specifications, usual NHS terms, prices and clinical indicators

How it will work Contracting

Members of the Federation will act according to the following principles: 1. Always ensure that patients are the primary concern for all action and decision

making

2. Collaborate with other Federation members and the central team: • Sharing resources where this is economic or enhances coverage • Work with other members to ensure pathways are delivered effectively and

access is maximised

3. Actively contribute to continuous improvement through service delivery, supporting central management, knowledge sharing or by any other means

4. Support bids by the Federation to extend the services offered to patients and the number of patients reached

How it will work Federation Charter

Medium term milestones

Establish Federation. Deliver

OOHS portfolio

Oct-14 Apr-15 Oct-15 Apr-16 Oct-16

Clinical benchmarking, continuous improvement and performance

monitoring

Wider integration with intermediate care and urgent care

Part 2: Where we are

Hammersmith &


Out of Hospital Services Contract

• 18 services; 31 locations; 451 delivery points • F&A plans down to service by practice, by month • 119 payment & KPI reports; 81 data quality reports • Practices receive 90% of price, Federation central costs covered by 10%

Practice name-lead ABPM Anticoag

Monitoring

Anticoag

Initiation

Case Finding, Care

Planning & Case

Management

Complex Common

Mental Health

Management

Complex

Wound Care

Diabetes (Level 1) Diabetes (High

Risk)

Diabetes (Level

2)

ECG Homeless Near Patient

Monitoring

Phlebotomy Ring Pessary Simple Wound

Care

Spirometry

Testing

Transfer of Care:

Severe and

Enduring Mental

Illness

Ashchurch Surgery - Winayak K 65 44 16 80 41 0 119 72 0 0 46 21 1,307 10 90 66 6

Ashville Surgery - Aras SF 124 88 31 149 8 0 220 134 0 268 86 30 2,428 18 167 123 12

Bridge House Centre for Health - Das B 33 0 0 39 19 0 57 34 0 144 22 0 627 0 43 32 3

Brook Green Medical Centre - Wingfield D 139 111 47 186 93 60 275 167 12 268 107 47 3,044 18 208 153 14

Brook Green Surgery - Slater L 53 37 14 61 36 0 91 55 0 268 35 15 998 0 68 50 5

Canberra Centre for Health 47 36 11 54 32 0 79 48 0 172 31 6 872 7 60 44 0

Cassidy Road Medical Centre - Dellaportas CI 57 0 0 72 0 0 106 64 0 0 41 13 1,165 9 80 59 0

Fulham Cross Medical Centre - Hussain Z 30 0 0 34 18 0 50 30 0 0 19 0 549 0 38 28 3

Hammersmith Surgery - Fernandes PFR 115 76 34 140 67 64 207 125 12 0 80 39 2,276 18 156 115 10

Lillie Road Health Centre - Jefferies S M 37 23 10 45 25 0 67 41 2 0 26 12 738 5 51 37 4

Lilly Road Surgery, - Blair G 96 69 26 113 51 64 167 101 9 0 65 34 1,842 13 126 93 8

North End Medical Centre - Wilson P 209 146 60 259 104 60 383 232 11 273 163 59 4,260 28 290 213 17

Palace Surgery - Mangwana B 59 0 0 69 39 0 103 62 0 0 40 0 1,265 0 78 57 5

Park Medical Centre - O'Gallagher D 107 73 32 129 57 0 190 115 7 0 74 33 2,142 17 144 106 8

Richford Gate Medical Centre - Koppel JI 124 88 39 151 72 0 223 135 11 0 94 40 2,520 19 169 124 13

Sailsbury Surgery - Muthiah RN 19 0 0 22 0 0 32 20 0 0 13 7 358 0 25 18 0

Sands End Clinic - Lawley GC 101 68 26 122 57 56 180 109 6 144 70 30 1,987 16 136 100 10

Shepherds Bush Medical Centre - Badat AA 43 30 12 50 0 0 73 44 0 0 36 13 808 0 56 41 0

Sterndale Surgery - Elliott C 58 40 16 71 0 30 105 64 0 0 0 15 1,247 9 79 58 0

The Bush Doctors - Samji F 142 99 38 176 81 60 261 158 12 268 101 45 2,983 19 197 145 13

