Growing and ageing population London is expected to grow by 1 million people by 2020 The number of over 65 year olds in London is set to increase by 19% by 2020 A high number of short term residents in the capital and homeless
Increasingly complex conditions General practice is facing a tidal wave of people living with a greater number of long-term conditions and living longer with those conditions. This means that the 10 minute appointment model with a single clinician may not be fit for purpose in the future.
Variation in performance Stark health inequalities across the 32 CCGs. Lower patient satisfaction with GP services than the rest of country with many Londoners struggling to see a GP at a time that is convenient to them and struggling to see a GP of choice. The variation in performance is stark with in borough variation and neighbouring practices having the very best and the very worst performance. More needs to be done to tackle variation. CCGs now have a statutory duty to improve GP services and are setting up opportunities for peer review and benchmarking of performance supported by NHS England’s data team and CSUs.
Growing patient expectations Patients are rightly expecting more from health services. This includes more convenient access through a number of different routes (online, Skype etc), and a wider range of services on offer at local practices.
Financial pressures The NHS is facing a financial challenges, and as with other public services. Primary care currently undertakes around 90% of contact with patients, however it has a relatively small percentage of the budget. While changes to the Minimum Practice Income Guarantee (MPIG) will ensure funding is equitable in the long term, there are some practices in London that are negatively affected by these changes. We are working with CCGs, Local Medical Committees and practices affected to find solutions to the challenges they face.
Infrastructure which is not fit for purpose There are a high number of smaller practices in London, which struggle to offer the same access and range of services as larger practice or those in networks. There is also a shortage of practice nurses, GPs and a high number of GPs nearing retirement age.
Slide 4 suggested notes
There are multiple perspectives on why change is necessary.
The impact of the pressures general practice is facing means that Londoners are increasingly frustrated with their ability to access the service and to see a GP of choice
GPs are telling us they are dissatisfied because they feel unable to provide the level of care they want their patients to receive, given funding restraints and infrastructure which is not fit for purpose.
Professional organisations such as the King’s Fund and Londonwide LMCs are also saying that general practice needs to make changes if it is going to rise to the challenges of the 21st century.
Across these voices, there is a consensus that the status quo is not sustainable.
We’ve heard these comments for many years. So what’s different about now? The challenges we’ve described in the call to action are familiar but in recent years have reached unprecedented and unsustainable levels – general practice is at a tipping point.
Slide 5 suggested notes
General practice in London may be at tipping point, but we believe GPs are ambitious about the future. Those involved with our transformation programme believe that with the right changes to the way they work – underpinned by investment – they will be able to transform the local services on offer to Londoners and make our primary care services among the best in the world.
In order to deliver this care, GPs from across the capital have produced a set of draft standards for general practice in London: an offer of what patients could expect to receive from their local practice in future.
The standards focus around three areas:
Accessible care We want patients to be able to book appointments easily, at a time that’s convenient for them and with a professional of their choice.
Coordinated care We want all the people involved in a patient’s care to work together and to the same plan, ensuring good join up and continuity between professionals and services.
Proactive care We want local doctors to support patients to lead healthy and happy lives – preventing treatable conditions and supporting patients to make healthy choices – subsequently reducing premature mortality, health inequalities and the burden of disease in the capital. This is about treatin the causes, not just the symptoms.
Slide 8 suggested notes
The draft standards have been developed by groups of expert GPs – led by former RCGP Chair, Clare Gerada, in partnership with patients and health and care organisations. They offer a bold new vision for the future.
GPs have led the work so far but we now need wider clinical engagement and input from the public to test the ambition of the standards. From May 2014 – autumn/winter 2014, we will be seeking the views of clinicians, professional bodies, charities, patient groups and other service users. These people will shape the development of the standards and ensure they are right for London.
Following this period of pre-engagement, the draft standards will be published for wider public feedback towards the end of the year.
Running at the same time as this engagement, work is underway to assess the costs and route map for securing delivery of the standards across the capital.
Once there is consensus that the standards are right for London, they will be rolled out for implementation over the next 3 - 5 years.
London - Transforming Primary Care
Open House Workshop
Transforming London’s Primary Care
17th June 2014
Challenges for London’s general practice
Growing and ageing population
Increasingly complex conditions
Stark health inequalities and varying performance
Growing patient expectations
A&E and acute services under strain
Infrastructure which is not fit for purpose
“It’s clear that we need to change the way we work. Transformation needs to be
radical and long-term – tweaking around the edges won’t cut it this time.”
Dr Clare Gerada
London voices are united on the need for change
Improving primary care: New GP standards for London
Better access to routine and urgent care from primary care
professionals, at a time that’s convenient and with a professional of
Greater continuity of care between NHS and social services, named
clinicians, and more time with patients who need it.
More health prevention by working in partnerships to reduce
morbidity, premature mortality, health inequalities, and the
future burden of disease in the capital. Treating the causes, not
just the symptoms.
What could London’s patients expect in future?
“I don’t have to take time off work to
access my GP practice. Appointments now
fit my lifestyle.”
“I know my care is being coordinated by a
team who knows me and my complex
conditions, from one service to another.”
“I get the care and support that enables me
to live the life I want to the best of my
“I can contact my practice by email, phone
“I’m clear about the ways I can improve my
own health and wellbeing and the
resources available to support me.”
Next steps for the GP development standards
Once agreed, the standards will be rolled out for implementation over the next 3 - 5 years.
On-going work to scope the costs and route map for securing delivery of the standards
Publish draft standards for wider public engagement later this year, with a growing
consensus around what London needs.
Test the ambition of the standards with a wider clinical, patient and charity audience. This
is taking place over the summer.
Work on developing draft GP Standards was led by expert GPs, building on the national
vision for primary care.
Transforming primary care: General practice – A Call to Action was published to start a
My General Practice
1. The things I really like about my practice are ……….
2. It would be great if my practice …………..
Patient groups Example service goals Example – how care will be different
I may require...
...care from an extended
...more specialist care
I may require...
...rapid, urgent access
...continuity of care
from a named GP
• Patients will have access from
8am-8pm, 7 days a week and
365 days a year
• Patients will only be asked to
make one call or click in order
to make an appointment
• Patients will be able to book 4
• Same day response for urgent
• Patients identified for
coordinated care will have:
- Involvement in their care
- Named GP / lead clinician and
team from which they routinely
- Multi-disciplinary reviews
“I will be supported to manage my own
health with greater confidence, knowledge
“My care will be coordinated, rather than
fragmented and transitions between
services will be seamless”
“I will be able to book ahead with my GP, at
least four weeks ahead”
“I will only have to make one call or click in
order to make an appointment”
“I will be able to have consultations via
telephone, email or skype”
...socially reliant on
• Patients will be asked about
their wellbeing, capacity for
improving their own health, and
their health improvement goals
• Co-design approaches to
improving health and wellbeing
building social capital
“I will have information tailored to my
needs on when, where and how to access
health and wellbeing support in my
“My local practices will work with our local
communities to discuss the population’s
health needs and co-design new services in
the community that support people to stay
That service offered must be personalised & adaptable to patient
needs as they change over the course of their lives