General Practice Transformation Champions, 28th March 2019, Novotel Hammersmith, London

1. Time for Care programme
Impact to date
Oct 2016 – Dec 2018

2. Time for Care coverage by
CCG area across England
as at end December 2018
Key shows stages of
engagement and delivery
Not Engaged
Yet
Showcase
Planning
Showcase
Follow-Up
Engagement Delivery Paused Complete
CCG Not
Taking Part

3. Time for Care - forward delivery plan to 31 March 2019
Participating practice coverage estimated to reach 38% by 31 March 19.
Practices (in delivery and coverage by %
Position as
at 30 June
18
% practices
participating/
coverage
Quarter 2 -
July - Sept 18
actual
Quarter 3 -
Oct - Dec 18
actual
(cumulative)
Quarter 4 -
Jan - Mar 19
planned
additional
Total
percentage
predicted
still to be
touched
(from
engaged
CCGCs)
North 729 34% 805 916 43 959 45% 963
South East 142 15% 162 202 25 227 25% 384
South West 223 37% 231 220 22 242 40% 360
London 349 27% 404 369 29 398 31% 714
Midlands & East 726 35% 788 756 48 804 39% 1,149
2,169 29% 2390 2463 167 2,630 38% 3,570

4. As at end of December 2018, over 205,157 hours of clinical General Practice time and 330,096
hours of admin time across 1,713 practices has been freed-up (from Productive General Practice
QuickStart and Learning in Action).
Practices have reported that their use of PGP QuickStart and Learning In Action has released time
and led to a wide range of significant benefits.
• GP time is being used more effectively; GPs report they are seeing the patients that need their
care and spending time on tasks that need their attention.
• Pressure and burnout has declined, GPs have described being able to more regularly start/finish
on time or reduce the amount and frequency of working excess hours and getting through the
daily workload better.
• Job satisfaction has increased. The joy of working in general practice has been restored, for some
GPs we’ve worked with this has literally made the difference between leaving or remaining in the
profession.
• Teamwork and morale has improved for practice teams with staff culture shifting from one where
‘this is the way we’ve always worked’ to ‘we can make things better.’
• Meaningful collaboration between practices is developing where practices are realising the
benefits of sharing learning and new ways of working that help them to standardise processes,
make efficiencies , improve working relationships and implement new models of care such as
Primary Care Home.
• Patients are benefitting from improvements made from safer and more efficient processes for
repeat prescriptions through to better access and more time with the right member of the clinical
team.
Summary of significant benefits

5. Impact so far – PGP Quick Start
• 1,323 sites have completed their support across six waves with
8,289 in-practice improvement sessions completed and 4,997
practice attendances at group-based learning sessions.
• Practices report that they are releasing 203,936 clinical and
329,899 admin hours from their implementation of PGP across
the first six waves.
• Potential for this to reach 321k clinical and 428k admin hours
as practices continue their work beyond our delivery support.
• Additionally, practices (wvs 2-6) have identified annual savings
of £960,927 and one-off savings of £178,121 from their work
(inventory etc.).
“We have made some really good progress...with some
tangible benefits already being seen. The staff involved have
really been engaged and enthused by the whole process – it’s
not often that they are exposed to such great training and
education, and therefore very stimulating…I think the
importance of this initiative goes much further than the
results of the individual processes that we are now improving.
It links into so many associated topics that are fundamental to
the sustainability of Primary Care.” Practice Manager
“An amazing quality value giving project.” GP

6. “Practices have really appreciated coming together to improve the three nursing
procedures. The programme has built relationships with staff across practices. Staff
have been able to share best practice with each other and have had an open and
trusting environment where frustrations and concerns can be voiced.” Practice Nurse
“PGP has been the real catalyst to enact ideas and accelerate implementation.”
Practice Manager
“I can really see how this programme adds value and helps to improve practices.”
Reception Supervisor
“This new process works already, its saving huge amounts of time – please don’t change
it’! It’s great.” Admin Manager
“A superbly delivered programme across a locality of different sized practices, with
common issues and similarities.” Director of Operations – Federation
“Believing in the fact that they can undertake change and implement new ways of
working has given new confidence to the staff.” Lead GP
Impact so far – PGP Quick Start

7. Impact so far – Learning in Action
• Practices come together for series of facilitated, interactive and
action-focused workshops. Using the frame of High Impact Actions, practices
identify local priorities and progress practical change.
• Tailored to local needs of primary care organisations.
• 622 practices/orgs implementing 463 projects across 46 collaborative groups.
• 75% of those practices/organisations who have completed their project reported
an increase in collaboration between organisations in local area.
• Complements other primary care developments.
• Typical duration: 6 delivery events over 6 months, wrap-around support in
between and to aid measurement.
• Extending coverage and building local sustainable facilitation for change e.g. W
Cheshire, Leicestershire and Sheffield.