The Fulham Centre for Health 85 53 0 100 0 0 148 89 0 268 58 0 1,575 10 112 82 0

The Fulham Medical Centre - McNicholas T 87 57 25 105 55 0 155 94 5 268 60 34 1,709 11 117 86 6

The Lilyville Surgery - Evans Mal 71 62 27 118 56 60 174 106 5 0 68 28 1,982 14 132 97 6

The Medical Centre (Ollgar Close) - Kukar RK 82 49 20 96 0 0 143 86 0 0 63 0 1,717 0 108 79 0

The Medical Centre, Dr Jefferies & Partners - Jefferies SM 158 113 58 216 96 53 319 193 5 268 131 49 3,568 22 241 178 15

The New Surgery - Miller S 0 42 19 77 46 0 113 69 6 0 51 21 0 7 86 63 4

The Old Oak Surgery - Anyiam-Osigwe 0 0 0 51 0 0 75 45 0 0 29 8 826 0 57 42 0

Westway Surgery - Dasgupta S 43 0 0 51 0 0 75 46 0 0 0 15 831 9 57 42 0

White City Health Centre - Dandapat R 46 54 14 53 0 0 79 48 10 165 38 17 944 6 60 44 0

White City Health Centre - Mirza NS 21 12 4 24 0 0 36 22 0 165 22 0 629 0 27 20 0

White City Health Centre - Uppal GS 81 0 0 96 0 83 141 86 0 165 62 0 1,775 0 107 79 0

In Year Volume 2,331 1,469 578 3,008 1,049 590 4,446 2,695 113 3,105 1,732 632 48,969 284 3,362 2,474 163

TOTAL CONTRACT VALUE PRACTICES 2015-16£30,818 £326,099 £83,882 £266,858 £168,372 £12,118 £149,734 £67,738 £20,467 £111,404 £25,266 £27,647 £133,540 £16,546 £33,831 £90,048 £44,654 £1,609,022

TOTAL CONTRACT VALUE FEDERATION£3,424 £36,233 £9,320 £29,651 £18,708 £1,346 £16,637 £7,526 £2,274 £12,378 £2,807 £3,072 £14,838 £1,838 £3,759 £10,005 £4,962 £178,780

Federated Working Transform Primary Care Population-based services: Service model changes - Inter-practice referrals/bookings - patient experience - Shared accountability for aspects of performance - quality - cost efficiency Make progress on community service integration: - skill mix - Ophthalmology “Super-partnership” - MSK - Cardio-respiratory “Back office shared services” - Memory Workforce Development / CPEN Deliver PMCF programme Whole Systems Integrated Care

Goals: what are we trying to achieve in terms of change?

Federation Priorities

HENWL Funding Total £126k

T&T Funding PMCF funding for

practices Transform

Primary Care

OOHS

Transform clinical delivery

Patient Engagement

New Revenue Sources: Community

Ophthalmology Community Memory

Research

CIS

10p per patient Oct-15 £20k

Central operations and governance

£145k

Outbound call pilot £15k

On-line accounts £20k

HealthWatch commissioned to support practices

Funding to support CIS referrals £15k

Back Office: Phase 1 £61k

Support partnership consolidation

£34k

Process Vision

Timeline Execution

Whole Systems Disease

Management Pilot £TBC

Preparatory work on ACO

creation

New Part 2 funding £65k

Central support: weekend service

Current Funding: Training

OOHS clinical training £32k

Reception training £10k

Nurse training £30k

Practice Manager HR training £6k

HCA training £17k




practices Transform

Primary Care

OOHS


Patient Engagement



Research

CIS



£145k




Funding to support CIS

referrals £15k



£34k

Process Vision

Timeline Execution




creation



Current Funding: PMCF revenue streams





HCA training £17k




practices Transform

Primary Care

OOHS


Patient Engagement



Research

CIS



£145k





referrals £15k



£34k

Process Vision

Timeline Execution




creation



Current Funding: Transition & Transformation budget





HCA training £17k




practices Transform

Primary Care

OOHS


Patient Engagement



Research

CIS



£145k





referrals £15k



£34k

Process Vision

Timeline Execution




creation



Current Funding: Whole Systems Funding





HCA training £17k

Part 3: What we have learned

Hammersmith &


There needs to be a clear reason to start

Write a prospectus

First who then what: get a strong chairman, someone to run it, and elect a GP Board

Run it like a start-up

Communicate lots and lots and lots

Build a good working relationship with the CCG

Expect difficulties

Have a clear plan for the first 12 months

Help practices to address the core business

Don’t get distracted with multiple priorities and projects

Don’t use any software that isn’t SaaS

Key Lessons

Establishing a CIC to host the local CEPN

Flipping the resource triangle

Practice Nurse audit

HCAs and the Care Certificate

GP fellows for urgent care and undergraduate teaching

Careers event 9 September

Testing software platform for training and competence reporting

Use Federation as employment vehicle for multi-site clinicians

Board development

Build out clinical governance

Quality improvement focus, e.g. diabetes network

Workforce Agenda

Thank you

[email protected]

07785 501952

Hammersmith &


mailto:[email protected]

EMERGING PICTURE SO FAR

39

Jim Fenwick, Chief Executive, Battersea Healthcare CIC and

Wandsworth CEPN


#HealthyLDN

Dr Judy Roberts, Director, Education and CEPN Lead, Battersea

Healthcare CIC and Wandsworth CEPN

Federation@

Wandsworth

Introduction

Jim Fenwick | Chief Executive, Battersea Healthcare CIC and Wandsworth CEPN

Dr Judy Roberts | Director, Education and CEPN Lead, Battersea Healthcare CIC and Wandsworth CEPN

Why we created a federation

Original development

Original contracts

Further contracts

Future developments

Future support needs

Why we created a federation

Threat to GPs in 2008

5 original federations

Ltd vs. CIC

Early projects (imms/Wandle

extra/QMH Polyclinic)

PCT seed money

Putney

Roehampton

Central

BTF

Battersea

Original development

Lots of legal advice and admin required

3 federations merger

CCG development and distraction for GPs

CIC to remove conflicts of interest

Able to keep localities

Putney

Roehampton

Battersea

Healthcare

CIC

Original contracts

2 pilots for outpatients – dermatology and MICAS

Included triage of all referrals

80% of tariff

Dermatology using Dermatology consultants,

registrars and GPSIs

MICAS using Sports and Exercise Medicine

consultants, Extended Scope Physios and GPSIs

Better patient experience

Lower wait times

Further contracts

CEPN – Initial model for HESL

LES contracts through CCG tender (Long-term conditions and Diagnostics)

CCG preference for single contract (with 100% coverage)

Open procurement

Future developments

Access – 8:00 – 8:00, 7 days

MCP Model

CEPN Expansion

Public Health

MCP and CEPN Model:

Primary care providers working together

Stakeholders:

40 GP Practices

1 CCG

1 Acute Hospital (plus 3 more in close proximity)

1 Community Services Provider

1 OOH/111 Provider

1 Mental Health Trust

1 Public Health Department

1 Hospice

14 Care Homes

60 Pharmacies

400 Charities

? Carers

375,000 Patients

Future support needs

Local

CCG

Regional

Commissioning collaboratives

South London or London wide

National

NHS wide

Local

Workforce and COI

Regional

IM&T and estates

National

NHS pensions for LES work

IM&T and estates

Q&A

49

Chis Adams, Chief Executive , H&F GP Federation


#HealthyLDN

Jeremey Fenwick, Chief Executive, Battersea Healthcare CIC and

Wandsworth CEPN


England

Session Host

Dr Marc Rowland, Chair of the Healthy London Partnership Innovation

Group, Co- Chair of the Transforming Primary Care Strategic Oversight

Group

Q&A Host

Dr Judy Roberts, Director, Education and CEPN Lead, Battersea

Healthcare CIC and Wandsworth CEPN

04


TAILORING YOUR LOCAL

NEEDS

50

INTELLIGENCE HUB

51

• There are 10 tables themed around our development support offer

• Spend 10 mins on each table to discuss your development needs and share

experiences

• Each table has a facilitator and subject matter expert(s)

Tips for the Intelligence Hub

• Discuss the importance of each topic

• Gain a clearer understanding of your organisational needs and resources available

to you

• Feedback any gaps in support and ways you would like support to be delivered

• Use the Self assessment tool to start mapping out your learning and development

& shape a tailored offer

Intelligence Hub

52

System Wide Support

Group 1 & 7

Regulatory & Legal

Group 2 & 8

Organisational Development

Group 10 & 4

Developing Partnerships

Group 6 & 5

Leadership

Group 9 & 3

Which Table Topic Is Your Top Organisation

Priority?