8. Impact so far – Learning in Action
"Lots of people have been in to tell us what to do and how to run the practice over the
years. You aren't doing that and it's the first time I feel like we might get it right!"
Practice Manager
“Attending the time to care sessions has brought fun, friendships and unearthed new
challenges. I have been able to work more closely with my practice manager, and
network with other likeminded practices locally. It has been fascinating to share
thoughts, ideas and ways of working. So much so, that I question why we have never
done this before. Primary care has traditionally been quite secretive about how we do
things, but the workshops have shown that collaboration can strengthen rather than
threaten business.”
GP
“This was so amazing (process mapping) - you just don't realise all the things you do, and
I look at some of these things and ask WHY???”
Practice Manager
“The journey has been very special to take part alongside colleagues from Newham,
including clinical and non-clinical staff who were willing to share their projects with the
whole group. Networking and collaborating with like-minded colleagues to share ideas
and tips has been the highlight of the programme.”
GP

9. Impact so far – Learning in Action
Practice set itself a goal by Oct
2018 to reduce the need for a GP
appointment by 10% from an April
2018 baseline through active
signposting and care navigation.
Reduction made from 274 to 207
GP appointments (25% reduction)
through receptionist training, ANP,
referral to MAS.
9 x practice posters at Learning
Action Celebration event Sept
2018 (example shown –
addressing 7 of the HIAs).

10. Impact so far – General Practice Improvement Leaders programme
• 373 individuals have completed the programme
(waves 1-15)
• 70 individuals are currently undertaking the
programme (waves 16-17)
• Participants: 35% GPs and 28% Practice Managers
• 26% of improvement projects focus on collaborative
working across multiple practices
“I was feeling a little despondent about my role and
general practice but after this programme and today
I have a new lease of life for my job!”
GP
“The programme itself gave me the confidence I
needed just at the right time with the upcoming
merger and building my role as Managing Partner
for the new bigger practice.”

11. Impact so far – General Practice Improvement Leaders programme
“This has been the best thing I have done in my 12 years as a GP. It has transformed my thinking, opened
opportunities, given me technical skills and connected me with like minded people. I think all I do in GP is
now tracked back to something from this course - its hard to remember a time without it.” GP
“Facilitation team were exceptional and for the first time in my 15 years in NHS I have learnt something
useful and relevant and feel I can really make a difference - thanks to whole team." Practice Manager
“Previously we established that >32 of same day appointments were clinically inappropriately booked.
Through measuring and managing the change process of this revised process we have been able to free up
half of the same day appointments and therefore alter the clinic approach to better use that time with
alternative clinic slots.” PCH Business Manager
“Have taught my team leaders PDSA cycles and process mapping and they have now got the confidence to
use them without my support to make small changes within their teams. The programme itself gave me the
confidence I needed just at the right time with the upcoming merger and building my role as managing
partner for the new bigger practice for the future.” Managing partner
“Working with our super partnership, other practices are now implementing 15 min appointments.”
Practice Manager
“The programme was one of the most useful things that I've done in terms of training within the NHS.
Sometimes in primary care it feels that we're out on a limb in terms of assistance for making things better.
This made me feel less alone and more able in doing that.” Systems lead

12. Impact so far – General Practice Improvement Leaders programme
Case study: Bottreaux Surgery
“Had we not made the changes we did the practice would have struggled to survive in the long-term.” Business Manager
Current GP working levels were unsustainable (poor work-life balance, cost concerns of booking locums meaning greater
pressure on GPs to cover absences), putting the long term sustainability of the practice at risk. The practice’s Business
Manager used creative thinking tools he learned on the programme to explore and address as a practice how they could
improve this position.
Activities: the manager worked with the GPs to draw-up a statement that best described what they needed to do to achieve
personal sustainability. GPs then felt compelled to make changes to the way they worked and used ‘Breaking the Rules’
techniques to explore their unwritten rules and working practices and how these could be broken. This led to discussions to
open-up ideas of ways to do things differently and, as a result, they made changed to the GP rota system.
Impact:
• The work-life balance for GPs has been transformed: they report that they no longer feel stressed and burned-out through
managing their daily workload better (work is shared equally amongst all GPs) and are home by 6.30pm (previously
10.00pm)
• The practice is more attractive to new GPs: salaried GP interested in joining the partnership tested the new rota system
and found it worked with family commitments, so became a partner.
• Staff are happier as queries are being answered in a timely, managed way
• The long-term sustainability of the practice means patients will continue to have access to their local surgery for the
foreseeable future.
”I feel like I have been given a gift.” Sam Radford, GP Partner, Bottreaux Surgery

13. Impact so far - Primary Care Improvement Community
Spread and Engagement across Primary Care
We see:
Increasing
awareness
and
membership
of the
community,
good levels
of
engagement
, and the
community
driving
action
amongst its
members
1569 1645
1809
2368
2640
3401
3813
3,939
2024 2080
2323 2400 2463
2916
4388
4526

14. Impact so far – Primary Care Improvement Faculty
Tom Margham
GP and Clinical Lead
EQUIP
Tower Hamlets
Nichola Durrant
Physiotherapist
QI Coach and
Facilitator
Charlie Kenward
GP and Clinical
Evidence Fellow
North Somerset CCG
Natalie Smith
GP and QI Coach
Wiltshire
Sheinaz Stansfield
Practice Managing Partner
and Nurse
Gateshead

15. #GPforwardview
GENERAL PRACTICE
FORWARD VIEW
Change Model for Health and Social
Care

16. Contact Details
Jo Godman j.godman@nhs.net
Jennie Joyce jennie.joyce@nhs.net