53

A. Leadership & Organisational Development

B. System Wide Support

C. Developing Partnerships

D. Regulatory & Legal

http://www.im-

cms.co.uk/application/assets/81/KeypadVotingTimeFilter/KeypadVotingChart.php?Title=14:45:%20The%20In

telligence%20Hub&ID=14803

Register your vote in the Intelligence Hub session tab

http://www.im-cms.co.uk/application/assets/81/KeypadVotingTimeFilter/KeypadVotingChart.php?Title=14:45: The Intelligence Hub&ID=14803




05


WHAT ARE THE NEXT

STEPS?

54

NEXT STEPS

55

Liz Wise, Programme Director, Transforming Primary Care, Healthy

London Partnership

Greg Cairns, Director Primary Care Strategy, London-wide Local Medical

Committees

www.lmc.org.uk

Provider Development: What Are The

Next Steps?

Greg Cairns Director of Primary Care Strategy, Londonwide LMCs

www.lmc.org.uk

GP Networks – fact or fiction?

• Significant activity

• Significant challenges

• Future Models, MCPs –

risks/opportunities?

www.lmc.org.uk

Addressing the Challenges

1. Not involved – don’t want/need to do it

2. We need a Federation; how do we do it?

3. We’ve got a federation, what next; how do we maintain momentum; ensure we’re sustainable; future proof?

• How many; who; where; achievements to date?

• Commissioner & Federation behaviour

• Capacity - time, skills, interest, leadership

• Maintaining GP core values and identity

• Governance, decision making

• NHS Pensions!!

www.lmc.org.uk

Deliverables (i)

• Strategic partnerships, influencing and

delivery

• Shifting sands – intelligence and analysis

• Share good practice and new models of

delivery

• Provide updates and hold London wide

events

• Effective system leadership

www.lmc.org.uk

Deliverables (ii)

• Focus on practical; doing it right!

• Road Map for successful delivery

• Work with GP Provider groups to develop tailored support

• Workshops/Events: London / SPG / Borough / Federation

• Peer Support; Shared Learning

• Practical Support/Guides/Experts: Procurement, bidding

Governance, decision making

Financial planning/modelling

Workforce development

• Continue to support @15 Federations

• Influencing commissioners – federations (at scale provision) a must to achieve transformative agenda?

• Links with Educational Commissioners, providers, incl LETB/CEPN/LEAD

NEXT STEPS

61

Provider Toolkit: supports provider organisations to develop, and to understand

their requirements in order to grow.

Support includes;

• Toolkit

• Case studies

• Self Assessment

• Learning needs analysis

Support Leadership Development

62

A new provider is being procured to offer a wide range of learning and development opportunities

This also includes an initiative to support 10 individuals (clinicians and non-clinicians) from each Strategic Planning

Group in the following ways:

A wide range of transformational

development packages will be available to

empower participants to devise their own

bespoke learning and development

programme, underpinned by joining a diverse

Action Learning Set.

Action

Learning

Master

classes

Guest

speakers

Strategy days Topic events Executive

coaching

Online

initiatives Publications Networking

Train the

trainer

Leadership

style

Topic action

learning

Transformational development packages

Support local area development

Local delivery

63

• We will work closely with you to plan your programme of support

• You will benefit from the LMC and the Transforming Primary Care team working

together to deliver local workshops and events

• We will share good practice and new models of delivery

• Provide updates and hold London wide events

We are also going to develop a programme for commissioners

• Commissioner development support – identifying provider readiness, creating

action learning sets that focus on realising the benefit of co-commissioning,

developing new contract models that are population based, underpinned with new

financial models, sharing emerging contract models and specifications.


Summary and Close

64

Thank You

[email protected]

mailto:[email protected]

Date post:	01-Feb-2018
Category:	Documents
Upload:	trinhnguyet
View:	217 times
Download:	2 times

Transforming Primary Care Provider Development 4th ... · PDF fileTransforming Primary Care...

Documents